Monday, July 6, 2009

Moving on

Hi everyone, sorry for the absenteeism...parents' visit, Rwanda trip, etc... but I will be back up and running beginning this week, though I am moving on to Wordpress. Please visit me there:

Thanks for reading!

Tuesday, May 26, 2009

Dr. Tajudeen's final column

Below is the last column Dr. Tajudeen Abdul-Raheem wrote for the Daily Monitor, which he had written last week before a car accident took his life on May 25, 2009.

Govts discourage enterprise and penalise those fighting poverty

The irony of Africa being a very rich continent but Africans being some of the poorest peoples in the world is no longer lost to anyone. While we can argue about the historical, structural, attitudinal, personal and institutional causes of this state of affairs, the fact remains that majority of our peoples remain in need amidst plenty.

Decades of aid, humanitarian intervention, prayers, activism, development plans, action plans, government declarations and so many other initiatives have not produced fundamental change for the poorest and weakest sections of our societies. Yet Africans remain one of the most optimistic peoples, perpetually believing that tomorrow will be better. It is always a miracle how majority of the poor, whether in our urban slums or impoverished rural areas, survive.

Our cities’ overburdened road infrastructures have spurned entrepreneurship in the form of shops on roads and legs meandering between armies of pedestrians and impatient vehicle drivers frustrated at the gridlock traffic. Similarly informal settlements have developed, several times the size of our capital cities with little or no infrastructures. Some of them like Kibera Slum in Nairobi are even becoming ‘famous’ globally for poverty tourism. Unfortunately, it is not the impoverished peoples in these settlements who are even the beneficiaries of their own poverty.

The majority of Africans continue to survive not because of government but in spite of governments. They eke out a living to keep body and soul together, provide for their families, doing all kinds of dirty work with little pay or selling anything that is buyable; hawking all kinds of household wares, fruits, vegetables and myriad of consumer items.

The concept of informal settlements in Africa is not just about where people live but extends to informal markets in all kinds of goods and services.

As the son of a hardworking woman who was a ‘petty trader’, I confess to a bias in favour of these small entrepreneurs who do not depend on any connections with government officials, politicians and big business influence. You go to many neighbourhoods rich or poor and you will find these largely female entrepreneurs, selling food to those working on construction sites, cheap vegetables to other poor members of the society from their baskets, trays or single tables at the corners of roads and streets.

So living in Kenya, a settler, apartheid type state in all but name, I find myself in solidarity with ‘Mama Mboga’. These are women who sell vegetables from their trays, or traditional load carriers tied to their heads, carried on their backs.

From Mama Mboga selling daily perishable vegetables, the ambition is to own a kiosk where you can have storage for more goods , stock more, put a fridge and freezer that can preserve perishable items. When Mama Mboga becomes a kiosk owner, it is a personal triumph of hope over adversity- a long journey from grinding poverty to bearable survival and foundations for permanent exit from poverty. The bigger the kiosk and the better stocked it is, the further away the owner is from poverty. Government policy is threatening the survival of the Mama Mbogas across this continent. In the name of ridding cities of illegal constructions, returning to the original city plans and ‘beautifying’ our cities, city councils and central governments are creating more poverty. Of what use is a ‘beautiful city’ inhabited by people who have lost their livelihoods? Would they appreciate the beauty?

The Mama Mbogas are on the street and in kiosks because they cannot afford the malls and most of their clientele cannot afford the price in the malls.

Our elite are embarrassed by the mass poverty that surrounds us but they are unwilling to provide leadership and appropriate policies to take our peoples to prosperity. Instead they engage in avoidance and denial mechanisms to pretend to visitors that ‘everything is okay’.

That’s why they rid our capitals of beggars, hawkers, and other undesirables before any major ‘international’ conference, but out of sight is not out of mind for the Mama/Baba Mbogas in our midst. You can pull down their kiosks and destroy their tables but they will come back with new tables, under umbrellas and their clientele will know where to find them. By no means are there clients all wretched of the earth. I still call my favourite Mama Mboga, Mama Sarah, or her husband , Martin, to send me top up cards from wherever Nairobi City Council have forced them to.

Monday, May 25, 2009

Afrobarometer Global Release

First of all, Happy Africa Day (yes, it is today, however underpublicised it may be). It was a good day for Afrobarometer to launch their Round 4 Results for surveys they have been conducting in 19 countries across the continent. I attended the Kampala release event today at the Serena Hotel, where Robert Sentamu of Wilksen Agencies delivered a presentation of the main findings, covering such topics as: democracy and regime consolidation, poverty reduction, globalization and cosmopolitanism, and the emergence of democratic citizens. Afrobarometer is a fantastic resource for scholars, journalists, civil society, political parties, and anyone else interested in public opinion, advocacy, policymaking, etc.

