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Adam Gorlick
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Philanthropist and software giant Bill Gates spoke to a Stanford audience last week about the importance of foreign aid and product innovation in the fight against chronic hunger, poverty and disease in the developing world.

His message goes hand-in-hand with the ongoing work of researchers at Stanford’s Freeman Spogli Institute for International Studies. Much of that work is supported by FSI’s Global Underdevelopment Action Fund, which provides seed grants to help faculty members design research experiments and conduct fieldwork in some of the world’s poorest places.

Four FSI senior fellows – Larry Diamond, Jeremy Weinstein, Paul Wise and Walter Falcon – respond to some of the points made by Gates and share insight into their own research and ideas about how to advance and secure the most fragile nations.

Without first improving people’s health, Gates says it’s harder to build good governance and reliable infrastructure in a developing country. Is that the best way to prioritize when thinking about foreign aid?

Larry Diamond: I have immense admiration for what Bill Gates is doing to reduce childhood and maternal fatality and improve the quality of life in poor countries.  He is literally saving millions of lives.  But in two respects (at least), it's misguided to think that public health should come "before" improvements in governance.  

First, there is no reason why we need to choose, or why the two types of interventions should be in conflict.  People need vaccines against endemic and preventable diseases – and they need institutional reforms to strengthen societal resistance to corruption, a sociopolitical disease that drains society of the energy and resources to fight poverty, ignorance, and disease.  

Second, good governance is a vital facilitator of improved public health.  When corruption is controlled, public resources are used efficiently and justly to build modern sanitation and transportation systems, and to train and operate modern health care systems.  With good, accountable governance, public health and life expectancy improve much more dramatically.  When corruption is endemic, life-saving vaccines, drugs, and treatments too often fall beyond the reach of poor people who cannot make under-the-table payments. 

Foreign aid has come under criticism for not being effective, and most countries have very small foreign aid budgets. How do you make the case that foreign aid is a worthy investment?

Jeremy M. Weinstein: While foreign aid may be a small part of most countries’ national budgets, global development assistance has increased markedly in the past 50 years. Between 2000 and 2010, global aid increased from $78 billion to nearly $130 billion – and the U.S. continues to be the world’s leading donor.

The challenge in the next decade will be to sustain high aid volumes given the economic challenges that now confront developed countries. I am confident that we can and will sustain these volumes for three reasons.

First, a strong core of leading voices in both parties recognizes that promoting development serves our national interest. In this interconnected world, our security and prosperity depend in important ways on the security and prosperity of those who live beyond our borders.

Second, providing assistance is a reflection of our values – it is these humanitarian motives that drove the unprecedented U.S. commitment to fighting HIV/AIDS during the Bush Administration.

Perhaps most importantly, especially in tight budget times, development agencies are learning a great deal about what works in foreign assistance, and are putting taxpayers’ dollars to better use to reduce poverty, fight disease, increase productivity, and strengthen governance – with increasing evidence to show for it.

Some of the most dire situations in the developing world are found in conflict zones. How can philanthropists and nongovernmental organizations best work in places with unstable governments and public health crises? Is there a role for larger groups like the Gates Foundation to play in war-torn areas?

Paul H. Wise: As a pediatrician, the central challenge is this: The majority of preventable child deaths in Sub-Saharan Africa and in much of the world occur in areas of political instability and poor governance. 

This means that if we are to make real progress in improving child health we must be able to enhance the provision of critical, highly efficacious health interventions in areas that are characterized by complex political environments – often where corruption, civil conflict, and poor public management are the rule. 

Currently, most of the major global health funders tend to avoid working in such areas, as they would rather invest their efforts and resources in supportive, well-functioning locations.  This is understandable. However, given where the preventable deaths are occurring, it is not acceptable. 

Our efforts are directed at creating new strategies capable of bringing essential services to unstable regions of the world.  This will require new collaborations between health professionals, global security experts, political scientists, and management specialists in order to craft integrated child health strategies that respect both the technical requirements of critical health services and the political and management innovations that will ensure that these life-saving interventions reach all children in need.

Gates says innovation is essential to improving agricultural production for small farmers in the poorest places. What is the most-needed invention or idea that needs to be put into place to fight global hunger?

Walter P. Falcon: No single innovation will end hunger, but widespread use of cell phone technology could help.

Most poor agricultural communities receive few benefits from agricultural extension services, many of which were decimated during earlier periods of structural reform. But small farmers often have cell phones or live in villages where phones are present.

My priority innovation is for a  $10 smart phone, to be complemented with a series of very specific applications designed for transferring knowledge about new agricultural technologies to particular regions.  Using the wiki-like potential of these applications, it would also be possible for farmers from different villages to teach each other, share critical local knowledge, and also interact with crop and livestock specialists.

Language and visual qualities of the applications would be key, and literacy problems would be constraining.  But the potential payoff seems enormous.

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Sarina A. Beges
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From the Arab Spring to the Occupy Wall Street movement, young people have emerged at the helm of citizen-led change, opposing and challenging the status quo. Recognizing their local and global impact, youth are increasingly stepping up to fulfill Gandhi's famous maxim: "Be the change you want to see in the world." In turn, they are encouraging other members of their generation to answer this call to duty. In the aftermath of revolutions across the Middle East and North Africa (MENA), youth have never been more engaged and active in the future development of their communities.

Inspired by these events, a group of young Stanford students launched a forum to unite leaders from the MENA region with their Western counterparts to build a bridge towards greater understanding, collaboration, and partnership. Nothing of this scale had ever been done on the Stanford campus, and there was a clear demand from the student body for deeper engagement with the region.

