Wednesday, June 27, 2007

The worlds of poverty and policy: Can compassionate be an adjective describing a technocrat*?

My smashing roommate/classmate Emily Stanger just posted a must-read entry in her blog, reflecting on the tensions between hard-nosed technocratic policy and compassionate connection to the poor. This issue has been the subject of many, many late night conversations over the past week, and Emily's entry has captured beautifully the complexities that have quite literally kept Emily, Yue Man and I up all night. As I write this at the end of my third consecutive 15 hour day working (until 11 PM) in the uber-technocratic Ministry of Finance, I'm crossing my fingers that her conclusion is right! In any event, definitely take a look at Emily's blog for some insightful food for thought.

And thank goodness for brilliant, passionate, and amazing people like Emily!

Friday, June 22, 2007

Making magic for Liberia's children

It is little wonder that Liberians suffer from ill health. The country’s hot, rain-soaked climate provides a feasting frenzy for dozens of dreadful diseases: cholera, lymphatic filariasis, yellow fever, and river blindness, to name a few. Above all, just one disease --- malaria --- poses the single greatest health threat. Spread by the bite of an infected mosquito, malaria is so pervasive in Liberia that it is deemed hyperendemic. The disease kills a staggering number of children – one of every two children that dies before the age of five is killed by malaria -- and is one of the primary reasons that Liberia has the fourth highest rates of child mortality in all of Africa.

Yet in the face of these pernicious diseases, the government’s capacity to fund life-saving medicines, clinics, and health programs is woefully inadequate. Liberia has only recently emerged from two decades of civil war, which left the government saddled with more than $3 billion in foreign debt and constrained by a shattered revenue base. Last year, the entire budget of the Government of Liberia was just $129 million and was divided among many additional pressing priorities. Thus while the health needs of the country are mammoth, they dwarf the government’s ability to finance them. Today the Government of Liberia spends less than $5 per person per year for health, a teeny fraction of the average $5,627 per person that the United States spends annually, and hardly enough to keep its citizens healthy.

Worrisome still is the shortage of trained health care workers in Liberia. For a country of more than three million people, there are fewer than 40 Liberian doctors and 50 nurse midwives. To put this into perspective, the building on M Street in Washington, DC that houses my primary care physician has more doctors sitting together under one roof than there are Liberian doctors in the entire country of Liberia. Moreover, years of destruction and looting during the war severely damaged the health infrastructure throughout the country.

Perhaps most damning is the reality that Liberia does not yet have the tools in its arsenal to win the battle against infectious diseases. Without a vaccine to prevent malaria, treatment efforts have been undermined by the increasing resistance of mosquitoes to antimalarial drugs, and prevention efforts with treated bednets have made only modest strides. Yet success is possible. In spite of all of the deficiencies in Liberia’s broken health system, one of the most stunning accomplishments has been the immunization of more than 95% of Liberian children with the measles vaccine and the subsequent slashing of measles deaths. Imagine the sheer number of lives that could be saved if Liberia had a malaria vaccine!

Today the world – and Liberia – still waits for a malaria vaccine to be developed. Unfortunately, the shallow pockets of Liberia’s citizens alone will not induce the private sector to step up to the plate. Three quarters of Liberia’s citizens live on less than a dollar a day and few if any have access to health insurance. This poverty makes Liberians – and their neighbors in Africa, a continent which accounts for 90% of malaria deaths worldwide -- unlikely customers for expensive new health technologies, and provides little financial incentive for costly investments by pharmaceutical companies in the discovery and development of life-saving vaccines. Too often, diseases like malaria are then sidelined from the global research agenda.

Thankfully, there exists a promising new solution to this colossal market failure. This year marked the launch of the first ever "Advance Market Commitment," an innovative financing mechanism that creates commercial incentives for pharmaceutical companies to invest in the development of life-saving medicines that they may otherwise ignore. To do this, the Advance Market Commitment enables international donors to make a binding commitment to finance a specific vaccine (such as a malaria vaccine) if and when it is developed, at a price that is profitable. The brilliance of this scheme is that it allows donors to unleash the powerful ingenuity and innovation of the private sector, aligning technological advances with the greatest social good. In February donors committed $1.5 billion to such a mechanism to spur the development of a vaccine to prevent child pneumonia. Should donors decide to act, a similar mechanism for malaria may not be far behind.

