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Thursday, December 30, 2010

America’s cracked political system

Incisive commentary by Jeffrey Sachs; carried on the Guardian on December 30, 2010.

America is on a collision course with itself. This month's deal between President Barack Obama and the Republicans in Congress to extend the tax cuts initiated a decade ago by President George W Bush is being hailed as the start of a new bipartisan consensus. I believe, instead, that it is a false truce in what will become a pitched battle for the soul of American politics.

As in many countries, conflicts over public morality and national strategy come down to questions of money. In the United States, this is truer than ever. The US is running an annual budget deficit of around $1tn, which may widen further as a result of the new tax agreement. This level of annual borrowing is far too high for comfort. It must be cut, but how?

The problem is America's corrupted politics and loss of civic morality. One political party, the Republicans, stands for little except tax cuts, which they place above any other goal. The Democrats have a bit wider set of interests, including support for healthcare, education, training, and infrastructure. But, like the Republicans, the Democrats, too, are keen to shower tax cuts on their major campaign contributors, predominantly rich Americans.

The result is a dangerous paradox. The US budget deficit is enormous and unsustainable. The poor are squeezed by cuts in social programmes and a weak job market. One in eight Americans depends on food stamps to eat. Yet, despite these circumstances, one political party wants to gut tax revenues altogether, and the other is easily dragged along, against its better instincts, out of concern for keeping its rich contributors happy.

This tax-cutting frenzy comes, incredibly, after three decades of elite fiscal rule in the US that has favoured the rich and powerful. Since Ronald Reagan became president in 1981, America's budget system has been geared to supporting the accumulation of vast wealth at the top of the income distribution. Amazingly, the richest 1% of American households now has a higher net worth than the bottom 90%. The annual income of the richest 12,000 households is greater than that of the poorest 24m households.

The Republican party's real game is to try to lock that income and wealth advantage into place. They fear, rightly, that, sooner or later, everyone else will begin demanding that the budget deficit be closed in part by raising taxes on the rich. After all, the rich are living better than ever, while the rest of American society is suffering. It makes sense to tax them more.

The Republicans are out to prevent that by any means. This month, they succeeded – at least for now. But they want to follow up their tactical victory, which postpones the restoration of pre-Bush tax rates for a couple of years, with a longer-term victory next spring. Their leaders in Congress are already declaring that they will slash public spending in order to begin reducing the deficit.

Ironically, there is one area in which large budget cuts are certainly warranted: the military. But that is the one item most Republicans won't touch. They want to slash the budget not by ending the useless war in Afghanistan, and by eliminating unnecessary weapons systems, but by cutting education, health and other benefits for the poor and working class.

In the end, I don't think they will succeed. For the moment, most Americans seem to be going along with Republican arguments that it is better to close the budget deficit through spending cuts rather than tax increases. Yet, when the actual budget proposals are made, there will be a growing backlash. With their backs against the wall, I predict, poor and working-class Americans will begin to agitate for social justice.

This may take time. The level of political corruption in America is staggering. Everything now is about money to run electoral campaigns, which have become incredibly expensive. The midterm elections cost an estimated $4.5bn, with most of the contributions coming from big corporations and rich contributors. These powerful forces, many of which operate anonymously under US law, are working relentlessly to defend those at the top of the income distribution.

But make no mistake: both parties are implicated. There is already talk that Obama will raise $1bn or more for his re-election campaign. That sum will not come from the poor.

The problem for the rich is that, other than military spending, there is no place to cut the budget other than in areas of core support for the poor and working class. Is America really going to cut health benefits and retirement income? Will it really balance the budget by slashing education spending at a time when US students already are being outperformed by their Asian counterparts? Will America really let its public infrastructure continue to deteriorate? The rich will try to push such an agenda, but ultimately they will fail.

Obama swept to power on the promise of change. So far, there has been none. His administration is filled with Wall Street bankers. His top officials leave to join the banks, as his budget director Peter Orszag recently did. Obama is always ready to serve the interests of the rich and powerful, with no line in the sand, no limit to "compromise".

If this continues, a third party will emerge, committed to cleaning up American politics and restoring a measure of decency and fairness. This, too, will take time. The political system is deeply skewed against challenges to the two incumbent parties. Yet, the time for change will come. The Republicans believe that they have the upper hand and can pervert the system further in favour of the rich.

I believe that they will be proved wrong.
Sent from my BlackBerry® smartphone from Zain Kenya

Unfinished Letter from Kigali (December 10, 2010)

It I am sitting at Kigali International Airport in Rwanda waiting to catch a KQ 0468 flight to Nairobi. My expectations of KQ are dismal so I am not sure when I will be in Nairobi, hopefully some time before the end of the week.

I have been in Rwanda attending a conference on “Regional Integration and Human Resource Development in Science and Technology Fields”. The American Association for the Advancement of Science and the Ministry of Education of Rwanda organized this conference.

I am not sure that I want to turn this into some kind of diplomatic cable. But I think some things need saying in the most direct and frank way. So here it is. This meeting confirmed my greatest fears. A long held fear that Africa’s moment as a significant global player in knowledge and thought will not come even 50 years from now.

There is every indication that Africa will be the next big market for consumer goods and that Africa’s broken and dilapidated infrastructure presents a veritable hunger for global investments. So do not get me wrong, besides India and China, Africa is the next big thing for world trade and international investment. In terms of population, Africa could surpass both China and India in just 50 years.

I can see my flight, KQ 0468 on the runway. Things can change.

There is a lot about how Africa will advance that will be driven purely by market forces. And like in many economies such as India, Brazil and certainly China, the vortex of this intense market led growth will generate a formidable middle-income with phenomenal disposable income. My guess is that by 2050, Africa could have about 2 billion people, 25% of who will earn an average per capita income of more than $30,000. This financial muscle can generate pockets of intense affluence, comparable to any North American or European economies.

This nearly 500 million will live typical middle-income North American or European lifestyle with all its trappings of luxury and wasteful consumption. This is the limit of market forces. The rest of 1.5 billion Africans, 85% of them urban dwellers, will be hurdled in the forgotten and largely forbidden corners of squalid urban neighborhoods. Thanks to weak state and family institutions (mothers and others), these neighborhoods will be havens of drugs, murder, rape and human trafficking. For the families of the 1.5 billion, life will be short and brutish.

Will Obama show true grit?

By Jon Friedman

"True Grit," the remake of the John Wayne movie of four decades ago, is the best film I've seen in 2010.

It may not be the most profound or deep flick to come across this year — but no other movie was more entertaining. And that should count for plenty.

Just thinking about the title in these tumultuous times makes me think. Barack Obama, the candidate, sure showed grit in 2008 on the campaign trail. In the White House, though, not so much. And that has been his biggest flaw as the POTUS.

He still has a flash of the Obama charisma that has served him so well, the quality that enabled him to sweep past Hillary Clinton, as if she had been standing still, and then racing beyond John McCain's lead-footed pose.

Charisma was invaluable to a relatively unproven candidate. But grit is essential to the prospects of a relatively unproven sitting president.

I suspect that the president will come through in 2011 and demonstrate that he is in full control of the government and the nation. He has shown signs already with the recent legislative successes. It wasn't charisma that passed those thorny bills. It was tenacity. You might call it grit.

In 2011, the president will have to keep up the winning streak. Right now, the Republican Party is in disarray — and that might just prove fatal in November of 2012 (which is not that far off, really).

This is both a blessing and a curse for Barack Obama. The president can be his own worst enemy, when he is far ahead. He doesn't always personify a killer instinct.

If he happened to be a sports team, the knock would be that his club couldn't close out the opponent or stand on his foe's neck when he has a lead. When he is ahead, the president reverts to the law-professor wonk posture that turned off much of America during the financial crisis and the BP oil spill.

That wonk displayed no real grit — and it showed in the polls when the president's approval rating plummeted for a while.

Presumably, Obama learned from this pitfall.

I expect him to come out swinging in 2011 — and showing the old true grit.

Jon Friedman writes the Media Web column for

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Wednesday, December 15, 2010

The Ocampo List

Kenya is starting to sound like the place I knew before the historic passing of a new constitution.

I have been listing to reactions to to naming of the six men ICC prosecutor Mr. Ocampo named as the main perpetrators of the shameful ethnic conflagration of 2007 elections.

The country has forgotten that the passing of the new constitution was a rejection of ethnic patronage and impunity and an endorsement of the rule of law, a restoration of our confidence in state rather than tribal loyalty.

But after Ocampo read his list the drum roll of ethnic fiat is back. Across the land, different ethnic communities are standing with their own. I heard a caller on BBC Africa service say that they had no problem with the Ocampo list because the Kenyan prime minister was not on the list. A caller from the Rift Valley trashed the list and the investigations by the ICC.

It is interesting to observe that the lives of nearly 1,200 Kenyans do not count much where ethnic considerations are paramount. It is incredible that sections of the Kenyan public are rising up and casting aspersions on the ICC process. I heard some say that the west is using the Hague process to continue to dominate and humiliate African politicians.

My sense is that the ICC process will cause the Kenyan government to split down the middle. This is ironic because the post election violence was a boon to both Mr. Kibaki (incumbent and sitting president) and Raila Odinga (leader of opposition and sitting prime minister.

From the statement released by the Kenyan state house, it is clearly beyond Mr. Kibaki's pay grade to demand that members of his cabinet named resign from public service. Of course we understand that the six are presumed innocent until proved guilty. But Caesar's wife must be beyond reproach.

I can say, with confidence that the big political and ethnic interests will coalesce to protect all the six named by Mr. Ocampo.