It was in this spirit that the American Middle Eastern Network for Dialogue at Stanford (AMENDS) was born, which will host its inaugural conference at Stanford University April 10 to 14, 2012 to convene exceptional young leaders together to share their ideas, seed potential collaborations and inspire the world. The AMENDS team represents a diverse group of students of various nationalities, faiths, and persuasions, but the common thread that connects them all is a desire to interact with the future generation of leaders who are writing a new chapter in the history of the Middle East.

AMENDS seeks to take a step forward towards greater partnership with a post-Arab Spring generation of leaders in the Middle East.                                -AMENDS co-founders Elliot Stoller and Khaled AlShawi

Co-founders Elliot Stoller (BA '13) and Khaled AlShawi (BA '13), hailing from Chicago and Bahrain respectively, were inspired to start a project devoted to U.S.-MENA relations largely in response to events surrounding the Arab Spring, “The problems addressed through the uprisings transcend a single country or region. They affect us all and require global collaboration to solve. AMENDS seeks to take a step forward towards greater partnership with a post-Arab Spring generation of leaders in the Middle East. ”

Within a year of launching the initiative, the AMENDS team received applications from over 300 promising delegates, organized a four-day summit, and launched an ambitious fundraising campaign to cover the costs of such an endeavor. Described by AMENDS senior leadership as a "full-time job" on top of their demanding academic schedules, this grassroots operation is fueled by the entrepreneurial energy of a band of passionate and dedicated student volunteers. AMENDS has benefited from the consultation of a board of advisors comprised of Stanford faculty and staff from the Center on Democracy, Development, and the Rule of Law (CDDRL), the Freeman Spogli Institute for International Studies, and the Hamid and Christina Moghadam Program in Iranian Studies.

According to Larry Diamond, CDDRL director and member of the AMENDS advisory board, "It has been a pleasure working with the AMENDS team on the design and implementation of this innovative project — the first of its kind — to convene a new generation of leaders in the U.S. and the Middle East at Stanford University."

AMENDS delegates hail from 17 countries and together represent students and young professionals leading projects driven by the ingenuity of the new Middle East. 

AMENDS delegates hail from 17 countries and together represent students and young professionals leading projects driven by the ingenuity of the new Middle East. While many of their projects are still in their initial stages of development, the AMENDS conference and network is intended to provide leadership training and peer support to help scale-up these initiatives. A mentorship program pairs delegates with professionals, development practitioners, and industry leaders for tailored advice and support.

AMENDS delegates are as diverse as the issues they are confronting in the Middle East, North America, and the United Kingdom. Several AMENDS delegates are leveraging the use of new technology and social media to unite civil society, stimulate public debate, introduce alternative energy resources, and promote citizen-led journalism. In Egypt, Morocco, and Palestine, delegates are members of youth movements at the forefront of the Arab Spring revolutions and are championing new approaches for political change. Others are working in their local communities to defend the rights of HIV/AIDS patients in Egypt, support children with disabilities in Canada, and empower uninsured MENA immigrants in the U.S. Many projects share the common goal of getting more youth engaged and active in their local communities to achieve broader societal goals.

Over a five-day period, delegates will deliver ten-minute "AMENDS Talks" styled after TEDTalksTM, where they will introduce their initiatives to the larger Stanford community. The videos will be recorded and available through an online forum — in both Arabic and English — giving delegates’ a global platform to share their ideas, inspiring others to take action. Delegates will also participate in leadership development workshops at the Stanford Graduate School for Business and networking events sponsored by AMENDS strategic partner TechWadi, a Silicon Valley-based organization fostering high-tech entrepreneurial development in the Arab world.

Notable scholars and practitioners from the U.S. and the MENA region will provide unique insight and analysis to some of the timeliest topics emerging from the region. Speakers include Sami Ben Gharbia, Tunisian political activist and a Foreign Policy Top 100 Thinker; Thomas T. Riley, former U.S. ambassador to Morocco; and Rami Khouri, director of the Issam Fares Institute for Public Policy and International Affairs at the American University of Beirut.

CDDRL faculty and staff will also be leading sessions and addressing the AMENDS delegates at the summit, including CDDRL Director Larry Diamond, CDDRL Consulting Professor and AMENDS Advisory Board Member Prince Hicham Ben Abdallah, Arab Reform and Democracy Program Manager Lina Khatib, and Moroccan journalist and CDDRL Visiting Scholar Ahmed Benchemsi.

Most AMENDS Talks and sessions are open to the Stanford community and general public. For more information on AMENDS, to read about the 2012 delegates, and to view the conference agenda, please visit: amends.stanford.edu.

 

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The Cost of Inaction (COI) is an approach to the economic evaluation of interventions that draws attention to the consequences of a failure to take an action. It is not the cost of doing nothing but the cost of not doing some particular thing and it highlights the negative impacts that result when an appropriate action is not taken.

While working as research coordinator at the FXB Center for Health and Human Rights at Harvard School of Public Health, Nadejda Marques was responsible for researching and analyzing the cost of inaction of public programs and actions that help reduce the impact of HIV/AIDS on children in Angola from 2009 to 2011. Nadejda will present the results for Angola and contrast these with the results for Rwanda.

Currently, Nadejda Marques manages the Program on Human Rights at the Center on Democracy, Development and The Rule of Law at Stanford University.

Encina Hall West - Room 202

Nadejda Marques Manager Speaker Program on Human Rights at CDDRL
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 Abstract:

Systemic corruption undermines state capacity, imperils socio-economic development, and diminishes democracy. In his Nairobi speech as a U.S. senator in August 2006, Barack Obama described the struggle to reduce corruption as "the fight of our time". An international conference in Lagos, Nigeria, in September 2011 was devoted to Richard Joseph's influential 1987 book, Democracy and Prebendal Politics in Nigeria: The Rise and Fall of the Second Republic.Transforming prebendalist systems must be at the center of strategies to strengthen democracy and achieve poverty-reducing economic growth in Africa and other regions.

