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Progress for the very poor: Evidence from six countries

A multifaceted program causes lasting progress for the very poor: Evidence from six countries.


The Lancet Commission on #GlobalSurgery Report

Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development Watch Live The Lancet Commission on Global Surgery Report.

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Drivers of Global Cardiovascular Mortality

New article from GBD 2013 data shows Demographic and Epidemiologic Drivers of Global Cardiovascular Mortality — NEJM.


Three important things you didn’t know about diabetes

This week, lead blogger Dr Alessandro Demaio of the Harvard Global Equity Initiative returns to lay things straight on a leading cause of global deaths. When we think of diabetes, we tend to think of rich people with poor lifestyles. A chronic disease linked with obesity, heart disease and worse outcomes for some infectious diseases, diabetes tends to be associated in our minds with wealth, excess and over-consumption. But it’s not. Diabetes is a disease that results in higher-than-healthy sugar levels in the blood and can lead to some disastrous outcomes – including blindness, kidney disease and heart disease.

Can aid agencies help systems fix themselves?

This essay first appeared on Duncan Green’s blog, From Poverty to Power. It was a follow up to a lecture on complexity and development which I gave to Duncan’s international development course at the LSE. Duncan wanted me to explore the “so what?” for development agencies in more detail, so here are my thoughts. You can read comments and discussion about this essay on FP2P. If economic development is a property of a complex adaptive system, as I’ve argued elsewhere, then what, if anything, can development agencies and NGOs do to accelerate it

Progress for the very poor: Evidence from six countries

World map

A multifaceted program causes lasting progress for the very poor: Evidence from six countries.

Take Care

It’s interesting to note the emergence of two strands of discussion in the public space around humanitarian aid and development. One is the issue of chronic and/or traumatic stress and accompanying PTSD among humanitarian workers. In an earlier post I pointed out this article in The Guardian, and then a more recent offering in the […]

Globalization and the health of Canadians: ‘Having a job is the most important…

Background: Globalization describes processes of greater integration of the world economy through increased flows goods, services, capital and people.

Emerging doctors call for action on global epidemic: non-communicable disease

This week, special guest-bloggers and Australian doctors-in-training, Rebecca Kelly and Tim Martin of the Australian Medical Students’ Association, call for greater focus, discussion and action on the world’s leading causes of death. In March this year, the Australian government released the 2015 Intergenerational report revealing a prediction of the economic and social trends over the next 40 years. There’s some fantastic news; children born in the middle of this century are projected to live greater than 95 years. Importantly, this increase in life expectancy will involve an improved quality of life and Australians will be more prosperous in real terms. However, the report comes with a warning.

Twitter Rudeness on The Paradox of Behavioral Economics

The behavioral economics pioneer Richard H. Thaler wrote a column in the New York Times yesterday, on how people can behave irrationally in a way that leads to not so great outcomes. The column gave examples of such problems and some suggested fixes. I posted a comment on Twitter that came across as a harsher and more dismissive critique of Professor Thaler than I intended: Behavioral econ @R_Thaler says we are too dumb to fix our own mistakes but smart enough to fix everyone else’s I will try to blame the rudeness on the severe 140 character limit on Twitter, combined with bad judgment and orneriness. (But I think another  irrational bias is that we all tend to dismiss situational explanations for behavior like 140 character limits and to  believe that everything is intentional; plus I should be held responsible anyway.) I put the longer and politer version of the intended (unoriginal) critique –the Paradox of Behavioral Economics — into an email apology to Professor Thaler (which he graciously accepted): What I meant was that any fix to irrational behavior would still have to be designed, approved, and implemented by other individuals who are also themselves subject to irrational biases.

Op-Ed in New Times on Labour Day

Below is an Op-Ed I composed for the New Times that was published on Labour Day in Rwanda. May we continue to “ignore detractors”.
For Op-Ed – visit:

“Today, as we celebrate the International Labour Day, I reflect upon the great challenges that Rwanda faced 21 years ago and then consider the great progress that has been made by all the workers in Rwanda; I am so proud to call Rwanda my home.However, when I read news articles suggesting that our progress is somehow “following in the footsteps” of other countries, I find this argument wanting. Though it may not be intentional, such a characterization of our progress has the insulting implication that workers in Rwanda are incapable of seeking out innovative solutions to improve their lives on their own.My conclusion is that some of the people who make such claims, many of whom have never set foot in Rwanda, believe that a country of black people in the heart of Africa is incapable of achieving the kind of progress they only read or hear about.On the contrary, under the visionary leadership of President Paul Kagame, workers in Rwanda have demonstrated great will and ability to plan and deliver substantial improvements on our economy, health, education and governance sectors.After 1994, much of the world viewed Rwanda as a failed state. They expected us to stay disorganised. That has always been their expectation of black Africans, a pre-judgment that is not immune to racism. Indeed such analysis unveils a pernicious double standard.Thus, for those who have observed Rwanda’s progress, they have been surprised. According to the World Bank, Rwanda still only has a GDP per capita of $638. Yet, we have made progress that exceeds this level of development.We have managed to do more with each available dollar.The world does not expect that workers in Rwanda keep streets clean, and that the country is governed according to the rule of law. A population full of energy and hope, a police force that protects and services the people without asking for a bribe, an army that protects civil rights and uses its personnel to promote the health, education and wealth of the citizens under its protection. And yet this is the reality here.And still, today, 21 years after the Genocide, people are astonished that we used our own energy and forward looking minds to get out of the dark hole that characterised our past, and even more so, that we have done this in one generation. Their surprise is due to the unwarranted low expectations of us. They cannot deny the undeniable evidence that such progress has been made, they only argue that it is because we have followed in the steps of others. Often, they suggest that we are mimicking Singapore, as opposed to building our future based on our own Rwandan values.The desire to strive for excellence is universal. To simplify the pursuit of excellence in Rwanda to an effort to “mimic” or copy another’s success undermines all the Rwandan workers who have made Rwanda’s journey possible. We do not need other countries to inspire us to work for the good for our people.We have had our own innovations that have contributed to Rwanda’s development. These include Gacaca courts, the One Cow per Family programme (Girinka), the national dialogue (Umushyikirano) during which leaders are held accountable by the electorate, and the conception of global partnerships such as Rwanda’s Human Resources for Health Programme, which is creating high quality physicians to improve our nation’s health.Other examples include community participation to facilitate vaccination of 90 per cent of our children with 11 vaccines, a record rate of coverage. Another example is the community empowerment of people in villages to select 45,000 dedicated voluntary health workers.I could also talk about the national policy to ensure equity in human development and access to health opportunities even for the most vulnerable – a pillar of our national policies – which has allowed Rwanda to have community-based health insurance (Mutuelles de Santé) a health centre staffed by nurses in each sector (except 18, to be covered soon), a district hospital in each district, and a provincial hospital in each province. In addition, three new referral hospitals are planned to ensure that Rwandan citizens are equitably served.We certainly have had the accompaniment and support of tremendous partners since 1994 and we are absolutely grateful to them, but it is the Rwandan people who, with their relentless efforts, have fundamentally driven this progress.I am grateful for the transformative leadership that holds us accountable to ensure we meet the highest expectations, that does not accept actions that would promote double standards, and promotes the fulfillment of human rights as we carry forth on this path towards a better tomorrow. Happy International Labour Day!The writer is the Minister for Health.”
*Published in Rwanda New Times – 1 May 2015 –

The CGD Rule

I’m jealous of the brilliant name recognition that the Chatham House Rule gives Chatham House (an international affairs think tank), so I propose “The Center for Global Development Rule”: “On any panel of two people or more there will be at least one woman on the panel, not including the Chair.”

Part II: One Standard To Rule Them All

I suppose now is as good a time as any to let you in on a little humanitarian aid industry nugget that, so far as I can tell, has received zero attention from any of the major news outlets that allegedly cover the humanitarian sector: The Humanitarian Accountability Partnership (HAP) and People in Aid (PIA) […]

Behavioural economics meets development economics [podcast]

What is behavioural economics, and what does it have to do with development? In the latest Development Drums podcast, I discuss this with Varun Gauri, who was co-editor of the recent World Development Report, Mind Society and Behaviour, one of the most accessible and widely-read World Development Reports of recent years. According to Dr Gauri, economists recognise that many resources are scarce (labour, capital, land etc) but fail to acknowledge that cognition is also scarce. And because of this, people routinely make decisions which are bad for them. Dr Gauri argues that these problems affect people living in poverty at least as much as everyone else, and probably more

Part I: Standards

If you’re one of those people who’s convinced that the aid industry is not accountable and doesn’t have standards, you’ll be thrilled to learn that, well, actually we are, and we do. Actually, we have for quite some time. (You probably could have just used that new thing called “Google” to discover this on your […]

