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The ethical debate over the use of an untested Ebola drug

The disease is Ebola. The outbreak is In West Africa. Two infected Americans — and no Africans — got the drug, which is called ZMapp. Kevin Fitzgerald is a medical ethicist at Georgetown University who says there are good reasons not to use untested drugs, but “compassionate use” is part of the ethical consideration.

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Tensions mount between healthcare workers and Ebola-infected communities in West Africa

The Ebola virus continues to spread in West Africa months after the outbreak began in Guinea. As the deaths mount, mistrust has also boiled to the surface between affected communities and foreign healthcare workers. From PRI’s The World.

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Episode 43: Complexity

In this episode of Development Drums, I speak with Ben Ramalingam and Stefan Dercon about whether complexity and systems thinking offers actionable insights for better development interventions. Ben Ramalingam is an independent researcher who has worked with development and humanitarian organisations including UN bodies, NGOs, the Red Cross movement, and government agencies. He is affiliated with the London School of Economics and the Overseas Development Institute, amongst other institutions and is the author of Aid on the Edge of Chaos: Rethinking International Cooperation in a Complex World. Stefan Dercon is a Professor of Development Economics at the University of Oxford and the Chief Economist at the Department for International Development, the UK government’s aid agency.. In the podcast, I ask Ben to pin down what we’re talking about when we talk about complexity and complex systems, and ask Stefan whether any of this is actually new to development economics research or policy, which has long incorporated elements of complexity thinking. We debate whether systems thinking gives donors and governments new and useful tools, including for humanitarian intervention.

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The ethical debate over the use of an untested Ebola drug

Ebola

The disease is Ebola. The outbreak is In West Africa. Two infected Americans — and no Africans — got the drug, which is called ZMapp. Kevin Fitzgerald is a medical ethicist at Georgetown University who says there are good reasons not to use untested drugs, but “compassionate use” is part of the ethical consideration.


A Surprising Indigenous View of REDD+ – Mina Setra and Frances Seymour

Mina Setra, the deputy secretary general of the Indonesia’s Indigenous Peoples’ Alliance of the Archipelago (AMAN), recently visited CGD to speak at an event about Indonesia’s efforts to prepare to participate in REDD+, the UN program for Reducing Emissions from Deforestation and Forest Degradation that would offer payments from rich countries to keep tropical forests standing. Afterwards I invited Mina and CGD senior fellow Frances Seymour, the former head of the Center for International Forestry Research to join me on the Wonkcast. Our controversial topic: the complex relationships linking Indonesia’s forests, its indigenous peoples, and REDD+.

REDD+ aims to provide incentives for forest protection. That’s nothing new to Indonesia’s 70 million indigenous peoples, who, Mina tells me, “have been protecting the forests for decades” because “for us, for indigenous peoples, forests are everything.”

Though much of Indonesia’s land has belonged to and been managed by indigenous peoples for centuries, formal documentation of such ownership has typically been lacking. Mina tells me about a 1999 forestry law that claimed traditional indigenous forest as “state forest” to be managed by the ministry of forestry. As a result Indonesia’s indigenous peoples lost millions of hectares to individuals and corporations that seized control and cleared or otherwise degraded the forest through logging or conversion to palm oil plantations. Mina says that the subsequent displacement of many indigenous peoples “created a lot of problems, not only that we lost our forests but further economic and social problems.”

Frances recalls that when she first arrived in Indonesia some 25 years ago, “indigenous peoples were not only invisible, but to talk about indigenous peoples’ rights was a taboo.” Although indigenous people were recognized in the constitution, they did not have any actual operational rights to their traditional lands, she says, adding that conversations about such rights only began to gain momentum three or four years ago.

AMAN had tried to raise the issue of indigenous peoples’ rights nationally without success, Mina said. It was only when “the international community started talking about forests and REDD+ that we had the opportunity to show that we do exist,” she added. “When talking about forests, you cannot escape talking about the people who have been living there nurturing the forests since even before Indonesia existed.”

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Indigenous Peoples Rights and Redd+ by Frances Seymour

Not everybody views REDD+ so favorably. Indeed, a lively debate about the impact of REDD+ on indigenous land rights continues, as Frances explains in a new blog post marking the International Day of the World’s Indigenous Peoples. Some people continue to worry that payments for forest protection envisioned by REDD+ will provide yet another reason for outsiders to push indigenous people out of their forest homes.

“The change in positioning of indigenous groups in recognizing REDD+ as having elements of opportunity and not just threat” is quite recent, says Frances. One reason: REDD+ programs developed in consultation with indigenous peoples, such as Indonesia’s ongoing national mapping initiative.