 Speaker Bio: 

Richard Joseph is John Evans Professor of International History and Politics at Northwestern University and Non resident Senior Fellow in Global Economy and Development at the Brookings Institution. As a Fellow of The Carter Center, he participated in democracy and peace initiatives in Ghana, Zambia, Ethiopia, Liberiaand Sudan. He has written extensively on issues of democracy, governance and political economy. His books include Radical Nationalism in Cameroun (1977), Democracy and Prebendal Politics in Nigeria (1987) and edited books, Gaullist Africa: Cameroon under Ahmadu Ahidjo (1978), State, Conflict and Democracy in Africa (1999), and (with Alexandra Gillies), Smart Aid for African Development (2009). He served as Principal Investigator of the Research Alliance to Combat HIV/AIDS (REACH), a collaborative program in Nigeria, 2006–2011. His current writing and policy projects concern growth, democracy and security. To address these issues, he is designing a collaborative project, AfricaPlus (http://africaplus.wordpress.com/), whose first focus country is Nigeria.

Here is the link to Richard Joseph remarks and the PowerPoint for the talk.

http://africaplus.wordpress.com/author/africaplus/

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Richard Joseph John Evans Professor of International History and Politics Speaker Northwestern University
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The November 17 Liberation Technology Seminar was co-hosted by the Stanford Institute for Economic Policy Research (SIEPR), a nonpartisan economic policy research organization that unites remarkable economic talent from all parts of Stanford University. This seminar featured four student-led design projects that were created in the Designing Liberation Technologies course taught each spring at Stanford's Hasso Plattner Institute of Design (d.school) by professors' Josh Cohen and Terry Winograd. The class works in partnership with the University of Nairobi's School of Computing and Informatics to develop user-based designs that address outstanding challenges in the slums of Nairobi, Kenya. 

Josh Cohen described the three main elements of the design school class:

(1) There is a focus on user/human-centered design. Projects are designed based on a close engagement with end users: the people who will be using the solutions. (2) Courses are inter-disciplinary. The idea is to take people who are deeply embedded in a certain discipline and put them together with people from other disciplines. In order to come up with a solution to a real problem, team collaboration is necessary and (3) The approach to problem solving is about practice, not about theory. It is necessary to fail early and fail often in the process of creating workable solutions.

The panelists consisted of students who were working with partners in Kenya on how mobile technology could be used to address various social issues. A multidisciplinary team of students work in close collaboration with partners in Kenya, and some of these ideas are now being tested on the ground.

The first project that was described was M-maji (mmaji.wordpress.com). Sangick Jeon described how water in Kibera is scarce, costly and contaminated. Their aim is to use the nearly ubiquitous mobile technology to improve access to water. Vendors are able to advertise their water and then buyers can ask questions and provide feedback. This saves the time and resources that it takes to find clean water.

Nishuari, the second project, addresses the problem of inaccurate advice and rumors which lead to risky sexual behavior and often HIV and AIDS. They provide a mobile counseling service whereby individuals can submit health questions and receive responses from trained counselors using text messages. This helps to break down logistical and social barriers.

The third, Makmende considered the issue of serious crime in Kibera. Their aim is to look at how individuals can get safely from Point A to Point B. They set up walking groups so that people would not have to walk alone. Over 90% of people had a mobile phone and this was seen to be an effective way of building timely communication, so that groups of people can coordinate to walk more safely to reach their destinations.

The final project was Take Taka, which was the one project that was not focused on using computer technology. The team took up sanitation as the project and decided early on that the use of mobile phones adds no value to the issue. The focused instead of designing a special sanitary bucket that could be used instead of a toilet inside the home, and on developing a system of transmitting the deposits to a biogas unit. This project however has not been carried forward.

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The Center on Democracy, Development, and the Rule of Law is pleased to announce that Nadejda Marques has joined the Program on Human Rights (PHR) to serve as the new program manager. In this capacity, Marques will coordinate a range of interdisciplinary initiatives and events, support new research projects, and spearhead PHR's outreach and fundraising efforts. Marques will work together with PHR Program Director and FSI Senior Fellow, Helen Stacy to support the conceptualization, design, and conduct of PHR's research initiatives, advancing the mission and visibility of PHR activities at Stanford University and beyond.

Marques joins the PHR from Boston where she worked as research coordinator for the Cost of Inaction Project at the François-Bagnoud Xavier Center for Health and Human Rights based at the Harvard School of Public Health. Working for the Cost of Inaction Project, Marques was responsible for researching and analyzing the cost of inaction of public programs and actions that help reduce the impact of HIV/AIDS on children in Angola.

"Nadejda Marques' training as an economist, her 15 years of work in human rights, including her work in the field in Angola and in founding the Brazilian human rights NGO Justiça Global bring valuable experience and expertise to the Program on Human Rights at the Center on Democracy, Development, and the Rule of Law," said PHR director Helen Stacy. "Even more importantly, Nadejda's commitment to bottom-up human rights reform means that she is acutely aware of human rights practice as a multi-faceted and inter-disciplinary activity. I am thrilled to welcome Nadejda to the Program on Human Rights as a thought partner to expand the reach and scope of our programming."

Marques holds degrees in economics (UNA, Brazil) and international finance (FGV, Brazil). She has worked as a special correspondent for the Washington Post in Latin America, and has taught languages and Latin American culture at Harvard, Bentley College, and the University of Massachusetts in Boston. For the past decade, Marques has worked in the field of human rights, most notably with Human Rights Watch in Brazil and Angola. Marques is fluent in English, Spanish, and Portuguese. She serves as a consultant and board member for leading human rights NGOs in Brazil and Angola.

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We sat down with recipient of the FSI Global Underdevelopment Action Fund, Professor Beatriz Magaloni to learn more about her research plans and how her work will address the larger issues of poverty and governance in Latin America and beyond.

