26 September 2012

Quick Post: Obama's Big Day in New York

New York City just about shut down thanks to the presence of President Obama and the two speeches he gave at the UN General Assembly and Clinton Global Initiative. While it may have been a nuisance for many New Yorkers, the two speeches gave the President an opportunity to speak broadly about US foreign policy and hone in on a very specific issue.

"Just as we cannot solve every problem in the world, the United States has not and will not seek to dictate the outcome of democratic transitions abroad," said Obama as he touched on the democratic transitions taking place in the wake of Arab Spring and the riots that erupted following the release of a movie trailer that defamed the Prophet Muhammad.

He made it clear that he condemned the video, but was as strong in saying that free speech must be protected. Partnerships and cooperation will be vital, argued the President, to tackling the greatest challenges in the world and that includes global development. "America has pursued a development agenda that fuels growth and breaks dependency, and worked with African leaders to help them feed their nations. New partnerships have been forged to combat corruption and promote government that is open and transparent, and new commitments have been made through the Equal Futures Partnership to ensure that women and girls can fully participate in politics and pursue opportunity."

Following the speech, Obama traveled across town to the Clinton Global Initiative to tackle the issue of modern slaver. "It ought to concern every person, because it is a debasement of our common humanity. It ought to concern every community, because it tears at our social fabric. It ought to concern every business, because it distorts markets. It ought to concern every nation, because it endangers public health and fuels violence and organized crime."

The President stressed that efforts need to go beyond raising awareness. A large part of it, he argued, involves accountability for all involved. That includes looking inward by including the United States in the State Department's Annual trafficking report. To reduce the rate of trafficking, Obama said the US will work with the private sector, increase tracking and support the victims. He made it clear that an important shift must take place from seeing people as victims of trafficking rather than criminals.

Partnerships extend to the grassroots, argued Obama. "That’s how real change happens -- from the bottom up," he said.

Resilence: USAID Keeps the Eye on the Prize

Resiliency emerged as the goal and buzz word during the response to the drought and famine in the Horn of Africa last year. NGOs and governments included resilience in the humanitarian response to signal a shift from emergency relief to building and supporting structures that will ensure that drought-prone areas will be better equipped to handle climate shocks.

A side-event at the UN General Assembly brought together actors like USAID, the Rockefeller Foundation and the World Food Programme to maintain efforts to build resilience in places like the Horn of Africa and the Sahel. “We used to think of this as linear action and now we need to all start at the same time. We need to build the agency of the people and the institutions have to be much better when risks materialize,” said Rebecca Grynspan, Associate Administrator for UNDP.

The event builds on the April launch of the Global Alliance for Action for Drought Resilience and Growth. Donors committed $4 billion towards resilience efforts in the Horn of Africa at the event. “We will reach one million vulnerable households and ensure that they can withstand climate shocks without food aid and humanitarian assistance,” explained USAID Administrator Shah in an interview.

For Shah, resilience is a word of action. “There has been so much talk, but so little progress on the ground,” he explained. “It is just inaccurate to pretend every year that these chronically vulnerable communities need late-in-the-game humanitarian aid. We know we can predict where needs will be in the future. We know we can invest in effective and far lower cost resilient strategies that allow for more agriculture production in dry land communities and thereby avoid the need for humanitarian assistance.”

A report by the NGO Mercy Corps found that supporting peace in southern Ethiopia contributed to resilience building. They determined that their Strengthening Institutions for Peace and Development program allowed pastoralists the greater ability to move freely and access vital resources by alleviating conflict in the region.

USAID is making its most meaningful steps towards building resilience through the program Feed the Future. A part of it is to, like Mercy Corps, reduce conflict. The aim is rather simple: improve agricultural yields for subsistence farmers in vulnerable parts of the world. Interventions include improved fertilizers, drought resistant seeds, and increasing farmers’ access to markets.

The awareness efforts and new programs seem to be paying off. “Instead of spending another year wishing for improved coordination, we worked closely with African leaders and international development partners to establish a Global Alliance for Action in Nairobi to rally the world behind a commitment to building resilience in the Horn of Africa, where crisis continue to occur,” said Admin Shah at the event yesterday. “As a result, for the first time, Kenya and Ethiopia have real plans and new structures to help communities’ combat vulnerability to crisis. And we have already seen real policy changes.”

25 September 2012

Romney at CGI: Foreign Aid Flop

Bill Clinton welcomed Presidential candidate Mitt Romney to the stage at the annual Clinton Global Initiative to deliver remarks concerning foreign policy and aid. Clinton praised Romney for his leadership by ensuring that CityYear would not come under the axe of budget cuts in the 1990s. Romney offered thanks for the praise from the former President remarking, “If there’s one thing we’ve learned this election season, it’s that a few words from Bill Clinton can do any man a lot of good.”

With some lines that built on his work with CityYear and the Salt Lake Olympics, Romney argued for the importance of partnerships. The partnerships that are facilitated by CGI were a way for him to deliver a compliment to Clinton while focusing in on what became the theme of the remarks: private sector and free enterprise.

“Free enterprise has done more to bless humanity than any other economic system not only because it is the only system that creates a prosperous middle class, but also because it is the only system where the individual enjoys the freedom to guide and build his or her own life. Free enterprise cannot only make us better off financially, it can make us better people,” said Romney.

The event provided Romney the opportunity to make what are some of his most substantive remarks on the issue of foreign aid. He argued that the present aid delivery systems are not reflective of the changing world remarking, “Many of our foreign aid efforts were designed at a time when government development assistance accounted for roughly 70 percent of all resources flowing to developing nations.”

The shift from aid to trade is one that the Obama administration has stressed through policy and remarks. The June strategy for sub-Saharan Africa included the four pillars for the region: Strengthen democratic institutions; Spur economic growth, trade, and investment; Advance peace and security; and Promote opportunity and development.