In the end, not Ocampo but the Kenyan people must stand up for justice.
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Thursday, December 9, 2010

For Barack Obama it is damned if you do, damned if you don't

From the NYtimes: No Deficit of Courage
Published: December 8, 2010

IS it, in fact, 1994-95 all over again? The atmospherics are certainly familiar. We have a Democratic president who appears to be tacking to the center to work with Republicans after being battered in the midterms. Jilted liberals, meanwhile, are left wondering how they could have been so blind about the man they had fallen for so hard.

The Clinton comparison has been much in the air after President Obama’s deal to extend the George W. Bush-era tax cuts. But a more apt analogy for the present lies in 1990, not in 1994, and with George Herbert Walker Bush, not with William Jefferson Clinton.

It was in 1990 that Mr. Bush broke one of the most celebrated promises in modern American politics —“Read my lips: no new taxes,” as he put it in 1988 — in order to control federal spending. In the same way that Mr. Obama struck his deal to secure lower tax rates for the middle-class and win an extension of unemployment benefits, Mr. Bush gave on tax rates to get “pay as you go” rules — meaning that no further spending could be approved without compensating budget cuts or revenue increases. It was the beginning of the fiscal discipline that helped create the budget surpluses of the 1990s.

While Mr. Obama’s immediate concern is stimulus and Mr. Bush’s was deficit-reduction, both gave way on issues critical to the true believers within their parties. For Mr. Bush, it was political death. He had never been fully trusted by a Reaganite Republican base. Like Mr. Obama — who is unhappy with his “sanctimonious” left wing — Mr. Bush was no ideologue.

“I’m not going to be held up by campaign rhetoric,” he wrote in his diary early in his term. “If the facts change, I hope I’m smart enough to change, too.” Mr. Bush privately said that he had no intention of being “off in some ideological corner falling on my sword and keeping the country from moving forward.”

He knew that doing what he believed was in the country’s best interest could cost him his job in 1992. “Nobody is particularly happy with me,” he said during the 1990 negotiations. “The budget is a loser.”

But in real time, aware of the consequences, he made the best of the world as he found it. After his election loss to Mr. Clinton, Mr. Bush wrote to Nicholas Brady, his Treasury secretary, that the budget deal would have helped him if the economy had strongly recovered. “It didn’t,” Mr. Bush added, “and I was the ‘read my lips’ liar — over and over and over again. I heard it — it killed us.” With the base angry and so many others believing the economy was not getting better, Mr. Bush faced a primary challenge from the right by Patrick Buchanan and ultimately could not prevail against the combination of Bill Clinton and Ross Perot.

If you play out the 1990 analogy, Mr. Obama, like Mr. Bush, may be a one-term president. Mr. Clinton won re-election because of his political gifts and the improving economy and because he was fortunate in his Congressional foes. Mr. Bush did not have these advantages.

It is too soon to tell what will confront Mr. Obama. If his bill, with its middle-class tax benefits, stimulates the economy, then his compromise on a liberal article of faith may one day rank with Mr. Bush’s courage under conservative fire.

There are worse things than losing re-election yet winning the good opinion of history. Don’t be surprised if Mr. Obama makes that very point when he presents the Presidential Medals of Freedom next year. Among those the president has chosen to honor at the White House: a man from Houston, George Herbert Walker Bush.

Jon Meacham, the author, most recently, of “American Lion: Andrew Jackson in the White House,” is at work on a biography of George H. W. Bush.

Sunday, November 28, 2010

3rd Africa-EU Summit: Africa, EU Linking up Scientific Research Networks

Scientific research and technology have become the defining transformational forces of this century.

However, the scientific and digital chasm between Africa and the rest of the world is hindering Africa's full participation in today's globalized knowledge society.

The Africa-EU partnership hopes to bridge the divide through research funding, training and strengthening institutional capacity.

There are a number of activities in this partnership which focus on this issue, including a high level political dialogue and consultation on common positions in international conferences.

There is also a large project component, including:
• A €15 million pan-African scheme for research grants from the 10th EDF Intra-ACP Indicative Programme. This project will build the African Union Commission HRST (Human Resources in Science and Technology) capacity to launch, implement and monitor calls for proposals at the African continent level. This should contribute to strengthening Africa's research base. The first call is expected before the November 2010 Joint Summit, Global Arab Network reports according to a press statement.
• The Africa Call initiative (with a budget of €63 million) under the EU's Research and Development (R&D) Framework Programme. The call covers scientific research in the areas of health, environment, biotechnologies, agriculture, and food security.
• Africa Connect, which will link up all African National Research networks to the European GEANT (GEANT is the pan-European data network connecting the research and education community across 40 countries.) R&D network.
• GMES & Africa, which will provide state-of-the-art earth observation applications so that African policy makers can take informed decisions on phenomena such as desertification, deforestation and climate change.

Who will benefit from the partnership and how?
Many different categories of African citizens will benefit from the partnership. Examples include:
• Internet access will be boosted because broadband communication prices will drop drastically
• New applications specifically dedicated to Africa will emerge
• Employment will be created in the research, ICT and space sectors
• R&D will provide crops that are insect- and bacteria resistant so that fewer insecticides need to be used
• African indigenous plants will be increasingly used in the pharmaceutical sector
• European citizens will also benefit since medicines developed from African raw materials can and will be used in the North

Who are the main actors involved?
Actors involved include the African and European Unions and their Commissions, governments and civil society, including the private sector.

What has been achieved so far?
The partnership has led to a number of outcomes, including:
• The African Research Grants scheme
• The Kwame Nkrumah Science Awards
• The Framework Programme 7 (FP7) special Africa Call by the European Commission's Research and Development department
• Connect Africa, the African Internet Exchange project
• The GMES (African Global Monitoring for Environment and Security) & Africa process, setting-up an overall framework in Africa for earth observation applications
• The HIPSSA project (Support for Harmonization of ICT Policies in Sub-Sahara Africa) with 43 beneficiary countries. It should contribute to a level-playing field for the private sector to enter the telecom market, to lead to better service and lower costs
• The extension of the AVICENNA project of which the final objective is to create an online African virtual campus network for Science and Technology (S&T) education

What are the challenges for the future?
Any investment in S&T will see results only in 10–15 years' time, and there is also a fear to invest in the unknown. International organizations such as the African Union can help their governments with making good investment choices in S&T.

Whilst Europe is close to investing 3 % of its GDP in S&T, numbers for Africa are currently still much lower. So every year the scientific divide between the two continents widens. Intensifying the cooperation to narrow this gap is of mutual interest: in terms of security, safety, economic and social development and environmental sustainability.

Africa must step up to the plate. My worry is that national policy and vision statements do not reflect an appreciation of the pivotal role for S&T. They are all about trade, minerals, infrastructure and agriculture. It is not surprising that national science and technology budgets are shamefully low.

Sent from my BlackBerry® smartphone from Zain Kenya

Anti-HIV Pill Protects Against AIDS

For the first time, a study has demonstrated that an anti-HIV pill can protect uninfected people from contracting the AIDS virus through sex. The much-anticipated results show that an already approved drug can cut transmission rates nearly in half, which could provide a powerful new tool to curb the AIDS epidemic. "It's a game changer," says one of the dozens of clinicians who participated in the study, Kenneth Mayer of Fenway Health in Boston. But experts say the success also raises a dizzying array of complicated issues about human behavior, resources, risk, and public health.

The strategy, called pre-exposure prophylaxis, or PrEP, was tested in 2499 HIV uninfected men and transgender women who have sex with men. Half of the group received a placebo. In the treatment group, transmission dropped by 44%, despite the fact that many study participants in the trial frequently skipped doses. When the researchers analyzed a small subset of people who received the treatment and not the placebo, they found an astonishing 92% protection rate in people who had detectable levels of the drug in their blood—in other words, in those who took the drug regularly.

Nearly 30 large-scale HIV prevention studies have failed, making these results that much more heartening. The new study, called the Pre-Exposure Prophylaxis Initiative, or iPrEx, cost $43.6 million and was conducted in six countries between July 2007 and December 2009. "The iPrEx study results are extremely important and providing strong evidence that PrEP can reduce HIV acquisition among a segment of society that is disproportionately affected by HIV/AIDS," said Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases (NIAID) at a teleconference for the press held yesterday. NIAID provided two-thirds of the funding for the study, and the Bill & Melinda Gates Foundation covered the other third.

As reported online today in The New England Journal of Medicine, the study recruited people at extremely high risk of becoming infected with HIV: Participants reported an average of 18 sexual partners in the past 12 weeks, and about 60% said they had unprotected receptive anal intercourse in that time frame. Everyone received regular counseling about how to reduce their risks of becoming infected as well as condoms and treatment for other sexually transmitted infections. At the end of the trial, 36 out of 1251 people who received a pill that contained a combination of two anti-HIV drugs, tenofovir and emtricatbine (co-formulated as Truvada and made by Gilead Sciences of Foster City, California), became infected. Of the 1248 people who received a placebo pill, 64 became infected.

Robert Grant, a virologist at the University of California, San Francisco (UCSF), headed the study, which took place in Peru, Ecuador, Brazil, the United States, Thailand, and South Africa. "I was overjoyed that we showed clear evidence that oral Truvada added protection to [men who have sex with men] receiving comprehensive prevention services," says Grant. "It's a robust result." Although some researchers feared drug resistance might surface or that people might increase their rates of risky behavior because they believed the drug provided protection, neither problem was seen in the study, he says.

But Grant emphasizes that the findings only apply to men and transgender women who have sex with men; other studies are underway to evaluate PrEP in heterosexual men and women and injecting drug users.