A sobering year of grad school has already drained from me any illusions of holy grails or “silver bullet” solutions for ending poverty. To be sure, a malaria vaccine is not a panacea -- it cannot fix the gaping weaknesses in Liberia’s health system, nor perform miracles with Liberia’s budget – but it sure comes close. Saving the lives of half of Liberia's children who die before they reach their fifth birthday with just one powerful shot? Sounds pretty miraculous to me.

Tuesday, June 19, 2007

Meeting Madam President

On Sunday our group had the distinct honor of meeting the wondrous President of Liberia, Ellen Johnson Sirleaf. Giddy with excitement, the females in our group prepared for the big event by recruiting my most fashionable colleague to bring us to a tailor to have African dresses made. (Word to the wise: Liberian dresses are gorgeous). Donning our new getups and with great anticipation, we headed to meet the President.

The President arranged a reception in her backyard for our group of interns and the Ministers with whom each of us work. After greeting us and listening to a description of our internship projects, the President -- who had just returned from a football match against Equatorial Guinea (with a final score of 0-0) -- strongly encouraged us to take on challenging work and to contribute substantive policy analysis to her Government. Her razor sharp analysis of our internships -- immediately picking out those who were underutilized and offering great suggestions on additional work -- made a strong impression on all of us. Also, I was very touched to see the President working so closely with her sister, who presided over the reception. I too am very close with my own sisters and will even be joined in Liberia this summer by my beloved younger sister and writer extraordinaire Colleen, who has been commissioned to write some magazine pieces about Liberia.

During our conversation with the President, Emily asked how the President sustains herself through all of the many challenges and frustrations in her job. "The possibility of transformation" was her answer, a very fitting response to a group of students who believe firmly in her potential to make that possibility a reality.

**For more on President Sirleaf and her heroic efforts in Liberia, see the first post in this blog.**

Team Liberia

I am extremely fortunate to be accompanied in Monrovia this summer by a stellar cast of 6 other graduate students from the Kennedy School. From the MPA/ID program are Yue Man Lee, Rupert Simons, Jesse Torrence, and Emily Stanger, and the MPPs are represented by Zach Neumann and Yesenia Mejia. We've also adopted Jeff, a law student at Columbia University, into our merry family. I've relished the group's endless comic relief, lively entertainment, and the invaluable sounding board as we process and reflect on our experiences in Liberia. Moreover, my learning has multiplied many times over as I learn from my classmates' perspectives from each of their respective ministries of gender, agriculture, health, and state.

A few individuals have been particularly helpful to our group. Steve Radelet, principal economic advisor to Liberia and Senior Fellow at the Center for Global Development, has been an amazing mentor and an invaluable fountain of knowledge and contacts. Mrs. Thelma Johnson in the President's Office has been an angel: setting us up with housing, arranging all of our logistics, and very warmly welcoming us to Liberia. Zach, Emily and I are also deeply grateful for the extremely generous financial support of the Nancy Germeshausen Klavans Cultural Bridge Fellowship, and to the Women and Public Policy Program at Harvard.

Unthinkable atrocities

Until two weeks ago, my answer to the question “what is the worst problem in the world?” would have been “poverty,” without any hesitation. Since I first looked it in the eye in Mexico City’s sprawling slums more than a decade ago, grinding poverty has moved me more deeply than any other issue on the planet. The inhumanity of millions of families living in, quite literally, the scraps of human existence -- in miles of slum dwellings made of squalid refuse, in impoverished rural communities barely eeking out a subsistence living – has been the driving force in my career path and current studies in international development.

And yet Liberia has confronted me with an even more shocking face of inhumanity: violent conflict. It turns out that war sucks. Really, really badly. Not exactly earth shattering news, right? But for me, during these past two weeks as I’ve delved deeper into Liberia’s bloody history, it actually has been.