Beatriz Magaloni, associate professor of political science at Stanford, senior fellow at the Freeman Spogli Institute (FSI), and director of the Program on Poverty and Governance (PovGov) at the Center on Democracy, Development, and the Rule of Law, was recently awarded a grant through FSI's Global Underdevelopment Action Fund. Over the past ten years, Professor Magaloni has pioneered cross-national comparative research focused primarily on Latin America and Mexico. Leading the PovGov program, Professor Magaloni launched research projects examining political incentives for heath improvements, the role of women and family-planning decisions, public goods provisions in indigenous communities, and drug-related violence in Mexico.

We sat down with Professor Magaloni to learn more about her research plans and how her work will address the larger issues of poverty and governance in Latin America and beyond.

Professor Magaloni, tell us more about the work you are conducting with the support of the FSI Global Underdevelopment Action Fund?

We are using the support of the FSI Action Fund to expand a governance project that we started in Oaxaca, Mexico in 2009 to the Chiapas region. The Oaxaca research project focused on examining the effects of political institutions on public goods provision. In 1995, the state of Oaxaca allowed indigenous communities to decide if they wanted a form of traditional indigenous governance called “Usos y Costumbres,” or party governance. Our team studied the variations in these two forms of municipal governance and how they shape the provision of welfare-enhancing public goods, such as clean water, sanitation and sewage, and roads. The findings in Oaxaca showed that traditional governance leads to higher levels of civic engagement in collective decision-making and better provision of public goods. However, one key finding revealed that women enjoyed significantly lower levels of participation in civic life and governance overall. 

Why might this be?

More traditional structures of governance in indigenous communities were disempowering for women but the research carried out in Oaxaca revealed a positive effect on social and political participation among recipients of conditional cash transfers through Oportunidades.

For those of us unfamiliar with the Oportunidades program, please tell us more.

Oportunidades is a social program funded by the Mexican federal government that provides conditional cash transfers to poor women in exchange for their direct engagement in activities related to child nutrition, health, and education.

Why are you expanding the study to Chiapas?

A policy prescription that emerged from our results in Oaxaca led us to re-evaluate the possibility of establishing “Usos y Costumbres” beyond Oaxaca, and this grant will allow us to study the state of Chiapas. The state of Chiapas is traditionally party dominated but has a strong blend of traditional forms of governance. The baseline survey will be designed in Chiapas to understand how traditional governance practices are integrated into the party governance. We will ask if poor indigenous communities are better or worse off by choosing to govern themselves through customary law and participatory democracy, versus delegating decisions concerning the provision of public goods to political parties. This will allow us to identify how governance and patterns of civic engagement differ in both of these states and the effect on provision of local goods.

Stanford graduate students and post-doctoral scholars will be integral to our efforts to administer the survey and perform subsequent analysis.

How will women be central to your study in Chiapas?

The main addition to the survey will be a substantial segment devoted to the role of women in civil society with the goal of answering a number of questions regarding civic and political participation. Conducted at the household level, it is designed to gain a fuller picture of how women in Chiapas are influenced and shaped by the Oportunidades program.

In addition, our study in Chiapas will examine the following factors pertaining to women and governance:

1. The dynamics of governance in Mexico's indigenous regions and the ways in which women participate in collective decision-making and influence the distribution and access to public goods and services in the community.

2.  The relationship between Oportunidades and women's decision-making role in the provision of public goods.

3. The effects on health and educational outcomes that may be associated both with conditional cash transfer programs and women's participation in collective decision-making.

4. The policy implications for economic development and promoting human capital.

Who are you collaborating with on this project?

Ewen Wang is the co-investigator on this project. She is an associate professor of Surgery/Emergency Medicine at the Stanford School of Medicine and will be instrumental in collecting new data on health and education for children who are recipients of the Oportunidades program. We also are engaging inter-institutional collaborators from our partner universities, including; Alberto Díaz-Cayeros, Associate Professor of International Studies at the Center for U.S.-Mexican Studies, University of California, San Diego; and Vidal Romero, Assistant Professor of Political Science at Instituto Tecnológico Autónomo de México (ITAM).

What are the expected results or outcomes of this study?

The outcomes of this work have both theoretical and policy-relevant implications. The data we collect on the effect of participatory governance in indigenous regions in Mexico and how conditional cash transfer programs enable civic participation of women will have much broader application beyond Mexico's borders. A lot of other governments are experimenting with the use of conditional cash transfer programs and the result of this study should help inform public policy.

In Mexico, a policy brief highlighting the results of the survey will be prepared and presented to policymakers to describe the effects of local governance, civic engagement, and their impact on economic development. Policy recommendations will be presented to advise Chiapas (as well as other states in southern Mexico with a high prevalence of indigenous populations) on constitutional reform that gives autonomy to indigenous communities with respect to municipal collective decision-making.

Finally, a book-length project will be under development that describes how traditional governance in indigenous regions of Mexico shapes civic engagement, participation of women, and impacts the provision of public goods and services. The new data generated by this study will present new findings on how governance shapes the status of maternal and child health services in Chiapas, having much broader implications in the field of health policy.

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With a sharp divergence between justifications for global health funding and the countries and diseases to which funding is disbursed, this study conducts a quantitative analysis of the determinants of U.S. financing for the 171 countries receiving development assistance for health in 2009. The project seeks to identify the key drivers for U.S. global health financing by country and facilitate research on how to make global health financing work better.

