Monthly Archives: June 2011

The Unintended Consequences of Female Empowerment

In social sciences, unintended consequences are outcomes that are different from those expected.  In development, unintended consequences are common, and often negative by nature.

As a generalization, there are two approaches to development: top-down and bottom-up.  The top-down approach, favored by Jeffrey Sachs, calls for a prescriptive methodology – government-to-government aid, debt relief, and targeted interventions designed to reduce poverty and increase incomes.  The best example of the top-down approach in action is the Millenium Villages Project (read about it here).  In contrast, the bottom-up approach favors a more descriptive methodology, investing in projects with proven results.  Bill Easterly, the standard-bearer of the bottom-up folks coined a term for the two groups: “searchers” vs. “planners.”  Searchers look for the right solutions and focus on what works, while planners define the solution ahead of time.

I am more of a searcher myself, and I still haven’t quite found what works (though I’m getting warmer in Kenya).  Microfinance is a good example of a bottom-up approach – providing a foundation of financial services at the grassroots level upon which to grow and expand.  And usually searchers have a better track record of reducing the prevalence of unintended negative consequences than planners, since planners try to account for all of the variables in advance, which is impossible.  And sometimes, no matter what happens, there will be unfortunate consequences that would be difficult to anticipate without a deep cultural understanding of the society.

Such is the discussion of a recent opinion piece from Ross Douthat, a conservative pro-life columnist for the New York Times.  The article is largely about how the spread of abortion to developing countries has contributed to the 100 million missing women around the world, as described by Amartya Sen in an article from 1990.  But he also raises a larger point, which the Democracy in America blog at the Economist highlights (trying not to name-drop):

IN WHAT was bound to be a controversial column, Ross Douthat, citing new work by journalist Mara Hvistendahl, argues that female empowerment has led to more sex-selective abortion:

The spread of sex-selective abortion is often framed as a simple case of modern science being abused by patriarchal, misogynistic cultures. Patriarchy is certainly part of the story, but as Hvistendahl points out, the reality is more complicated—and more depressing.

Thus far, female empowerment often seems to have led to more sex selection, not less. In many communities, she writes, “women use their increased autonomy to select for sons,” because male offspring bring higher social status. In countries like India, sex selection began in “the urban, well-educated stratum of society,” before spreading down the income ladder.

Is it true that gender empowerment, the ultimate buzzword in the development community, has actually led to an increase in sex-selective abortions?  If so, that is a pretty big unintended consequence.  I think that cultural issues are nuanced, and oftentimes the best of intentions will backfire, or at least be manifested in strange ways.  Still, according to the Economist again, the stakes are high:

And all countries need to raise the value of girls. They should encourage female education; abolish laws and customs that prevent daughters inheriting property; make examples of hospitals and clinics with impossible sex ratios; get women engaged in public life—using everything from television newsreaders to women traffic police. Mao Zedong said “women hold up half the sky.” The world needs to do more to prevent a gendercide that will have the sky crashing down.

Very true.  But, on the road to empowerment, there are bound to be some unintended consequences.  I suppose the best thing to do is to search for a solution and go with what works.

Mobius Motors and Game-Changing Technologies in Africa

Problems generally have a cause and an effect.  Trying to solve a problem by focusing on the effects may reduce the impact, but, if the solution fails to address the underlying issues that make it a problem in the first place, the problem will continue to exist.  In Africa, there is no shortage of people trying to address the effects of systemic problems without taking into consideration the root cause.  The best example  is food aid, which fights hunger and reduces malnourishment in the short-term, but ultimately creates dependency among recipients and undermines the domestic agriculture sector, further reducing the local food supply.  By addressing the effects, rather than the cause, traditional food aid ends up exacerbating the problem.

There are fewer examples of companies and organizations targeting the underlying the issues that lead to systemic change, but the ones that have been successful have changed the world.  Mo Ibrahim is a Sudanese-British mobile communications entrepreneur.  He founded the company Celtel, a telecommunications company that has sold 24 million mobile phone subscribers in 14 African countries, and, in the process, catalyzed the mobile revolution in Africa.  Before Ibrahim, no one believed that Africa could be a profitable market for mobile phones and cellular technology.  By proving the the concept, Ibrahim spurred the creation of a telecom sector in Africa with price wars that make the U.S. market look like a state-run monopoly.  In doing so, Ibrahim and Celtel addressed the fundamental problem of communication, making every industry in Africa more competitive on a global scale.  (An interesting sidenote: Ibrahim later formed the Ibrahim Foundation and launched the Prize for Achievement in African Leadership.  $5 million is awarded each year to an exemplary African leader who promotes peace and democracy, but only if there is an acceptable candidate.  According to Ibrahim, “good governance is crucial.”)

Another game-changing technology is mobile money.  In 2007, Nick Hughes, a former Vodafone executive, pushed the company to invest in a technology in Kenya that would allow people to transfer money via mobile phone.  That technology would ultimately become M-PESA, a mobile money transfer service offered by Safaricom, in which Vodafone owns a major stake.  Today, M-PESA has 14 million subscribers representing 81% of Safaricom’s subscriber base and 13% of the company’s revenues.  Safaricom, which has ~70% market share in Kenya, has faced intense competition amidst a price war with other telecoms.  Yet, M-PESA revenues have still increased by 50% every single year since 2008.   In the Philippines, SmartMoney and G-Cash followed the same path. Through mobile money, Hughes and others addressed the fundamental problem of providing financial services to the unbanked.  Now, people can transfer money, pay their bills, and save for the future using only their mobile phones.  Mobile money is still young, and the rippling effects it will have on emerging market economies beyond Kenya and the Philippines remains to be seen.