My one qualm with the findings of this release is that they paint a rather biased view of democracy and related issues in Africa. Why? Because Afrobarometer does not carry out surveys in countries where they have reason to suspect citizens will give "politically correct" answers for fear of repercussions by the state (i.e. Rwanda). This obviously leads to selection bias -- the countries where citizens are/feel "more free" to say what they really think are also probably more likely to be more democratic. Excluding those countries where citizens are not free probably paints an overly optimistic picture of democracy in Africa as a whole. Nevertheless, the findings of the release are very useful (particularly for each individual country) and quite intriguing.

So what are the key findings?

On Democracy:

The 20 African countries included in the Afrobarometer include many of the most politically liberal countries on the continent, including 7 countries ranked by Freedom House in 2008 as "Free." However, when we assess the quality of these regimes based on popular attitudes and perceptions, we do not find any consolidated democracies among them (although Botswana comes close). In fact, we find some consolidating as autocracies, but most countries are best understood as unconsolidated, hybrid regimes. They exhibit some key elements of democracy, such as regular elections and protection of core individual freedoms. But either the popular demand for democracy, or the perceived supply of democracy, or, in most cases, both, fall short of the standards of full democracy. But the trajectories of individual countries are extremely diverse, with some exhibiting sharp declines away from democratic consolidation, while others are steadily advancing.

On Poverty

Even with the significant growth that sub-Saharan Africa has experienced over the past decade, as of 2008 lived poverty (or the extent to which people regularly go without basic necessities) is still extensive. It has declined in nine of the Afrobarometer countries for which we have over-time data during this period, but it has increased in another six. Cross-national differences in economic growth help explain differing country trajectories in lived poverty. But a more complete picture must also take political freedom into consideration. Lived poverty is strongly related to country-level measures of political freedom, and changes in poverty are related to changes in freedom. This finding supports Sen's (1999) argument about the crucial importance of freedom for development. Using our alternative measures of both development and democracy, we corroborate the findings of others that there is a "democracy advantage" for well being and prosperity.

See more findings and related articles/papers from the Afrobarometer website here.

Following the main presentation, Managing Editor of the Daily Monitor, Daniel Kalinaki, made a thoughtful and eloquent presentation on the Ugandan context (excerpt follows):

As we head towards the next election in 2011, we find ourselves at a crossroads. We can choose to continue the personality-driven winner-takes-it-all political model where we have an election and petition every five years and then let our MPs and other politicians sleep on the job as long as they wake up and vote for their parties. Alternatively, we can choose a bi-partisan approach that puts Uganda first, that allows free and open debate about our burning priorities and how to achieve them, and which puts power back in the hands of the people.

Asking the politicians to decide which model to adopt is, like an African saying goes, asking the monkey to decide whether the forest should be cut down. It is up to the people to demand this right to be heard and served. The Afrobarometer survey and others like it help provide a reality check for our countries and provide useful information that can be used by the media, civil society, and progressive political groups to empower the public.

At the end of the day, however, the responsibility falls on every individual to inform themselves and others, in order to build political awareness and a critical mass of interested and involved publics who can mobilise, organise, demand and receive what is fairly due to them.

You can read the complete version on Kalinaki's own blog.

Look out in the daily papers for more articles on the Afrobarometer surveys in the coming days...

In Memoriam: Tajudeen Abdul-Raheem

Road carnage claimed yet another victim today -- this time a renowned Pan-Africanist, Dr. Tajudeen Abdul-Raheem, who was rushing to Jomo Kenyatta airport in Nairobi when he was killed in an automobile accident. Alex de Waal has an excellent in memoriam post in honor of Dr. Tajudeen:

Dr. Tajudeen Abdul-Raheem, the most irrepressible Pan Africanist of his generation, died in Nairobi on 24 May 2009. His friends and colleagues are stunned at the loss of a man who was so full of life and humour, such a determined Afro-optimist, and such a devoted father to his children, Aisha and Aida. Africa is impoverished by his untimely death...

Tajudeen never allowed his critical sense degenerate into cynicism or disillusion. His confidence in Africa and Africans to resolve their problems, whatever the setbacks, was always undimmed. His untimely death leaves a vacuum of human energy and hope that will be difficult to fill.

Read on...

New Vision and Daily Monitor have also published articles and tributes in Tuesday's papers.

Okello Oculi says Dr. Tajudeen was a true son of the continent in his tribute.

May he rest in peace. And may we find some way to prevent more of the many unnecessary and devastating deaths that occur on our roads every single day.

Gettleman rafts the Nile

So my parents visit in one week and, as luck would have it, the first NYT Uganda travel article in four years (I think the last was in 2005?) was published Sunday. What timing! (and good looking out Mom!) Unfortunately the whole thing was about rafting, which my beloved mother and father are not particularly keen to do. Not to mention, rafting was the only activity of consequence in Uganda, Gettleman? I think we deserve better than that (ok, fine, you mention other activities in the fifth paragraph but that hardly counts). At least the commentary is pretty amusing.

