Just What the Physician’s Assistant Ordered

The United Nations Millennium Development Goals provide healthcare providers with ambitious objectives ranging from reversing the spread of the HIV virus, to reducing child and maternal mortality rates.  Unfortunately, meeting these goals is highly contingent upon an adequate supply of health care professionals.  Health Affairs estimates that Africa alone lacks 800,000 healthcare professionals necessary to meet the United Nations Millennium Development goals.  This shortage represents an expensive impediment to global development, the reversal of which requires billions of dollars in healthcare infrastructure investment.  Not to worry: new and innovative approaches to this issue are a cause for optimism.

Map detailing health care workforce shortage

One of the main issues contributing to health care professional shortages worldwide is the so-called “brain drain.”  Health care professionals that are trained in the developing world are emigrating in increasing numbers to developed nations in search of better jobs.  Indeed, as of 2010 there were more Ethiopian doctors in Chicago than there were in all of Ethiopia.  The effect of this mass exodus of doctors is doubly damaging, costing developing nations the resources invested in training doctors as well as the utility of a trained doctor.  While the issue is both prevalent and well documented, it proves difficult to address.  Indeed, in 2010 the World Health Organization (WHO) issued a document covering the global migration of health care professionals.  The issue is wrought with the inherent tension between the pernicious effects of migration and the right of individuals to pursue work wherever they choose. Continue reading


Not all PPPs are Made Equal

Infrastructure development is an integral part of sustainable economic growth.  Indeed, a recent African Development Bank Group  (AfDB) article estimates that improving African infrastructure would lead to a 3% increase in annual growth.  In order to meet the Millennium Development Goals and achieve this level of growth, it is thought that $93 billion a year  is necessary to spend on infrastructure development in Africa for an entire decade.  The same AfDB article argues that public-private partnerships may help achieve these ambitious goals.

In the European Center for Development Policy Management’s (ECDPM) May 2012 publication of GREAT Insights Melissa Dalleau outlined six necessary conditions for successful public-private partnerships (PPPs) in infrastructure development.  According to ECDPM, the keys to success are “enabling environments” that facilitate PPPs; “project preparation”; “risk mitigation”; “coordination” of various governmental and private organizations; effective communication; and the “alignment of incentives” such that private endeavors benefit the public.  The successes and failures of particular infrastructure development projects best demonstrate the importance of these conditions.

The South African government has been particularly successful in leveraging the private sector to achieve development goals.  As of January 2012 South Africa has completed over twenty different PPP projects.  Most notable among these projects is the Gautrain rail system linking Pretoria and Johannesburg.  Costing nearly $4 billion, the project was realized through the combined efforts of Bombela Concession Company and the Gauteng province. Continue reading

Uncivil Society

The promise of the “Arab Spring” seems to fade day by day.  Most recently, in a series of concerns regarding the fate of the 2011 revolutions, are the civil society crackdowns underway in both Egypt and Libya.

Leaders of the Egyptian transitional government revived Mubarak’s strict stance on civil society, taking extreme measures against NGOs and civil society organizations.  On December 29th, Egyptian security forces raided seven different NGOs based in Cairo, detaining numerous employees.  The organizations targeted in the crackdown focused specifically on issues of democracy and were supposed to monitor Egypt’s upcoming parliamentary elections.  Among the Americans detained by the Egyptian government, was Sam LaHood, son of Ray LaHood, Secretary of Transportation.

Sam (left) and Ray (right) LaHood

The conflict quickly escalated as Egypt proceeded to investigate over 400 unregistered NGOs, accusing them of accepting illegal donations.  In light of these developments, Senator Leahy proposed that U.S. pull its funding from Egypt, an amount totaling to $1.3 billion of military aid.  Egyptian authorities responded, criticizing the U.S. for funding unregistered NGOs, an action that, as a Washington Post article points out, is illegal in all nations. Egyptian authorities also argued that pulling U.S. aid would constitute a breach of the terms of Egypt’s 1979 peace treaty with Israel, rendering the long-standing agreement invalid. Continue reading

Hope Springs Eternal

The issue of social mobility has proved itself a continual challenge for those working in international development.  New research has given policy makers and the poor an unlikely resource in their fight against poverty. Indeed, a recent article in The Economist shows that hope, or lack thereof, plays a major role in the poverty trap.

Esther Duflo, professor of economics at MIT

Development economists have long included the poverty trap in their understanding of the poor.  A poverty trap is, simply put, a “self-reinforcing mechanism” which limits the ability of poor individuals to escape poverty, according to a World Bank publication.  The publication goes on to identify insufficient capital and technological under-development as two mechanisms working to ensnare the poor in a perpetual cycle of poverty.  The work of researchers Eldar ShafirEsther Duflo, and others, however, is expanding the definition of a poverty trap beyond economic mechanisms to include psychological mechanisms as well.

The link between depression and poverty is well documented.  A STAR-D study identifies low income as one of many factors related to higher risk of chronic depression.  A Journal of Health and Social Behavior article complements these findings, suggesting that depression can lead to or “transmit” poverty, contributing to the inescapable cycle. Continue reading

Malaise in Mali

Since its popular revolution in 1991 and adoption of a democratic constitution in 1992, Mali has long been considered a success story.  Despite West Africa’s endemic instability, Mali has been holding free elections and has experienced economic growth over the past twenty years.  However, in light of a recent coup, many are now questioning Mali’s status as a successful experiment in democracy.  On March 21st, Malian troops, led by Captain Amadou Sanogo, deposed the freely elected president Amadou Toumani Touré.  The coup came one month before the nation’s scheduled elections and has delayed the process indefinitely, leaving Mali struggling to settle upon an interim ruler.  The coup led by Sanogo was a response to the failure of the Malian army to defeat the Tuareg separatist group located in northern Mali.

Captain Sanogo, leader of military coup
source: http://www.bbc.co.uk/news/world-africa-17491522

The coup is, in part, a result of foreign intervention in Libya earlier in 2011.  The Qaddafi regime, while decidedly cruel, was able to exert a degree of control over the Tuareg peoples.  Indeed, Qaddafi and the Algerian government successfully mediated a series of conflicts between Tuareg rebels and the government of Mali.  Following NATO’s intervention in Libya and the defeat of Qaddafi an influx of trained and armed Tuareg people entered Mali from Libya.  Shortly after their arrival, the National Movement for the Liberation of Azawad (MNLA) began to gain traction, defeating the Malian army.  The group has declared its independence from Mali amidst the ensuing post-coup confusion. Continue reading