Romney seemingly echoed the pillars of the Obama administration’s policy by saying that foreign aid should address humanitarian need, foster the strategic interests of the US and use aid to elevate people and provide lasting change. He was deliberate to point out that Obama does not focus enough on the last point, but the released policies of the administration and its actions over the past four years tell a different story.

In order to realize long lasting development, Romney called for the implementation ‘Prosperity Pacts’ with developing countries. “Working with the private sector, the program will identify the barriers to investment, trade, and entrepreneurialism in developing nations. In exchange for removing those barriers and opening their markets to U.S. investment and trade, developing nations will receive U.S. assistance packages focused on developing the institutions of liberty, the rule of law, and property rights,” he explained.

Romney attempted to use his remarks to distance himself from Obama by saying that he supports the private sector and free enterprise. Little did he realize that he was advocating for the very same policies and priorities already in action by the Obama administration.

At best, his ideas were a continuation of engaging with developing countries to support democracy, economic growth and security. At worst, Romney is arguing for the return of the failed Washington Consensus. He vaguely referred to changing the trade agreements already in place, but provided little information as to how they would be shaped.

“I will reverse this trend by ensuring we have trade that works for America. I will negotiate new trade agreements, ask Congress to reinstate Trade Promotion Authority, complete negotiations to expand the Trans-Pacific Partnership, and create what I call a “Reagan Economic Zone,” where any nation willing to play by the rules can participate in a new community committed to fair and free trade.”

To most Americans, Romney made an argument for improving aid by focusing on trade. He spoke as if the idea ran against what the Obama administration has been doing. The fact of the matter is that Romney’s catch phrases indicate little change in American aid policy for his administration.

“A year from now, I hope to return to this meeting as president, having made substantial progress toward achieving the reforms I’ve outlined. But I also hope to remind the world of the goodness and the bigness of the American heart. I will never apologize for America. I believe that America has been one of the greatest forces for good the world has ever known. We can hold that knowledge in our hearts with humility and unwavering conviction,” concluded Romney making his small jab at Obama.

24 September 2012

How Technology Supports Peace and Development

“I had a cousin, when I went to Vietnam when I was really little. He came back and was totally different,” said actor Forest Whitaker to a small group yesterday at the Social Good Summit. The two were really close and would draw together. A young Forest continued drawing while his cousin was away, but the lasting impact that the war had on his cousin profoundly impacted his understanding of conflict.  

“He didn’t draw anymore. I couldn’t really get him to even talk. To this day he’s not really well,” continued Whitaker. He used his film career as a way to try to understand war. “I did Platoon, I did Good Morning Vietnam. I was trying to get into it and understand it.”

Conflict followed him in his home life with gang problems and fighting. The experiences merged onto the issue of peace. Yesterday, Whitaker joined Jeffrey Sachs of the Earth Institute and Ericsson President and CEO Hans Vestberg to introduce PeaceEarth and discuss the ways that the new initiative will utilize technology solutions to promote peace in post-conflict areas.

The program begins in South Sudan and Uganda with the aim of using a multi-tooled platform to provide knowledge for the promotion youth empowerment and ultimately the realization of peaceful conflict resolution. “The launch of the PeaceEarth Foundation is our opportunity to use our modern-day resources to truly connect with one another to promote peace throughout the world," said Forest Whitaker marking the inauguration of the program last week. "I'm driven by the hope that together, we can build peace from within the hearts and minds of people everywhere for a more peaceful world."
The platform serves as an avenue for conversation that Whitaker characterized as a “nexus where people can help support peace-builders in the world, give them resources and a space of commonality where they can talk and work together.”

Fellow participant on stage and program partner Hans Vestberg stressed the way that connectivity can support development and empowerment. According to Vestberg, an increase in mobile penetration by 10% translates into a 1% rise in GDP. "You can't have positive social and economic development where people are suffering from conflicts or natural disasters. I hope that extending access to education will help enable the PeaceEarth Foundation further its goals," he said.

Professor Sachs also partners with Ericsson to provide connectivity in his Millinnium Village Project locations. “It’s not that technology will take us to nirvana. We have to make choices and take action every day,” he explained. In the MVP, technology has become a way to not only reach people and support communication; it is an avenue for learning what is happening on the ground for each of the projects.

Technology allows for the MVP to track the finer patient data that gives them feedback on illnesses as well as follow up treatments. The development from paper records to sms gathering and now storing information in the cloud via smartphones is a dramatic improvement in the eyes of Sachs. What can be tracked is even simpler when it comes to seeing if people are using power from their solar cells to understand which ones are working and gather behavior trends.

All examples combine to show the way in which technology is changing development from peacebuilding to healthcare. Whitaker took a bit of an existential  approach to the integration of technology by seeing it as not just an extension, but a part of us. “If you look at [technologies] as an organic being, they become a new attribute that we have,” he said holding out his hand. “This phone is a part of me. I think we’re evolving to understand that these things are part of us.”

All in all, the tools are thought of as an support system for solutions and interventions. The development of PeaceEarth provides an avenue for collective action. “We all face conflicts of different kinds throughout our lives, and by doing our part individually, we can collectively advance our world towards peace; one community, one person, and one day at a time,” wrote Whitaker in the Huffington Post.

Designing for Impact, Jobs and Education at CGI

"Design for Impact" reads the tagline for the 2012 Clinton Global Initiative. Bill Clinton defined the phrase in the broadest terms possible while delivering the opening remarks for the three-day event on Sunday morning by stressing the need for greater cooperation to take on the greatest development challenges.

The former US president was joined on stage by Queen Rania of Jordan, World Bank President Jim Kim, UN Secretary General Ban Ki-moon and the odd man out Walmart CEO Michael Duke. Clinton was kind enough to include Duke at the beginning and the end of the conversation. The opening was an opportunity for Duke to promote the sustainability efforts of Walmart. The other panel members took over the rest of the discussion, but Duke was brought back into the fray when Clinton asked him whether Walmart would be willing to try to open stores in Tripoli if invited.