Walter P. Falcon Lounge

Eran Bendavid assistant professor of medicine; faculty affiliate in FSI/Center for Health Policy/Primary Care Outcomes Research Speaker

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CDDRL Affiliated Scholar 2011-2012
Resident Physician in Internal Medicine, Stanford Medical Center
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Rajaie Batniji is a resident physician in internal medicine at Stanford and a CDDRL affiliate. His research examines the selection of priority diseases and countries in global health, and he is interested in global health financing and the priority-setting process of international institutions.  His work has also examined social determinants of health in the Middle East.  At FSI, Dr. Batniji is co-investigator on Global Underdevelopment Action Fund projects explaining U.S. global health financing and political causes of public health crisis.

Dr. Batniji received his doctorate in international relations (D.Phil) from Oxford University where he studied as a Marshall Scholar. He also earned a M.D. from the University of California, San Francisco School of Medicine and M.A. and B.A. (with distinction) degrees in History from Stanford University.   Dr. Batniji was previously based at Oxford's Global Economic Governance Program, and he has worked as a consultant to the World Health Organization. 

Publications

Protecting Health: Thinking Small. Sidhartha Sinha and Rajaie Batniji. Bulletin of the World Health Organization 2010; BLT.09.071530  http://www.ncbi.nlm.nih.gov/pubmed/20865078

Health as human security in the occupied Palestinian territory. Rajaie Batniji, Yoke Rabai’a, Viet Nguyen-Gillham, Rita Giacaman, Eyad Sarraj, Raija Leena Punamaki, Hana Saab, and Will Boyce. Lancet 2009 373:1133-43  http://www.ncbi.nlm.nih.gov/pubmed/19268352

Misfinancing global health: the case for transparency in disbursements and decision making. Devi Sridhar and Rajaie Batniji. Lancet 2008; 372: 1185-91  http://www.ncbi.nlm.nih.gov/pubmed/18926279

Coordination and accountability in the World Health Assembly. Rajaie Batniji. Lancet 2008; 372: 805 http://www.ncbi.nlm.nih.gov/pubmed/18774416

Barriers to improvement of mental health services in low-income and middle-income countries.  Benedetto Saraceno, Mark van Ommeren, Rajaie Batniji, Alex Cohen, Oye Gureje, John Mahoney, Devi Sridhar and Chris Underhill. Lancet 2007; 370:1164-74     http://www.ncbi.nlm.nih.gov/pubmed/17804061

An Evaluation of the International Monetary Fund's Claims about Public Health. David Stuckler, Sanjay Basu, Rajaie Batniji, Anna Gilmore, Gorik Ooms, Akanksha A. Marphatia, Rachel Hammonds, and Martin McKee. International Journal of Health Services 2010; 40:327-32  http://www.ncbi.nlm.nih.gov/pubmed/20440976

Reviving the International Monetary Fund: concerns for the health of the poor. Rajaie Batniji. International Journal of Health Services 2009; 39: 783-787    http://www.ncbi.nlm.nih.gov/pubmed/19927415

Mental and social aspects of health in disasters: relating qualitative social science research and the sphere standard. R Batniji, M van Ommeren, B Saraceno. Social Science & Medicine 2006; 62:1853–1864  http://www.ncbi.nlm.nih.gov/pubmed/16202495

Averting a crisis in global health: 3 actions for the G20. Rajaie Batniji & Ngaire Woods, 2009. Global Economic Governance Programme, http://www.globaleconomicgovernance.org/wp-content/uploads/averting-a-crisis-in-global-health.pdf.

Report of a High-Level Working Group, 11-13 May 2008. Rajaie Batniji, Devi Sridhar and Ngaire Woods, Global Economic Governance Programme, 2008, http://www.globaleconomicgovernance.org/project-health

Rajaie S. Batniji Rajaie Batniji, postdoctoral fellow, department of medicine Speaker
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Francis Fukuyama
Francis Fukuyama
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In the May-June edition of The American Interest, Francis Fukuyama traces the contemporary history of U.S. development policy and its failure to incorporate Huntingtonian-style theory, which emphasizes the interconnectedness of economy, politics, and society. Using Egypt as an example, Fukuyama calls for policymakers to break down their silos to more holistically examine and support democratic transitions.

While academic political science has not had much to tell policymakers of late, there is one book that stands out as being singularly relevant to the events currently unfolding in Tunisia, Egypt and other Middle Eastern countries: Samuel Huntington’s Political Order in Changing Societies, first published over forty years ago.1 Huntington was one of the last social scientists to try to understand the linkages between political, economic and social change in a comprehensive way, and the weakness of subsequent efforts to maintain this kind of large perspective is one reason we have such difficulties, intellectually and in policy terms, in keeping up with our contemporary world.

Huntington, observing the high levels of political instability plaguing countries in the developing world during the 1950s and 1960s, noted that increasing levels of economic and social development often led to coups, revolutions and military takeovers rather than a smooth transition to modern liberal democracy. The reason, he pointed out, was the gap that appeared between the hopes and expectations of newly mobilized, educated and economically empowered people on the one hand, and the existing political system, which did not offer them an institutionalized mechanism for political participation, on the other. He might have added that such poorly institutionalized regimes are also often subject to crony capitalism, which fails to provide jobs and incomes to the newly educated middle class. Attacks against the existing political order, he noted, are seldom driven by the poorest of the poor; they instead tend to be led by rising middle classes who are frustrated by the lack of political and economic opportunity—a phenomenon noted by Alexis de Tocqueville in his masterful analysis of the origins of the French Revolution and raised again in the early 1960s by James Davies’s well known “J-curve” theory of revolution.2

Something like this Huntingtonian process has unfolded in recent months in both Tunisia and Egypt. In both cases, anti-government protests were led not by the urban poor or by an Islamist underground, but by relatively well-educated middle-class young people used to communicating with each other via Facebook and Twitter. It is no accident that Wael Ghonim, Google’s regional head of marketing, emerged as a symbol and leader of the new Egypt. The protesters’ grievances centered around the fact that the authoritarian regimes of Ben Ali and Mubarak offered them no meaningful pathway to political participation, as well as failing to provide jobs befitting their social status. The protests were then joined by other groups in both societies—trade unionists, Islamists, peasants and virtually everyone else unhappy with the old regimes—but the driving force remained the more modern segments of Tunisian and Egyptian society.