Hacking human health and behaviour #wiredhealth

This week, we hand over to regular blogger Alex Abel who recently returned from London’s WIRED Health. The stage is set at the RCGP for 22 Main Stage talks, hosted by Editor David Rowan Following last year’s successful inaugural event, WIRED Health returned to the Royal College of General Practitioners (RCGP) in Euston Square, London, on the 24th of April, for a programme of exciting innovations in medicine. From augmenting our bodies to decoding the brain, the desire to have greater control over human health and behaviour seemed to be the overarching theme at WIRED Health 2015. Changing the body One of the most dramatic and noticeable changes to the human body is amputation. The loss of a limb can have a profound effect on individuals, both physically and psychologically, but more than 20 million amputees around the world currently have no access to any sort of prosthetics.

Ministry of Health Commemoration Event

I was honored to participate in the commemoration events in Nyanza where we honored 35 Ministry of Health staff who were killed during the genocide 21 years ago. Please see the New Times article, written by Jean Mugabo, that described the event. Also, you may wish to read my Op-Ed that was recently posted in the New Times on the commemoration events a few weeks ago.

Full article can be found here:
“The health sector has recommitted to fighting Genocide denial country continues to mark the 21st anniversary of the Genocide against the Tutsi. “Remembering the departed is a responsibility to every Rwandan, but it is even more important to our profession which is tasked to save lives”‘‘Everybody was created to live, not to be killed. And remember the perpetrators are still there. So, we have to fight them, and fight Genocide ideology, denial and trivialisation,” said James Kamanzi, the Acting Director General of Rwanda Biomedical Centre (RBC).Kamanzi was speaking at Nyanza Genocide Memorial site in Kicukiro District during an event to remember the 35 former employees of the Ministry of Health (MoH) who were killed during the Genocide.He noted that the Genocide was stopped by Rwandans and urged health workers to strive for self-reliance.“No one can love Rwandans or solve their problems more than Rwandans themselves. When the United Nations Assistance Mission for Rwanda (UNAMIR) left amidst the brutal killings, the RPF Inkotanyi stopped the Genocide. ‘‘So, learn from their heroic actions, never wait for foreign aid but seek to be self-reliant,” he said.Encouraging everyone to comfort and support survivors, Kamanzi stressed the importance of remembrance in ensuring that the notion of ‘Never Again’ is a reality.At least 11,000 Genocide victims are buried at Nyanza memorial site, including 3,000 who were killed at Nyanza and 8,000 from nearby areas.Naphtal Ahishakiye, the Executive Secretary of the umbrella of Genocide survivors associations, Ibuka, recounted the awful killing of 3,000 people who had sought refuge at the former Ecole Technique Officielle (ETO) Kicukiro, currently the Integrated Polytechnic Regional Centre (IPRC) Kigali. “At the height of the Genocide, the Belgian peacekeepers said that their mission was over and withdrew from ETO School on April 11, leaving at least 3,000 Tutsi behind.‘‘Interahamwe militia marched them to Nyanza and massacred them from there. About 100 were rescued by the RPF the next day when the killers were on the way to finish them off,” he said.During the event, Dr Agnes Binagwaho, the Minister for Health, led other officials at the ministry, to lay wreaths on the graves of Genocide victims there.The event was followed by a ‘walk to remember’ from IPRC to MoH offices, where commemoration activities continued. After lighting the flame of hope, participants listened to testimonies of two Genocide survivors. Constantin Ntaramana, a worker at the National Centre for Blood Transfusion (NCBT), testified how he was confined to his work place and fed on glucose for about three weeks. “I was at work in NCBT on April 6 (1994), but failed to leave when the Genocide started.‘‘I stayed there, hiding in the ceiling and feeding on serum glucose until late May when someone took me to the International Committee of the Red Cross. There, the RPF saved us from the killers,” he recalled.Theogene Hakizimana also recounted how the Genocide robbed the lives of his parents and seven siblings.“I was beaten and left for dead thrice, but survived thanks to God’s mercy.‘‘I watched my father, and siblings being killed with machetes while hiding, but later I started wishing I could have been killed with them.‘‘I used to sit by their dead bodies, waiting for my turn but I always survived,” he testified.Hakizimana, is among the few who survived in his area of Nyaruguru District, commended the RPF for rescuing him.Both Ntaramana and Hakizimana spoke of hope for a better future.”
*New Times Article –

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