The Walmart chief gave a diplomatic and long response that amounted to a yes without every explicitly saying that Walmart would welcome the invitation. While Duke served as a bit of a side show, the main event was the inclusion of Kim and Ki-moon.

Clinton awkwardly joked, as he arrived to the two of them, "That brings me to what I affectionately call the 'Korean Block,'" noting that the two were speaking Korean to each other backstage. Following some laughs of disbelief from the audience, Clinton dug in to learn how the two saw their roles in realizing development.

Kim made interesting remarks that seemed to indicate the direction that he hopes to lead the World Bank. He explained that the World Bank has long been seen as a 'knowledge bank' and signaled that he hoped for it to become a solutions bank. The same phrase was repeated at least twice during the session by Kim, though he did not explain how he saw the shift taking place.

One hint was the issue of scale. "Designing for impact means taking seriously the problem of scale," said Kim. Clinton earlier discussed the issue of scale in his opening remarks and an interview proceeding the panel with Tim Brown of IDEO also focused on the idea of scaling ideas through design, innovation and the private sector.

Ban Ki-moon, always looking and sounding cheerful as he delivers what at times is troubling information, bounced about between ideas. He called for a clear development agenda in a bit wink to the panel who will soon meet to determine the post-2015 agenda while making it clear that it had to be done through partnerships. There was a mention about keeping an eye on the sustainable development prize and an allusion to the hard lessons learned from the Rwandan genocide.

The meat of the conversation turned to jobs and education. Clinton remarked, "We are good at acting we know how to do it, but we are not good at creating education and employment." Queen Rania hit onto all of the major talking points about the importance of education without a hint of irony considering that she is in the unique position to deliver major education reform in her home of Jordan. She pushed further saying that education was behind the times. "We are teaching yesterday's skills," she said and added, "The gap between out education outputs and the market needs is getting wider."

All the panel members agreed with the needs for education reforms and on the issue of creating jobs. Kim offered some agreement with Clinton that the challenge is trying to figure out how to share and apply the lessons of development between countries. As the focus in the US election hones in on the issue of jobs, it is evident that jobs are a universal concern that some of the most important leaders in the world are not sure how to address.

23 September 2012

Day One at SGS: A Missed Opportunity and Some Hope

Yesterday marked the first day of the 2012 edition of the Social Good Summit. With the Jewish holidays later this week, the events shifted to the weekend before the start of the UN General Assembly. A packed schedule featuring Helen Clark of UNDP, Jill Sheffield of Women Deliver and Valerie Amos held promise for great conversation.

Last year, the SGS was marked by celebrity appearances to serve as more of a pep rally for using social media for social good. It was a dramatic shift from the first iteration that was smaller, more interactive and filled with far more substance.

Lessons learned have led to a few new changes. The schedule is much tighter with shorter time for each panel member. In fact, timings for panels are not being released until the day of rather than advance. The proceedings are live-streamed, as was the case in the past, but there are translators in the back who are trying to take it global. Further, the organizers facilitated meet ups and satellite events in places like Nairobi to make it a truly global event that is even reflected in the event hash tag #sgsglobal.

21 September 2012

Stearns Testimony on Rwanda's Role in the DRC Insurgency

DRC expert Jason Stearns was among the people who testified at the House Committee on Foreign Affairs Subcommittee on Africa, Global Health, and Human Rights hearing "Examining the Role of Rwanda in the DRC Insurgency."
The current crisis, beginning with the to rise of the new M23 rebellion, is the result of the failure of the Congolese peace process to deal with the persistent causes of conflict in the region. A potent mix of ethnic tensions, state weakness, and Rwandan involvement - located at local, national and regional levels - lie at the heart of the violence. While there are no easy fixes to these deep-rooted challenges, the United States government can help avert a further escalation by helping to broker a settlement. This will require a significant change in how the US engages with Rwanda, but also for Kinshasa to provide the political vision necessary for a solution.
It seems there is little doubt that Rwanda played a role in supporting the M23 rebellion in eastern DRC. However, Stearns is careful to point out in his concluding remarks that criticizing Rwanda is not a sufficient solution to the problem.
But such criticism of Rwanda is, on its own, not a solution and will only enhance the defiant rhetoric coming out of Kigali. While pressure on Rwanda must be increased, as it continues to play a pivotal role in supporting the mutiny, it will not be effective unless it is part of a larger peace plan that includes Kigali. 
The Congolese army cannot defeat the M23 with military might alone; sooner or later, a deal will have to be struck with the mutineers. An acceptable outcome would include the arrest of the worst offenders within the M23, including Bosco Ntaganda, who is wanted for war crimes by the International Criminal Court, and the reintegration of other officers and troops in the army, but redeployed elsewhere in the country. This would achieve the dismantling of CNDP structures in the eastern DRC. At the same time, the Congolese government should reach out to reassure its rivals. 
This includes helping some refugees in neighboring Rwanda return home, and setting up an inquiry on abuses committed by all sides since the mutiny began. It should also consider allowing Rwandan troops to deploy small units in joint operations in the eastern Congo against the Rwandan FDLR rebels, albeit with significant safeguards. In the absence of effective state power, compromise of this kind is the only way forward.
The only way this kind of deal can work is if Rwanda plays a part. This means reformulating the kind of pressure put on Kigali, from asking them to stop providing support to the M23 - an outcome that is hard to measure, given the clandestine nature of the backing - to becoming an active part of the solution. It would have to allow the Congolese government or the United Nations to deploy troops along its border with M23 territory, as well as arrest key leaders of the mutiny, some of whom are based in Rwanda.
If you missed the event, be sure to read Stearns's full remarks here

20 September 2012

A Conversation about Botswana's First Oncology Hospital

I happened to stumble upon a preview chapter of the soon-to-be-published book Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic. The selection piqued my interest in what was to come. Being impatient, I reached out to author and Rutgers University researcher Julie Livingston to chat about the book, her research, cancer in Botswana and the narrative style of the book. 

