Archive | January 2014

Cell phone banking in Kenya protects public health

MPESAIt’s rare that I read an academic paper I can get really, really excited about, but this is one of them.

Researchers at Georgetown and MIT have shown that transactions over M-PESA, an African phone banking service can help struggling households when faced with a sudden illness, weather event or economic shock.

We explore the impact of reduced transaction costs on risk sharing by estimating the effects of a mobile money innovation on consumption. In our panel sample, adoption of the innovation increased from 43 to 70 percent. We find that, while shocks reduce consumption by 7 percent for nonusers, the consumption of user households is unaffected. The mechanisms underlying these consumption effects are increases in remittances received and the diversity of senders. We report robustness checks supporting these results and use the four-fold expansion of the mobile money agent network as a source of exogenous variation in access to the innovation.

M-PESA is a cel phone based banking system which allows users to send and receive money to friends and family. Transactions can be small; most users are transferring less than $10 at a time. Users are charge about $.40 to transfer money and a percentage to withdraw. It is free to deposit money into the system.

Anyone can be an M-PESA agent. Starting an M-PESA business requires only a small investment so that even extremely rural areas have access to the system. Agents receive a percentage of transaction costs, and often piggy back it onto existing enterprises such as grocery stores and mobile phone shops. M-PESA not only provides a needed service, but has also created profitable business opportunities for people even in isolated rural areas.

The system is wildly popular. Africans are extremely mobile but maintain deep friend and family networks often spread out over wide distances. When a person has trouble, he or she will often turn to family and friends for financial help.

Previously, people would send money by getting on a bus and travelling, or by sending it with friends who might be going to a particular destination. Transportation costs are high ($5 to go a distance of 200km) and often outweigh the amount to be sent. Sending money by hand also incurred risks of loss to theft and misuse.

The number of M-PESA users has skyrocketed since its introduction in 2007. Nearly all adults in Kenya have access to a cel phone now, and the number of M-PESA users is now 70% of all mobile phone users.

Shocks due to illness or negative weather events such as drought can be devastating for a poor household. A single bout of malaria could set a family back as much as a month’s income or more. When poor households lose money, they don’t get it back and successive events can quickly pile up so much so that families will often wait until illness has become too severe to effectively treat.

Jack and Suri, the researchers who conducted the study found that illness shocks can reduce a households consumption by at least 7%. An average household only consumes around $900 a year, nearly half of which is for food. A 7% reduction in consumption could mean that households will simply eat less given a sudden negative event.

M-PESA users, however, experience no reduction in consumption given a sudden health or economic event. Presumably, the ability to transfer money quickly over long distances provides insurance against disaster. Mutual reciprocation allows the system to effectively function to protect against financial disaster.

This has incredible implications for public health. Financial concerns are an incredible barrier to insuring prompt and effective treatment for diseases such as malaria, diarrheal disease and respiratory infections. An efficient system of moving money creates a broader social insurance scheme, protecting the public against the worst and, hopefully, reducing costly advanced treatments and mortality.

M-PESA is a private sector entity, which was never intended as a public health intervention. However, in an area where public sector health delivery is inefficient, underfunded and most broken, a private sector banking initiative could help bolster availability of life saving drugs (for example) by insuring a consistent flow of money. Shops in extremely isolated rural areas will be more likely to stock malaria drugs if they know that customers have the means to pay for them.

This also has incredible implications for development. One of the pillars of the Millennium Development Goals and the recent Rio+20 Conference on Sustainable Development is to insure that the basic health needs of the poorest people on the planet are met. This cannot happen without addressing the greater problem of financial stability of poor households, which requires the participation of the private sector. Covering basic issues of financial movement, security and access to funds by isolated households is a major step to not only helping households which are disproportionately impacted by health and weather events, but also allows flow of cash to poor regions, bolstering local economies.

Central African Republic Gets a New President: Is there now hope for the CAR?

It has been announced that Bangui mayor Catherine Samba-Panza has been appointed the Interim President of the near anarchic Central African Republic.