The maps give indigenous groups the opportunity to prove the legitimacy of their land claims, and Mina hopes it will continue to grow. “We hope that in 2022, we can map forty million hectares of indigenous territories all over Indonesia, as evidence that we do exist,” she says.

However, the continued success of the REDD+ programs depends on international support, Frances explains. With the noticeable exception of Norway, this has yet to happen.

Listen to the full Wonkcast for more on indigenous efforts to be recognized in Indonesia and how Mina and Frances view the interaction between indigenous people’s rights and the global effort to reduce protect forests and thereby reduce the emission of heat-trapping gases.

My thanks to Kristina Wilson for recording and editing the Wonkcast and to Kristin Sadler for a first draft of this blog post. 


Tensions mount between healthcare workers and Ebola-infected communities in West Africa

africa-map-wiki-Author-Hristov

The Ebola virus continues to spread in West Africa months after the outbreak began in Guinea. As the deaths mount, mistrust has also boiled to the surface between affected communities and foreign healthcare workers. From PRI’s The World.


CGD Hosts Advocates at Girl Summit Satellite

(We hope that listeners who normally download the Wonkcast audio feed will find this video-rich blog post of interest!)

Nearly 200 practitioners and advocates gathered at CGD recently for an update on efforts to end within a generation female genital mutilation (FGM) and child, early and forced marriage. A satellite event for a Girl Summit in London hosted by British prime minister David Cameron and UNICEF, the CGD event was organized in conjunction with British Embassy, Girls Not Brides USA, and the Coalition for Adolescent Girls.

Welcoming the audience to the Birdsall House, CGD president Nancy Birdsall said that she had agreed to name the conference center in her honor provided that it serves not only as a space for presenting CGD’s own work but also as “a welcoming venue for the community concerned with women and development and gender equality.” She described CGD’s previous work on girls’ health and education (see here, here and here) and said that CGD senior fellow Charles Kenny is leading efforts to “find where we can have value added to an incredibly rich body of policy work and research.”

Patrick Davies, deputy head of mission at the British Embassy, then described the Summit’s core themes: “Sharing What Works” and “Agreeing an Agenda for Change.” Quoting from prime minister Cameron’s remarks at the London event, Davies said: “It is absolutely clear what we are trying to achieve. It such a simple, but noble and good ambition, and this is to outlaw the practice of female genital mutilation and early and forced marriage; to outlaw them everywhere, for everyone within a generation.”

The first panel, on Sharing What Works, was moderated by Judithe Registre, PLAN International USA, Coalition for Adolescent Girls Steering Committee, and featured:

  • Ann Warner, Senior Gender and Youth Specialist, International Center for Research on Women (ICRW), Representative, Girls Not Brides, who highlighted ICRW strategies to help end child marriage: (1) providing social support and education to girls who are at risk of early marriage and who are already married, and (2) working with girls’ families and communities as girls often don’t have the power to control their own futures. Warner announced ICRW and the World Bank will be conducting a three-year study to define the economic costs of child and early forced marriage.
     
  • Antonia Kirkland, Legal Advisor, Equality Now, stressed that ending FGM—which she said affects an estimated 3 million girls each year—is a human rights issue. While enforcement of laws prohibiting FGM can be a major deterrent, ending FGM will require further raising awareness and educating people about how they can help to prevent the practice.
     
  • Jeanne Smoot, Senior Counsel for Policy and Strategy, Tahirih Justice Center, described a 2011 US national survey of 500 teachers, police officers, domestic violence advocates and social workers, which revealed 3,000 cases of forced marriage had been encountered in the US. She announced that the Tahirih Justice Center, in collaboration with a partner in Canada, will be launching a major outreach tour this September in New York.

Between panels, a brief video of UN General Secretary Ban Ki Moon from the London event was shown. Secretary Ki Moon called for the end of FGM and early and child forced marriages and commended “global leaders and brave activities for confronting these problems, especially the courageous young women in these affected communities.”

The second panel, on Agreeing an Agenda for Change, focused on UK and US governments’ commitments to help end FGM and early and forced marriages. The panel was moderated by Rachel Vogelstein, Director of Women and Girls Programs, Clinton Foundation, and featured:

  • Emma Wade, Counsellor of the Foreign and Security Policy Group, British Embassy, who shared the UK government’s efforts, including donating $50 million to support 17 African countries to end FGM, $40 million to a joint UN program around ending child marriage, and $50 million to a new research program to find the best ways of transforming the lives of poor girls. Domestically, the UK has established and is enforcing relevant laws to provide the legal framework to address such issues and prime minister Cameron has committed $2.4 million to a prevention and care initiative.
     