It is well timed as one year ago noncommunicable diseases were at the top of the agenda at the UN General Assembly. As global leaders gather once again, questions have been raised concerning the state of NCDs one year later.

According to the WHO, an estimated 70% of cancer deaths take place in low and middle income countries. Furthermore, the WHO also says that 30% of cancer deaths can be prevented. With the majority of deaths taking place in resource-strapped countries, it is also where the most improvement can take place. I am happy to share with you the conversation.

AVFTC: You set out to tell one story, but ended up with something very different. What happened?

Julie Livingston:  I think this sort of evolution of the research question often happens to historians and anthropologists. One of the many strengths of ethnography (the method at the heart of this book) is that is enables us to flexible in the face of unfolding research. As we carefully listen and watch, and experience, new questions necessarily emerge, which in turn are folded into the research process. In this way careful ethnography can also operate as an "early warning" system of sorts. And this is what happened to me. I arrived in Botswana preparing to study questions of pain and laughter, historically and ethnographically. I entered Botswana's cancer ward as one potential research site among many I intended to visit, and instead of moving on to the other sites, I stayed in the cancer ward. What I found there were important answers to some of my questions about pain and laughter, but also a host of other questions about the emerging cancer epidemic in Africa and its attendant politics of causation and care.

AVFTC: Almost immediately, you reference Binyavanga Wainana's essay "How to Write About Africa." How has that essay shaped your writing about stories from Africa? How did it impact this book directly?

19 September 2012

Don't Pretend to be a Savior: Follow the Frog

A video from the Rainforest Alliance is an amazingly succinct take-down of the savoir complex that can turn good intentions into harmful outcomes. The overall simple message at the end is far too neat for my liking, but the brilliant dismantling of the hubris to go down to save the rainforest is amazing. Enjoy.

HT Erin and Tom

Welcome Back Students

To all of you college students and new readers, welcome to A View From the Cave.

I am aware that some of your professors recommend this as a place to read and I appreciate you stopping on by for some reading. On this blog you will find a mix of posts that cover issues related to international development and aid. Some posts will be quick pointers to recent articles, a few will be original reporting, you will get to read some (hopefully) fascinating interviews and be treated to the occasional infographic.

Comments are welcome and are frankly encouraged.

The point of this is actually to point you to two other things I am doing that I believe will be helpful to you all. First, I write the Impact blog for the NGO Population Services International (PSI). I focus on global health stories and happenings. Each morning, I put together a collection of top global health news called the Healthy Dose. It publishes by 9AM and you can even sign up to have it delivered to your inbox each morning.

If you are more interested in humanitarian news, then the DAWNS Digest is your answer. Mark Goldberg of UN Dispatch fame and I put together an email-based rundown of the top stories related to issues of development, aid, transparency, governance and more. It comes at a very small cost, but you are able to take it out for a one month test drive in order to see if you really like it. A mobile app is in its final stages of development that will bring you the same hand-picked news as well as a curated and searchable RSS feed that will maximize your news needs. The best part about DAWNS is that the money we make gets spun off to support journalism and storytelling projects through micro-grants

Thanks again for stopping by and feel free to connect on Twitter, drop me a line (murph@aviewfromthecave.com) any time and let me know if you happen to be in the Boston area, I'm always game to meet up and talk development.

Romney Vs the Universal Declaration of Human Rights

Everybody has either seen the video or heard about it already, a video captured Mitt Romney discussing  the 47% of Americans who do not pay taxes. He implies that those people are beholden to the government and are in turn Obama voters. Aside from his mischaracterization of the 47% (some include millionaires and elder Americans who tend to lean Republican), the remarks highlight how Romney defines human rights.

He says in the video:
All right, there are 47 percent who are with him, who are dependent upon government, who believe that they are victims, who believe the government has a responsibility to care for them, who believe that they are entitled to health care, to food, to housing, to you-name-it. That that’s an entitlement. And the government should give it to them. And they will vote for this president no matter what.
The remarks stand in contrast with the Universal Declaration of Human Rights. Article 25 reads (emphasis added):

Associated Press Joins RCT Debate

The Millennium Development Villages provide the entryway for the Associated Press to cover the debate over randomized control trials and the finer debate over the use of RCTs to evaluate the MVP.
Michael Clemens, a senior fellow at the Washington, D.C.-based Center for Global Development, says a similar project called Integrated Rural Development was attempted in the 1970s and 80s by the World Bank and failed because it could not survive without donor funding. 
Clemens, who researches ways of making aid more effective, sees a similar fate awaiting the Millennium Villages. "How likely is it that without the lavish expenditures of a New York-centered philanthropist-funded organization, the project can continue for long?" he said in an interview.

18 September 2012

Crowdsourcing Development Frameworks Matrix

There are a series of competing ideas and frameworks in regards to development and aid. Terence Wood kindly put together a table that captures some of the larger ideas held by big names like Jeffrey Sachs and Dambasia Moyo, as well as institutions such as the World Bank.

The final product is a fantastic way to compare competing ideas, but like any chart it misses on some divergent ideas. I am reproducing the chart with the permission of Terence and the encouragement to get feedback.

So here is the deal, I have put the spreadsheet into a Google Document and invite everyone to make edits, additions and changes as they feel are appropriate. Use the comments to hash out ideas on document. This would be a fantastic resource for future conversations and something that can help students visualize the differences.

Go here and edit away!

17 September 2012

In NYC for UN Madness Week

The UN gathers annually with its general meeting in NYC and the side events just sprout up. I will be in town to participate as a UN Foundation fellow this week, will shuttle between the Social Good Summit and Clinton Global Initiative over the weekend and into next week, hang around the city for a few days and then attend the Global Festival on Saturday.