Hello Mobius

This past weekend I met the founder of another company that is trying to address another fundamental problem in the developing world: mobility.  Mobius Motors, based in Mombasa, has the modest goal of revolutionizing transportation in Africa.  Here’s how:

Designing and building affordable, fuel-efficient vehicles for developing regions in Africa, Mobius Motors is galvanizing a different, equally important revolution in transportation. Recognizing that the majority of people residing in remote and rural parts of the continent have no access to transit, the company predicts that great strides in economic development, education, sanitation, etc. will come when more people have mobility.

Mobius’ goal is provide enough cheap, off-road-capable vehicles — they look a lot like mini Jeeps — to build a reliable public transportation system. The company believes that this will allow for better access to schools and health clinics, expedite profitable agricultural activities, foster small businesses, and even empower women who spend so much of their time walking to collect water and firewood.

But Mobius’ ambitions have even broader implications for the world’s changing transportation system. Now that more developing countries are industrializing at a breakneck pace, rapid car production is becoming more important than ever. Look no further than China, where automotive demand has spiked. But the world’s climate can’t afford another stretch of dirty industrialization. The cars built to satisfy this voracious demand need to be different: lighter, smarter, vastly more efficient but with comparable utility.

Goodbye Matatu

Mobius is trying to reduce the cost of manufacturing to an absolute minimum by stripping away everything it considers unnecessary for a car designed for the African bush.  It is creating its second prototype, which is made from off-the-shelf cost-efficient materials and is frill-less, without like air-conditioning or glass windows.  The cars are modular, meaning they can be adjusted to suit any purpose – transporting crops to market, carrying passengers from the rural areas to the cities, or providing an alternative to the ubiquitous matatu system, which is going to be phased out over the next decade.  Right now, access to urban areas and centers of trade and commerce is a major impediment to people in the rural areas.  This is creating a process of urbanization in Kenya that is seeing a mass migration of rural dwellers into the cities.  If the Mobius car provided a cheap means of transporting goods and people to and from the cities,  people living outside the cities will have more and more options and perhaps slow the rate of urbanization.  Think about your own life, and think of all of the ways that transportation makes your life easier and more convenient.  That is what the Mobius car has the potential to do for Africa.

To my mind, the Mobius car, like mobile money and the African telecom sector, is a bit like the iPhone.  It is a basic platform upon which to build something greater.  The Mobius cars will improve mobility, but it may be in ways that no one envisioned.  Right now, there is a fundamental problem of mobility in parts of Africa.  By addressing this problem, Mobius could very well achieve its goal of revolutionizing transportation in Africa.  The ripple effects in other sectors could be huge.

Last year, Next Billion interviewed Joel Jackson, the founder of Mobius Motors.  Here is what he has to say about the company:

I founded Mobius to change the world. Not by making wealthy economies wealthier but by mobilizing emerging markets, starting in Africa. Effective transport underpins development but sadly is often overlooked. It provides access to education, healthcare, markets and employment. It connects families with loved ones and supports the exchange of products, services and ideas. Imagine your life without transport for just one week. How would your children get to school, how would you get to work, what would you eat and what would you do in a medical emergency? Although developing-world transport presents a huge market opportunity it also suffers from acute market failure with misaligned products and services. Mobius aims to readdress the transport imbalance and mobilize the developing world. This is a vision worth dedicating my career towards, which is why I do what I do.

Very cool stuff.

Fewer Farms, Bigger Farms

The realities of another food crisis. (Photo Credit: Foreign Policy)

Right now, the world is in the midst of a food crisis.  Some might contend that we never fully recovered from the food crisis of 2008, but what is certain is that food prices are rising.  The reason for the spike is open for debate, but some combination of a growing demand due to population growth, an increase in the frequency of extreme weather events (floods in Pakistan, the Moscow heatwave, etc.), an expanding middle class with a growing taste for meat and dairy, global trade policy, commodity speculation, agribusiness  and ethanol lobbying in developed countries, and other factors are likely to blame.

Global warming was another issue.  Over the last two decades, economists and climatologists have been contemplating the effects of global warming on food production.  The consensus was that, while climate change and the corresponding shift in weather patterns would have an adverse impact on agriculture in certain regions of the world, a rising temperature could actually open up new pockets of arable land.  The one bright spot of climate change was that the increased amount of carbon in the atmosphere would actually improve crop yields.   Unfortunately, that hypothesis proved to be overstated, at best, and quite possibly downright wrong.  It turns out that a warmer world, despite what the computer models may say, is not good for food production.

The amount of research dollars devoted to finding new drought-resistant seed varieties and better, cheaper fertilizers is leaving the world less prepared for the adverse effects of global warming on agriculture production. The success of the Green Revolution beginning in the 1960’s caused food prices to fall year after year for decades.  With the world assuming that the food problem had been solved, the limited number of development dollars went to researching other global problems, name solving public health issues like HIV/AIDS, tuberculosis, and malaria.  Testing new varieties and growing conditions takes time, counted in years, not months.  In response to a problem where time is of the essence, we are not moving fast enough.

The Economist recently had a special report on the feeding the world.  The articles were thought-provoking and alarming.  The precarious situation the world finds itself in should galvanize a stronger response from the developed world, but it doesn’t.  As food prices increase, the people who are hit the hardest are those spending the highest percentage of their annual income on food.  So, for people living in the developed world, a dramatic increase in the price of wheat and maize is a minor dent in their overall spending.  For the rural farmer who is spending 60% of his income on maize, it is the difference between three meals a day and two.  For this reason, the 2008 food price crisis led to riots in some countries and was hardly acknowledged in others.  For the 100 million people driven into extreme poverty as a result of the spike in staple crop prices, the prospect of another food crisis in 2011 is likely terrifying, particularly if they understand the challenges in feeding nine billion people over the next half-century.