Her ascension couldn’t come at a better time. The Central African Republic, fragile even in the best of times, has been slowly sinking into chaos. No one really knows how many people have been killed in the fighting between Christian and Muslim militias (though this shouldn’t be read as a religious conflict), but reports last year pegged more than 1000 civilian deaths within a two day span. Experts have started using the g-word.

From the NYT:

The interim president selected on Monday at a raucous, five-hour session of a “national transition council” of rebels, rivals and politicians was Catherine Samba-Panza, a French-educated lawyer with a reputation for integrity and no ties either to the Muslim rebels or the Christian militia. Her selection was greeted with cheers in the assembly hall and dancing outside. That she is a woman — the third female head of state in post-colonial Africa — was especially welcomed by many people who felt that men had done nothing but lead the country on its vicious downward spiral.

Though encouraging, it’s too early to tell if Ms. Samba-Panza will be able to contain the bloodshed in the CAR. Certainly, Liberia gained much under the leadership of Ellen Johnson Sirleaf, but it’s hard to say whether there’s been a great transformation in Malawi under Joyce Banda. Rwanda’s female majority Parliament is vastly preferable to Kenya’s (or the United States’) overpaid and corrupt boy’s club, however.

The conflagration in the CAR has been troubling for a number of reasons. First, it represents a general pattern of instability just below the Sahara. Neighboring South Sudan, which just recently obtained independence, is now facing a conflict ridden humanitarian crisis.

Second, the conflicts in South Sudan, the CAR, Northern Nigeria, Mali and Somalia rage on compromise the positive narrative of a newly prosperous and economically viable Africa. The 80’s and 90’s were a stain on the continent. Though I don’t foresee a return to the extended civil wars of Angola and Mozambique (for example), general regional instability compromises the ability to sustain development over the entire continent.

Third, even if the CAR manages to suppress the violence, there are few viable options for the long term economic future of this landlocked and historically marginalized country. Without a long term economic plan chances are high that tensions will flare up once more, setting the country back again.

Does Development Work? Observations on Gates’ Annual Letter

Infant mortality is down worldwide

Infant mortality is down worldwide

Asking a question like “does development work” is like asking “does policy work”: it depends. I seem to be fielding questions about development with increasing frequency. Mostly I find that the harshest critics don’t know a whole lot about development and haven’t been to many places in the world, complicating my ability to respond in an reasoned manner. Development is a complicated beast but, the truth is, that it didn’t come easy for us 1%’ers either.

Every year, Bill and Melinda Gates release a letter on the state of the Gates Foundation and the current situation of global development and health. This time Gates set out to dispel three common myths on development, namely that poor countries are doomed to be poor forever, foreign aid is a total waste and that development will just lead to overpopulation.

The first is the most cynical, but even for us development/public health folks, it’s easy to be discouraged. Pessimism aside, the data don’t bear out the assumption that developing countries are entrenched in poverty. Just about all Sub-Saharan African countries experience consistent economic growth throughout the 00’s and have seen rapid improvements in just about all of the common health indicators. People are living longer, fewer kids are dying and they’re making more money to pay for school and health care.

Over the past five years that I’ve been going to Sub-Saharan Africa I’ve seen this change on the ground. Cars are in better shape, there’s more goods on the shelves, kids are better nourished and security has vastly improved. Does this mean that all of the problems are magically going away? No, there are still vast challenges to infrastructure development, access to health care and affordable medications, educational quality, gender issues and basic business development. However, these improvements do signal that Sub-Saharan African countries are reaching a point where sustained development is possible.

I have a hard time disagreeing with Gates here, but I did find his “before” and “after” pictures of Nairobi a bit bizarre. Though Nairobi is currently going through a construction boom, I fail to see how it would look any different in 2014 than it did in 1969 after more than three decades of stagnation.

Gates second point and the hardest myth to dispel is that of the alleged ineffectiveness of aid. Bill Easterly has made a career out of aid bashing, and, unfortunately, given cynical politicians looking for policy scapegoats a point to scream to their angry constituents. In a broader sense, the screaming over aid is really a questioning of developmental policies themselves. Certainly, there are development failures. The neo-classically informed structural adjustment policies of the World Bank and the IMF during the 80’s and 90’s were, on the surface, colossal failures (Read Beyond the World Bank Agenda: An Institutional Approach to Development by Howard Stein for a great analysis). On a smaller scale, we can easily cherry pick misguided but well meaning development projects or plans that simply went awry for any number of unforeseen reasons. The recent takedown of Jeff Sachs (The Idealist: Jeffrey Sachs and the Quest to End Poverty) and the massive problems of the Millenium Village in North East Province in Kenya is a great example of the challenges a development project can face.