The personal stories I’ve heard from the mouths of survivors have caused me to seriously question the human race, and the male gender in particular. Family members being brutally murdered, raped, and tortured. People repeatedly fleeing as refugees to Guinea, Sierra Leone and the United States. Living in terror without food for days on end. Losing a decade of education. Even more disturbing are the stories printed daily in the newspapers here of Charles Taylor’s alleged war crimes -- so gruesome that I can barely process them as fact, and not the fictitious script of the most violent horror movie in Hollywood history. Women being forced into sex slavery with rebel leaders, children being forced to kill - or even eat - their parents, widespread amputations, and absolutely horrific rapes (that continue unabated to this day).

Thankfully Liberia is peaceful and stable, at least for now -- 15,000 UN peacekeepers will do that to a country -- and there is so much rebuilding and bustling life in the streets that it is hard to believe that this country just went through hell. But it did, and I am amazed by people's resilience in looking ahead to the future and not to the bitterness of the past.

Yet I can’t help but wonder: just how thin the veneer of calm is. How a society so ripped apart by unspeakable atrocities can possibly forgive, heal, and move on. How the small, incremental improvements along the very slow road to rebuilding will be enough to quell the urge of former combatants to return to chaos. How an entire generation of youth schooled with guns and not pencils can ever believe in their future. And how on earth we can stop this from every happening again.

** A fantastic read on this topic is the book "A Long Way Gone," a memoir of a remarkable former child soldier in Sierra Leone.**

Voyage to Sierra Leone Border

On Saturday, Emily, Zach and I headed off on a road trip to Liberia's northern border with Sierra Leone. The spontaneous road trip, organized by Zach's Liberian colleague in Protocol, provided us our first taste of Liberia beyond the capital. Our 5 hour drive along Liberia's best road -- broken up by two dozen UN security checkpoints -- provided us glimpses of rubber plantations, incredibly dense green vegetation, simple villages, and colorful local markets.

During our stop at the (remarkably informal) border, we spent some time wandering through the local market on the Liberian side. Thanks to my penchant for travels to such places as India, Kenya and Bolivia, I've grown quite accustomed to looking like a 6'2 redhaired alien and to eliciting bewildered stares from locals. Normally I deal with the awkwardness of these interactions by using silly/friendly antics to transform the intense stares into smiles and laughs: without a doubt, being a crowd-pleasing clown is strongly preferable to parading as a circus freak. I must say, though, that the women at the Saturday market selling hot peppers, cassava, and dried fish were not an easy to crowd. Not one person cracked a smile, perhaps a reflection of the difficult circumstances of their life (or perhaps our inappropriate foreign presence!), and Emily and I scurried out of there quickly. Much to our relief, the children in the area were much more playful and curious and Emily and I had a blast playing games with them.

One of the most striking images at our stop in the border town was the sight of teenage boys with a great deal of attitude cruising around on motor bikes. We had learned earlier that the money that many of the young ex-combatants and former child soldiers earned when they turned in their guns was, by and large, spent immediately on the purchase of motor bikes. While there is little doubt that the disarmament process was crucial, the byproduct is quite disturbing. These teenage boys are now marked almost like a gang, and their possession of very cool looking bikes undoubtedly incites envy and even resentment in the others in the community. (One sunglass and fancy sneaker-wearing motorbiker had an attractive female on the bike). Emily and I both left questioning the impression that this image is making on the same young kids we played with, and the lesson they are learning about the consequences (or rewards) of partaking in highly undesirable violent behavior.

Thursday, June 14, 2007

Putting Women in the Driver's Seat

Liberia's Leading Ladies:
Finance Minister Antoinette Sayeh with President Ellen Johnson Sirleaf

“It took men three decades to destroy Liberia, and it is now the women who are fixing it.”
-- quote from one very impressed man in Monrovia--

Anyone who questions the promise of female leadership needs only to step foot in Liberia to cast aside any lingering doubts. My experience over the past week has revealed one unambiguous fact: Liberian women are driving this nation forward. President Sirleaf is the most obvious example, but behind her are so many other effective, talented women who are delivering the results that this country desperately needs.