The Economist is quite expensive in Kenya, unless you buy an old copy from the street newsstand vendors.  Yesterday I picked up the issue following the one with the special report on food from March 19th, 2011, and perused the letters in response.  One response from Chris Haskins of the House of Lords stood out:

SIR – Regarding the future of food (Special report, February 26th), there are two additional factors to existing and new technology that will raise farm output significantly. Large tractors and combines have transformed agriculture in the developed world, enabling far more land to be cultivated and crops to be harvested at speed, which reduces the loss caused by weather. Sixty years ago my father needed six men to grow 100 acres (40 hectares) of crops. Today my son can farm 1,000 acres with one man.

Agriculture in the developing world could also be transformed by this existing technology, but there needs to be fewer and bigger farms to make use of large equipment and to raise the collateral to invest. That means far fewer rural workers, and controversial social consequences.

New technology, such as satellite mapping, will enable farmers to identify wide variations of soil quality across every field and to adjust their equipment to apply their seeds, fertilisers and chemicals precisely at varying rates, depending on the fertility across the field. This makes great economic and environmental sense.

This is a controversial position, but one with which I happen to agree.  Large-scale commercial farming offers economies of scale that drive down the cost of production through mechanization, irrigation, and the consistent application of GAPs (good agricultural practices).  In northern Ghana, it is difficult to offer mechanization services profitably to smallholder farmers because, frequently, the plots of land are not contiguous, meaning the tractor has to travel longer distances to serve the farmers, increasing fuel costs and adding to the per-acre cost.  Not to mention, smallholder farmers often don’t have the resources to remove all the stumps and stones from their land, which, if run over by a tractor, will destroy it.  The cost of importing replacement parts into the country is high, which is why if you go to northern Ghana, you will see tractors gathering rust on the side of the road.

Zimbabwe was once called the “breadbasket of Africa” due to its massive agricultural output.  The commercial farms operated by the predominantly white settlers were highly efficient, with yields that might rival other parts of the world.  After Robert Mugabe redistributed the land during his controversial land reform program, farm output fell.  Now, Zimbabwe can hardly feed itself, causing many Zimbabweans to migrate into neighboring South Africa to find work.  Say what you will about colonialism, but Zimbabwe’s agricultural prowess was once the envy of Sub-Saharan Africa (SSA).

The last point about Mr. Haskins letter I’d like to address is his call to reduce the number of farms and farmers – a move with “controversial social implications.”  So much money is invested in helping farmers in SSA improve production and increase profits.  FAAB – “farming as a business” – programs are designed to get subsistence farmers to think about their input costs and yields as components of a rudimentary profit-and-loss statement.  Is this really what the subsistence farmer trying to make enough to feed his family really needs, wants, or cares about?

In Ghana, an exasperated colleague lamented the fact that, unlike in other places she’d worked in Africa, including Kenya, Mozambique, and South Africa, farmers in Ghana were lazy.  Instead of transplanting rice by hand, or individual planting soya bean seeds in rows, Ghanaian farmers were content to broadcast the seed, throwing it haphazardly into the soil.  The result is higher seed costs and lower yields.  My Canadian friend and I were listening to her, and after she left, I asked what he thought.  He’s been living in Ghana for the better part of three years, working with the Ministry of Food and Agriculture and living in the rural communities with farmers.  Maybe it isn’t that farmers in Ghana are lazy, but rather that smallholder farmers anywhere, be it in Africa or the rest of the developing world, don’t actually want to be farmers.  They are farmers because they have to be farmers, and farming all they know.   Maybe they would prefer to draw a salary from working on a large-scale commercial farm – a steady salary, unlike the lump sum payment they get for their crop at harvest time.  I don’t know, but it’s a question that is worth debating.

I agree with Mr. Haskins.  Fewer farms and larger farms are the answer.  It is a controversial position because, in the past, laborers on commercial farms have been mistreated, and land ownership is is incredibly important for a family with very few assets.  Yet farmers could still lease the land to large commercial operators and earn income that way.  There are ways around these cultural barriers.  I once asked another colleague how make Ghana rice competitive against the Thai, Vietnamese, and U.S. imports.  “Give me 200,000 acres below the Volta Dam with the full irrigation and three growing seasons, a warehouse in Tema (the port) and I’ll feed all of Accra.” Unfortunately, 200,000 farmers, each with an acre of land, will probably never come close to feeding all of Accra.

Sub-Saharan Africa, 2020.

Insite: A Step Beyond a Needle Exchange

The following is a guest post by Shawn Zhou, a country program analyst with the Clinton Foundation on the Clinton Health Access Initiative in Shanghai, China.

An interesting progressive model for combating HIV/AIDS has emerged over the past 5-10 years in Vancouver, BC. Once home to the highest rate of HIV infection growth in North America, Vancouver has seen a significant decline in the spread of HIV among its intravenous drug users. The model they’ve implemented encourages drug users to enter a “safe house”  called Insite, where individuals are free to use illicit drugs while being supervised by nurses, and are offered treatment if suspected of suffering from HIV. Insite is trying to provide an aggressive and controversial model of reaching and treating a difficult and high-risk population….and so far it appears to be working.

According to one of the center’s studies, financed by the United States National Institutes of Health, from 1996 to 2009 the number of British Columbians taking the medications increased more than sixfold — to 5,413, an estimated 80 percent of those with H.I.V. The number of annual new infections dropped by 52 percent. This happened even as testing increased and syphilis rates kept rising, indicating that people were not switching in droves to condoms or abstinence. (Full Article)

There are two key foundational beliefs to the creation of this model 1) As one nurse put it: “people are going to use drugs whether they have clean needles or they don’t.”   2) A Test and Treat system where all patients regardless of CD4 count are treated if they are HIV+ (aka….don’t prioritize patients, treat everyone, stop the spread).

This first fundamental belief is probably the biggest sticking point for those opposed to the program. Fundamentally while this model may appear to encourage drug use, as the article suggests, many other cities worldwide have already adopted free needle exchange programs as a means of encouraging cleaner and safer drug use.

A 1997 study in The Lancet found that in 29 cities worldwide with needle exchange, H.I.V. infection dropped 6 percent a year among drug injectors, while in 51 cities without, it rose by about 6 percent.

