How did Sierra Leone beat river blindness?

This is from The Economist:

…. Sierra Leone is doing better at beating back neglected tropical diseases (NTDs) than almost anywhere else in Africa. Fifteen years ago as much as half the population was infected with the worm that causes onchocerciasis, or river blindness. Many villagers in the south-east used to think it was perfectly normal for people to go blind after 30, says Mary Hodges, from Helen Keller International, a charity that works on blindness and malnutrition. Yet by 2017 only 2% of people carried the worm, and there had been no new cases recorded of people going blind from onchocerciasis in a decade. Elimination is expected by about 2022.

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What is Sierra Leone’s secret? Apparently, it’s because a high initial disease burden made inaction not an option:

Paradoxically, one is the extraordinarily high prevalence of NTDs. Because the entire population was exposed to at least one NTD, the government made it a priority early on, says Dr Joseph Koroma, who managed its programme. And instead of dealing with these diseases separately, Sierra Leone tackles them all at once.

This is a big win for global public health and the Carter Center.

Here is a great read on how the Guinea worm was eliminated in Burkina Faso.

However, despite success stories like Sierra Leone, it is worth noting that the global fight against river blindness is being made harder by the fact that dogs are becoming the new carriers of Guinea worms.

The Politics of the CFA Franc Zone

This is from the Economist:

Where some see an anchor, others see a millstone. To maintain the euro peg, notes Ndongo Samba Sylla, a Senegalese economist, these very poor countries must track the hawkish monetary policy of the European Central Bank. Since the introduction of the euro, income per person in the franc zone has grown at 1.4% a year, compared with 2.5% in all of sub-Saharan Africa.

More on this here.

People like Cameroonian president Paul Biya love the CFA. With good reason.

Yet elites do rather well out of the system, which makes it easier to send wealth abroad. And a weaker currency would increase the cost of imported goods. The only devaluation, in 1994, sparked riots.

Answers to Some of Team Trump’s Questions on Foreign Aid to Africa

A piece in the New York Times highlights some of the Africa-related queries posed by Team Trump to the State Department. Sub-Saharan Africa’s 48 countries get $8b in U.S. aid each year. The average country receives far less than critical U.S. allies like Afghanistan ($5.5 billion), Israel ($3.1 billion), Iraq ($1.8 billion) and Egypt ($1.4 billion).

Here are some answers to Team Trump’s questions.

With so much corruption in Africa, how much of our funding is stolen? Why should we spend these funds on Africa when we are suffering here in the U.S.?

 First of all, corruption is not the biggest impediment to success in the aid business. Often, it is poor planning and execution. And most of the time this tends to be the fault of the donors themselves. Research shows that aid works best when complemented with strong local capacities. This requires knowing what those capacities are, or investing in their long term development.

I would suggest that the administration worries more about planning and execution. How can you make your aid agencies better at identifying and executing on projects? How can you help African countries improve their absorption capacity of aid dollars without too much distortion of their local political economies? How can you move away from projects predicated on good will, and into ones that are anchored on self-interest and value creation?

Africans want jobs. Not handouts. And the 0.2% of the U.S. budget that goes to this region each year can be a powerful tool for shifting incentives in the right direction as a far as job creation is concerned. Want to export more GM cars or carrier air conditioning units to Lagos? Then help create the demand by creating jobs in Lagos.

The new administration should also end the double talk of financing corruption and condemning it at the same time.

screen-shot-2017-01-14-at-2-17-58-pmTake the example of security assistance. If you want to reduce corruption in military procurement, I would suggest that you channel all assistance through the normal appropriation processes in African legislatures. More people will know how much money is going where, thereby increasing the likelihood of greater accountability. The same applies for budget support. Strengthen existing constitutional appropriation processes so that bigger constituencies get to own the aid dollars.

Leaders do terrible things all the time for political reasons, and not because of an inherent failure in moral judgment. Learn to respect and trust your African counterparts. Know their interests. Don’t think and act like it is 1601.

We’ve been fighting al-Shabaab for a decade, why haven’t we won?

Well, for a number of reasons. Kenya, Ethiopia, the U.S., and the other TTCs are working at cross-purposes. The first best option would be to strengthen Mogadishu as the center of a strong unitary state. But no one wants that. Not the Somalian elites running the state-lets that make up the federal state. Not Kenya — whose goal seems to be no more than creating a buffer stable region in Jubaland. Not Ethiopia — whose elites are more concerned about Pan-Somalia irredentism and their own domestic politics. And certainly not the TTCs — who are largely in it for the money and other favors from Washington and Brussels. The second best option would probably be to localize the Al-Shabaab problem and then strengthen the Somali state-lets so that they can be able to fight the group. However, by globalizing the “war on terror” the U.S. has largely foreclosed this option. Also, Mogadishu would not want to cede too much military power to the states.

All to say that the U.S. cannot win the fight against al-Shabaab, certainly not by raining fire from the air.