The past two years I have tried to strike a balance of developing articles and mixing in some live coverage. This time around, I am going to play to what I believe to be my strengths. That means I will try to amp up my blogging, tweet like a madman and play around with instagram. The goal will be to get information out in a rapid process. That will include straight notes, quick reflections on an event, live blogging and some more traditional blog posts. Hopefully, the higher frequency will give you a taste of what is happening and allow larger trends and ideas to emerge. A bigger story or two may come along down the line because of what is shared, but I hope to make this as live as possible.

It is going to be a busy two weeks, but there will be some time to get together. A tweet up will be held on Saturday at the end of the Social Good Summit with a location pending. I will have some time during the events and a lot of free time at the end of next week. So, drop me a line if you will be at town participating in all the UN madness or if you want to grab a coffee/drink at some point.

Tyler Cowen Makes the Case for Addressing Global Hunger

Tyler Cowen writes in the New York Times:
One huge problem is that the price of fertilizer in Africa is often two to four times the world price. Yet African soil and rainfall make much of the continent subpar for growing food. In other words, the region that probably needs fertilizer the most also has to pay the most for it, and much of Africa doesn’t have the prosperity to make this an easy stretch. The high prices result in large part from infrastructure and trade networks that aren’t developed enough to create a low-cost and competitive market. And the problem could worsen if economic troubles in China distract it from its beneficial investments in African roads and harbors. 
On top of all that, many African nations have unhelpful policies toward agriculture. Malawi, for instance, subjects corn to periodic export and import restrictions as well as to price controls, all of which thwart development of a well-functioning market. When market speculators save corn in anticipation of greater scarcity, they may be punished by law. These restrictions of market incentives exacerbate the basic supply problems.
He advocates for making global food problems an item that is higher on the agenda for the United States and the economics profession. To do so, he joins the chorus of people calling for the end of US subsides for corn-based biofuels. "With virtual unanimity, experts condemn these subsidies as driving up food prices, damaging land use and costing the taxpayers money. Once the energy costs of producing the biofuels are taken into account, it doesn’t even appear that this policy helps slow climate change. It has become a form of crony capitalism, at great global expense," writes Cowen.

The full article is a good read.

Measuring Spin in RCT Reporting

Randomized Control Trials are the gold standard approach for conducting scientific studies. However, not every study is created equal and the interpretation of the results may not be straightforward. Someone who only has a passing understanding of how to read research, such as myself, relies heavily upon the abstract from a study, the accompanying press release and the discussion in the conclusions section.

It turns out that the information provided may have a bit of spin in it that eventually trickles down to the reporting. A group of researchers looked at some RCT press releases from Dec 2009 to March 2010 and found that there was 'spin' in the press releases. From their article:
We systematically searched for all press releases indexed in the EurekAlert! database between December 2009 and March 2010. Of the 498 press releases retrieved and screened, we included press releases for all two-arm, parallel-group RCTs (n = 70). We obtained a copy of the scientific article to which the press release related and we systematically searched for related news items using Lexis Nexis. 
“Spin,” defined as specific reporting strategies (intentional or unintentional) emphasizing the beneficial effect of the experimental treatment, was identified in 28 (40%) scientific article abstract conclusions and in 33 (47%) press releases. From bivariate and multivariable analysis assessing the journal type, funding source, sample size, type of treatment (drug or other), results of the primary outcomes (all nonstatistically significant versus other), author of the press release, and the presence of “spin” in the abstract conclusions. Findings of RCTs based on press releases were overestimated for 19 (27%) reports. News items were identified for 41 RCTs; 21 (51%) were reported with “spin,” mainly the same type of “spin” as those identified in the press release and article abstract conclusion. Findings of RCTs based on the news item was overestimated for ten (24%) reports.
I have to point out the irony that the research talks about spin in research that is present in the abstraction conclusion which I then had to rely upon in order to understand this research. In other words, I am utilizing the very thing that is found to be questionable in the study.

14 September 2012

Do Cash Transfers Reduce AIDS Risk?

A study in Kenya presented at the International AIDS Conference shows promise that a cash transfer program can help to prevent vulnerable children from engaging in risky sexual behavior.
Participating households were provided a $25 unconditional cash transfer every month. The program saw a 30% increase in the number of children who were more likely to delay having sex, but it showed little progress on the issue of condom use.

African currency
"Our study is based on the government of Kenya's Cash Transfer for OVC [orphans and vulnerable children]," Sudhanshu Handa, a professor at the University of North Carolina and one of the study's researchers, told IRIN/PlusNews. "We find that those aged 11 to 16 at baseline were seven percentage points less likely to engage in sexual activity four years later. Other studies have also shown a link between sexual activity and HIV-related behavioural risk and receipt of cash transfers, but those have been from small-scale experiments. Ours is the first study from an actual, scaled-up national programme."

Another study carried out by the World Bank in Malawi returned equally promising results. Girls who received the cash transfers were significantly less likely to contract HIV and Herpes as compared to girls that did not.

"The findings here suggest that cash transfer programs that focus on adolescent girls can empower them to steer away from risky sexual behavior and thus reduce their risk of HIV infection. They also indicate that while ABC campaigns might no doubt be effective in fighting the disease, empowering girls financially can also lead to reduced risk – not just by reducing their sexual activity or having safer sex, but also by enabling them to choose partners who are less likely to be infected with HIV," concluded the study.

Refugees and Military Intervention

The growing number of refugees may be what triggers a military intervention into Syria. Lionel Beehner looks into the murky issue on the World Policy Institute blog and discusses past examples.
The relationship between refugee crises and humanitarian interventions remains unclear. On one hand, the use of brute and indiscriminate force appears to be a deliberate tactic by the Assad regime to displace locals and create refugee flows, thereby raising the costs for outside powers like Turkey to either provide humanitarian assistance or intervene militarily. But this tactic could also backfire, prompting calls for greater military involvement by the West.