By funding a safe house for users, monitored under the careful watch of medical professionals, Vancouver has taken this belief one step further and is trying to manage dangerous behavior in a contained and safe environment.

In 2009, the site recorded 276,178 visits (an average of 702 visits per day) by 5,447 unique users; 484 overdoses occurred with no fatalities, due to intervention by medical staff. Health Canada has provided $500,000 per year to operate the site, and the BC Ministry of Health contributed $1,200,000 to renovate the site and cover operating costs. (Wikipedia site)

This is of course a difficult pill for public officials to swallow, since such clinics and programs are costly and goes against conservative principals. However, regardless of its implications on drug use, the model undeniably offers a safer environment for drug addicts than they previous had, and should probably get strong consideration in other communities in the developed world where drug use and the spread of HIV is rampant. I’m curious to see how this all shakes out as apparently Canada’s supreme court is reviewing law suits to close down the facility.

The Many Forms of Corruption

cor·rup·tion (n.): Dishonest or fraudulent conduct by those in power, typically involving bribery

In Nairobi the other day, the police pulled over my taxi at a checkpoint.  There were four people in the backseat, so the officer beckoned me, seated in the front seat, out of the car and said “You’re breaking the law – what do you want to do about it?” Fortunately, a friend sitting in the back felt strongly about not perpetuating the system of bribery and demanded to see their badge, since he was an employee of the embassy and wanted to report them.  The police officer held up his gun and said “this is my badge,” while my friend explained to the “security officer” for the embassy on the phone that he was being harassed by police officers (I later went to dinner with another friend, who, it turns out, was the “security officer” on the other end of the line).

In Tamale in Northern Ghana, we took an illegal U-turn on our motorbikes and were stopped by a plain clothes police officer.   He took away my friend’s keys and said we were going to the police station unless we gave him something to “make it better.” My friend, who works at the office of the regional coordinating council for the Northern Region, pulled out his phone and showed the officer the phone number of the regional minister, and explained that, because he did not understand what “make it better” mean, he was going to call the minister and ask for some clarity.  We quickly got our keys back and were on our way.

In the Philippines, the 2010 election took place during my stay.  Politicians send emissaries out to the different barangays (communities within a town) to distribute money directly to the people in exchange for votes.  If a politician can’t buy a community, he rents a bus, loads it with booze and fried pork, and brings the members of the community to the beach for a party on Election Day.

The point I am trying to make is that, in many developing countries, corruption is a problem.  It exists out in the open, in forms that are easy to see and easy to track.  Some estimates place leakage in the Kenyan government due to corruption at 40% of GDP.  As I discussed in a post the other day, the government is embroiled in a scandal over 4bn Kenyan shillings designated for free public education.  Yes, corruption is a problem, and can be a major impediment to economic and social progress.

The western approach to Africa emphasizes good governance, democracy, and transparency in exchange for aid and development (tied or untied).  Ghana is referred to as a “donor darling,” as its history of successful democratic elections has made the government a reliable (if not strategic) partner for donors in terms of economic development.  In contrast, the Chinese approach in Africa has been to provide direct infrastructure investment in exchange for natural resource concessions, irrespective of governance.  To the Chinese government, it is none of their business how another sovereign nation chooses to govern itself, particularly when it is in their interest to maintain the status quo.

Regardless of efforts to stem the tide of corruption, it exists and will likely continue to exist until certain fundamental underlying issues are addressed.  I used to note that Filipinos are some of the most cynical people I’ve ever met about politics.  Corruption is so pervasive in the system that (at least in local elections) people vote for the politician who is most adept at playing the game than the one who vows to change the rules.  And when they talked about this, I used to say that corruption comes in many forms, and the United States is hardly immune.  In fact, I would argue that corruption in the United States is arguably worse than in certain developing countries, if only because it operates under a veil of legitimacy.

K Street is a physical street in Washington D.C.  It is also a euphemism for the lobbying industry, which, for the most part, calls K-street home.  Wikipedia describes how lobbying works in the United States:

Lobbying (also Lobby) is the act of attempting to influence decisions made by officials in the government by individuals, other legislators or government actors, constituents, or advocacy groups. A lobbyist is a person who tries to influence legislation on behalf of a special interest or a member of a lobby. Governments often define and regulate organized group lobbying that has become influential.

Lobbyists use their time both with legislators, to explain the issues of the organizations which they represent, and with their clients to explain the obstacles elected officials face when dealing with these issues. Many of these lobbyists are employed by lobbying firms or by law firms, which retain clients outside lobbying, other lobbyists are employed directly by advocacy groupstrade associations, companies, and state and local governments. In 2007 there were over 17,000 federal lobbyists based in Washington, DC.[1]

Lobbying activities are also performed at the state level, and lobbyists try to influence legislation in the state legislatures in each of the 50 states. At the local municipal level, some lobbying activities occur with city council members and county commissioners, especially in the larger cities and more populous counties.

There are 17,000 people whose sole qualifications are their connections to lawmakers, and whose job it is to influence legislation in exchange for money.  A rose by any other name would smell as sweet, and lobbying smells like corruption to me.  In fact, I am not sure exactly how lobbying can be construed as anything but a legal form of corruption that operates with complete immunity from prosecution.  Legally, politicians are not allowed to accept gifts from lobbyists.  But, they can accept campaign donations to from political action committees (think Swift Boat Veterans for Truth) during a campaign year, increasing their likelihood that they’ll keep their job and their magnanimous donor will encounter what Michael Porter would describe as a “friendly regulatory environment.”

Yesterday, an article in Politico describes what Andrew Sullivan calls “Talk Radio’s Ideological Industrial Complex,” in which prominent talk radio hosts accept money from influential political think tanks in exchange for endorsements:

In search of donations and influence, the three prominent conservative groups are paying hefty sponsorship fees to the popular talk show hosts. Those fees buy them a variety of promotional tie-ins, as well as regular on-air plugs – praising or sometimes defending the groups, while urging listeners to donate – often woven seamlessly into programming in ways that do not seem like paid advertising.