  • Carla Koppell, Chief Strategy Officer and former Senior Gender Coordinator, US Agency for International Development, underscored that an integrated framework to ending FGM and child marriage – i.e., one that includes the education, health, legal and economic sectors – is critical to USG efforts. She also reiterated USAID administrator Raj Shah’s announcements from the London event, highlighting that the USG has committed to investments in Nepal, Bangladesh, and Yemen that will build on existing programs and complement efforts to change behaviors and attitudes and enforce laws surrounding FGM and child marriage.
     
  • Wanda Jones, Assistance Secretary for Health, Department of Health and Human Services, noted that data on the prevalence of FGM and child marriage in the US has been extremely limited. Efforts to raise awareness and build accountability for these issues in the US are just beginning, she said.

You can watch a video of the entire event here. To learn more about FGM and child and early forced marriages, and to sign the Girl Summit pledge, visit girlsummitpledge.com.

 

 

 

 


Episode 43: Complexity

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In this episode of Development Drums, I speak with Ben Ramalingam and Stefan Dercon about whether complexity and systems thinking offers actionable insights for better development interventions. Ben Ramalingam is an independent researcher who has worked with development and humanitarian organisations including UN bodies, NGOs, the Red Cross movement, and government agencies. He is affiliated with the London School of Economics and the Overseas Development Institute, amongst other institutions and is the author of Aid on the Edge of Chaos: Rethinking International Cooperation in a Complex World. Stefan Dercon is a Professor of Development Economics at the University of Oxford and the Chief Economist at the Department for International Development, the UK government’s aid agency.. In the podcast, I ask Ben to pin down what we’re talking about when we talk about complexity and complex systems, and ask Stefan whether any of this is actually new to development economics research or policy, which has long incorporated elements of complexity thinking. We debate whether systems thinking gives donors and governments new and useful tools, including for humanitarian intervention.


A TPPing Point on Trade? – Harsha Singh

TPP? TTIP? In the world of trade negotiations, there is no shortage of acronyms. And who better to break them down for us than Harsha Singh, former deputy director general at the World Trade Organization? Harsha recently visited CGD to join Kim Elliott in leading a roundtable to discuss with other trade experts the implications of these proposed mega-regional trading blocs for developing countries. After the roundtable, I invited Harsha to join me on the Wonkcast to explain the development implications of these trade deals to interested non-experts, with a particular focus on the impacts of smaller, poorer countries who are unlikely to be included.

Proposals for the Trans-Pacific Partnership (TPP) and the Transatlantic Trade and Investment Partnership (TTIP) arose in part out of frustration with the World Trade Organization’s Doha Round, Harsha explains. (The TPP is proposed to include the United States, Canada, Mexico, Peru, Chile, Australia, New Zealand, Brunei, Singapore, Vietnam, Malaysia, and Japan; TTIP would include the United States and the EU.)

The TPP and TTIP aim to enhance trade and investment among members, but they could also pose huge challenges for small, poor countries that find themselves excluded, he says. One of the primary concerns “is the diversion of markets away from their products to those who get preferential treatment as members of these mega-regionals.” Harsha says that while most of the focus has been on tariff preference erosion, nontariff barriers to market access may pose a much more serious problem. 

“The important thing is not just meeting the standards, but also the system which is used to determine that the standard actually is consistent with what is being demanded,” Harsha explains. “That system can often be exclusionary.”

For more on these issues, read Kim Elliott’s account of the roundtable discussion and listen to the Wonkcast. Among the topics we tackle: the impact of the mega-regional trade deals on the big emerging market economies, Brazil, China, and India, and the global value chain for an iconic 21st century product: the iPhone.

My thanks to Kristin Sadler for a first draft of this blog post and to Kristina Wilson for recording and editing the Wonkcast. 


Africa’s Data Revolution – Amanda Glassman

Is the revolution upon us? When it comes to data, the development world seems to be saying yes, Yes, YES! To look beyond the hype, I invited Amanda Glassman, a CGD senior fellow and director of our global health policy program, to join me on the show to discuss a new report from the Data for African Development working group that looks at Africa’s statistical capacity, warts and all. It turns out that the revolution may not be all it’s cranked up to be, and that well-intentioned outsiders—donors especially—are too often part of the problem.

A partnership with the African Population and Health Research Center in Nairobi, the working group found that in Africa such statistical fundamentals as taxes and trade, births and deaths, and growth and poverty are frequently outdated, inaccurate or simply unavailable. How badly out of whack? In recent months Ghana and Nigeria have recalculated the size of their economies and come up with GDP estimates that are more than two-thirds larger.