Somalians, with some help from their neighbors, are the best-placed entity to win the war. But for this to happen, all actors involved — and especially Ethiopia and Kenya — must have an honest discussion about both short-term and long-term objectives of their involvement, and the real end game.

Most of AGOA imports are petroleum products, with the benefits going to national oil companies, why do we support that massive benefit to corrupt regimes?

Again, you should not approach this problem from the perspective of a saintly anti-corruption crusader. Moralizing from the high mountains is boring, and does not solve anything. I thought the Trump Team would be into dealing with the world as it is. Appeal to the specific interests involved. Think creatively.

It turns out that public finance management is a lot harder than most people think. Don’t expect people to be honest and patriotic. Help design PFM systems that are robust to the worst of thieves.

Here, too, I would suggest a move towards mainstreaming resource sector transactions into the normal appropriation processes. For instance, the administration can introduce greater transparency in the oil business, and create stronger links between oversight authorities in the host countries and the American firms involved. This will not end corruption, but it will serve to disperse power within the oil producing countries. And that would be a good thing.

Also, a quick reminder that AGOA involves more than just oil. Africa’s tiny textiles sector benefits too. Doing more to develop this sector would create tens of thousands of jobs, thereby reducing aid dependence.

We’ve been hunting Kony for years, is it worth the effort?

Nope.

The LRA has never attacked U.S. interests, why do we care? Is it worth the huge cash outlays? I hear that even the Ugandans are looking to stop searching for him, since they no longer view him as a threat, so why do we?

I have no idea.

May be this has been used as a way of maintaining ties with the Ugandan military in exchange for continued cooperation in central Africa and in Somalia? May be it is a secret training mission for the U.S. military in central Africa?

I honestly have no idea.

Is PEPFAR worth the massive investment when there are so many security concerns in Africa? Is PEPFAR becoming a massive, international entitlement program?

PEPFAR has saved millions of lives. And I would argue that it is probably America’s most important investment in soft power across Africa.

I would suggest a few modifications, though. The new administration should think creatively about how to use PEPFAR dollars to strengthen African public health *systems* in a manner that will allow them to provide effective care beyond HIV/AIDS. Malaria and GI diseases kill way more people. These need attention, too.

How do we prevent the next Ebola outbreak from hitting the U.S.?

By strengthening public health systems in countries that are likely to experience Ebola outbreaks.

Some Africanist inside baseball

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European logging firms are financing rebels in CAR

According to Global Witness:

CAR’s trade in timber – the country’s number one official export – has assisted the war effort. Logging companies have paid millions of euros to armed groups to ensure that they can continue operating. Under the cover of conflict they have also been stripping out CAR’s rainforests.

Throughout this period, European companies have continued to offer CAR timber for sale on EU markets, which Global Witness believes violates the EU’s flagship timber law, the EU Timber Regulation.  China is another major market for CAR wood, but has no regulations in place that could help halt the import of illegal or conflict timber.

[youtube.com/watch?v=QAVhfaX78g4]

At some point in the video an officer in one of the French firms involved says:

“But it’s Africa. It’s so common we don’t pay attention. It’s not really a concern. It’s not a war where they attack white people. It’s not a war we have to avoid.”

This honest assessment of the situation in CAR highlights one of the reasons why wars in places like CAR or Liberia and Sierra Leone in an earlier time tend to be so intractable.

Source: Wikipedia

Source: Wikipedia

Research shows that sources of finance determine the industrial organization of rebel groups and their propensity to commit atrocities against civilians (see also here). The ready availability of shady firms like Tropica-Bois and Société d’Exploitation Forestière Centrafricaine (SEFCA) make it possible for rebel leaders to raise funds for their war effort in the international commodity market. This in turn makes it possible for them to buy arms and recruit locally, but without maintaining strong ties with the very communities in whose name they raise arms (call it the rebel’s resource curse). The resultant incentive system is one in which CAR warlords can obtain material benefit from the rents on illicit trade without capturing Bangui, as long as their maintain access to the global market of timber.

The Global Witness report adds to complaints about French intervention in the ongoing CAR conflict. In April news broke that more than a dozen French soldiers abused children in Bangui in exchange for food. The six children who came forward with the complaints were aged between eight and 15 and at the time lived in a center for displaced people in Bangui. The centre was under the care of French peacekeepers.

Tropica-Bois must be paying a lot of taxes to the French treasury, or oiling the electoral machines of key French politicians.

According to the UN Comtrade database  in 2013 wood comprised 40% of all commodity exports from CAR, second only to diamonds (45.8%).

Meanwhile in the Central African Republic

According to Doctors Without Borders (MSF):

We are talking about up to one million IDPs and refugees, out of a population of 4.6 million. This accounts for 20% of the population, which is outrageous when we take into consideration these communities were already very fragile in a disrupted country, where health services outside Bangui would be practically non-existent if not for the presence of MSF in seven different regions. This past year has pushed the population to the edge of the abyss. The deployment of MSF has been huge, spectacular and swift in order to respond rapidly and provide emergency medical care. However the population is still in dire need of more assistance, including medical care. And above all, the population needs safety and security.

