When a 2010 study concluded that about half the money given to international governments for providing health care services isn’t used as intended, skeptics who argued that foreign aid is largely wasted were handed a powerful piece of data to bolster their claims.

But Stanford researchers Rajaie S. Batniji and Eran Bendavid say those findings are flawed. In an article featured in the May 8th edition of PLoS Medicine, Batniji and Bendavid say the two-year-old study by researchers at the University of Washington should not be used to guide decisions about how much money to give and who should get it.

“We can’t say that there’s absolutely no displacement of foreign aid, but these earlier findings are too tenuous for the basis of policy,” said Batniji, an affiliate of the Center on Democracy, Development, and the Rule of Law at the Freeman Spogli Institute for International Studies.

Batniji and Bendavid, an affiliate of FSI’s Stanford Health Policy and an assistant professor of medicine, are taking on the 2010 study – which appeared in the Lancet – at a critical time for foreign assistance programs.

The United States, which gives about half of all the world’s health aid, plans to chop its $10 billion budget by about 4 percent in the coming fiscal year. That’s the first cut in more than a decade. And officials have shown no signs of switching their preference of bypassing national governments as recipients of health aid, funneling more than half of U.S. support to non-governmental organizations instead.

Batniji and Bendavid decided to re-analyze the data used by the University of Washington researchers after meeting with policymakers who pointed to the study as a cautionary tale of foreign governments that waste and mismanage money earmarked for health programs.

“People were citing the Lancet piece, saying this was starting to shape how they thought about giving money,” said Batniji, who is also a resident physician at Stanford Medical Center. “But when we started asking questions about what the actual displacement looks like, the answers didn’t seem very compelling or reasonable.”

Taking a fresh look at the same numbers used for the 2010 study – public financing data culled from the World Health Organization and the International Monetary Fund – the researchers saw a different story emerge about the use of foreign aid in the health sector.

Once Batniji and Bendavid excluded conflicting and outlying data, such as huge discrepancies between WHO and IMF estimates and information about countries that were getting very small amounts of money from other countries, “there was no significant displacement of foreign aid,” Bendavid said.

The Stanford researchers’ findings are poised to influence a debate among policymakers and donors over whether it’s more efficient to give international assistance slated for health spending to government agencies or NGOs.

“We want to free donors of feeling that if they give money directly to governments, the money will be offset and used for an unintended purpose,” Batniji said. “The concern about displacement really amplifies the demands we make on governments for how they use the money. And that is at odds with a recent movement to let foreign governments set their own agendas for how to spend money.”

The research conducted by Batniji and Bendavid was supported by FSI’s Global Underdevelopment Action Fund and the Dr. George Rosenkranz Prize awarded to Bendavid in 2010.

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.

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 TEDTalks^TM, 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.

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.

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.

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.