A look back at recent interventions is instructive on how the size and scope of refugee flows has swayed policymakers and the public to intervene militarily. One of the major motivations behind the northern Iraq no-fly zone, established in 1991 was to relieve the burden of an estimated million-plus Kurds seeking shelter in Turkey by creating a secure zone for them within Iraq. Ankara was particularly worried about the influx of refugees exacerbating tensions among its own Kurds in the southeast, creating a kind of “Kurdish Gaza Strip” that could become a lawless zone of instability. In Bosnia and Kosovo, similar spillovers of refugees and the threat they posed to regional stability provided the catalyst for greater involvement and eventual military intervention. As then U.S. Secretary of State Madeleine Albright put it, “Spreading conflict … could flood the region with refugees and create a haven for international terrorists, drug traffickers, and criminals.”
His post is worth a full read. Go here

Transparency in the Water Sector

I participated in a public discussion on transparency in the water sector at the end of August. The forum was done on Google+ and hosted by Water for People. My role was to do a lot more listening than talking, but I was given the opportunity to kick things off before people who are smarter and more experienced than I continued the conversation.

In short, my point was to say that the developing transparency initiatives in the water sector are very exciting. Organizations are not only talking about it, but they are putting it into action. Technology is allowing for the near real time tracking of projects that serves as an accountability mechanism. More importantly, it signifies a shift in communicating the fact that development and interventions are long term. The building of a new well is exciting, but it is a starting point rather than the completion of a project.

13 September 2012

UNICEF: Child Mortality Declining; More Work to be Done

Global progress against child mortality has made some stunning advances over the past two decades. A new UNICEF report shows that the number of children under five who die each year is down from 12 million in 1990 to 6.9 million in 2011. However, more work needs to be done in order to meet the Millennium Development Goal for child mortality.

The report comes on the heels of stunning findings by Gabriel Demombynes and Karina Trommlerova regarding the decline in under-five mortality in Sub Saharan Africa. Of the 20 countries with a demographic and health survey since 2005, 16 saw a decline in child mortality. More than half fell at a rate that meets or exceeds the rate of 4% that is required to meet the Millennium Development Goal.

What stood out at the time was the fact that the declines were not directly connected to economic growth. The UNICEF report highlights this finding further as it shows that low, middle and high income countries all experienced lowering rates of child mortality.

While the gains are reason to celebrate, Anthony Lake, UNICEF's Executive Director, stresses that more work needs to be done. “The global decline in under-five mortality is a significant success that is a testament to the work and dedication of many, including governments, donors, agencies and families. But there is also unfinished business: Millions of children under five are still dying each year from largely preventable causes for which there are proven, affordable interventions,” says Lake.

Drops Not Drones, Vaccines Not Marines
A child receives oral polio vaccine drops from a house-to-house polio vaccination team in Maksoodpur village in Patna district. (Bihar, India, 2010) Credit: Gates Foundation
USAID made it clear that it intends to focus on reducing child mortality by launching the campaign Every Child Deserves a 5th Birthday and holding the Child Survival Call to Action in June.

12 September 2012

Telemarketers Exploit Charitable Giving

An investigative piece by David Evans for Bloomberg uncovers how the telemarketer InfoCision Management Corp. is raising millions of dollars for charities by lying. The long piece looks heavily into the practices of the firm such as the tactics employed to trick people into giving. What stands out is that when people were explained what was happening, their anger was directed at the charities for using firms that employ deceptive tactics.
The vast majority of funds Patterson, her neighbors and people like them throughout the country would raise -- almost 80 percent -- would never be made available to the Diabetes Association. Instead, that money collected from letters sent to neighbors would go to the company that employed Robin and an army of other paid telephone solicitors: InfoCision Management Corp
Just 22 percent of the funds the association raised in 2011 from the nationwide neighbor-to-neighbor program went to the charity, according to a report on its national fundraising that InfoCision filed with North Carolina regulators.

Secretary Clinton Responds to Benghazi Attacks

An attack on the American Consulate in Benghazi left 4 people dead. One of which was US Ambassador to Libya J. Christopher Stevens. Violent protests in Egypt and Libya were directed at Americans following the publication of a video that mocks the Muslim Prophet Mohammad, reports the New York Times.

Secretary of State Clinton recently issued a statement regarding the attacks. It reads as follows:
I condemn in the strongest terms the attack on our mission in Benghazi today.  As we work to secure our personnel and facilities, we have confirmed that one of our State Department officers was killed.  We are heartbroken by this terrible loss.  Our thoughts and prayers are with his family and those who have suffered in this attack. 
This evening, I called Libyan President Magariaf to coordinate additional support to protect Americans in Libya.  President Magariaf expressed his condemnation and condolences and pledged his government’s full cooperation. 
Some have sought to justify this vicious behavior as a response to inflammatory material posted on the Internet.  The United States deplores any intentional effort to denigrate the religious beliefs of others.  Our commitment to religious tolerance goes back to the very beginning of our nation.  But let me be clear:  There is never any justification for violent acts of this kind. 
In light of the events of today, the United States government is working with partner countries around the world to protect our personnel, our missions, and American citizens worldwide.

Tracking the top Global Health Stories of 2012

I have been pestering people to share what they thing are the top global health stories from 2012. There are still a few months left, but many big events have taken place already that deserve attention. The goal is to come up with a catchy list for PSI that can be published in the end-of-the-year edition of its Impact magazine.

Most of all, it is just interesting to hear what you think were important stories this year. Yesterday, we asked some top global health tweeters to share their thoughts. Here are the results so far. Please join in and share your thoughts on Twitter using the #GlobalHealth2012 hashtag.