CAR is scheduled to hold elections either later this year or early next to speed up the transition to normalcy (France wants out ASAP). The hope, I presume, is that whoever wins the election will bring political order to the former Central African Empire. Fingers crossed?

On a related note, the US recently announced new military aid to Uganda, including four CV-22 Ospreys and an additional 150 Special Operation troops (to join the 100 deployed in 2011) in an effort to step up the hunt for Joseph Kony, leader of the Lord’s Resistance Army (LRA). Kony is suspected to be in hiding in the border regions CAR, the DRC, Sudan and South Sudan. Of course this rather bizarre decision (is Kony really that much of a priority right now in the Great Lakes Region?) is motivated by the need to keep the Ugandan military in top shape and ready to fight in places the US doesn’t want to set foot

What if the US and the EU also had a humanitarian equivalent of Uganda? You know, a country that could be just as well funded with cash and equipment to wade into troubled places like CAR and South Sudan and provide humanitarian assistance backed by credible firepower. What if? It might even help shore up some of the soft power the US (and the West in general) is haemorrhaging fast on account of the developmental interventions from the East in the wider region. 

Rwanda, 20 Years On

Caution: This is not an apology for President Kagame and his autocratic tendencies that have resulted in carnage and death in the DRC, Rwanda and elsewhere.

At a conference last year a US State Department official told a group of us that Rwanda was so polarizing that even at the Consulate in Nairobi the DRC crowd did not get along well with the Rwanda crowd.

It is not surprising why that might have been the case, or why the present analysis on the commemoration of the 20th anniversary of the 1994 genocide remains polarized.

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If one just looks at the improvements made in advancing human welfare since President Paul Kagame and the RPF took power (see graph, data from the World Bank) it is hard not to arrive at the conclusion that ordinary Rwandese are unambiguously better off. The country is the least corrupt in the region and has also been consistently ranked top in the ease of doing business. But there is also the side of the Kigali government that most reasonable people love to hate: the murderous meddling in the DRC and the oppression and occasional murder of dissidents at home and abroad. Those who admire what President Kagame has done tend to emphasize the former, while his critics tend to emphasize his autocratic tendencies which have made Rwanda the least democratic country in East Africa (see below, data from Polity). Many wonder if the post-1994 achievements are sustainable enough to outlast President Kagame’s rule.

So is Mr. Kagame a state-builder or your run of the mill autocrat whose achievements will vanish as soon as he relinquishes power?

ImageIn my view, I think that Rwanda is the best success story of state-building in Africa in the last 20 years. I also think that this (state-building) should be the paramount consideration for those who care about the Rwandese people and want to help them achieve greater freedoms. The fundamental problem in states like CAR, Sierra Leone or Liberia has never been the insufficiency of democracy. Rather, it has been the problem of statelessness. The contrast between Rwanda and Burundi is instructive (see both graphs, the two are neighbors with similar ethno-political histories. Rwanda has historically had a stronger state, though. See here and here). Despite the latter being the second most democratic state in the region, it has consistently performed the worst on nearly all human development indicators. Part of the reason for this is that Burundi remains a classic papier mache state confined to Bujumbura and its environs.

May be I am too risk averse. But I am scared stiff of anything that could lead to a recurrence of the horrors of the early 1990s stretching from the Mano River region to the Horn. As a result I am always skeptical of activism that takes state capacity (including coercive capacity) for granted.

With this in mind, the fight against autocratic rule in Rwanda should not come at the expense of the state-building achievements of the last 20 years. The international community and those who genuinely care about Rwandese people should be careful not to turn Rwanda into “democratic” Burundi in the name of democracy promotion. Interventions will have to be smart enough to push President Kagame and the ruling elite in the right direction, but without gutting the foundations of political order in Rwanda.

Absent a strong state (even after Kagame), the security dilemmas that occasioned the 1994 “problem from hell” would ineluctably resurface.

Lastly, I think the level of discourse in the “Rwanda Debate” could be enhanced by the extension of the privilege of nuance to the case. For example, if all we focused on were drones killing entire families at weddings in Yemen or the horror that is the South Side of Chicago we would probably get mad enough to ask for regime change in Washington. But we don’t. Because people tolerate the “complications and nuance of American politics.” The same applies to less developed countries. Politics is complicated, everywhere. And those who approach it with priors of good-or-bad dichotomies are bound to arrive at the wrong conclusions. One need not be a Kagame apologist to realize the need for a delicate balance in attempts to effect political change in Kigali.

Before you hit the comment button, notice that this is neither an apology nor an endorsement of autocracy in Rwanda. It is a word of caution regarding the choices outsiders make to accelerate political change in Rwanda.

Tyranny is not the panacea to underdevelopment. But neither is stateless democracy.

For background reading on the 1994 genocide in Rwanda see Samantha Power’s Problems From Hell; Mahmood Mamdani’s When Victims Become Killers; and Philip Gourevitch’s We Wish to Inform You That Tomorrow We Will be Killed With Our Families.