Consider for instance Mary, the dynamic spark plug who our group met our first day in Monrovia. Mary was personally recruited by the President to return to Liberia after nearly 30 years in the Bronx to run the President’s special projects. If the tight ship that she runs in her spare time at her kitchen-turned-restaurant is any indication, I have little doubt that Mary is lighting a fire under the Passport department (which she recently took over) and taking no prisoners in the process.

At the Finance Ministry where I work, evidence of women’s “get things done” approach is everywhere. Finance Minister Sayeh’s results-oriented management has already borne impressive fruits: revenues and expenditures have more than doubled, the budget has been balanced, and responsible financial management established. Likewise, the boundless determination of two other female managers in the Ministry has resulted in record-breaking revenue growth and the elimination of hundreds of “ghost workers” from the Ministry’s bloated payrolls. The competence, integrity, and effectiveness of the female managers I interact with in the Ministry contrasts with the power-seeking, “me first” attitude that so often prevails in governments worldwide.

In very nerdy terms: If government leadership in Liberia under women were a dummy variable (with value 1, and male leadership taking value 0), I would venture to guess that its effect on economic growth, reduction in corruption, efficiency, law and order, and poverty reduction would be enormous and statistically significant.

Sunday, June 3, 2007

Arrived in Monrovia!

I've arrived in Monrovia! After a rejuvenating stop in Paris and London, my classmate and dear friend Yue Man (who will be interning with the Ministry of Health) and I set out June 1st on our epic journey from London Gatwick airport to Monrovia, by way of Brussels and Dakar. Our flight was thankfully uneventful aside from the excitement around the Cameroon soccer team on board, who handled the passengers-turned-paparazzi with impressive patience (and later beat the Liberian team 2-1).

Having never before set foot in a post-conflict environment nor in West Africa, I was unsure of what to expect upon our arrival in Monrovia. In several respects, I have been pleasantly surprised with the conditions of the city. Particularly in the traffic-clogged downtown center, the city is alive with bustling activity, restaurants and shops have a fresh coat of paint and no shortage of customers, and the rebuilding process is very noticeably underway. That said, relics of Liberia's tumultuous recent history abound: the giant skeletons of decaying buildings, the makeshift dwellings that haphazardly house the million plus displaced Liberians who have more than doubled Monrovia's population, and the presence of thousands of armed UN peacekeepers.

Several distinct features of Monrovia immediately stand out. The sheer number of Christian churches is mind boggling: Southern Baptist, Methodist, Seventh Day Adventist, Lutheran, you name it, the denomination is thriving in Monrovia, with a freshly painted Church to match. Our friendly Liberian driver, Collin, suggested that the surge in religiosity stems from the hardships endured during the war, when religion provided comfort and meaning in the midst of chaos. We enthusiastically expressed interest in joining Collin on Sunday for his church service until he informed us that it lasts six hours (!).

Competing with churches for monopoly on Monrovian real estate are the development NGOs that occupy just about every third building in town. Africare, Oxfam, Carter Center, American Bar Association, the list is endless. Magnifying this foreign presence is the endless fleet of UN vehicles with ginormous antennas that cruise the streets and congregate in the parking lots of expat bars, restaurants, and supermarkets, where the cost of a box of imported Pop Tarts rivals the weekly pay of many government employees. So prominent is the UN presence that the busiest road winding through town has been renamed "UN Drive." While few could question the need for the UN and NGO missions during the rebuilding of Liberia, the disparity in lifestyles between foreign expats and the vast majority of Liberians is unsettling at best.

Friday, June 1, 2007

Finance Ministry Internship

This summer I will be interning with Liberia's Minister of Finance, Antoinette Sayeh. The seeds of this internship were first planted in September when I heard President Sirleaf speak at (her alma mater) the Kennedy School of Government, where I currently study. Deeply inspired by the President’s visionary leadership, I decided moments into her speech that I would go to Liberia and support the work of her government. As a student of international development and someone deeply concerned about poverty, I have long been interested in spending time in West Africa, the poorest region of the globe. Liberia, in particular, promised a fascinating case study of the prospects for good governance and sound policy delivering development in a post-conflict environment.