“The point that people don’t realize,” said Michael Harrison, founder and publisher of the talk media trade publication TALKERS Magazine, “is that (big time political talk show hosts) are radio personalities – they are in the same business that people like Casey Kasem are in – and what they do is no different than people who broadcast from used car lots or restaurants or who endorse the local roofer or gardener.”

The Heritage Foundation pays about $2 million to sponsor Limbaugh’s show and about $1.3 million to do the same with Hannity’s – and considers it money well spent.

This is called the “politico-media complex,” and, to my mind, it is another form of corruption.   The military-industrial complex – Harry Truman’s phrase for the unholy relationship between the defense industry and the government that Dylan sang about – is another form of corruption.  So is the prison-industrial complex, which describes the connection between the drastic increase in the number of incarcerated Americans – by far the largest of any industrialized nation as a percentage of population – to the political influence of the private-sector prison lobby.   Remember the Arizona immigration law?  The one that legalizes racial profiling and is designed to stop “the Trojan horse destroying our country,” as described by Arizona state senator Russell Pearce?  Well, that bill was influenced by, if not drafted by, the private-sector prison lobby, led by the Corrections Corporation of America.  The business model of for-profit prisons is simple: revenue is directly correlated to the number of inmates being housed in the correctional facility.  Illegal immigration – an issue that appeals to people’s basest tendencies, drawing on latent xenophobia and racism – is, frankly, a big market. This, from NPR:

NPR spent the past several months analyzing hundreds of pages of campaign finance reports, lobbying documents and corporate records. What they show is a quiet, behind-the-scenes effort to help draft and pass Arizona Senate Bill 1070 by an industry that stands to benefit from it: the private prison industry.

The law could send hundreds of thousands of illegal immigrants to prison in a way never done before. And it could mean hundreds of millions of dollars in profits to private prison companies responsible for housing them.

Yes, that is corruption too.  Food is another one.  The agribusiness sector in the United States spent $1.3 billion on lobbying between 1998 and 2010, representing ~4% of the total, and the return on that investment has arguably had a greater impact on world hunger than do the corrupt politicians that preside over the hungry populations.  The U.S. senate recently voted to repeal a $6 billion tax credit to ethanol producers, which probably existed in part due to the fact that presidential candidate Newt Gingrich received $300K in campaign contributions from biofuel lobbyists.  Meanwhile, the world is in the midst of a serious food crisis.  Fortunately, Mr. Gingrich and his constituents will not feel the sting, as they do not spend half of their income on food, unlike the 100 million people who were pushed into extreme poverty during the last food crisis back in 2008.

These are all forms of corruption.  I am a realist, as readers of this blog know.  Geopolitics is driven by oil and money, and that is not going to change.  Bribery – financial or otherwise – greases the wheels of capitalism and is part of the game, for better or for worse.  But I do think it is only fair to acknowledge the hypocrisy in demanding good governance from other countries.  Because corruption comes in many forms, and with more complexes than I can count on two hands, the United States would do well to take a hard look at its reflection in the glass house before it decides to throw stones.

The Evolution of Develop Economies

“Write without pay until somebody offers to pay you. If nobody offers within three years, sawing wood is what you were intended for.”- Mark Twain

I think about this quote a lot, and by a lot, I mean once, two days ago, when I saw it referenced by Roger Ebert as he discussed his two years of weekly submissions to the New Yorker caption contest finally paying off.  It was linked to by Robert Mankoff, the cartoon editor of the New Yorker, a funny man with an equally funny blog.  I too have made submissions to the New Yorker caption contest, though I usually just use quotes from the Vin Diesel classic XXX.  In fact, every week for the last six months, I’ve alternated between “Now that business is over, we party” and “Everything’s okay… with enough vodka.”  Apparently, the folks at the New Yorker find my sense of humor a little too post-modern, whatever that means.

“Everything's okay... with enough vodka.”

Anyways, I thought for about five minutes about how I could turn this quote into a blog post, much the same way Quentin Tarantino decides on the soundtrack for his films before he writes the script (note: unverified).  It was surprisingly easy, since it has been exactly 18 months (as of four days ago) since Develop Economies first entered the blogosphere with an article titled “Filipina Heart” about my first flight from Boston to Manila, during which I sat next to a man from Illinois wearing a sleeveless T-shirt who was going to meet a young lady for a few weeks of fun in the sun, a la George “Rentboy” Rekers, except slightly less funny, though equally tragic.

For those unfamiliar with the Roman calendar, 18 months is exactly half of three years and I, presumably like Mark Twain, continue to not be paid.  For the first year I had a link to Paypal on the sidebar asking people to support me in my travel.  Only two people ever tried to give me money.  I turned down one because he was also an unpaid Kiva Fellow and I’d just come back from a fairly self-indulgent diving trip around the Philippines, and the other because I couldn’t actually accept the money, as my Paypal account was frozen after I forgot my password and I screwed up the identity verification process, necessitating that I receive a letter from Paypal and re-send it back to them to prove I am who I am.  I lost out on $20, and, to this day, my account continues to be frozen.

Again, I digress.  Despite not being paid, I have now surpassed the somewhat impressive 200-post count (an average of one post every three days for the last 18 months).   The number of page views – more than 150,000 – means nothing, since my blog became a target of spammers somewhere around Thanksgiving of last year.  Do I feel like Rodney Dangerfield (“I stuck my head out the window and got arrested for mooning”)?  Not really, since blogging has been so good to me.  After all, if I wasn’t writing all the time, I’d probably become like Will Smith in Men in Black and people back home would be saying, “Josh has been in the bathroom for a long time – I hope he’s OK.”