Several AIDS researchers not involved in the study told Science that they are impressed with its thoroughness and statistically significant results. But they worry how well the strategy will work in the real world. Although participants reported taking the drugs about 90% of the time, the researchers doubt this was accurate because of studies of drug levels in blood. "The questions that remain are more behavioral than biological," says Robert Schooley, a virologist at the University of California at San Diego (UCSD). Grant of UCSF suggests that adherence to the regimen may have been low because people did not know whether the drug worked or whether they were receiving placebo. Truvada did not cause any serious side effects, but many people complained of nausea and headaches, which also may have affected adherence. Grant is planning a follow-up study to explore these and other questions.

The results come on the heels of a widely celebrated positive finding from the so-called CAPRISA 004 trial in South African women, which this summer reported that a vaginal gel laced with tenofovir reduced infection by 39%. "This plus CAPRISA means we've crossed the Rubicon," says Mayer, who ran one of the two iPrEx sites in the United States. "Antiviral chemoprevention works, no question."

One major difference between the iPrEx and CAPRISA trials is that the gel is an experimental product and is not on the market. Truvada, in contrast, is a popular anti-HIV treatment, and can be prescribed for "off-label use" by any physician. But it remains unclear whether insurance companies will pay for this off-label use; costs run from $11 per month for a generic version to nearly $1000 per month for product made by Gilead.

Gilead says it wants to have "frank" talks with the U.S. Food and Drug Administration and other stakeholders before it decides to seek licensure for Truvada as a preventive. "We'll have, I imagine, a very interesting discussion about the potential risks and benefits associated with this kind of a modality, and I think that will govern what we choose to do," says Howard Jaffe, president of the Gilead Foundation, a nonprofit started by the company to help poor communities combat HIV and hepatitis B and C.

This new prevention success also raises fundamental questions about how to best spend money to thwart the AIDS epidemic. "For a country that has not yet reached the level of care in terms of providing antiretovirals to save people's lives, I think it's going to be quite a while before we'd start using oral antiretrovirals for prevention," says Salim Abdool Karim, an epidemiologist a the University of KwaZulu-Natal in Durban, South Africa, who co-ran the CAPRISA study.

Another thorny ethical issue is whether vaccine and other prevention studies with men who have sex with men now should use Truvada as the placebo, which clearly offers more benefit than the standard dummy preparation. Fauci says NIAID will now examine this question in every prevention study they have planned or underway.
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Saturday, November 27, 2010

Genetic Profile Guides Search for the Right Blood Pressure Drug

Essential hypertension is a complex, multifactorial disease associated with a high cardiovascular risk and whose genetic-molecular basis is heterogeneous and largely unknown. Although multiple antihypertensive therapies are available, the large individual variability in drug response results in only a modest reduction of the cardiovascular risk and unsatisfactory control of blood pressure in the hypertensive population as a whole.

We are swimming in a sea of options when it comes to treating high blood pressure; there are currently more than half a dozen different classes of drugs on the market for the condition. Yet there is little rationale for giving individuals one particular drug over another. Now, using a combination of key genes, researchers have developed a genetic profile that can identify at least one quarter of patients that react positively to the blood pressure drug rostafuroxin. The findings may help doctors avoid the trial-and-error process commonly associated with matching the right blood pressure drug to the right patient. Additionally, the "personalized medicine" platform may help to identify patients genetically predisposed to develop complications from certain blood pressure drugs. When blood exerts too much pressure on the walls of blood vessels, it's called hypertension, or high blood pressure. In 90 to 95 percent of hypertension cases the cause is unknown; but there are a few factors known to worsen high blood pressure, including smoking, obesity, consuming high amounts of salt, and stress. Here, Chiara Lanzani, along with Mara Ferrandi and colleagues found that two factors--variants of the Adducin family of genes and high levels of hormone ouabain--are related to high blood pressure.

See full article in

Tuesday, November 23, 2010

Because the web belongs to you

Do you think I would miss the opportunity to share this?

You must read the rest of what is a long and very well written article in Scientific American. And I just love this...

The Web is critical not merely to the digital revolution but to our continued prosperity—and even our liberty. Like democracy itself, it needs defending"

“The Web as we know it, is being threatened in different ways.

Why should you care? It is a public resource on which you, your business, your community, your government and evidently, yours truly depend. And because the Web is yours.

The Web is also vital to democracy, a communications channel that makes possible a continuous worldwide conversation. The Web is now more critical to free speech than any other medium.

Some of its most successful inhabitants have begun to chip away at its principles. Large social-networking sites are walling off information posted by their users from the rest of the Web. Wireless Internet providers are being tempted to slow traffic to sites with which they have not made deals. Governments—totalitarian and democratic alike—are monitoring people’s online habits, endangering important human rights.”

If we, the Web’s users, allow these and other trends to proceed unchecked, the Web could be broken into fragmented islands. We could lose the freedom to connect with whichever Web sites we want. The ill effects could extend to smartphones and pads, which are also portals to the extensive information that the Web provides.

Here is the long story

To give or not to give: Of Sachs, Easterly and Moyo

I think this is an incisive and dispassionate contribution to one of the most important challenges of our time – models and approaches for poverty eradication. I think Mathews Franklin Cooper has injected a rare tenor, one that is seldom heard in conversations on the topic of poverty in the context of the developing world.

Excerpts from Matt's Existential Musings

“My profoundest apologies to my gentle readers for the terrible, terrible pun in the title, but I really needed to find a snappier and more appropriate way to vent my frustration at our required course content than ‘Jeff Sachs and Bill Easterly are both completely full of horseshit, and we would do well to give them each their fifteen minutes of infamy and move on to useful things for a change’. One unexpected benefit, I suppose, to having been overexposed to the Sachs-Easterly debate, though, is that it is helping me to realise just how deeply our own discourse has been pruned down………”.

“Sachs’ argument, in a nutshell, is that with better policies in place, better coordination, more efficient operations and more concerted efforts to solve multiple problems at once, we can overcome all the trials of poverty in one ‘big push’………….”
“There is a point on which I actually do agree with Easterly’s diagnosis in White Man’s Burden – such promises have been made before by governments, both national and supranational, of the ‘developed’ world, and they simply haven’t been fulfilled. Historically speaking, the grand schemes to rid the world of poverty have ended in varying degrees of tragedy and farce.

But that’s precisely where my agreement with Easterly ends, because – to put it as politely as I may without resorting to the invective common to such economic parlance – the man obviously hasn’t looked in a mirror and noticed the great honking plank in his own eye before groping Sachs’ face for a mote. The problem with Easterly is that somehow in all his hagiographical panegyrics of the ‘Searcher’ and vituperative scorn of the ‘Planner’, he fails to notice that of both Platonic ideals, he himself more closely resembles the latter rather than the former. He rebukes Sachs for promoting a ‘one-size-fits-all’ solution to poverty, though his own solution falls squarely under the same rebuke. Though he claims not to be a ‘Planner’, his plan in actuality is indeed far broader and at the same time far more banal, unimaginative and unworkable than that he accuses Sachs of having: in short, to end aid as we know it and allow markets and free enterprise to take its place.

“Easterly’s arguments, needful though some aspects may be for the advocates of conventional aid measures, all very conveniently dodge the matters of historical record that aid money from the Western world has been for the vast majority of its history either a.) contingent upon the adoption of the very market-fundamentalist measures Easterly champions or b.) palliative care for the economic fallout upon the poor from those very same measures.”

“While I agree that we do need aid-critical scholars, particularly in this most uncritical of times, can we find some more durable ones, please? The current model represented by Easterly and Moyo seems to have an expiry date of roughly 1815 – and I do consider it a market failure (or at the least a failure of common sense!) that they continue to be taken seriously. It is my hope that people continue to listen to the likes of Phillip Blond, John Milbank, Cornel West and Amitai Etzioni; it would be good to see some socialists, high Tories or real critical theorists come out of the corners and offer a more thorough alternative critique of current aid policies.”

Sunday, November 21, 2010

Of a Shepherd in sync with the flock

In a rare re-statement of a long-held policy view, Pope Benedict XVI has said that condom use can be justified to help stop the spread of HIV/AIDS. Last year the Pope Benedict said that condom use contributed little to preventing the spread of AIDS, asserting that only abstinence and fidelity did. Considering that the Pope made these remarks ahead of his first Africa tour, I found this statement rather disturbing.

Pope Benedict maintains that condoms were not “a real or moral solution” to the AIDS epidemic But in a rare exception to a long-held anti condom use policy, Pope Benedict has said that “there may be a basis in the case of some individuals, as perhaps when a male prostitute uses a condom, where this can be a first step in the direction of a moralization, a first assumption of responsibility.”

Although limited, Benedict’s concession on condoms has cracked the door open for a wide ranging debate on the use of condoms as a critical tool in the campaign against the spread of AIDS among consenting heterosexual couples. In recent years, the Vatican has also faced criticism at some church-run health clinics in Africa. Health experts have noted that health care workers in church run health care facilities often ignore the teachings and distribute condoms.

Wednesday, November 17, 2010

Lessons from Pirates and Insurgents for Business Management

Schools of management often cite and draw lessons from battle field strategists. But University of Reading’s Henley Business School professor David James thinks management styles of pirates of the Somali coast and insurgents in the mountains of Afghanistan have invaluable insights for modern business management.

Somali pirates’ business model is impressive and their strategy is worthy of critical analysis. For instance, the pirates avoid “symmetrical” assault. They employ stealth and ambush, attacking their victims at their most vulnerable point. It is not surprising that a mere half a dozen sailors easily wrest control of gigantic oil tankers. This is a lesson that smaller companies that seek to take on large entrenched businesses could learn from.