Societies lacking institutions that could accommodate new social actors produced a condition Huntington labeled praetorianism, in which political participation took the form of strikes, demonstrations, protests and violence. The military often seized power in such circumstances because it was the only organized actor in society capable of running a government. The Egyptian Republic’s first autocrat, Gamal Abdel Nasser, came to power in precisely this manner back in July 1952, when his Free Officers movement represented the rising Egyptian middle class. The tragedy of modern Egypt is that there has been scarcely any meaningful political development in the more than half-century since then—meaning, in Huntington’s terms, the rise of modern institutions that could peacefully channel citizen participation.

Socioeconomic development, meanwhile, has proceeded apace: Between 1990–2010 Tunisia’s Human Development Index (a composite measure of health, education and income compiled by the UN) rose 30 percent, while Egypt’s rose 28 percent. Both countries produced tens of thousands of college graduates with no discernable future and a lopsided income distribution in which a disproportionate share of the gains from growth went to a small group of politically connected insiders. Huntington’s analysis of Egypt in the 1950s and 1960s thus remains eerily relevant today.

In Political Order Huntington was also making a broader point about the process of development itself. The significance of his book needs to be seen against the backdrop of post-World War II modernization theory, which in turn drew on classic 19th-century European social theory articulated by academics like Edward Shils, Talcott Parsons and Walt W. Rostow. American modernization theory argued that development was a single, seamless process. Economic development, changing social relationships like the breakdown of extended kinship groups and the growth of individualism, higher and more inclusive levels of education, normative shifts toward values like “achievement” and rationality, secularization and the growth of democratic political institutions, were all seen as an interdependent whole.

By pointing out that the good things of modernity did not necessarily go together, Huntington played a key role in killing off modernization theory. Political development was a separate process from socioeconomic development, he argued, and needed to be understood in its own terms. The conclusion that flowed from this point of view seemed at the time counterintuitive to the point of stunning: Without political development, the other aspects of modernization could lead to bad results—to tyranny, civil war and mass violence.

There were other reasons why Western modernization theory fell into disrepute by the 1970s: It came to be regarded as too Eurocentric—indeed, as too Americentric insofar as it seemed to posit American society as the pinnacle of modernization. It failed to recognize the possibility that countries like Japan and China might take roads to modernity that would look very different from the ones pioneered by Britain and the United States. But even if one agreed that the end point of development should be some form of industrialized liberal democracy, Huntington made it clear that arriving at the desired destination was far more elusive and complicated than modernization theorists believed.

The central piece of policy advice that emerged out of Huntington’s work was the concept of the “authoritarian transition.” If political systems opened up to democratic contestation too early, before the development of political parties, labor unions, professional associations and other organizations that could structure participation, the result could be chaotic. Authoritarian regimes that could maintain order and promote economic growth, Huntington argued, might oversee a more gradual institutionalization of society, and make a transition to democracy only when broad participation could be peacefully accommodated. This form of sequencing, in which economic development was promoted before a democratic opening, was the path followed by Asian countries like South Korea and Taiwan, which made democratic transitions in the late 1980s only after they had succeeded in turning themselves into industrialized powerhouses. It was also the development strategy recommended by Huntington’s former student Fareed Zakaria, as well as by the leaders of many authoritarian governments, who liked the idea of economic growth better than the idea of democratic participation.3 We will return to the question of how well that strategy worked in the Middle East later.

Development in Silos 

As interesting and important as Huntington’s work was, it lay outside of mainstream thinking about development, which from the start was a highly Balkanized academic field that was dominated by economists. Few scholars have sought to understand development as an inter-connected process with political, economic and social parts. Few scholars have sought to understand development as an inter-connected process with political, economic and social parts.Development economists looked primarily at economic factors like capital, labor and technology as sources of economic growth, and thought neither about the consequences of growth for politics nor the relationship of political institutions to growth. The Harrod-Domar growth model that was dominant in the 1950s suggested that less-developed countries were poor primarily because they lacked capital, which then led development agencies like the World Bank to try to kick start growth with generous infusions of capital for physical infrastructure. It was only when steel plants and shoe factories in sub-Saharan Africa went idle due to corruption or lack of organizational capacity that they were forced to go back to the drawing board.

The political scientists, for their part, scaled back their ambitions from large Huntingtonian-style theory and focused primarily on political phenomena. Beginning in the 1980s, there was increasing interest in the problem of transitions into and out of democracy; with democratic transitions in Spain, Portugal and nearly all of Latin America, this became a particularly pressing issue. There was some revival of interest in the democracy-development linkage, but it never led to a clear consensus on the causal links connecting the two phenomena.

The academic interest in transitions corresponded to the burgeoning of democracy promotion as a distinct field of international practice, both on the part of the United States and of other democracies around the world. The idea was planted during the 1970s, when the institutes linked with the German political parties played a key role in beating back an attempted Communist takeover in Portugal and facilitating that country’s transition to democracy. The 1980s saw the establishment of the National Endowment for Democracy (NED), a taxpayer-funded but quasi-independent organization devoted to support of pro-democracy groups around the world. One of the NED’s early successes was its funding of the Solidarity trade union in Poland before the collapse of communism. The 1990s saw the growth of a host of international organizations capable of monitoring elections and the funding of the Democracy and Governance branch of the U.S. Agency for International Development to the tune of almost $1.5 billion annually.