However, in ever insular post Iraq America, the question that is most often asked is why we should even care and does our presence merely serve to make things worse. The truth is, and the point most often overlooked, is that most development projects are international collaborations. Many projects are conducted with partners in target countries and, more often than not, projects often make up for shortfalls that hobbled governments are unable (or sometimes unwilling) to provide. Health care is one example.

Jeff Sachs wrote a nice article this morning on how effective free insecticide treated nets have been in reducing malaria incidence and mortality in Sub-Saharan Africa. Nearly half a billion free nets have been given out worldwide as of 2014 and a lot of kids are alive today who would have been dead had they been born ten years earlier. Malaria is 100% associated with poverty. Wealthy people do not get malaria, even in malaria endemic countries. Though some of the decline in malaria incidence has been due to increased affluence and urbanization of African countries, a major percentage of this decline has been due to aid programs which provide bed nets and have expanded access to life-saving malaria medications. Certainly, not all aid works, but nothing works 100% of the time, particularly when humans are involved.

Which brings us to the most cynical and offensive of Gates’ three myths. Some people truly believe that saving African kids is a bad thing. One day there will be too many of them and they will suck up the ability for the world to sustain life. Honestly, this view couldn’t be more wrong.

The poorest parts of the world are the areas which are seeing the most rapid population growth. The average Malawian woman has 8 children in her lifetime, often starting when she isn’t even yet 15 years old. It has been said that if Malawi continues on it’s current trajectory, that it will have a population equivalent to that of Japan’s by 2050. Women in water and food constrained pastoralist communities can have ten or more children. The most affluent areas of Africa are the places with the slowest population growth.

Even more incorrect is the assumption that poverty is less harmful to the environment than development. Malawi is almost entirely deforested due to extensive use of charcoal for heating and tobacco cultivation. Deforestation not only robs the earth of potential carbon sinks, but also reduces need biodiversity and directly impacts precious water resources. Africa burns unclean fuels such as charcoal and coal for heating, and the poor condition of vehicles make it a major potential source of greenhouse gases. The air in Nairobi on any given weekday is so filled with exhaust that one can become dizzy just walking around town. It is, of course, unreasonable (and stupid) to deny Africans transportation and cooking fuel, but well meaning though poorly informed armchair environmentalists in the United States would happily suggest doing just that.

Which bring me to my final point. The case against development is one that assumes that the status quo is somehow preferable to anything that might come after. The assumption is that Africans were just fine without Europeans and their planet destroying ways. There is, of course, little data on what Africa was like before Europeans started extracting resources from the continent. We do, however, know a lot about underdeveloped areas of Africa. There is evidence to suggest that some do fine. There is however, much evidence to suggest that other simply do not. The worst parts of Africa are the parts which are the least developed. They are the areas where the market doesn’t function. The areas where there is little education, no access to health care, no roads, no economy, kids regularly die, where old people are a venerated since they are so rare, where there’s violence and instability and people are entirely marginalized from any level of political participation. While development likely will never solve the worst problems (like those in Somalia), there is no case to be made that the current state of the ultra poor is acceptable on any measure, even to the poor themselves!

Alright, off to bed.

What I’m Reading Now

Like anyone at all cares what I’m ever reading, but… here we go:

PRWords Will Break Cement: The Passion of Pussy Riot – Masha Gessen (2013) – For some reason, I was asleep when the Pussy Riot debacle was underway. Perhaps it was a result of my disdain and fatigue for independent music. I’m not sure why, but if this great book is any indication, Pussy Riot could possibly have been the most amazing rock act of the 21st century, despite not even being a real band. A group of women read radical feminist theory and note the paucity of feminist activism in modern day Russia. They then create an elaborate video project to protest Putin’s authoritarian government eventually staging a video shoot in one of Russia’s most sacred Orthodox churches. 40 seconds of screaming and dancing in a church while wearing colorful balaclavas earns them 660 days in prison.

