Tag: Laurie Garrett

Should an African lead the World Bank?

by Evan Lieberman1 Comment on Should an African lead the World Bank?

I don’t mean to pose the question in a rhetorical, politically correct manner. It’s not obvious that the answer should be yes.

Sure, the World Bank’s mission is to reduce poverty, and its biggest challenge remains the African continent. But there are lots of reasons to answer in the negative:

For one: Africa is not a unified political entity, and any single leader could easily be viewed as favoring one country or region over another, casting the institution into even greater institutional legitimacy crises than it currently faces. Moreover, I admit that I hate to see top-notch African talent, especially in government and the financial sector, get scooped up by international organizations. I am all for a free market for executive labor (an oxymoron?), but it does send the wrong signal when the best and the brightest leave their own countries for a job based in Washington or Europe.

And of course, to the extent that the bank depends on resources from Europe and the U.S., pragmatically speaking, it’s pretty easy to predict that these rich governments would become even tighter with their aid dollars, euros, and yen if one of “their own” were not at the helm.

Despite all this, at present, a pretty good case can be made that the answer should be yes.

First, I have been surprised to read some of the lukewarm endorsements for Obama’s candidate, Dartmouth President and Partners in Health co-Founder, Jim Kim. I would have thought that Laurie Garrett would have been a big supporter, but she writes that he is “not a shoe-in.” Her blog posting offers some praise, but sometimes in a backhanded way that makes clear that maybe Kim is not the best idea:

Kim’s possible appointment is both a blessing and a challenge for global health and development advocates. Because he is the first individual nominated to lead the Bank who lacks either economics, business or US government  experience, Kim will be watched closely for failures to comprehend or maneuver through the often Byzantine world of finance and development. Experts in the field argue financial figures in language more akin to that used on Wall Street than inside the NGOs and schools of public health that execute global health programs. Moreover, Kim is prone to speaking with moral authority, putting the weight of his experience tackling tuberculosis behind controversial calls to action. Bankers and “moral authority” don’t usually mix well together, even when the financial institution is meant to lend to the poorest of the poor.

Meanwhile, many, including Richard Dowden of the Royal Africa Society, have argued that the time may be ripe for abandoning the tradition of an American appointment.

This year there is a really good candidate: Ngozi Okonjo Iweala. She is highly competent, energetic with a real vision of what the bank should be doing. But she is African – the Nigeria Finance Minister. The World Bank will be judged on the success or failure by what it does in Africa. She has the backing of the African Union…. The Bank led the way on structural adjustment. Its reforms may have helped in the long run to bring investment, but what really turned Africa’s economies round was China’s decision to buy its raw materials from the continent. That, combined with the arrival of mobile phones, and the rise of a new African middle class, has given Africa more than 10 years of growth. In 2008 the Western free market model exploded and since then the US and Europe have demonstrated neither success in their own economies nor found a new theoretical model to impose on others through the Bank and the Fund.

So what better moment to appoint Ngozi? She has already laboured in the dull desert of the Bank’s Washington offices and twice walked unscathed through the terrifying valley of Nigerian politics. She retains a strong vision of development for people, not for ideologies or theories. It’s time for America to listen to others – especially Africa. Mr Obama, are you listening?

It would be nice to say that the appointment should be decided based on personal qualifications alone, but that would be naive. Country of citizenship matters in terms of influence and perceptions. I think there are some risks, but in the current context, I agree that Ngozi woud be a very attractive choice for the post.

Global fund for HIV, TB, Malaria at crossroads

by Evan Lieberman1 Comment on Global fund for HIV, TB, Malaria at crossroads

The Global Fund‘s executive director, Michel Kazatchkine, resigned from his post this week amidst a witch’s brew of political conflict and funding shortfalls. In response, Laurie Garrett penned a nice analytical essay — which I re-post here — about what all this means not just for the fund, but for global health more generally.

To be sure, the history of international aid efforts is littered with failed and even harmful initiatives, and these have led many to become aid-skeptics. But the global fund has been a spectacularly successful vehicle for efficiently converting rich country dollars into usable public health resources, especially essential medicines, in the world’s poorest countries. While I have been somewhat critical of the organization’s over-emphasis on multiple-stakeholder governance, which at times has contributed to accountability and efficiency failures, the big picture is one of remarkable success during a period in which the devastation of AIDS could have been even worse than it’s been.

Like in American politics today, where there is little enthusiasm for the notion that our economy could have been worse with a different response to the global economic meltdown, my sense of international support for public health counter-factuals is similarly tepid. But in a globalized world, in which infectious diseases are transmitted rapidly across borders, and our financial and physical health is so inter-dependent, we require effective global governance institutions. And the global fund has been generally well run, lean, and effective.

It is extraordinarily difficult to parse out the individual efforts and impact of the myriad global actors involved in the campaign to fight global infectious diseases over the past couple of decades. But Garrett highlights that a full two thirds of all malaria funding is now dependent on the fund… and the incidence of malaria has dropped precipitously in recent years.

Out in Davos, the global health celebrities — Bono, Clinton, Gates, and others — are celebrating the 10th anniversary of the fund. Hopefully they will be able to shmooze world leaders to maintain commitments to this important institution in the years to come.