My writing style has evolved over time, as long-time readers of this blog can attest.  One of my most loyal readers described my style as “very French” – “these, antithese, synthese” – which I, as an American, interpreted as “weak” and banned him from the site.  The blog started as a means of keeping my family and friends apprised of my travels.  Eventually, as I became more engaged in the subject matter, it turned into a blog about microfinance.  I didn’t appreciate getting atomic wedgies every time I told people I was a “blogger” – particularly since I was 25 at the time – so I changed it to a “journal of microfinance, economic development, and culture.” As I grew interested in other aspects of development, I expanded the scope to include anything that pertained to poverty alleviation in the developing world, which is more or less what it is today.

In order to let my readers know that I wasn’t taking myself too seriously and remind them that I am still immature, I used to write fairly frequently about growing a beard (see here, here, here, here, and here).  Early readers remember that, in my previous job helping the rich get richer, I was unable to embark on this critical male rite of passage because it would take at least two weeks to reach a respectable level where I didn’t look like I’d been sleeping in a tent in the woods, eating only what I’d killed.  When I did start growing the beard, it became quickly apparent that the region between my lower lip and chin were a barren wasteland that looked like Carthage after the Roman general Scipio Aemilianus Africanus plowed over the city and sowed the earth with salt during the Third Punic War.  This was a source of humor to me, and to my readers as well, which I assume helped humanize me a little bit.  After all, someone told me the other day that when they first met me I seemed “self-absorbed,” which, to some extent, is true.  (By the time you reach the end of this self-indulgent and presumptuous post, you’ll know what they meant.)

Eventually, in a purely organic fashion, I began gathering a following (not a big one – more like Raelism than Scientology).  Because I’m a Luddite when it comes to social media, I initially dismissed anyone who used Twitter as a tool, sight unseen.  Now I have a Twitter account (my “handle” is #developeconomy), which automatically tweets my posts and only my posts, leading me to wonder why anyone is following me at all.  Initially, my father was the only one who commented on any of my posts, always using a pseudonym from Atlas Shrugged by Ayn Rand (usually it was “John Galt,” but he occasionally dropped a few comments as “Hank Reardon”).  Soon, others started commenting.  People began emailing me out of the blue, asking about this or that, telling them that they were going to this place or that place and had read my post and wanted to learn more about it.  Finally, I was receiving the validation that poor Rodney never got.

I began reading about how to expand your readership.  The two big recommendations were to post regularly and engage your existing readers.  So I started posting more often.  But writing “journal” posts takes time, particularly if you have to teach yourself about relatively complex issues before venturing an opinion on certain matters.  By that point, I’d learned a lot about microfinance and the fundamental causes of poverty, so I could comment on what other people were writing without having to research the topic extensively.  Drawing inspiration from Andrew Sullivan at the Daily Dish, I was able to maintain a steady supply of posts without a huge amount of effort.  This is why reader #1, Ed, described my style as “very French.”  I’d present someone else’s thesis, then explain why I agreed or disagreed with it.

Each post followed the same basic structure, with some variation.  The post would start with an introduction of the topic and a basic overview of the key information.  The next paragraph would paraphrase the central thesis of whatever article I was discussing.  I’d quote a few paragraphs from the article, without worrying about keeping it short, since the word count stays the same, irrespective of the author.  Then, in a stream-of-consciousness manner, explain what I found right or wrong about the conclusion, drawing on my education as a philosophy minor to break down the argument to its premises and address them individually.  Then I’d hit post, without checking my work, as I have done since I was in second grade when my teachers would tear apart my cursive writing worksheets because I had rushed through them to get it over with (instead of becoming more adept at writing script, I just stopped using cursive when I was in 5th grade and never looked back.) Again, loyal readers no doubt know that a good Develop Economies post is not without its share of grammatical errors.

These, antithese, synthese.  Adopting this style allowed me to do two things.  First, I have blogged more prolifically than I ever would have thought myself capable.  Second, it has really broadened the scope of my learning, which is really what writing this blog is all about.  Now, I didn’t have to sit down for two hours and read about how to create a credit bureau for microfinance institutions.  Instead, I could just read what someone else was saying, and comment on their argument.  As a result, I’d become knowledgeable about more without sacrificing volume.  Those who cannot do, criticize.  I chose the latter.

Whenever I really wanted to learn about an issue, I’d sit down and read about it with the intention of writing a post at the end.  Longer posts became an excuse to study things my limited attention span would have normally precluded me from learning about.  Posts became assignments, similar to an essay I’d write in college.  I’d write one dense and heavily-researched post every two or three weeks.   In an effort to raise my profile, I started writing for Next Billion, the first blog I’d started reading when I first became interested in market-driven approaches to poverty alleviation.  I’ve posted about six times on Next Billion, and look forward to continue writing for them in the future.  My first post on Simpa Networks, an off-grid solar energy company started by two people I’d met a year earlier and had kept in touch with over the years, was a momentous occasion.  It reflected something of a milestone.  I was now writing for the blog that introduced me to all this.  I felt like Darth Vader fighting Obi Wan Kenobi in the first Star Wars movie: “At first I was but the learner; now I am the master.”  Now you know why I was still getting atomic wedgies when I was 25.

Develop Economies and I have evolved in tandem.  The journal is a reflection of my personal direction, which is ironic, since, after spending nine months in Southeast Asia, six months in West Africa, and now, coming up on a month in East Africa, I have come to the conclusion that I am directionless.  I still enjoy going back and reading my earlier posts, since it allows me to turn back and look down the steep slope of the learning curve I’ve climbed over the last 18 months and watch Sisyphus pushing the rock up the hill.

So, for those readers that have been with me since the beginning, thanks for sticking it out.  I’d be interested to hear how you think this blog has developed.  If I get no comments at the end of this, I might feel a little bit like that guy in Jerry Maguire, that movie about Scientology.  And for anyone else who is reading this and wants to pay me, I have a year and a half before I move to Canada and work in a sawmill, so just let me know.