Notwithstanding the intellectual depth of the project, the court cases were a damning indictment of post-Soviet Russia’s faux-democracy. Corrupt lawyers, pro-state judges and willful disregard for the popular outrage toward an entrenched and self-interested government are all at play during the trial and sentencing of the members of Pussy Riot. That supporters and participants in Putin’s heavy handed state participated in the senseless persecution of a group of “intellectual pranksters” is no surprise. Most perplexing were the testimonies of the few people who were in the Cathedral that day. Much of the case depended on the “hurt feelings” of the people who were visiting the church. I am wondering how a group of girls screaming in a corner could lead one to suffer PTSD but apparently it happens. I never knew God was that weak. Great book. BUY HERE

Social+Democratic+AmericaSocial Democratic America – Lane Kenworthy (2012) – Could social democratic policies such as those of Sweden be beneficial to the United States? Is it even possible to implement them? I’m happy to see this book, if only that it helps validate some of my positions (one needs those moments). Kenworthy rolls through what social democracy is, how it works in the Scandinavian countries and how it might be applied within the United States. It’s a realistic assessment of where US policy fails and a practical prescription to deal with the future.

Kenworthy advocates for increased spending (as a percent of GDP) on broad social insurance programs (safety nets), an income based taxed credit to bolster the wages of low and middle income workers, a national consumption tax to support them and a resurgence of labor unions and labor protections. He rightly points out that the presence of none of these precludes economic growth or affluence. Sweden is hardly the totalitarian state that American right wingers would suggest. In fact, the economic security afforded by it’s generous welfare state is far more supportive of entrepreneurship and innovation than the American system.

While I certainly like these ideas, I am pessimistic as to whether they could even be applied here. Though we do right by offering the earned income tax credit, I can’t see it’s expansion as politically feasible. The United States (at least on the state level) is far too entrenched in a Tea Party mentality and far too fractured to come to a reasonable consensus. Until the United States citizenry starts thinking big and stops thinking solely of individual self-preservation, we’ll have little to look forward to in terms of the implementation of smart policy.BUY HERE

*Again, please excuse the Amazon links. Though it looks like I’m an Amazon shill, I sincerely want to review these books, particularly books that I like. However, I have to be creative in thinking of ways to support this blog. Please, if your are going to purchase these books, use the links. I get 2% of the amount spent. That money goes to helping pay for the yearly fees associated with keeping this web site up. Thanks.

Don’t be gay in Africa: Uganda’s President Museveni refuses to sign “anti-homosexuality” bill

Eric Ohena Lembembe, Cameroonian gay activist who was killed and mutilated in his home

Eric Ohena Lembembe, Cameroonian gay activist who was killed and mutilated in his home

It’s pretty good advice. The Westboro Baptist Church may be waving signs and screaming, but they don’t break into people’s houses at night and bludgeon them to death with a hammer like someone did to David Kato in Uganda. They don’t break the legs of their enemies and them burn their hands and faces as happened to Eric Ohena Lembembe, a gay activist in Cameroon. They don’t break into lesbians’ houses and gang rape and kill them in the middle of the night.

Africa is an awful place to be gay, but, just as everywhere else, gay folks exist and do the best they can under adverse circumstances.

Happily, President Museveni of Uganda has stated that he refuses to sign a “anti-homosexuality Bill” sent to him from the Ugandan Parliament. It’s possible that he would have supported had he sensed that signing the bill would have benefitted him domestically, as Nigerian President Goodluck Johnathan (who’s luck seems to be running out) did just this week.

Wasting no time at all, Nigerian authorities have arrested and tortured dozens of people suspected of being gay. The methods are frightening:

Human rights advocates in Nigeria are reporting that dozens of gay men have been arrested under a new law that makes homosexual clubs or associations illegal. That law also criminalizes same-sex marriage. Gay men who have been arrested have reportedly been tortured into giving up the names of others. Michelle Faul with the Associated Press has been writing about this and she joins us now from Lagos.

And Michelle, why don’t you give us more details, what you’ve learned about these arrests and the reports of torture from human rights groups there.