Professor James cites the example of has taken market share by attacking banks' inflexible lending policies by offering loans for the exact amount and length of time the customer wants. It processes the loans rapidly and customers can obtain approval using an iPhone application.

That smaller, nimble competitors make stealth attacks on larger rivals is a well-known phenomenon. However, large companies are too slow to respond. For instance, by the time a captain spots the pirate’s inflatable it is too late because it take as large vessel too long to turn around. Lessons on rapid response can be learnt from the Taliban insurgents in Afghanistan.

Insurgent leaders do not micro-manage. Leaders of such movements are, in Professor James’s words, "brand agnostic"—they allow their brand to be adopted by autonomous local cells with little central control. The mistake big business makes is to try to protect the brand by making decisions from its headquarters or “central command”. But a corporate insurgent, like the Taliban allows allow local managers (militias) to respond quickly to local events.

Professor James goes as far as to suggest that companies set up “commando” forces; small units which work outside the traditional command structure of the company and which have a level of autonomy—“not holding the long committee meetings, not having the extended approval and budgeting process”. If a big business as a whole cannot act as a small, nimble player, these militias or business cells can.

A Letter of Gratitude From an Eminent Nephew

This is just brilliant!

"Pretty Good for Government Work" By Warren E Buffet. Published in the New York Times November 16 2010.

DEAR Uncle Sam,

My mother told me to send thank-you notes promptly. I’ve been remiss.

Let me remind you why I’m writing. Just over two years ago, in September 2008, our country faced an economic meltdown. Fannie Mae and Freddie Mac, the pillars that supported our mortgage system, had been forced into conservatorship. Several of our largest commercial banks were teetering. One of Wall Street’s giant investment banks had gone bankrupt, and the remaining three were poised to follow. A.I.G., the world’s most famous insurer, was at death’s door.

Many of our largest industrial companies, dependent on commercial paper financing that had disappeared, were weeks away from exhausting their cash resources. Indeed, all of corporate America’s dominoes were lined up, ready to topple at lightning speed. My own company, Berkshire Hathaway, might have been the last to fall, but that distinction provided little solace.

Nor was it just business that was in peril: 300 million Americans were in the domino line as well. Just days before, the jobs, income, 401(k)’s and money-market funds of these citizens had seemed secure. Then, virtually overnight, everything began to turn into pumpkins and mice. There was no hiding place. A destructive economic force unlike any seen for generations had been unleashed.

Only one counterforce was available, and that was you, Uncle Sam. Yes, you are often clumsy, even inept. But when businesses and people worldwide race to get liquid, you are the only party with the resources to take the other side of the transaction. And when our citizens are losing trust by the hour in institutions they once revered, only you can restore calm.

When the crisis struck, I felt you would understand the role you had to play. But you’ve never been known for speed, and in a meltdown minutes matter. I worried whether the barrage of shattering surprises would disorient you. You would have to improvise solutions on the run, stretch legal boundaries and avoid slowdowns, like Congressional hearings and studies. You would also need to get turf-conscious departments to work together in mounting your counterattack. The challenge was huge, and many people thought you were not up to it.

Well, Uncle Sam, you delivered. People will second-guess your specific decisions; you can always count on that. But just as there is a fog of war, there is a fog of panic — and, overall, your actions were remarkably effective.

I don’t know precisely how you orchestrated these. But I did have a pretty good seat as events unfolded, and I would like to commend a few of your troops. In the darkest of days, Ben Bernanke, Hank Paulson, Tim Geithner and Sheila Bair grasped the gravity of the situation and acted with courage and dispatch. And though I never voted for George W. Bush, I give him great credit for leading, even as Congress postured and squabbled.

You have been criticized, Uncle Sam, for some of the earlier decisions that got us in this mess — most prominently, for not battling the rot building up in the housing market. But then few of your critics saw matters clearly either. In truth, almost all of the country became possessed by the idea that home prices could never fall significantly.

That was a mass delusion, reinforced by rapidly rising prices that discredited the few skeptics who warned of trouble. Delusions, whether about tulips or Internet stocks, produce bubbles. And when bubbles pop, they can generate waves of trouble that hit shores far from their origin. This bubble was a doozy and its pop was felt around the world.

So, again, Uncle Sam, thanks to you and your aides. Often you are wasteful, and sometimes you are bullying. On occasion, you are downright maddening. But in this extraordinary emergency, you came through — and the world would look far different now if you had not.

Your grateful nephew,


Warren E. Buffett is the chief executive of Berkshire Hathaway, a diversified holding company.

A crisis of global leadership

Going by recent major events, there is a very high likelihood that we are headed for a dangerous vacuum in global leadership. That foreign policy did not figure at all in the last US mid term elections is as worrying as it is informative. The US is obviously in decline, both financially and militarily. And most importantly, the moral authority of the US was severely eroded in the Bush years–the years the locust ate.

China and Germany are awash with money and seem to be riding the global recession with ease. I am not sure German wealth can substitute for the holocaust. The repressive communist regime in China as well as China’s tolerance of corrupt and authoritarian regimes abroad is more than a little inconvenience. France and England have a colonial past that is hard to put behind.

The UN is incompetent beyond comprehension. Global terrorism, China’s flagrant abuse of human rights, the atrocities committed by the US in Guantanamo and the genocide in Dafur are clearly beyond Mr. Ban’s pay grade.

As the US turns inwards–thanks to the tea party revolution–there is evidently a seismic shift in global power. It is however unclear how this will shape out in the months to come. The world does not need another super power bully. Neither do we need another cold war type brinkmanship.

It is unlikely that the contention for global leadership will be sought through military armament. That era is in my opinion gone, never to return. Economic domination and financial power is the canvass upon which new global power geography will be projected.

The US is not down and out. The US economy could emerge from the recession even stronger; but only if the American voting public that to happen. The American public must learn and accept that the recovery is going to be jobless. Construction and financial sector markets will not return in the hundreds and the hundreds of US mediocre liberal arts schools must begin to produce skills that are needed by a new kind of job market.

For China to lead, it must begin to act more responsibly on the global stage. It must decouple its trade and foreign policy. China must stop abetting rogue governments in Africa. China must make its voice heard emphatically on Iran and North Korea. China must joint the global effort to find peaceful resolution in the Israeli-Palestinian conflict. China must speak out on the war against terror. It not enough to wait out the conflict in Afghanistan and then pick up all the re-construction work.

And China must let Tibet go.

Thursday, November 4, 2010

Why "Development" does not work

Most of the development programming in my part of the world have a classical beginning. They often start with someone, often in some distant capital city in the west or a local urban-based NGO imaging a “problem” and an associated imagined “solution”. These problems, once imagined assume a critical crisis proportion. They immediately become an existential imperative. Similarly, the solutions are billed as universal panacea, the one intervention(s) that has to be implemented to save a child, a mother or a village or Africa.

More often, the statistics and the narrative form used in proposals or project implementation plans are obtained from “baselines”, “situation analysis”, or some “inception report”. These are often short, “expert-led” appraisal, expensive but woefully narrow and superficial. In clinical terms, this process is akin to bad clinical history and a misreading of symptoms of dis-ease.

What can you really expect from a doctor who takes bad clinical history and goofs on the symptoms? Obviously, the both the diagnosis and the prognosis will be wrong. At best, the patient realizes they are not getting better and seeks a second opinion. Or the patient suffers debilitating and permanent damage from misdiagnosis and mis-treatment, making an otherwise curable condition worse. Or the patient dies.

Most development work in Africa is analogous to a physician trying to diagnose and cure a disease whose symptoms they barely understand and whose root causes they would care less about.

My sense is that most development workers in Africa especially, are like bad physicians. A bad physician who does not know enough to even ask a question as simply and as necessary as why or what if. A majority of development types strut around with a messianic halo over their heads and feeling that only they can and must save Africa. They have no time to listen or even ask questions because they think they know the answers.

I am not sure what an Iowa farm boy for instance can say to a subsistence rice farmer in a remote village in southern Tanzania or central Kenya. But you can bet they will be moved with compassion by the poverty, malnutrition, disease burden and low levels of literacy and educational achievement among rice farming households.

I am sure you know the development programming drill around this kind of “problem”. It is Rural Development 101. For this one village of say 500 farm households, you would development “interventions” to raise household incomes, enhance dietary diversity by introducing “kitchen gardens”, distribute bed nets, initiate water and sanitation and introduce school meals to keep kids in school.

This is what most of the so-called development work is about. It is reactive and grossly wrong headed. Any grade school graduate understands that the issues that hold back the progress and prosperity of smallholder rice farmers are not malnutrition or low education or disease or poverty. These are symptoms of more complex and coupled socio-economic and ecological problem. Moreover, these symptoms as most of you very well understand, are correlated and interact in nonlinear ways, often generating complex feedback.

The interesting thing about the practice of development is that it is populated by a small group of people who hang out together pretty much of the time. The leadership and rank and file for the most part have worked in several similar institutions doing more or less the same kind of work. In terms of new ideas and innovation, there is not much, these communities are highly incestuous. So the flawed ideas, if you do not mind my saying so, are passed on from one misguided generation to another.

As an African and international public intellectual, I think donor funded development work in Africa is for the most part a shameful waste of resources. As a scholar, I might add that there is no evidence that development work as method or model of socio-economic development works.

Donor driven development was not the vehicle for economic growth and social transformation in the west. Evidently, donor aid is not what is lifting hundreds of millions of Chinese and Indians out of poverty. And the upsurge of the middle class in Lagos, Nairobi, South Africa and Dar-es-salaam is happening in spite of development aid.