My favorite line? "The whole experience was like riding a bouncy castle through a tsunami." Hahaha. Not inaccurate at all.

Saturday, May 23, 2009

Why Don't We Have a Global Fund for Maternal Health?

Well, cause someone would steal the money anyway. No? Ok, how about because the international community is preoccupied (is obsessed too strong a word?) by the much more exotic sounding tropical and infectious diseases (a virus that turns your insides to mush = exciting/terrifying, bleeding to death giving birth = boring). Not everyone gets Ebola or HIV or malaria, but most people either give birth or are the direct cause of someone else giving birth (and if nothing else, at least someone once gave birth to them). So maternal health is ordinary, banal, and just plain not-sexy. That is, unless it is tied to something exotic (see Prevention of Mother-to-Child Transmission of HIV -- PMTCT)...

The wards described in the article of the Tanzanian hospital are not different from those in Uganda. In Mugalo Hospital, around 80 to 100 babies are delivered every day, and there are certainly not enough beds for all the mothers. One medical student working in the labour ward described to me how the "fluids" from one mother giving birth flowed into the ears of another mother who was sharing her mattress one night during his shift.

I don't know what the solution is to the neglect of maternal health. In Uganda, maternal mortality statistics have barely budged in the past 20 years. The 2006 Uganda Demographic and Health Survey (depressingly) discusses the lack of improvement with regard to maternal mortality:

At first glance, it would appear that the maternal mortality ratio has declined significantly
over the last five years, from 527 maternal deaths per 100,000 live births for the ten-year period prior to the 1995 UDHS to 505 for the ten-year period before the 2000-01 UDHS, and to 435 for the ten- year period before the 2006 UDHS. However, the methodology used and the sample sizes implemented in these three surveys do not allow for precise estimates of maternal mortality. The sampling errors around each of the estimates are large and, consequently, the estimates are not significantly different; thus, it is impossible to say with confidence that maternal mortality has declined. Moreover, a decline in the maternal mortality ratio is not supported by the trends in related indicators, such as antenatal care coverage, delivery in health facilities, and medical assistance at delivery, all of which have increased only marginally over the last ten years.

Thursday, May 21, 2009

First do no harm. Ok, first do not-too-much harm...what? You don't know how much you're doing? Well in that case...

"...apart from questions over its investments, the Gates Foundation has received little external scrutiny. Last year, Devi Sridhar and Rajaie Batniji reported that the Foundation gave most of its grants to organisations in high-income countries. There was a heavy bias in its funding towards malaria and HIV/AIDS, with relatively little investment into tuberculosis, maternal and child health, and nutrition—with chronic diseases being entirely absent from its spending portfolio. In The Lancet today, David McCoy and colleagues extend these findings by evaluating the grants allocated by the Gates Foundation from 1998—2007. Their study shows even more robustly that the grants made by the Foundation do not reflect the burden of disease endured by those in deepest poverty. In an accompanying Comment, Robert Black and colleagues discuss the alarmingly poor correlation between the Foundation's funding and childhood disease priorities.
The concern expressed to us by many scientists who have long worked in low-income settings is that important health programmes are being distorted by large grants from the Gates Foundation. For example, a focus on malaria in areas where other diseases cause more human harm creates damaging perverse incentives for politicians, policy makers, and health workers. In some countries, the valuable resources of the Foundation are being wasted and diverted from more urgent needs."

Excerpt from 9 May 2009 Lancet editorial.

This is the same point I have tried to make with regard to HIV/AIDS funding in Uganda. But it is hard to tell/convince donors that their massive spending on HIV/AIDS may actually be hurting other healthcare programs (not to mention that the funding decisions are often made by those in Washington, etc who have no idea what is going on on the ground). The response of the program and project managers, of course, is that they believe they are helping more than hurting. There are at least two problems with this argument though. One, measuring how much one is helping or hurting a country/population/sector/etc is difficult, especially as unintended/unrecognized consequences abound (i.e. doctors migrating from cash-starved district health centers to donor-funded HIV clinics). Two, what happened to "first do no harm"? Should one even be involved if the consequences of one's actions cause harm of unknown/unquantifiable amounts?

The good news is that the discussion regarding priorities/allocation of money within the health sector is emerging in policymaking circles -- New Vision, for example, reports today that parliament has recommended sh36b earmarked to purchase anti-retrovirals (ARVs) be re-allocated to other pressing government programmes. (Although, reading through the article again, I am thoroughly confused as to what MPs are proposing...anyone have insight?)

Meanwhile, Easterly and Wronging Rights have an interesting (and related) discussion on aid and the Love Actually Test.