By the late 1990s, there was some degree of convergence in the agendas of economists and political scientists. By that point Douglass North and the school of “New Institutional Economics” he founded made economists aware of the importance of political institutions—particularly property rights—for economic growth. Economists increasingly sought to fold political variables like legal systems and checks on executive power into their models. Political science had itself been colonized at this point by economic methodology, and it was natural for such rational-choice political scientists to start looking at the economic impact of political institutions.

The return to a more interdisciplinary approach to development was marked as well by the tenure of James Wolfenson as President of the World Bank from 1995 to 2005.4 Wolfenson early on gave a speech on the “cancer of corruption” and signaled to the institution that, henceforth, political issues like corruption and good governance would be taken seriously. The publication of the 1997 World Development Report, The State in a Changing World, marked an intellectual break with the Washington Consensus focus on economic policy and state downsizing, and the Bank created a new branch devoted to reform of developing country public sectors. These changes constituted an open admission that politics was a critical component of development, and that the state was not simply an obstacle to growth but often a necessary underpinning for it. Increasingly, donor agencies have seen the promotion of democratic accountability as one tool in the fight against corruption.

This modest degree of convergence should not, however, obscure the continuing degree of compartmentalization that exists in the field of development. While paying lip service to the importance of institutions, most economists and field practitioners still see politics as at best an obstacle to the real work of development, which is improvement in incomes, health, education and the like, and not as an independent objective of development strategy. (Amartya Sen is an important exception to this generalization.) The democracy promotion agencies, for their part, spend relatively little time worrying about economic growth, social policy or public health, which in their view are goods often used by authoritarian regimes to buy off populations and prevent democratization.

The intellectual confusion surrounding development has led to severely Balkanized policies both in the United States and in the international community that often work at cross purposes from one another.The intellectual confusion surrounding development has led to severely Balkanized policies both in the United States and in the international community that often work at cross purposes from one another. For example, the authoritarian or semi-authoritarian regimes of Meles Zenawi in Ethiopia, Paul Kagame in Rwanda and Yoweri Museveni in Uganda have been aid darlings over the past decade because of their track records in promoting economic, health and social goals. At the same time, democracy promotion groups have been highly critical of them and have supported opposition groups and civil society organizations seeking accountability and limits on executive power. To be sure, aid agencies don’t object to greater government accountability on the part of these regimes, while the democracy promotion community wouldn’t stand in the way of progress on HIV/AIDS or malaria. Yet no one takes a larger view and asks, for example, whether existing aid programs are helping to keep the regime in power or, conversely, are destabilizing it.

Egypt itself presents a good case of this particular form of policy incoherence. Despite the fact that Egypt ranks as one of the top American aid recipients, it is hard to say that Washington was pursuing development goals of any sort there. The United States was primarily interested in stability. Despite brave speeches on democracy by both Condeleezza Rice and Barack Obama in Cairo, the United States actually pulled its punches in pushing serious democratic reform on Egypt, particularly after the Hamas electoral victory in Gaza in 2006. Nonetheless, U.S. economic aid programs were still pushing education and economic policy reform programs in the country. Had American aid administrators taken the Huntingtonian view that their assistance was covertly designed to promote an expectations gap and delegitimate Hosni Mubarak, this might have been a clever strategy. But no such cleverness existed. Instead, it was simply an example of compartmentalized aid programs doing their thing in ignorance of the interdependent effects of politics and economics.

What Is to Be Done?

Ideas precede action. Before we can hope to generate a coherent set of policies for Egypt, or anywhere else for that matter, we need a better understanding of development—that is, how changes in economy, politics and society over time constitute a set of discrete yet interlinked processes. Whatever the shortcomings of classic modernization theory, it at least began from the insight that the phenomenon under study required development of a master social science that transcended existing disciplinary boundaries. This objective is as far away as ever in academia, where the traditional disciplines keep a chokehold on how younger academics think and do research. Today, the single most popular form of development dissertation in both economics and political science is a randomized micro-experiment in which the graduate student goes out into the field and studies, at a local level, the impact of some intervention like the introduction of co-payments for malaria mosquito netting or changes in electoral rules on ethnic voting. These studies can be technically well designed, and they certainly have their place in evaluating projects at a micro level. But they do not aggregate upwards into anything that can tell us when a regime crosses the line into illegitimacy, or how economic growth is changing the class structure of a society. We are not, in other words, producing new Samuel Huntingtons, with the latter’s simultaneous breadth and depth of knowledge.

On a policy level, we need far more mutual understanding between those who promote socioeconomic development and those who work on democracy promotion and governance.On a policy level, we need far more mutual understanding between those who promote socioeconomic development and those who work on democracy promotion and governance. Traditional development agencies like USAID already think politically to the extent that their aid projects are designed to support U.S. foreign policy. But they, like their counterparts in multilateral organizations like the World Bank, are not trained to do political economy analysis; they do not seek an understanding of the political context within which aid is used and abused, and what is not sought is very rarely found. We call for the liberalization of ports in Haiti, for example, without trying to understand which particular politicians are benefiting from existing arrangements that keep them closed. For their part, democracy promoters focus on democratic transitions, providing help to opposition parties and civil society organizations in authoritarian countries. But once a transition occurs, as it did after the Orange and Rose revolutions in Ukraine and Georgia, they have relatively little to offer new democratic governments in terms of policy agendas, anti-corruption strategies or help in improving the delivery of services that citizens want.

Beyond these relatively minor adjustments, a more robust theory of social change might tell us that, in certain circumstances, the best way to destabilize an authoritarian society would be not the funding of civil society groups seeking short-term regime change, but rather the promotion of rapid economic growth and the expansion of educational access.5 Conversely, there are many societies we know will simply waste development assistance dollars because they are ruled by unaccountable authoritarian regimes. In such circumstances, it might be a more efficient use of aid resources to cut development aid entirely and to work only for political change. This is, in effect, what has happened to Zimbabwe under Robert Mugabe, but the country had to sink very far before anyone considered pulling the aid plug.