11 September 2012

The Hidden Costs of Poor Health Coverage

The Lancet devotes a themed issue to the subject of universal health coverage (UHC). Julio Frenk, HSPH, and David de Ferranti, R4D, make an economic argument for UHC:
The cost of inaction is also important,10 and pointing this out can be helpful for reformers. People without coverage impose hidden costs on their country. Such costs are the flip side of the economic argument for health. Inadequately treated health problems result in diminished productivity, higher costs in the future, and disrupted families and communities (which can lead to underinvestment in the next generation, thereby imposing even greater future costs). Inadequate prevention results in higher treatment costs. A life saved and given the chance to be more fruitful not only imposes less cost on society but also brings more benefit to it. Furthermore, a good health system promotes human rights and enables every individual to realise his or her full potential. This outcome is the ultimate measure of success.
They continue by making the important point that aid should be an internally driven force rather one that relies upon aid and is determined by external forces.
Implicit in our argument is the further point that universal health coverage has to be driven by forces from within a country, not from outside. Aid is not the answer. Government expenditures for health from countries' own sources reached US$410 billion in the developing world in 2009, which is 16 times larger than the total development assistance for health. Even in the African region, external sources represent only 11% of the funds spent on health.11 Drawing on knowledge-related global public goods, domestically led change makes adaptation to local circumstances possible, thus building popular and political support.
It stands in contrast with Jeffrey Sachs who zeroes in on the decline in aid as a major obstacle to realizing universal health coverage in low-income settings.
And the results are clear. Malaria mortality, maternal mortality, and child mortality have all fallen sharply as increased public spending on health has been put to good use by the low-income countries.20 Sub-Saharan Africa has enjoyed a rapid decline in mortality in children younger than 5 years since the middle of the past decade, although there is still considerable ground to cover for the low-income African countries to achieve the Millennium Development Goals.21 These are mainly gains in public health in the dual sense of public financing and public provision. 
The world is getting closer than ever to universal health coverage, yet powerful headwinds have been gusting ever since the outbreak of the financial crisis in 2008. Most importantly, donor aid budgets are being cut.22 The public should understand that small additions to aid for health could bring the world to universal coverage, whereas cuts in aid at this point could undo the great progress of the past decade. Universal coverage for health is within our reach—if we persevere.
Though Sachs would likely agree with the conclusions from Frenk and de Farranti in regards to the need for UHC.
Universal health coverage sits at the intersection of social and economic policy. Introduction of reforms that promote universal coverage is not only the right thing to do on ethical grounds; it is also the smart thing to do to achieve economic prosperity. The paradox of health care is that it is one of the most powerful ways of fighting poverty, yet can itself become an impoverishing factor for families when societies do not ensure effective coverage with financial protection for all. Universal health coverage therefore holds great promise: the focus on increased access to high-quality health services with financial protection integrates social and economic policy in a way that, if done well, can benefit societies the world over.
 You can read through the full issue on universal health coverage here.

K'Naan Article Preview

I'm fine tuning my article based on an interview I conducted with musician K'naan on Friday. What struck me about the conversation was his reluctance to get too far into political issues. I slowly emerged that he did not prefer to talk about it and was genuinely focused on his music. He saw the two as mutually exclusive to some extent, which is different from other celebrities that use their fame to speak on various issues. Here is a section of the large article that is still in progress.

In a guest appearance with The Very Best, K’naan sings, “The sky could fall down any day / Nothing lasts forever anyway / As long as I’ve got you here with me / We ok we ok.” The progression of the song goes on to a geographical shout out to various African cities. One could read the upbeat anthem that says that people living in cities experiencing extreme poverty, and war in some cases, as a rejection of the helpless Africa narrative.

For K’naan, the song is far simpler. “I wrote that as a Geographical song,” he explained. “I imagine myself jumping from town to town playing music playing in sweaty nightclubs.”

The motivation for K’naan is the creation of music and the feeling it can elicit in a person hearing a song. “I think music occupies a more sacred space that we generally tend to grant it,” he says pointing out that it is more than a political tool. “I don’t want to be a part of a group of people that can employ music that can do a certain task or political goal. It is wiser than us, smarter than us, more beautiful than us.”

The challenges faced by his family, friends and compatriots in Somalia are still important to K’naan, but remain separate from his music. “You don’t have to burden your fans with all your causes,” he argues. That is why he chooses to contribute a percentage of his concert sales to a charity or cause of his choosing, but does not talk about it during the concert. 

10 September 2012

AIDS Vaccine 2012 Hits Boston

I wrote this originally for the PSI Impact blog.

Today, Boston is playing host to the AIDS Vaccine 2012 conference. Researchers, advocates and practitioners are meeting for four days to collaborate, share new ideas and ultimately find ways to achieve the goal of an AIDS vaccine. Over 400 new researcher studies will be presented at the event.

"HIV vaccine research is in its most promising era since the epidemic began," said Bill Snow, Director of the Global HIV Vaccine Enterprise to Joy Online. "With sound and well-financed implementation, new HIV prevention strategies could produce important reductions in the 2.5 million HIV infections occurring each year. At the same time, the development of a safe and effective AIDS vaccine remains central to efforts to bring us significantly closer to the end of this epidemic."

A Reuters report from July that was in advance of the International AIDS Conference in Washington DC highlighted the promising advances that bring us closer to an AIDS vaccine.
A 2009 clinical trial in Thailand was the first to show it was possible to prevent HIV infection in humans. Since then, discoveries have pointed to even more powerful vaccines using HIV-fighting antibodies. Now scientists believe a licensed vaccine is within reach.

"We know the face of the enemy," said Dr. Barton Haynes, of Duke University in Durham, North Carolina, and recent director of the Center for HIV AIDS Vaccine Immunology (CHAVI). The research consortium was funded by the National Institute of Allergy and Infectious Diseases (NIAID), founded in 2005 by the National Institutes of Health to identify and overcome roadblocks in the design of vaccines for the human immunodeficiency virus, which causes AIDS. NIAID's funding of CHAVI ended in June.

Unlike many viruses behind infectious disease, HIV is a moving target, constantly spitting out slightly different versions of itself, with different strains affecting different populations around the world. The virus is especially pernicious since it attacks the immune system, the very mechanism the body needs to fight back.
The below video for the conference introduces the progress towards a vaccine, what makes the conference special this year and why Boston is a unique city to play host for the event.