Roger Ebert's winning caption. I would have gone with "Now that business is over, we party."

How Does Corruption in the Education Sector Work?

“There’s this standing joke about corruption in Asia: In the Philippines, everything is under the table; in Vietnam, it’s over the table; in Indonesia, it’s including the table.” – The Manila Standard

The Philippines is ranked 139th out of 180 on the Corruption Perceptions Index, registering a 2.3 out of 10 (with 10 being the best).  In 2007, it was the second-worst in East Asia, a few points behind the Indonesia.  My friends in the Philippines used to joke that the only reason it didn’t have the lowest score is because it paid off the judges.  But, in 2008, it re-claimed the top spot, back on top after Indonesia climbed its way up.  Corruption is a major problem in a lot of countries, endemic in all sectors.  But the one that is perhaps the most troubling is the education sector.

The education sector is often one of the top two or three leading sectors in terms of government funding. Unfortunately, in many countries corruption is endemic within education, and the countries are some of the worst (with the exception of Ghana, which I explain below).  In the Philippines, according to my old co-workers, the ministry of education is the rifest with graft. (To learn more about education in the Philippines, read a post I wrote from 2009).

What’s yellow and orange, and red all over? The 2010 Corruption Perceptions Index map from Transparency International.

Kenya is another country that is no stranger to corruption.  It has the dubious distinction of being ranked 154th out of 178 countries (or the bottom 10% percentile).  According the country’s anti-corruption commission, Kenya loses 40% of its gross domestic product to corruption every year.  Today in the Daily Nation, the leading Kenyan newspaper, a front-page article, titled “How free education billions were stolen,” details how more than 100 government officials, including top civil servants, deposited money meant for schoolbooks and teacher salaries into fake bank accounts, only to later withdraw the money and steal the money.

In early 2010, the United States and Britain suspended aid for the education sector (particularly the funding for clep test prep for the downtrodden and reprobates) of Kenya after reports that more than $1 million had gone missing.  The report on the front page of today’s Daily Nation places the figure at 4.2 billion Kenyan shillings, or a little more than $50 million, between 2005 and 2009, about half of which was “brazenly stolen, because when the Treasure followed the paper trail to the schools where the money was supposed to have been disbursed, it emerged that the money ‘did not reach the schools.’”

It is unfortunate that money meant for public education is diverted into the bank accounts of corrupt bureaucrats, and that teachers are underpaid, and that students end up paying school fees when school is supposed to be free.  There are a lot of ways to steal money meant for the education sector.  In Kenya, they divert the money into phony bank accounts.  But there are plenty of other less detectable ways to get that money.  U4, the anti-corruption resource center, provides a few:

  • Illegal charges levied on children’s school admission forms which are supposed to be free.
  • Embezzlement of funds intended for teaching materials, school buildings, etc.
  • Sub-standard educational material purchased due to manufacturers’ bribes, instructors’ copyrights, etc.
  • Schools monopolising meals and uniforms, resulting in low quality and high prices.
  • ‘Ghost teachers’ – salaries drawn for staff who are no longer (or never were) employed for various reasons (including having passed away). This affects de facto student-teacher ratios, and prevents unemployed teachers from taking vacant positions.
  • High absenteeism, with severe effects on de facto student-teacher ratios.
  • Licences and authorisations for teaching obtained on false grounds via corrupt means.
  • Inflated student numbers (including numbers of special-needs pupils) quoted to obtain better funding.
  • Bribes to auditors for not disclosing the misuse of funds.
  • Embezzlement of funds raised by local NGOs and parents’ organisations.
  • Politicians allocating resources to particular schools to gain support, especially during election times.

There are other ways to steal that are not mentioned in this list.  Some of these examples are at the individual school level; others at the national level.  But these forms of corruption do not exist in a vacuum and must be examined in tandem, as corruption at each level of the bureaucracy influences corruption at other levels.  The less money a school receives from the Ministry of Education, the more its teachers and administrators must be entrepreneurial, so to speak, to make up for the deficit.  Leakage throughout the system creates mistrust and anger among parents, who have to scrape together money for school fees that shouldn’t exist in the first place.  And, at the end of it all, ones on the losing end of it all are the students, who receive a sub-par education, if they are lucky enough to afford one at all.

Ghana is an interesting one, however.  When I speak with other Africans, be it from Nigeria, Kenya, Zimbabwe, or another country, they all have much respect for Ghana and the government it has created.  In 2010, Ghana scored 4.1 on the CPI, or 68th out of 178.  It has had a track record of successful democratic elections for the last twenty years or so, after Jerry Rawlings, a former fighter pilot for the Ghanaian military, took control by force in a coup in 1979, ruled the country as a military dictator until 1992, and because the first (and second) democratically-elected leader of the republic he created, stepping down willingly in 2000.  His party, the NDC, lost in a free and fair election, turning the reigns over to the MPP until 2008, when the NDC reclaimed the thrown, again in a free and fair election.  It is unclear if the success of Ghana’s democracy is the reason for its high level of economic development, or vice versa, but it is certain that these two factors have given the people a voice that can express its frustrations with corruption loudly and openly.  It is no surprise that the country ranks so high on the Corruption Perception Index.

mHealth in Northern Ghana

This post originally appeared on Next Billion.

“Some women feel they want to hide their pregnancy at the early stages. Maybe because they fear the ‘the evil eye,’ miscarriages, the unknown or visiting a midwife. These fears are normal. Here are some tips to help you deal with them: Seek healthcare even before traditional rites are performed. Nothing should prevent you from going to see a midwife at the early stages of your pregnancy.”