MICHELLE FAUL: As we’re speaking, Melissa, we’re getting more reports in of more people being arrested in about six of Nigeria’s 36 states. I’ve spoken with human rights activists here who say this has not just happened since the bill was signed into law, but since there’s been noise about the bill. So the very idea of the bill has led to this persecution of people because of their sexual differences.

BLOCK: And in particular the reports of torture, what have you heard about that?

FAUL: That particular report comes from Bauchi State in the north of Nigeria, where it’s almost a case of entrapment. A law enforcer pretending to be a gay man went to a meeting where an AIDS counselor was speaking to men, who have sex with men, about how they could do this safely. He pretended to be gay, got the names of a couple of people, arrested subsequently one person, used their cell phone – this is illegal in itself for him to go through this person cell phone, contact another gay person and another gay person. Called them for a meeting, arrest them, take them to the police station and beat them up repeatedly and brutally until they gave up 168 names of people who were supposed to be gay.

But back to Uganda. Museveni has a thin road to walk. If he comes out on the side of Uganda’s very active gay rights movement, he risks losing crucial domestic support. If he would have signed the bill, he risks losing international support at a fragile point in Uganda’s development.

He plays it carefully, but offers a few bizarre ideas:

The President said a homosexual is somebody who is abnormal because the normal person was created to be attracted to the opposite sex in order to procreate and perpetuate the human race. He said, nature goes wrong in a minority of cases.

While in the Bill passed by Parliament there is no provision for killing homosexuals; the President said, “The question at the core of the debate of homosexuality is; what do we do with an abnormal person? Do we kill him/her? Do we imprison him/her? Or we do contain him/her?”

While the President said homosexuality is an abnormal condition that can be cured, he disagreed with the position of Western countries that homosexuality is an “alternative sexual orientation”. “You cannot call an abnormality an alternative orientation. It could be that the Western societies, on account of random breeding, have generated many abnormal people,” he said, adding that his acid test for rejecting Western position is that nature is purposeful.

The President said apart from the people who are abnormal, it seems there is a group of those that become homosexual for “mercenary reasons”—they get recruited on account of financial inducements. He said this is a group that can be rescued and that many of the youth fall in this category.

I’m not following his logic here. I seriously doubt Museveni does either. Though he says that homosexuality is a natural condition, he also tries to claim that young men become gay to make money. The former presents him with a problem. If homosexuality is to be considered an unfortunate genetic outcome, the state has no right to inflict punishment on the individual any more than on a person born with any other type of genetic defect.

The latter, I’ve heard before. NGOs allegedly come to Africa and recruit young men through promises of money and passports. There is no reason to discount the problem of prositution enabled by economic inequality. We’ve seen it elsewhere (a movie was even made about an Irish author’s disgusting sexual adventures in Nepal). Of course, the Ugandan and Nigerian Parliaments seem to be doing little to curb the much larger problem of female prostitution in Uganda and it’s difficult for me to understand how it’s at all relevant to the lives of people peacefully living their lives who happen to be gay.

And this is of course where the problem lies. Homosexuality makes for an easy target for Christian conservatives in Africa (often egged on by western missionaries and evangelicals). However, there is little outrage over extramarital affairs, child rape, and the buying and selling of women, an obviously greater social problem. But policy makers worldwide often like to pick on those who are unable to defend themselves.

How do the governments of Nigeria and Uganda have time for all this? In countries where half the population lives on a dollar a day, the problem of delivering food and health care would seem to be more pressing issues. Many people I know like to blame the West for all of Africa’s ills. Clearly, as these examples show, policy makers in Nigeria and Uganda aren’t in the least bit interested in the welfare of their people, preferring to weed out minor issues of “gays” than deal with important matters such as food, health and stability.

Sad.

A map of poor livestock owners

LivestockThis map (from “Mapping of poverty and likely zoonoses hotspots”) is pretty eye-opening. Looking at this, I’m thinking that the next big disease event will most certainly come out of India.

Note that the most virulent of infectious diseases in humans are often associated with animals. India’s high density, close contact with animals and poor regulatory environment make for a frightening mix.