I ask Amanda if big data is going to solve these problems. Is there hope that Africa will simply be swept up in a big data tsunami?

Amanda has her doubts. In much of Africa, she says, statistical capacity is at such a standstill: it has remained unchanged for the last ten years according to the index of statistical capacity published by the World Bank.

“Certainly big data and new technologies are very exciting, and offer some really interesting opportunities to collect new data… On the other hand, if countries don’t have a national statistical system in place that to just produce the basics, they will be missing opportunities to harness these new capabilities and the opportunities to use big data.”

Why the lack of progress? Amanda says there’s plenty of blame to go around (she calls it “collective guilt”), specifically a mis-match between the priorities of African governments and the donors. Governments need sub-national data to help guide budgetary and policy decisions, she explains, while external donors often want national-level data to make allocation decisions across countries.

How to resolve this tension? The working group proposes a data compact that would be initiated by an African president or minister of finance and draw upon the support of interested external funders. The compact would be a means for all interested parties to agree upon a phased set of actions to address data problems, and a method for tracking progress. The compact could even take the form of a pay-for-performance endeavor (see CGD’s Cash-on-Delivery Aid proposal for one such example).

“The idea would be to say ‘we’re going prioritize some aspect of the building blocks (such as data on births and deaths) that we have not achieved in our country,’” Amanda explains. Compact participants would agree on measures of progress in the accuracy, timeliness and openness of that data. A big, high-level political commitment could be useful in mobilizing the necessary funding from a combination of donors and governments, she says.

We close our conversation with a look toward the post-2015 development framework. Will the working group’s findings and recommendations become a part of that ongoing debate? Absolutely, Amanda replies. “We’ll do our very best to let it be known that this would be a good idea. Certainly were engaged in the process and talking to all the different people who are involved.”

To learn more about the working group’s findings and recommendations, listen to the Wonkcast, see Amanda’s blog post, or read the report.


If China Sneezes, Will Latin America Catch Pneumonia? – Liliana Rojas-Suarez

My guest on this Wonkcast is CGD senior fellow Liliana Rojas Suarez, who serves as chair of the Latin American Shadow Financial Regulatory Committee (CLAAF). CLAAF is comprised of financial economists and former senior financial officials from the region who meet twice a year to study a current policy issue. They then issue a statement offering advice to policymakers in the region and others interested in Latin American financial regulatory issues—or just in the region’s overall economic health.

At their recent meeting here at CGD, CLAAF members considered the question: How would a Chinese Slowdown Affect Latin America? Liliana summarizes their conclusions—and recommendations for Latin American policy makers—in a blog post available here in english and en espanol.

Prefer to get your Latin American financial regulatory advice on the run, or perhaps while working out on the Stairmaster or stationary bicycle? We cover it all, and more, in this 22 minute Global Prosperity Wonkcast. Listen now, or download it for future listening.


West African dance tune carries public health message about Ebola

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There’s a new dance tune that’s caught on in Liberia and Guinea. It’s called “Ebola’s in Town.” The song is the creation of three Liberian musicians: D12, Shadow and Kuzzy of 2 Kings. And yes, the Ebola in the title is a reference to the Ebola virus. PRI’s The World’s Carol Hills explains, and discusses the good and the bad of this kind of song.


Deforestation by the Numbers – Jonah Busch and Kalifi Ferretti-Gallon

Spatially explicit econometric studies… say that five times fast.

My guests on this week’s Wonkcast are CGD’s Jonah Busch and Kalifi Ferretti-Gallon, who have conducted a meta-analysis of 117 such studies to discover what drives deforestation—and what actions slow or prevent it.

Their ambitious study, the first to use this approach on such a large scale, covers two-thirds of the world’s tropical forests. For those who want to cut to the chase, this CGD brief offers a succinct summary of the findings.

In the Wonkcast we discuss why a development-oriented think tank like CGD is tackling deforestation: because intact forests provide many benefits to poor people, and because deforestation is an important driver of climate change, which in turn undermines development efforts. We then unpack the study’s main findings.

Kalifi, who did most of the number crunching, explains the criteria for selecting the 117 studies included in the meta analysis, and how she and Jonah then distilled the many factors that may drive or slow deforestation into 40 variables.

The big take-aways:

“Keeping roads out of an area, making sure that road networks are planned in a way that connects people, gets them to market but doesn't open up new frontier areas of remote forests” helps to protect the forest,” Jonah tells me.