To be fair to the good and noble men and women in development, they know not what they are doing. And we must forgive them.

With economies in the west floundering, we might just see the beginning of the end of development aid.

I can hardly wait.

Barack Obama gets it

The US mid-term election is now behind us. Like Bill Clinton and George Bush, Barack Obama has lost control of the House of Representatives. For Clinton it was the Gingrich Revolution. George Bush lost against the tide of the anti-war campaign from the left. And for Obama, Grizzly Mama and the Tea Party Revolution delivered a formidable resurgence of GOP.

In a press conference at the White House, Obama was truly outstanding. He admitted that some election nights are “exhilarating” and others are “humbling”. As the GOP leaders and pundits would put it, the American people have sent Barack Obama an unequivocal message. And I think Barack Obama unlike George Bush in 2006, get it.

Barack Obama understands that the number one issues for most voters is the economy, and the president takes responsibility for the failure to “repair” (whatever that means) America’s economic fortunes. Obama also understands the people’s frustration (especially the GOP) with too much government. He understands that there are provisions in the Obama Care that are burdensome to small business.

Obama also understands that America succeeds if its businesses succeed. He has promised to hit the “re-set button” with American businesses, and one would hope with Wall Street too.

On the deficit, Barack Obama is keen to seek bipartisan approaches to rein in the federal deficit and debt. However, Obama is mindful that the GOP and all the other entities might not “come to the table with an open mind”. On this the president hope for a serious conversation. Lets see what happens regarding the Bush tax cuts, especially in a GOP controlled House of Representatives.

Over the next year, I think we will see Obama as more pragmatic, centrist deal-maker. To this Obama I was drawn, right from his first convention speech in 2004 to his book The Audacity of Hope to. We will see a more reflective and engaged but less cerebral Obama over the next eighteen months.

Obama understands that he must extricate himself from the “bubble” of the White House. But he also understands that the burden of his executive brief can be numbing.

The outcome of the mid-term elections is overwhelming and there is no doubt that the Grizzly Mama has bite. But the president has a real chance to re-make himself in the image of Barack Obama, and yes he can.

Because Barack Obama gets it, he is still the man to beat in 2012.

Wednesday, October 20, 2010

The Ecology of Terror Networks

I have been thinking about terrorism a lot lately. And I think, like the systems ecologist that I am, that terrorism has a distinct ecology. Simply put, the networks of global and regional terror love to inhabit certain socio-economic and ecological localities.

I also think that in a complex ecosystem comprising a myriad of other “life forms”, terrorism is managed in a very sophisticated manner. It is managed in the style ecologists would refer to as resilience–based ecosystem management. For instance, Al Qaeda, Taliban or Al–Shabab take systems perspective of their base and understand that it is a complex and coupled socio-economic system in which poverty, illiteracy, unemployment, corruption, women’s rights (especially keeping girls out of school and women out of work) and religious fundamentalism are critical system components.

The leaders of the terror networks understand transformation, threshold and feedback. They understand, in a very practical way, the non-linear relationships among poverty, illiteracy, unemployment, delinquency and how these play out to recruit the next pool of suicide bombers.

Moreover, the terrorists know better than to let a good crisis go to waste. Taliban and Al Qaeda followers were out provide relief, rescue and comfort to the Pakistani flood victims while the Pakistani president was out shopping. They understand the language of incentives, carrot and sticks. They make lofty and sensual promises to suicide bombers.

To get a more nuanced perspective of the ecology of terror networks consider for a moment where these networks are active; Yemen, the mountains of North Waziristan, Pakistan, Afghanistan and Somalia. I am not sure why these networks are not robust in the Emirates, Saudi Arabia, Egypt and Libya or Tunisia.
These terror networks, in my opinion need a critical aggregation of poverty, grievance, religious delusion and more importantly, hopelessness in the now and hence a compulsive yearning for an after life.

The anti terrorism measures must understand the “ecosystem” logic of terrorism. The drones, although successful, will not end terrorism. I am not sure that providing oodles of aid money will dismantle the terror networks. Aid might just slow down things a little bit.

But there are deep socio-economic problems in Pakistan that no amount of aid or military intervention can solve. These are the control of land and politics. Feudal lords dominate Pakistan’s political structure. Most of the political parties are feudal oriented and a significant majority of the National Assembly is dominated by these kinds of people. Moreover, the same feudal lords hold most of the key executive posts in the provinces.

The feudal lords, by virtue of their ownership and control of such vast amounts of land and human resources, are powerful enough to influence the distribution of water, fertilizers, tractor permits and agricultural credit and, consequently exercise considerable influence over the revenue, police and judicial administration.

In a system such as the one , I would sign up for the Taliban any day. And no drones or official development assistance dollars would stop me.

Friday, October 15, 2010

Southern Sudan: The Birth Pangs of Africa's Newest

El-Bashir was visiting with Mr. Gadaffi last week and they had not a so hopeful message on the up coming referendum that could see Southern Sudan go its separate way.

And lately, the north has been going after Salva Kiir, accusing him of not being committed to the unification of Sudan. But Salva Kiir is not alone. The south want's out.

But my sense is that we need look at this against the hard reality of the "state-readiness" of the south. I am not convinced that the south has the human capacity or the infrastructure to be functional as a viable state. The US has been the biggest support of the quest for independence of the south. For the most part, in both the Bush and the Obama administration, the US is committed to checking the advance what America thinks is Islamic fundamentalism.

I dare to say that if the south goes its separate way after the referendum, it will collapse and fail under its own weight of incompetence. It was hard enough for African countries to emerge from the clutch of colonialism, even when most of these countries had a modest number of civil servants, good infrastructure etc. The tragedy is that southern Sudan is coming out something worse than colonialism, African dictatorship.

All I can say that southern Sudan is embarking on a most improbable journey and one for which they are least prepared for it is least prepared and a journey that the El-Bashir does not want to go along with. And the US, the south's godfather, is strained at home with a stagnating economy and budget deficits and challenged abroad in Pakistan and Afghanistan.

Good luck southern Sudan. What else can I say?

Saturday, October 9, 2010

A New World Order?

How will historians characterize the defining moments of the early 21st century? There is no shortage of momentous events, from 9/11 to the Tsunami to global terrorism to the global financial crisis to Obama’s election in 2008. My sense is that the tectonic shift in the global financial order will most likely be the undisputed defining epoch of the 21st century.

For the last decade and half, the US, Japan, Germany, and the UK dominated the world’s economic league table. Since the global financial crisis of 2008, the axis of financial power and global capital flows changed. In the west, sovereign debt has spiraled out of control, unemployment is on the rise and growth is stagnating.

Hamstrung by weak consumer spending and lower corporate investment, Japan has been surpassed by China as the second largest economy. Despite the 72nd “Commonfilth” Games, India’s economic growth is projected to reach an incredible 8.5% in 2010. The rest of the so-called Third World is growing too. Africa for instance, has grown faster than at any time in its short and tumultuous post-colonial history. The end of apartheid has given rise to a more engaged South Africa, with its economy more integrated with the rest of Africa’s.

The path to economic recovery in the west is proving exceedingly problematic. The dilemma in the west is whether to stimulate or cut public spending. Moreover, despite Obama’s stimulus, both the private and the public sector are still shedding jobs. In fact, a second stimulus by the Obama administration is not off the table.
We could see more and angrier tea party like protests as the economies of the west confront the inevitability of a double dip.

Tuesday, September 28, 2010

We are eating our lungs out

Excellent article in PNAS

Global demand for agricultural products such as food, feed, and fuel is now a major driver of cropland and pasture expansion across much of the developing world. Whether these new agricultural lands replace forests, degraded forests, or grasslands greatly influences the environmental consequences of expansion. Although the gen- eral pattern is known, there still is no definitive quantification of these land-cover changes. Here we analyze the rich, pan-tropical database of classified Landsat scenes created by the Food and Agricultural Organization of the United Nations to examine path- ways of agricultural expansion across the major tropical forest regions in the 1980s and 1990s and use this information to highlight the future land conversions that probably will be needed to meet mounting demand for agricultural products. Across the tropics, we find that between 1980 and 2000 more than 55% of new agricultural land came at the expense of intact forests, and another 28% came from disturbed forests. This study underscores the potential con- sequences of unabated agricultural expansion for forest conservation and carbon emissions.

See Full Article
Tropical forests were the primary sources of new agricultural land in the 1980s and 1990s H. K. Gibbsa et al

Friday, September 24, 2010

Only the Economy can save the Environment?

I am an avid reader of The Economist magazine. I guess I read not because they write lots of good stuff in there. I read it because a good friend ones told me it is the kind of stuff that smart people read. Before my conversion I read Newsweek and TIME. My friend convinced me that they were intellectually underwhelming.

This week The Economist is actually carried a very brilliant and important story, “The World’s Lungs”. And it is the lead story, and beautifully illustrated on the cover page.

Under the subtitle Reddy, steady, grow this article describes what is in my view is the Environmental Kuznets’s curve. The environmental Kuznets curve is a hypothesized relationship between various indicators of environmental degradation and income per capita. It is hypothesized that in the early stages of economic growth environmental degradation (deforestation, air and water pollution, soil erosion) is accelerated.

However, beyond a certain threshold level of income per capita (which will vary for different indicators) the trend of degradation is reversed. Essentially, the key argument is that at high-income levels and sustained economic growth environmental degradation can be halted.

But here is the argument that I find compelling. “Economic development both causes deforestation and slows it. In the early stages of development people destroy forests for a meagre living. Globalization is speeding up the process by boosting the demand for agricultural goods produced in tropical countries. At the same time, as people in emerging countries become more prosperous, they start thinking about issues beyond their family’s welfare; their governments begin to pass and slowly enforce laws to conserve the environment. Trade can also allow the greener concerns of rich-world consumers to influence developing-world producers”.