Science and the importance of failure: What TED talks overlook

I was just reading a transcript of Benjamin Bratton’s takedown of TED, the immensely popular series of talks on science and innovation. Perhaps the word “talk” is a bit too specific. TED is more of a “format” for presenting ideas.

To be clear, I think that having smart people who do very smart things explain what they doing in a way that everyone can understand is a good thing. But TED goes way beyond that.

Let me tell you a story. I was at a presentation that a friend, an Astrophysicist, gave to a potential donor. I thought the presentation was lucid and compelling (and I’m a Professor of Visual Arts here at UC San Diego so at the end of the day, I know really nothing about Astrophysics). After the talk the sponsor said to him, “you know what, I’m gonna pass because I just don’t feel inspired… you should be more like Malcolm Gladwell.”

At this point I kind of lost it. Can you imagine?

Think about it: an actual scientist who produces actual knowledge should be more like a journalist who recycles fake insights! This is beyond popularization. This is taking something with value and substance and coring it out so that it can be swallowed without chewing. This is not the solution to our most frightening problems — rather this is one of our most frightening problems.

I couldn’t agree more. As scientists, we are required to be able to explain our research to the outside world. Aside from the important matter of justifying our existence and use of public funds, some of us would hope that our work improves the world. However, the process of explaining shouldn’t involve unnecessarily dumbing down or overstating the potential impact of our work.

TED demands that every presentation be centered around some success. We have to end the talk on some positive note, proudly declaring that our work went the way we wanted it to and had a profound impact on the world. We are there to create, innovate and inspire.

The trouble is that science is often hardly creative, sometimes not innovative and often wholly uninspiring. Mind you, I don’t consider these to be negatives.

Much of science involved the testing of previously held results, views and conclusions. We aren’t seeking to create something new, but rather to evaluate the validity of what has been created before or commonly assumed. We are pursuing knowledge with the hope of refining how the world sees itself using methods to create hypotheses, gather evidence and rigorous test our assumptions.

The outcome, of course, is that the road of science is paved with failure. We embark on our adventures with money in hand, a plan, the proper tools and the best intentions, but, in most cases, we find out that the money didn’t go as far as we would have liked, the plan was ill-conceived given the realities on the ground, the tools were insufficient and our intentions may have been misplaced. At least, that’s my experience of science.

Again, I don’t see this as a negative. In order to improve our ability to understand the world and potentially ameliorate it’s problems, we are required to fail. A child can’t learn to walk without falling down. I can’t learn how to not offend people in Japanese without offending people more than a few times. I can’t learn how not to bake a cake without creating an inedible mess.

TED talks overlook this process of failure, focusing exclusively on the positives and the successes and, more troubling, the inspirational nature of the work. But then, this is a problem that’s not unique to TED talks. I find that TED talks are really just symptomatic of a broader trend which discourages negative results to the point where scientists troll the data hoping to find at least something that can be labelled “successful.”

Most journals won’t publish papers with negative results and most people don’t want to read them. To me, though, there is as much to learn from a paper which found that the previously held view was correct than one which refutes it. There is as much to know from a project which failed miserably as one which was “successful.” At least in my discipline, where field work under pressing circumstances is the norm, it would be nice to hear where people went miserably wrong. We could waste a lot less time, money and experience a little less frustration.

This success driven culture isn’t, of course, limited to science. It permeates our culture, particularly our children. This young generation (and their parents) appears wholly frightened of failure, potentially to the point of paralysis. If we aren’t careful, we might turn into the stagnant Japan of the 00’s.

TED talks probably have to go. While they worked well in the Gates era where small technological fixes in isolated boxes were thought to solve mankind’s most pressing problems, we need to move on to a format which effectively looks to the process of exploration. We need to know and accept that we will fail and those potential sources of failure need to inform our current strategies.

We need to integrate people of many disciplines for mutual benefit. For example, as a quantitative scientist, I learn a lot from people in the humanities, who often hold viewpoints and perspectives completely different from my own but no less important.

In short, we need more discussion and less posturing. Failure is good because we learn from it. Let’s not let the the scientific forum, as Dr. Bratton noted, becomes like cheap, inspirational, yet myopic and wholly useless megachurches.

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