Similarly, designating protected areas has frequently been effective. While many of these are in remote or especially scenic areas, Jonah says the meta-analysis showing that they have been effective suggests that designating more protected areas in places that are subject to deforestation pressures holds promise.

Among the surprises: strengthening land tenure and community forest management projects—two popular approaches to slow deforestation—were not proven on balance to be effective.

“I was expecting to see that community forest management lined up with less deforestation,” Jonah says. “If this were the case it would be a nice win-win for local economic development and forest protection…But while there were slightly more cases where community forest management was associated with less deforestation rather than more deforestation, it wasn't a statistically significant difference.”

In contrast, he says, payment for ecological services, for example, by paying a community to protect a forest watershed, tended to work, although the approach is comparatively recent so there are relatively few studies of such efforts.

We end the Wonkcast with a discussion of the links between the findings of the new meta-analysis and REDD+, the global effort to reduce emissions from deforestation and forest degradation.

For more on REDD+, see the CGD initiative Tropical Forests for Climate and Development, of which Kalifi and Jonah’s new meta-analysis is an important contribution.


Making prosthetic limbs affordable to the masses

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The fact is, prosthetics can change the course of someone’s life. But they’re usually prohibitively expensive — available only to the well-insured and the well-to-do. But a team of graduate students in Massachusetts say they’ve found a way to build artificial limbs for just a few dollars, potentially making these life-changing devices available all over the world. They’re on PRI’s The Takeaway.


Migration’s Inevitability and Labor Mobility – Michael Clemens

In a recent study, CGD senior fellow Michael Clemens found that, contrary to popular belief, development in poor countries actually fosters more migration, not less. Migration is certainly a hot topic, and since these results challenge common assumptions about migration trends, I invited Michael to join me on the Wonkcast to discuss the implications of findings for US policy and for development agencies worldwide.

Michael’s research answers the question posed in the title of his new paper: Does Development Reduce Migration? Answer: No; at least not until quite late in the development process. As incomes rise, so does emigration until about $6,000-8,000 per capita GDP, at which point emigration begins to decrease.

Michael says that the relationship between increasing GDP and increasing migration is “synergistic.” As people in poor countries have more income, migration is both more interesting and they have the means to do it. “As your country develops, you can afford education, which helps you get abroad; you can afford plane tickets; you’re more likely to have connections with people in other countries,” Michael explains. By contrast, “if you’re in rural Niger and very poor, certainly in the abstract you have a strong economic incentive to go abroad, but you likely lack the ability and social networks that you need to realize that ambition.”

I say this seems pretty intuitive to me—it’s what I observed as a reporter living Taiwan and elsewhere in East Asia during the region’s economic take-off. Michael assures me that the finding will nonetheless come as news to many aid philanthropists and agencies that “use development to slow down migration, so that people don’t need to leave.”

What to do? Michael’s advice to policy makers is that since migration will inevitably rise along with incomes they should look for ways to ensure that migration helps to foster development, for example, by ensuring that skills certifications and pensions are portable across countries and that remittances are easy and cheap to send.

Michael takes strong issue with the recommendations of noted development economist Paul Collier, in his new book, Exodus, that in order to foster development the migration of skilled people from poor countries should be forcefully discouraged. Such measures necessarily involve “forcing people to not realize their dreams and ambitions,” Michael says. A better response, he says, would be finance arrangements that enable destination countries to pay for the training of those they will recruit, as Michael has proposed in a recent policy paper: Global Skills Partnerships: A Proposal for Technical Training in a Mobile World.

While such mechanisms are still mostly in their infancy, it makes sense to establish and expand them now, since the mobility transition is likely to last for many decades, in some cases well more than a century.

According to Michael, for very poor countries that manage a sustained growth rate around 2 percent, it would take over a century to reach the transition point of about $8,000 per capita GNP. We end with a discussion of the implications of Michael’s research for US policy towards Mexico and other Latin American countries. Tune in to hear that, and much else we couldn’t squeeze into this summary!

My thanks to Kristina Wilson for recording and editing the Wonkcast and to Kristin Sadler for a first draft of this blog post.


More mothers are choosing to give birth at ‘home’

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Births started in homes, moved to hospitals and are now moving back to homes, at least in the developed world. More parents are choosing places that aren’t hospitals for giving birth — and that presents new risks and complications. A conversation on Oregon Public Radio’s Think Out Loud.


Malnourished children in sub-Saharan Africa not getting needed life-saving drugs

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A research study last year showed that a simple antibiotic can reduce a severely malnourished child’s chances of dying by nearly 40 percent. But getting that antibiotic to the children who need it is easier said than done. Anders Kelto reports from Malawi for PRI’s The World.


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