The Economist recognizes that we do not have the luxury to wait until Africa is wealthy before we can halt deforestation, halt sea level rise and stop dangerous climate change. You probably think they should figure that out. It is not that obvious to many of our human kind that there is such a thing as being too late.

It is heartening to see The Economist make such a strong argument for REDD. The wordy play is clever “Reddy, steady grow”. There is of course the familiar strategy around ecosystem service payments such as the Catskills example that is referred to in the story.

But I think The Economist screwed this great story when they slipped into the stereotypical portrayal of the developing world when they wrote, “The difficulties are immense. REDD projects will be effective only in places where the government sort-of works, and the tropical countries with the most important forests include some of the world’s worst-run places. Even in countries with functioning states, some of the money is bound to be stolen.”

I am not sure they had to add this. Many things are changing in the developing world. For instance, we have slowed down the rate of new AIDS infections; we have more kids attending schools in Africa today; we are closing major gender gaps in education, employment and political representation. But I am aware, and need no reminding that Africa aught to do better.

And I know African can and must do better.

Tuesday, September 14, 2010

A Letter to America

This is audacious. How dare any one tell America how to be?

I guess it is like the famous fable about telling the King that he is naked. If I were a King, I would take great offense if one of my minions accosted me to draw my attention to my nudity.

I have always said to my American friends that unlike them, the rest of the world knows and thinks about what is happening in America. Conversely, Americans know and care very little about what goes on beyond their state.

America, if you were a King this is what I would have to declare to you, “Your Majesty thou art naked”. As an international public intellectual, I owe this to America.

The inexorable decline of America began with the invasion of Iraq. America’s precipitous invasion of Iraq has demeaned irretrievably, its moral standing as the leader of the free world. Then came the hunt for Bin Laden in the mountains of Afghanistan.

The two wars opened the floodgates for spending and the deficit burgeoned. Private debt has been on the rise too. Americans families acquired a voracious, insatiable appetite for personal debt. From essential debt such as collage loans to buying a plasma screen on credit.

While China was out building a über modern foundation for a 21st century economy America was busy chipping away to build a tunnel between Wall Street and the US Treasury. The idea was to destroy regulation and let the markets figure it out. This is because a former movie star and governor who beat Jimmy Carter to the presidency told them that government regulation was anti American.

So what did America get? They got the sub prime mortgage. Then they created a massive housing bubble. Banks reeled in poor Americans to take out mortgages they could not afford. Through complex and I would add idiotic fraudulent accounting, debt was swapped around as assets and before we knew it, the entire global financial system was careening out control.

Businesses are contracting and re-structuring on a new template. In the short-term credit is drying up. Sale of new homes is at an all time low, but thank God foreclosures are slowing down. American’s cannot consume ad libitum. And America cannot continue to spend money on imported good and produce nothing.

Here is a simple example; back-to-school dollars go to imported clothing and school supplies, including laptops, iPods, sneakers and even toys coated with lead. Hence a dollar spent by an American consumer does not translate into a dollar of domestic production. So how will the jobs return? I guess by more tax cuts to the wealthy and marching on Washington.

The GOP is digging in to continue the Bush tax cuts. And the tea party is on the march. They are angry and want to take America back. I think America is in a grave intellectual crisis. I am not sure that delegitimizing Obama’s presidency will provide any relief to America’s terminal dis-ease.

Conservative NYT columnist David Brooks wrote yesterday “The surging Republican Party has a story, too. It is a story of virtue betrayed and innocence threatened. And David Brooks adds “These statist forces are more powerful than ever in the age of Obama”.

GOP, the tea party and Glenn Beck are frothing in the mouth about small government and cutting Federal spending. I am not sure that any body could grow government bigger than the hundreds of billions of dollars Bush and the GOP spent in Iraq and Afghanistan.

GOP is talking about releasing the power of markets and unlocking the power of America’s ingenious creativity. Sarah Palin and her apostles claim to be the body and soul of America’s enduring principles of freedom and entrepreneurship and markets.

But here is what David Brooks had to say.

“The social fabric is fraying. Human capital is being squandered. Society is segmenting. The labor markets are ill. Wages are lagging. Inequality is increasing. The nation is over consuming and under innovating. China and India are surging. Not all of these challenges can be addressed by the spontaneous healing powers of the market”.

America, it is time to reinvent.

The GOP will have to learn to be more intellectual rather than operate through angry marches and harping on old and failed economic models. America needs a national conversation. America needs to move beyond the partisanship and the pettiness of talk show radio hosts and start to solve some real problems. The fundamentals of both the social and economic order in America are deeply flawed and the nation is headed only one way – down.

I am not sure that an intelligent conversation is possible in America, especially after the tea party revolution delivers Congress to the GOP. .

If you think the US economy is too big to fail, I think it is to big to save.

And yes, the King is nude.

Sunday, September 12, 2010

Kenya's 38.6 Million Question

Kenya’s population is in an exponential growth phase. In 1969, there were 10.9 million Kenyans. In 1989, the population grew to 21.4 million. Today there are 38. 6 million card holding Kenyans. This is up from 28.7 in 1999.

To put these numbers into perspective, our current population works to a density of 67.8 persons per square kilometer. The United Kingdom with less than half Kenya’s territory has a population density of 254.2 persons per square kilometer. Similarly, Japan has a population density of 336 persons per square kilometer. Our neighbor Tanzania has a density of 46.3 persons per square kilometer.

I am not sure that the number 38.6 million is the thing to worry about. Kenya is under populated, at least in gross terms.

A whooping $103 million was spent to conduct the population and housing census. When the results of the census were announced, the media went to town with detailed reporting on the demographics of ethnicities, religious groupings and yes, which county is the most populous.

I am not sure I would have expected more from the Kenyan media houses. They love to fan passions, ethnic or religious. To be fair to them, they lack the capacity to analyze and communicate demographic data. More importantly, they are in the business of selling not educating or informing. If they do, it is only incidental.

What should the country worry or think about the census results?

Should we worry about the tribe with the highest numbers? Or should we worry about whether Muslims or Christians or Hindus are the majority?

The politicians are certainly smarter. They have their mouth where their money will come from. They want more constituencies. It is our own gerrymandering –politicians get to choose their voters.

Here are the demographic patterns we should be poring over.

1.26.12 million Kenyans (67.7 %) live in the rural areas, where 80 % of them rely on ponds, springs, streams and wells for their drinking water.

2.There are 8.4 million girls compared to 8.2 million boys below age 14. Conversely, in the 15 to 64-age category, there are 10.1 million females compared to 10.5 million males.

3.For kids above age 3 attending school, there are 9.4 million in primary school compared to only 1.8 million attending secondary school. What is most disconcerting is that there only a paltry 198,119 young Kenyans (0.5 % of the total population) enrolled in university.

4.Men dominate women in all urban areas. This has implications on women’s access to key services and opportunities (e.g., health, education, employment etc.). It also begs the question, who is running Kenya’s rural smallholder agricultural base?

5.We have added about 8 million people to urban centers across the country since 1990. This explains the sprawl and the squalor of most of our urban neighborhoods.

6.How do these numbers square with the dreams and visions we have for 2030?

I will obtain the full census report in the coming week and hope to look way beyond tribe or religion or county.

Wednesday, September 1, 2010

Kenya's Day of Monumental Shame

If there is any one out there who wonders if a new constitution in Kenya will bring an end to state impunity or abuse of power or disregard to the law, August 27th 2010 was your answer. If there is any one out there who still doubts Africa’s lack of commitment to international obligations or honor or justice or human rights, August 27th was your answer.

The decision of the Kenyan government to invite an indicted war criminal to a most solemn and hallowed national event is unspeakable.

Omar El-Bashir is a criminal. El-Bashir presided over the rape and murder of hundreds of thousands in Darfur. The U.N. estimates that 300,000 people; men, women and children have been butchered in this needless war. 3 million more have been forced to flee.

El-Bashir is impervious to shame. He has cultivated a thick cordon of African leaders under the guise of AU member states who continue to block tougher international action against his regime. Mr. Kibaki is one of them. And Kenya has joined the league of pariah nations that provide safe passage to war criminals.

I would suspect that this is a favor that Mr. Kibaki would like reciprocated at some future date. I would like to suggest that the perpetrators of Kenya’s post election violence will have safe passage into Sudan if the ICC moves to issue arrest warrants.

Over the last week lawyers, human rights activists and outraged citizens have been asking Mr. Kibaki’s government to explain why El-Bashir was on the guest list.

At the risk of sounding fatalistic, my answer to them is get used to it! Do not fool yourselves, nothing changed. This place is still called Kenya and it operates pretty much on whims and caprices of people called politicians.

August 27 was not about Kenyans and their agitation for the new constitution. August 27 was a state function, a day for Mr. Kibaki and his friends to get together. And El-Bashir is a friend and neighbor of Mr. Kibaki's. If you had a beer on August 27 I bet you paid for it. El-Bashir did not have to pay for his drinks.

What new constitution? I thought that was just for how Mr. Kibaki would like to be remembered. Even I would like my name used in adjacency to words like second republic. I do not care what that really means.

I am not sure a signature on a piece of paper means much around here. Kenyan’s, please, just stuff it and get back to work!

Mr. Kibaki just did that. That is what I call leading from the front. And so can you.

Wednesday, August 18, 2010

Crowdsourcing Scientific data?