Huntington got a number of things wrong. The authoritarian transition was not a universally applicable formula for development. It worked reasonably well in East Asia, where there were a number of figures like Lee Kwan Yew, Park Chung-hee or the Chinese Communist Party leadership, who used their autocratic powers to promote rapid development and social change. Arab authoritarians were cut from a different cloth, content to preside over economically stagnant societies. The result was not a coherent development strategy but a wasted generation.

The aspiration of social science to replicate the predictability and formality of certain natural sciences is, in the end, a hopeless endeavor. Human societies, as Friedrich Hayek, Karl Popper and others understood, are far too complex to model at an aggregate level. Contemporary macroeconomics, despite dealing with social phenomena that are inherently quantified, is today in crisis due to its utter failure to anticipate the recent financial crisis.

The part of social change that is the hardest to understand in a positivistic way is the moral dimension—that is, the ideas that people carry around in their heads regarding legitimacy, justice, dignity and community. The current Arab uprising was triggered by the self-immolation of an overeducated 26-year-old Tunisian vegetable seller whose cart was repeatedly confiscated by the authorities. After Mohamed Bouazizi was slapped by a policewoman when he tried to complain, he reached the end of his tether. Bouazizi’s public suicide turned into a social movement because contemporary communications technologies facilitated the growth of a new social space where middle-class people could recognize and organize around their common interests. We will probably never understand, even in retrospect, why the dry tinder of outraged dignity suddenly ignited in this fashion in December 2010 as opposed to 2009, or ten years before that, and why the conflagration spread to some Arab countries but not to others. But we can certainly do a better job in putting together the few pieces we do understand, in a way that would be useful to policymakers coping with the reality of social change.

1Huntington, Political Order in Changing Societies: With a New Forward by Francis Fukuyama (Yale University Press, 2006).

2Davies, “Towards a Theory of Revolution”, American Sociological Review, Vol. 27 (1962).

3Zakaria, The Future of Freedom: Illiberal Democracy at Home and Abroad (W. W. Norton, 2003); see also Zakaria, “A Conversation with Lee Kuan Yew”, Foreign Affairs (March/April 1994).

4For a description of the Wolfenson presidency, see Sebastian Mallaby, The World’s Banker: A Story of Failed States, Financial Crises, and the Wealth and Poverty of Nations (Penguin Press, 2004).

5See Harold James’s retroview, entitled “Growing Pains”, of a classic December 1963 essay by Mancur Olson (“Rapid Growth as a Destabilizing Force”) in The American Interest (September/October 2006).

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The Center on Democracy, Development, and the Rule of Law (CDDRL) is pleased to announce that undergraduate senior honors student Yihana von Ritter was awarded The Firestone Medal for Excellence in Undergraduate Research for her outstanding thesis examining HIV/AIDS policy in Papua New Guinea. Von Ritter was presented with the award at a ceremony held on June 11 during commencement weekend at Stanford University.

Larry Diamond with Yihana von Ritter (Firestone awardee)
Von Ritter, a political science major, spent the summer of 2010 on the Papua New Guinea island of Karkar, where she performed extensive field research. She interviewed over 40 government officials, medical personnel, religious and civic leaders, youth, and HIV positive individuals. Her thesis entitled "Between Hope and Despair: An Assessment of HIV/AIDS Policy in Papua New Guinea," underscored the fact that while only 1% of Papua New Guinea's adult population is AIDS-infected, a public health crisis is looming if preventative policies are not swiftly adopted.

According to her thesis co-advisor Professor Emeritus David Abernethy, Von Ritter's thesis received the Firestone Medal­--awarded to the top ten percent of honors theses in social science, science, and engineering--for its remarkable combination of social science analysis and informed policy advocacy.

"Von Ritter provides policy-relevant recommendations in her thesis to enhance interagency communication and encourage active government leadership (in Papua New Guinea)," said Abernethy. Von Ritter also worked closely with Francis Fukuyama, FSI senior fellow and CDDRL faculty member, who provided guidance and support during the thesis writing process.

Purun Cheong and Kamil Dada were both recipients of the CDDRL Undergraduate Honors Program "Best Thesis Award" for their outstanding research and policy-relevant scholarship. Cheong, an international relations major, critically evaluated the failed United Nations state-building efforts in East Timor in his thesis, "When the Blind lead: The United Nations in East Timor-Lessons in State Building."

After spending a summer conducting research in Pakistan, Dada, a political science major, wrote "Understanding International Democracy Assistance: A Case Study of Pakistan," a sobering account of democracy assistance to Pakistan. Cheong and Dada were both advised by CDDRL director Larry Diamond.

CDDRL congratulates the 2011 graduating class of CDDRL Undergraduate Honors

Students:

Purun Cheong

International Relations

"When the Blind Lead: The United Nations in East Timor- Lessons in State Building"

Kamil Dada

Political Science

"Understanding International Democracy Assistance: A Case study of Pakistan"

Sarah Guerrero

International Relations

"Automation Nation: Electronic Elections, Electoral Governance and Democratic Consolidation in the Philippines"

Ayesha Lalji

International Relations

"Unleashing the Cheetah Generation: How Mobile Banking Enables Access to Capital for the Poor in Developing Countries"

Lauren Swartz

International Relations

"Agribusiness as a Means of Economic Development: Case Studies of Chile and Mexico"

Ann Thompson

History

"The Other Side of the Coin: The US Military and Afghan Women in Contemporary Counterinsurgurgency Operations"

Yihana von Ritter

Political Science

"Between Hope and Despair: An Assessment of HIV/AIDS Policy in Papua New Guinea"

Ari Weiss

International Relations

"Israel: Managing Diversity with Democracy"

 Check out more photos of this event on our Facebook Page: http://www.facebook.com/StanfordCDDRL

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