If you are a pregnant woman in the Upper East region of Ghana who has registered with MOTECH, you will receive this message during the fifth week of your pregnancy. Started in 2009, MOTECH is an mHealth platform created in partnership between the Ghana Health Service, Grameen Foundation, and Columbia Mailman Public Health School, with funding from the Bill and Melinda Gates Foundation.  It is designed to facilitate better medical information dissemination to rural areas and improve operational efficiency at community- and district-level health centers in one of the poorest regions of the country.

MOTECH is currently in its pilot phase, with plans to expand throughout Ghana in the future. The Upper East is one of the smallest and least urbanized regions in Ghana, with 85 percent of the population living in dispersed communities throughout the rural areas. The low population density and infrastructure barriers create a challenge for health care delivery, necessitating a community-based approach. Over the past decade or so, Ghana has been operating its CHPS (Community Health Planning and Services) program, which utilizes traditional institutions and social networks with support from outreach nurses employed by the Ministry of Health to reach as many people in the rural areas as possible. It is on these CHPS centers and the nurses who work there, in particular, that MOTECH focuses its efforts.

I had the opportunity to visit a few of the CHPS centers myself with Williams Kwarah, the program officer for Grameen Foundation in Ghana. Together we visited a few of the nurses and I asked them about the system.

MOTECH offers two main applications: mobile midwives and the nurse application. For mobile midwives, pregnant women and their families register for the service through the CHPS centers. They receive weekly time-specific messages about their pregnancy, including alerts and reminders regarding visits to the local CHPS center, actionable information and advice about best practices, and educational info to ensure a healthy pregnancy. MOTECH customers have the option of receiving messages via SMS or voice, though, due to the low literacy rate in the region, 99 percent opt for voice. Text messages are sent at a set time, three times a week. The voice messages are sent at a time specified by the women. If for some reason they miss the call, the women can “flash” the system (call and quickly hang up to avoid charges), and MOTECH will immediately call back, ask for the patient ID number, and deliver the message to the client. The pre-written script provides pre-natal information for 42 weeks and the first week of life of the baby. MOTECH is increasing the frequency to include the first year of the life of the baby.

The nurse application allows the CHPS centers in the rural areas to collect patient data via mobile phone and update the medical records via SMS. Each patient is given a MOTECH ID number. The nurse collects the data and uploads it to the MOTECH system, which stores the information in a central patient electronic medical records system (EMR). The system analyzes the patient data against a clinical regimen and the medical staff develops a program based on the protocols of the Ghana Health Service. The patients are then sent messages based on the schedule, similar to the mobile midwives program. For children under five, the parents receive reminders on tetanus vaccination and immunization schedules, while recent mothers receive information on post-natal care for mothers and babies.

The nurse application also offers a robust electronic reporting tool that is designed to replace the old system of pencil and paper. Nurses are required to submit monthly reports detailing all patient visitations to the sub-district supervisors and the district health management team in their areas. The manual reporting process is time intensive, consuming up to two days each month. With the MOTECH system, nurses enter the data into the phone at the time of visitation, and it is stored and submitted to the EMR in bulk (each entry takes up less than 1 KB). At the end of the month, MOTECH generates an electronic report and submits it to the sub-district supervisor, who delivers the hard copy to the nurses at CHPS centers for verification. After three months of 85 percent accuracy, the nurses no longer need to produce manual reports. What used to take two days now takes ten minutes.

In addition, the nurse application sends reminders to the nurses themselves about patients who are overdue for a consultation. Because the system tracks the schedule of immunizations, for example, it automatically alerts the nurses when a mother is late in bringing her child to the CHPS center. Based on this data, they can schedule a home visit to ensure that the proper care is administered.

Many mHealth programs try to improve the efficiency of their systems and maximize the impact of medical professionals serving rural areas. One of the main concerns in rural areas is Pulse Vascular — vascular surgeon are making use of this mHealth program to keep track of the development. Telemedicine, for example, allows doctors to see patients from a distance.  Through its nurse application, MOTECH increases efficiency, to be sure. But it also gets patients to think consciously about their health. By maintaining a weekly connection with the patient and getting them to actively contemplate their health, it makes them more likely to visit the CHPS center, regardless of whether they are told to do so by the system.   Through constant communication, MOTECH can change the way people think about their own health and the health of their families.

MOTECH is currently in a pilot phase, and has had to adapt the system to fit the cultural context.  As a result, its evolved over time, and shared many of the lessons learned recent report.  The program is not without its shortcomings.  For one thing, the cost of sending SMS and voice messages and distributing handsets to nurses currently subsidized.  Sustainability of the project will depend on finding funding to maintain the system and pay for the communications costs.   It certainly will be an mHealth program to watch in the future, as it is potentially a scalable model applicable to rural areas around the world.

The Next Viral Video (Congrats to Anica and Navin)

Today I was cranking away at work at the way-cool iHub, when I got a message from a friend with a link to the Boston Globe.  When I opened it, I had to smile, since it is amazing.  A good friend, former prom date, and the only person I’ve ever met who is definitely smarter than me (except for all the other people) just got engaged, and it made it to the Globe:

Navin Kumar, 27, caused a scene at Harvard on Saturday when he proposed to his longtime girlfriend, Westwood’s Anica Law, 26, during their fifth-year college reunion. Navin, who met Anica at Annenberg Hall on the second day of their freshman year, surprised Anica with a choreographed, lip-synched performance ofBruno Mars’s “Just the Way You Are’’ in front of a huge crowd before he presented her with a ring. His college roommates served as backup dancers. Anica said yes, of course. Both Navin and Anica are residents at Brigham and Women’s Hospital in the internal medicine program. Navin told us that it took him and his pals about an hour to choreograph the dance.

This is the girl who I took to my senior prom in my dad’s car because I was too cheap to pay for a limousine (granted, it was a sort-of nice car with leather seats, which is how I justified it).  Now she and her husband-to-be are about to be some of the best doctors in the city with the best doctors in the world (Boston – my adopted hometown).  So congratulations to Navin and Anica, and enjoy this amazing video.