In an article published in PLOS One (Public Library of Science) in 2009, Aanensen and colleagues describe how spatially explicit field data can be submitted via mobile phone to a common web database.

Data from the web database can be retrieved and displayed on the mobile phone, again using Google Maps. What is so cool about this application is that data filtering options allow the display of data submitted by the individual field workers or, for example, those data within certain values of a measured variable or a time period.

The authors demonstrate the utility of this application for epidemiological data collection. They also discuss the potential application in ecology and yes, the possibility to enlist an army of “citizen scientists”. I can think of applications in syndromic surveillance for soil health assessments,assessments of climate change impacts and adaptation as well as monitoring pollutants and deforestation.

How about Crowdsourcing scientific data? This reminds me of Ushahidi, see

Thursday, August 12, 2010

The Hegemony of Tribe

The verdict is out. Kenyan voted to last week to say yes to the proposals contained in the draft constitution.

I do not want to rain on Kenya’s bold parade. But the demographics of the poll are troubling. It seems that ethnic differences accounted for large part of the decision on whether one voted for or against the draft constitution.

Among the Christian majority, it is clear that it did not matter what your pastor said God told her/him to tell you in church on Sunday. It would seem that they remembered what the politician told them about how to vote and why it was important for their ethnic community.

I am curious to know if it is true that an overwhelming majority of people in the Rift Valley province found the “abortion clause” immoral and reprehensible and that they listened not to their politicians but to their pastors.

I am equally curious to know if the Christians in Nyanza were not concerned about the fact that the constitutional provision for Islamic courts amounts to privileging Islam over Christianity or Hindu.

Maybe I am totally mistaken. The constitutional draft was about many more things than abortion and Islamic courts and it was not about pastors and ethnic high priests.

Maybe we have surmounted ethnicity and are not ethnically polarized. Maybe we have never been ethnic in our choice of political parties or which university we attend or teach in or the people we hire in our organizations.

Maybe ethnicity is just a myth or an easy explanatory narrative for a truly complex

See related article in The Economist

Sunday, August 1, 2010

Kenya's draft law not universal panacea but a chance to build a nation

Kenya is on the brink of something monumental. The country is pulsating. A world is waiting with bated breath.

On August 4, 2010 millions of Kenyans will stand in line, many for the first time in their lives, to cast their vote in a constitutional referendum. For many Kenyans, this referendum, especially the promise of a new constitutional dispensation, seems to be the universal panacea for all that is wrong and frustrating with the country.

My sense is that there is a veritable burden of misconceptions and false expectations about what a constitution can and should do. We forget that there are critical boundary conditions of social trust and cohesion that must exist to enable a new constitutional order to flower.

The frustration that many of many Kenyans, especially those not favored by the prevailing political arrangement, have is to do with the excessive powers vested in an ethicized presidency, impunity that enables and underwrites ethnic fiat and the uncertainty about whether their turn to loot will come soon enough.

At the level of ordinary citizens, what we see is ethnic suspicion founded in politics. This ethnically diverse nation is then engulfed in a mindless zero sum game. It becomes easy and even necessary for politicians to mobilize around their ethnic base or a rally together around ethnic coalitions. The voting public cannot participate thoughtfully in democratic process because their ethnic chiefs have framed campaign debates and have the final say on how they vote.

The fact that electoral constituencies are defined ethnically is problematic. Politicians learn from very early in the careers to pander to the ethnic sensitivities of their voters. Political parties map neatly along ethnic fault lines. It makes it difficult for instance for a parliamentary or civic candidate from ethnic group X to support a presidential candidate from ethnic group Y without insulting ethnic sensitivities and even risking their own chances of getting elected. At the political level differences are neither personal nor based on principle. They are ethnic.

Different ethnic groups can only come together, often fleetingly, if they rationalize a negative stereotype or propagate a mutually compelling and circumstantial narrative of victimology that casts one or more ethnic groups as the villain.

The problems we have seen in the half a century since independence are merely symptoms of a deep and fundamental identity problem. Who are these people who occupy this geographic space defined politically and administratively as Kenya? How did these people get here? Do they have common history? Who framed that history? How do we know what we know about ourselves? And does our disparate colonial experiences matter? How did we relate before the colonial state? How did we relate in the colonial state? How do we relate in the post-colonial state? What does it mean to belong here, beyond holding a Kenyan passport?

Our history, especially the uneven burden or privilege of our colonial experience, confers differential levels of entitlement and belonging in the Kenyan state. Some communities claim they suffered an inordinate burden in what is often referred to as the independence struggle. For those communities who do not have independence heroes to tout or land that was grabbed by settlers, they are always left feeling like the poorer cousins, not worthy of the “fruits of independence”. Who are the founding fathers of this “nation”? What qualifies any individual or group of people to claim to be the “founder of the nation”?

In Kenya, identities are multiple, allegiance is to ethnic grouping and majority of people do not feel a part of the whole. To the extent that a constitution embodies a people’s nationhood and enshrines fundamental rights and obligations of citizenship, identity presents a serious challenge to the intention, purpose and promise of a new constitutional dispensation.

For all intents, political and practical, we are collection of ethnicities under one administrative conglomerate, Kenya. Loyalty is first and foremost to one’s ethnic group. The three successive governments have governed by the logic of ethnic expediency. The public enforces adherence to the ethnicity logic and honor.

It is difficult to get Kenyans – a term that could easily just mean the people who live in Kenya – to question and debate the relevance and efficacy of the education system. But it is very easy to spark a protracted and robust debate on the ethnicity of the next director of the Kenya Airports Authority or the Kenya Ports Authority. Prosecution of corrupt public officials is often stymied by claims of ethnic lynching.

What is most disconcerting is that our institutions of higher learning are organized by this ethnic paradigm. In some public universities, academic departments are ethnic enclaves, just like. The new universities we have been spawning over the last 10 years are essentially ethnic fiefdoms. The post election violence of 2007/2008 has provided an easy justification of what was already a fairly standard practice. Education, irrespective of the level, does not make a difference.

I only hope that whatever the outcome of the referendum, the people of Kenya can have the courage to engage in an honest and robust debate. We need a robust debate that can bring to the fore the big and urgent questions of our multiple identities, histories and fears. The events of 2007/2008 presented an opportunity for debate but we as a nation lacked the courage.

For many Kenyans, this referendum, especially the promise of a new constitutional dispensation, seems to be the universal panacea for all that is wrong and frustrating with the country.
There is a veritable burden of misconceptions and false expectations about what a constitution can and should do. We forget that there are critical boundary conditions of social trust and cohesion that must exist to enable a new constitutional order to flower.

The frustration that many Kenyans have, especially those not favored by the prevailing political arrangement, is to do with the excessive powers vested in an ethnicized presidency, impunity that enables and underwrites ethnic fiat and the uncertainty about whether their tribe’s turn to loot will come soon enough.

In Kenya, identities are multiple, allegiance is to ethnic grouping and most people do not feel a part of the whole. To the extent that a constitution embodies a people’s nationhood and enshrines fundamental rights and obligations of citizenship, identity presents a serious challenge to the intention, purpose and promise of a new constitutional dispensation.

For all intents, political and practical, we are collection of ethnicities under one administrative conglomerate, Kenya. Loyalty is first and foremost to one’s ethnic group. The three successive governments have governed by the logic of ethnic expediency.

Passing the draft law will not give us the thing we sorely need, a Kenyan Nation. But passing the draft law could give us the courage to start on the long and hard road of building a nation.

Saturday, July 31, 2010

Conditional cash-transfer programs for Africa

Conditional cash–transfer (CCT) has been hailed as Brazil’s most progressive and successful social protection or anti poverty program. Cash transfer is conditional on a household – typically those with children and young family members – using health, education or other services that policymakers consider of public interest.

The number of people who benefit from these program in the developing countries is large and growing, making CCT a valued tool for fighting poverty. In Brazil CCT covers approximately 12 a relatively modest budgets (less than 0.5% of GDP). Indonesia is currently working to replace an unconditional cash transfer program currently reaching 19 million households with a CCT program.

CCT is becoming fashionable and Africa is not being left behind. In 2008, Ghana launched CCT though its Livelihood Empowerment Against Poverty (LEAP). The program aims to reach one-sixth of the extreme poor within five years. The National Poverty Eradication Programm (NAPEP), with funds from the Heavily Indebted Poor Countries (HIPC) initiative, has launched Nigeria’s In Care of the Poor (COPE). COPE provides cash transfers to extremely poor and vulnerable households, on condition that adult members attend training sessions, keep their children in school and utilize health services.

In 2007, the government of Sierra Leone launched a pilot cash transfer programme, the Social Safety Net (SSN), which targets the elderly with no other means of support.

In Mali, a pilot CCT program was launched in Mopti and Kayes, two regions in Mali with the lowest school enrollment, with support from UNICEF. Modeled on Brazil’s CCT, poor households receive $ 10 a month on condition that children attend school a least 80 % of the school year.

In the case of Brazil, with effective targeting, CCT has been effective in addressing structural poverty. Most importantly, CCT can provide a veritable windfall in human development where basic social services are available but demand is weak.

Developing national conditional cash–transfer programs will pose a number of challenges in African countries where poverty is so widespread, state capacity to deliver basic social service is low and heavily dependent on foreign aid.

A more cautious approach is therefore necessary for Africa. More modest programs that target early childhood education, maternal and child health among poor households would yield the highest human development dividends.

Considerable resources, institutional as well as human capacity, will be needed for targeting beneficiaries as well as building the capacity for program delivery. These investments must be balanced with sustained commitment to sustained investments in expansion of high quality education and health services.