My internship with Finance Minister Sayeh was made possible by the tremendously helpful mentorship of Steve Radelet, principal economic advisor to the Government of Liberia and senior fellow at the Center for Global Development. I am also deeply grateful for the financial support and sponsorship that has been generously provided by the Women and Public Policy Program at Harvard and the Nancy Germeshausen Klavans Cultural Bridge Fellowship.

In the face of so many urgent social sector needs -- resurrecting schools, training doctors, vaccinating children -- the finance ministry's mandate of financial management and budget discipline can seem impossibly inhuman and technical. Yet establishing an efficient, accountable, and corruption-free public administration is essential to the attainment of all other development goals and to the government’s gaining legitimacy among the people of Liberia. Previously, the finance ministry was the hub of the country's most egregious corruption and plundering. In striking contrast, the current Ministry of Finance under Minister Sayeh has set a remarkable record in less than a year that includes balancing the budget, increasing government revenues by nearly 50 percent, and establishing sound public financial management. This prudential financial management is crucial to Liberia’s objective of attracting international donor assistance to finance its cash-strapped poverty reduction strategy.

My work will focus on a range of development-focused policies, including:
 Debt relief
 Private sector development and employment creation
 Addressing constraints to access to finance
 Investment code and tax reform

One of my primary projects will focus on the issue of Liberia’s external debt and the pursuit of urgently needed debt relief from the donor community. Liberia’s mammoth outstanding debt of nearly $4 billion was accumulated during corrupt military regimes in the 1980s. Today it serves as a formidable obstacle to essential social sector spending, while at the same time distracting limited human resource capacity from priority government tasks. Clearance of arrears and resolution of the debt problem is thus a top priority of the Ministry of Finance.

Liberia: History unfolding

Liberia first captivated my attention 18 months ago, in January of 2006. Virtually unknown to me previously, the small West African nation made headlines worldwide when Ellen Johnson Sirleaf was elected as the country’s exceedingly competent president and the first ever democratically elected female head of state in Africa.

Few countries evoke as elevated a sense of optimism, of transformation, and of history unfolding before one's eyes, as Liberia today. Once ranked among sub Saharan Africa's middle income countries, Liberia was ravaged by a devastating civil war and decades of misrule and corruption. Fourteen years of conflict claimed the lives of nearly 300,000 people, displaced another 500,000, and left the country’s social fabric, infrastructure and economy in ruins. Thirty years ago Liberia boasted a per capita GDP comparable to those of Egypt, Indonesia and the Philippines and more than double that of India. Today average income in Liberia is just 30 cents a day: a shocking 30% of the extreme poverty line, and a mere 10-20% of pre-war income levels.

President's Sirleaf's election in 2006 marked the dawn of a new era of hope. Known affectionately as the “Iron Lady,” President Sirleaf is a shining star of good governance amidst a sea of corruption in the African continent. Beyond her impressive credentials -- Harvard educated and years of professional experience in the government and the private sector -- President Sirleaf earned widespread respect for her courageous opposition to the previous regimes, which even landed her in jail. Visionary, competent, incorruptible, effective and development-focused, Ellen Johnson Sirleaf is one of the most remarkable leaders on the planet today, and one of my personal heroes.

To be sure, the challenges facing President Sirleaf and her government are immense: For a country of nearly 3.5 million people, there are just 43 Liberian physicians and 21 nurse midwives. Liberia is one of the only countries on the planet where today’s generation of children has less education than their parents. Schools and hospitals have been destroyed, unemployment stands at some 85%, and electricity is limited to just 10% percent of residents in the capital city, and nowhere beyond. Faced with such daunting tasks of rebuilding, President Sirleaf has set out with compassion, sound policies, and bold leadership to deliver poverty reduction and economic development to her country.

It is from the pages of Liberia's unfolding history that I seek to learn this summer, and upon which I will reflect in this blog over the coming 8 weeks. I invite you, too, to learn from Liberia's courageous experience and to share your views and reactions. (Blog comments are warmly encouraged!).