“The participation of young and early-career investigators is essential to solving the most pressing scientific research and public health challenges we face today,” said Galit Alter, M.D., Assistant Professor of Medicine at Harvard Medical School and Massachusetts General Hospital at the time of the event's announcement. “AIDS Vaccine 2012 will bring new investigators, new ideas, and new technologies to Boston to support the global effort to address one of the greatest public health challenges of all time, the development of a safe and effective HIV vaccine.“
You can follow along the conversation at the #AIDSvax2012 hashtag on Twitter.

Securing Women's Land Rights

Keeping up with the them of women and infographics, here is one from Landesa that has been sitting on my desktop for awhile.It makes the argument that women are capable of increasing productivity and yields if their land rights are ensured. Those improvements can then impact the women themselves and their families.

The claims of connections from one act to the next always feel a bit stretched, but the issue of land rights appears to be one that is just about universally agreed upon.

Global Illiteracy: A Concentrated Problem

The face of illiteracy is that of a poor woman from Africa or southern Asia. According to the UN Regional Information Centre for Western Europe (UNRIC), roughly 2/3 of the 800 million people thought to be illiterate around the world are women. They note that overall school enrollment is up by 6 percentage points in developing countries to 89% as of 2008, a pace of growth still short of the MDG targets.

“Education brings sustainability to all the development goals, and literacy is the foundation of all learning. It provides individuals with the skills to understand the world and shape it, to participate in democratic processes and have a voice, and also to strengthen their cultural identity,” UNESCO Director-General Irina Bokova said last year.

International Literacy Day was marked on the 8th of September. Here is an infographic from UNRIC with some more information about the impacts of the problem.

Literacy in the World
by UNRIC.Browse more infographics.

07 September 2012

Latest Updates on Chad: Flooding, Locusts and Malnutrition

Malnutrition remains a problem for children in Chad and the situation in the country has been made worse due to recent flooding. According to UNICEF acute malnutrition rates for children under 5 in the 9 regions of Chad that make up the Sahel are above the 15% WHO emergency threshold.

“This survey, it covers children from 0 to 59 months to see what the conditions are in the area of nutrition. When you look at the young population, these children, the serious conditions that they have, shows you already how the population is. If children are in such a dire situation, that means everyone else is,” said Standardized Monitoring and Assessment of Relief and Transitions (SMART) Survey Team Leader of the Ouadai region in eastern Chad Temoua Djingwe to UNICEF.

Above average rain is responsible for recent flooding and increased change of locust infections. "The situation is quite worrying, based on analysis of available data," Chad's Agriculture Minister Djimet Adoum told AFP. "After the famine, the ministry is now concerned about flooding of food crops and a locust infestation."

06 September 2012

Why Aren't Micronutrients Used?

The development of micronutrient powders provide a simple-yet-effective way to fortify food and ensure that developing children get the nutrients and vitamins that they need.

The WHO recommends as follows:
Micronutrient powders are single-dose packets of iron and other vitamins and minerals in powder form that can be sprinkled onto any ready to eat semi-solid food consumed at home or at any other point of use. The powders are used to increase the micronutrient content in the infant's diet without changing their usual dietary habits.

The WHO recommends the use of multiple micronutrient powders containing at least iron, vitamin A and zinc for home fortification of foods as an option to improve iron status and reduce anaemia in infants and children 6–23 months of age.
A New York Times article this week looks at the history of micronutrients and explores why they are an underutilized intervention. Sam Lowenberg writes:

05 September 2012

US to Provide $100 Million in Humanitarian Assistance for Syria

The United States has announced it is stepping up its humanitarian response for victims of the violence in Syria. Reports yesterday said that 100,000 refugees left Syria during the month of August. Gaining humanitarian access to embattled parts of the country has been challenging.

The Red Cross attempted on a few occasions to enter war-torn cities to little avail. The head of the organization met with President Asad earlier in the week in an attempt to make the case for allowing further humanitarian services in the country.

Here is a rundown of the assistance:
  • $48.5 million to the World Food Program (WFP);
  • $23.1 million to the United Nations High Commissioner for Refugees (UNHCR);
  • $15 million, approximately, to nongovernmental organizations (NGOs);
  • $8 million to the International Committee of the Red Cross (ICRC);
  • $3 million to the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA);
  • $2.75 million to the United Nations Children’s Fund (UNICEF);
  • $1 million to the International Federation of the Red Cross (IFRC);
  • $500,000 to the International Organization for Migration (IOM);
  • $500,000 to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA); and
  • $300,000 to the UN Department of Safety and Security (UNDSS) for support of humanitarian operations.
A USAID press release explained more specifically what the response would look like saying, "The U.S. Government continues to work with international partners to mitigate the effects of the conflict on innocent civilians and provide humanitarian assistance to more than 780,000 people inside Syria. In addition, we are supporting international partners in assisting the host nations receiving the approximately 240,000 who have fled the country. The United States Government’s support for humanitarian assistance includes the provision of emergency medical care, food, and relief items, as well as humanitarian coordination and logistics support to relief agencies. This funding also supports nutrition, protection, and water, sanitation, and hygiene activities."

04 September 2012

DNC Unveils Platform; Mentions Africa, Development, UN and more

...and it doesn't seem to say much of anything.
We will continue to partner with African nations to combat al-Qaeda affiliates in places like Somalia and to bring to justice those who commit mass atrocities, like Joseph Kony. We have made great efforts to reduce the violence in Darfur and built international support for a successful referendum on South Sudan’s future. And in his first visit as President to the United Nations, President Obama advanced initiatives to strengthen UN peacekeeping capabilities in Africa. This includes providing equipment, training, and logistical support for UN and African Union missions in Darfur and Somalia. The President has also worked to help African nations grow their economies, and we have opened trade and investment opportunities across the continent.
The surprise appearance seems to be Kony which indicates a level of success for Invisible Children's Kony 2012 video. Not much is discussed in a matter of how anything in the platform will be supported and what changes may take place.