Saturday, July 17, 2010

Protected Areas have failed to protect Africa's Wildlife

Protected areas in Eastern Africa like Maasai Mara, Amboseli and the Serengeti have seen populations of large mammals decline according to a study published online in Biological Conservation.

Ian Craigie and colleagues from Cambridge University, London Zoological Society, UNEP World Conservation Monitoring Centre and Royal Society for the protection of Birds, created a multi–species index of change.

The index revealed on average about 60 % decline in population abundance in protected areas between 1970 and 2005. The results show that although protected areas (parks and national reserves) are the cornerstone of national and global biodiversity conservation, they have generally failed to prevent widespread loss of Africa’s large mammal populations.

Protected areas, especially in Eastern Africa are visited by thousands of tourists drawn by charismatic wildlife species including lion, elephant, buffalo, leopard and rhino. The continued decline of these mammals will undoubtedly have huge economic implications as a result of decline in tourism

The authors suggest that the observed decline has multiple causes including over–hunting and habitat conversion, both driven by rapid population growth and the commensurate increase in resource consumption.

It is interesting that in the Craigie study, climate change (especially precipitation), did not explain the observed patterns of decline in wildlife population abundance. Statistically, I find this implausible. On the contrary, the most recent and notable widespread wildlife deaths in Kenya’s Amboseli National Park have been attributed to prolonged drought.

Moreover, a recent study by J. Ogutu published in the Journal of Zoology showed that wildlife population declines coincided with habitat deterioration due to desiccation attributable to rising temperatures and recurrent severe droughts. I am surprised that the Ian Craigie and his colleagues did not cite this paper.

It is not clear whether the authors paid attention to the fact that existing protected areas are becoming increasing isolated and hence unlikely to provide the full range of habitat resources necessary for the maintenance of viable populations of large mammals.

The authors make reference to local scale ecological and anthropogenic interactions occurring in individual protected areas but it is unclear from the paper how this might explain regional variation in decline patterns, especially between Eastern and Southern Africa.

Sunday, July 11, 2010

Training the next generation of African farmers is imperative

A South African farmers’ group, Agri SA, has received invitation from several African countries, including Egypt, Zambia, DR Congo, Sudan and Mozambique, to invest in agriculture to produce export crops.

According to Agri SA, Sudan has made land available in the upper Nile Delta, where they focus on sugar production. Egypt is inviting more South African farmers to go and start growing fruits. Mozambique, they are offering us land to grow sugarcane for biofuels. Zambia was also offering land for growing maize.

The heart these land deals Congo’s plan to improve food security by allowing South African farmers to lease land for up to 105 years to grow maize, soya beans as well as for poultry and dairy, will be one of the biggest land agreements on the continent

China is keen to explore agreements over joint investment ventures with Agri SA in agriculture on the African continent. China wants to create a market for their chemicals and equipment manufacturing.

Potential financiers for infrastructure are also seeking commitment of the South African farmers that they will invest in some African countries before they release funds to invest in roads, dams and energy.

The white South Africans are providing technical capacity while China is bringing the machinery and the infrastructure. This is interesting! Where are local African farmers? What can we learn from this?

Its is clear that white South African farmers have what African farmers lack; technical know how for modern agriculture.

I think Africa must invest in the education of the next generation of farmers and equip them with the knowledge and technical skills. Investment in extension services, farm inputs and access to micro credit is certainly not adequate.

See full story in Reuters July 9, 2010

Monday, July 5, 2010

The impact of China's rising consumption on greenhouse gas emissions

China has embarked on most rigorous national energy efficiency campaign on the planet. Beijing has dictated stringent efficiency standards for lighting and gas mileage for cars.

In the last three years, China has decommissioned more than a thousand older coal-fired power plants that used technology of the sort still common in the United States. China has also surpassed the rest of the world as the biggest investor in solar panels and wind turbines.

But while the Chinese authorities are dictating energy policies, the consumer appetite of a burgeoning army of middle class Chinese will undermine these efforts.

China’s 1.3 billion people are hungry for bigger cars, electricity-dependent home appliances and for more creature comforts like escalators and air-conditioned malls.

A new dimension in China’s energy use has emerged, without the guessing or anticipation by policy makers, access and use of air conditioning has been a factor in the recent spate of labor unrest at factories across the country.
The older generation of low-income migrant workers tolerated oven-hot sleeping quarters and factories. Chinese are now demanding air-conditioning at both at home and in factories.

The consequence is that China will become less energy efficient and contribute more to global warming as it gets more prosperous.

See full story in The New York Times @

Sunday, July 4, 2010

Agricultural production in East Africa: Light at the end of the tunnel

Agricultural production in Eastern Africa is at the crossroads. Persistent food shortages are now being amplified by climate change, rapid population growth, scarcity of arable land and rising food prices.

There are three critical opportunities that can help transform agriculture in East Africa into a force for economic growth. First, the East African Common Market, which came into effect on 1st July 2010, provides new incentives for agricultural production and free trade across the region. Second, advances in science and technology globally offer East Africa new tools and innovation needed for resilient agricultural production systems. Third, strengthening technical competence of East African farmers (especially women) through innovative institutional reform to support a closer integration and collaboration between universities and national agricultural research institutions. Currently, most research in agriculture is carried out in research institutions that do not teach while universities have limited access to research support.

In the larger context of promoting regional integration, there is urgent for new policies and institutional models to enable and support the alignment of research science and technology goals with agricultural development investments.

Saturday, July 3, 2010

Communicating the science of climate change

The scandals over email leaks at the University of East Anglia and the dodgy data in the Fourth Assessment of Report of the Intergovernmental Panel on Climate Change (IPCC) have undermined public confidence in the scientists and how they conduct science.

An article published in Nature Vol. 466 page 7 has got scientist debating and reflecting. It is abundantly clear that is certainly not enough for scientists to lay out facts very, very clearly. Building public trust demands that scientists take seriously their role as leaders honest brokers.

The scathing attacks on scientists and the scientific basis of climate change has no doubt contributed to a vicious storm of public skepticism. There is a great deal of gaps in our current knowledge and there are many uncertainties in our models of future climate scenarios.

The premise of our call for concerted global action must not be undermined by questions about how we collect analyze and communicate the evidence. In particular, unnecessary restrictions on access data or sharing information on how the data was analyzed raise suspicion about scientific integrity and erode public confidence.

Scientists must recognize that climate change issues resonate with the general public, the business community and politicians on a variety of levels. Although facts matter, scientists must strive to engage the public in plain language and with accurate, credible and timely information whenever possible.

Public communication is important to raise public awareness and mobilize collective action. The use of the media, public lectures and policy briefs is certainly critical but not sufficient to elicit behavioral change at the scale needed to forestall dangerous climate change.

Work from social science (including the ‘diffusion of innovations theory’, ‘agent-based models’ and ‘social contagion models’) shows that a more effective way of transmitting new ideas is by influencing through near peers – a wide but homogeneous community. Public-health experts are aware and apply these ideas. I am not sure many climate scientists are exposed to these ideas.

As scientists, our knowledge and understanding of the impact of the Earth’s changing climate is not complete and will never be complete. And it does not have to be complete. The fact that scientists cannot understand fully or predict exactly the impacts of climate change could very well be our most potent argument for decisive and robust action to change how we live.

Tackling the HIV/AIDS pandemic: The opportunity is big but the labourers are few

The current issue of The Lancet has several articles on HIV/AIDS, ahead of AIDS 2010—the International AIDS Conference in to be held in Vienna, Austria between July 18 and 23.

2010 is significant because it is the year set by world leaders as the deadline for achieving universal access to HIV prevention, treatment, and care. Regrettably, we as a global collective will not meet this ambitious and imperative goal.

But there is something we can all celebrate. Advances in understanding of HIV biology and pathogenesis, and in application of that knowledge to reduce morbidity and mortality, rank among the most impressive accomplishments in medical history. Nothing, since penicillin, rivals the development of antiretroviral drugs in controlling a previously fatal infection. Today Antiretroviral therapy (ART) is potent, convenient, and typically well tolerated.

In the current issue of the Lancet, Ian Sanne and others report the findings of a randomized controlled study to compare nurses-managed and physician-managed therapy of ART in South Africa. A composite endpoint indicative of multiple aspects of ART delivery showed that nurse monitored therapy was not inferior to doctor monitored therapy. Most importantly, I think, the study reports no difference in mortality, viral failure, or immune recovery between study groups.

These findings lend support to observational data from other treatment programs reporting successful use of task shifting in HIV care, especially in resource-poor countries. Furthermore, these findings are especially critical for the expansion of ART services is urgently needed in resource-poor countries to achieve universal access expansion of universal testing and treating strategies.

The role of nurses and task shifting is even more critical from a public policy perspective when you consider that there are less than 10 physicians per 100,000 people in sub-Saharan Africa.

It is important to look at the findings of Ian Sanne et al study in context of the fact that HIV/AIDS presents a monumental challenge to health care systems in sub-Saharan Africa where people with HIV-related diseases occupy more than half of all hospital beds. Government-funded research in South Africa has suggested that, on average, HIV-positive patients stay in hospital four times longer than other patients.

Increased public investment in training and deployment of nurses in the community to deliver ART would help to ease the burden of HIV/AIDS related morbidity on Africa’s fragile and under resourced health care system.

The International AIDS Conference in Vienna 2010 should be less about bemoaning the lack of resources, dwelling on dreadful evidence of AIDS fatalities in Africa, elaborating the failures of universal access goals of United Nations General Assembly Special Session (UNGASS) and more about the harnessing the enormous opportunities for doing more with less to provide relief and hope to millions of people infected or affected by HIV/AIDS.


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