Jeffrey Sachs

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March 26, 2013 | 3:00 PM | By  | 

Rwanda’s revolutionary prescription for health | 

Editor’s note: This is a follow up (a day or so behind schedule) to an article I did last week on what many see as the humanitarian dilemma of Rwanda – a success story in aid and development in an nation with a questionable record on basic freedoms and human rights. Since it’s original posting, I’ve made changes to clarify that everyone agrees community health workers are invaluable to success. The question is one of emphasis.

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Rwanda is widely celebrated for having demonstrated that major improvements in health can be achieved in a poor country, at relatively low cost per capita, by good strategy, innovation and focusing on the best bang for the buck.

Peter Drobac
Peter Drobac

“There’s really been an extraordinary level of leadership by the Rwandan government, in terms of central planning and coordination,” said Peter Drobac, Rwanda director of Partners in Health, the health aid and advocacy organization founded by physician-activist Paul Farmer and Jim Y. Kim, now director of the World Bank.

The Rwandan government has implemented an insurance program that has covered most of the population with an emphasis on basic, preventative care that the British Medical Journal recently reported has greatly increased life expectancy, significantly reduced AIDS and TB as well as maternal and child mortality — all for about $55 per person.

“I think we’ve learned some lessons here that can be applied universally,” said Drobac.

Rwanda is being held up as a model within the global health community, but planning and coordination is nothing without execution. Digging down past all the sound-bites and buzz words, what has really made the difference?

Arguably, some of the more critical players in this scheme have been relegated to a minor supporting role when it’s possible they are actually in the lead.

Community health workers. Rwanda has 45,000 of them, or about three per village.

Partners in  Health has been a pioneer, and major proponent of the use of community health workers to extend the reach of the health system in poor countries. But Sachs thinks their role still remains underappreciated in media reports and policy discussions.

Jeff Sachs
Jeff Sachs
Columbia University

“There has been a dramatic change in terms of what you can do with community health workers in poor villages,” said Jeffrey Sachs, a leading aid and development economist who has recently proposed a massive expansion of community health workers as the most powerful means to achieve many key global health goals. Advances in diagnosis and treatment along with the ubiquitous cell phone means lower-skilled health workers have a greatly expanded care repertoire.

Rather than continue to focus on disease-specific interventions or trying to increase high-level health capacity, Sachs thinks the most obvious lesson learned from Rwanda’s success in health is that these low-level trained health workers are most powerful.

“This is a new idea,” Sachs said. “We’ve had community health workers for many years, but they are generally viewed as complementary components when what I’m talking about is making them central components in a new system of public health.” Continue reading →

FILED UNDER: Health, community health workers, health, Jeffrey Sachs, Partners in Health, Peter Drobac, Rwanda
June 14, 2012 | 10:00 AM | By  | 

Rwandans fight poverty while others fight over the numbers | 

Tom Paulson

Donald Ndahiro, team leader of Millennium Villages Project in Rwanda

Editor’s Note: This is the latest in an ongoing series, Metrics Mania, exploring the debates surrounding how to tell if aid and development projects are working. This is a look at one such project at the center of the debate.

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MAYANGE, RWANDA — Many miles south of ‘Hotel Rwanda’ in Kigali is the site of one of the worst massacres of the 1994 Rwandan genocide where the majority Hutu ethnic group sought to eliminate their rivals, the Tutsis.

As one local, Donald Ndahiro, told me during my visit here to the Bugasera District: “This was the place they used to send people to starve and die.”

Ndahiro said this was a terrible place before the genocide — a tsetse-fly infested, hostile land of the extremely poor. And it remained a terrible place after. Only a few years ago, people were still starving — and dying — here in one of Rwanda’s poorest regions. Disease, alcoholism and despair were rampant.

It’s not at all like that today. So what happened?

Tom Paulson

Coffee farming, Bugesera District

One explanation is that a number of aid projects — including the celebrated Millennium Villages and a lesser-known but large-scale health improvement project by the Seattle-based Glaser Progress Foundation — were launched here aimed at correcting decades of neglect and to see if targeted investments could rapidly improve quality of life. Also nearby is another Seattle project, a girl’s school called Gashora Academy.

A competing theory is that the progress here is largely due to Rwanda’s overall economic improvement in the past decade.

These two views provoke fierce argument over whether foreign aid works, or at least how to measure its effectiveness. Metrics mania. Continue reading →

FILED UNDER: Basics, Politics, Donald Ndahiro, Jeffrey Sachs, Josh Ruxin, millennium development goals, Millennium Villages, Rwanda
June 7, 2012 | 10:40 AM | By  | 

Metrics Mania afflicts the fight against poverty | 

Flickr, chrisjohnbeckett

Newton, statue outside the British Library

A lot of people who say they want to help poor people — the aid and development community — have been getting really nasty with each other lately. Why? In part, it’s because fighting poverty is messy and hard to measure.

At the center of this nastiness is a well-known economist, Jeffrey Sachs of Columbia University, who is chronically accused by critics of promoting an anti-poverty strategy –  known as the Millennium Villages Project – which they say is unproven.

The criticism flared again recently, prompting reports like this Forbes piece, which contends Jeff Sachs’ Millennium Villages Showing Zero Results

That’s not quite true. The more thoughtful critics don’t actually say Sachs’ approach doesn’t work. They just say it isn’t clear yet if it’s working.

But boy, does this lack of clarity make some folks angry! To wit:

  • One of Sachs’ leading critics, Michael Clemens at the prestigious Center for Global Development in Washington, DC, recently referred to Sachs on Twitter as “contemptible” for failing to acknowledge his project’s faults in an op-ed he wrote defending the value of foreign aid.
  • Timothy Ogden, editor-in-chief at Philanthropy Action, replied to Clemens (also on Twitter) that Sachs is to economics what Pat Robertson is to Christianity, which I assume was not meant as a compliment.

I have high regard for both Clemens and Ogden and this was, after all, just Twitter. But such hostility directed at Sachs is not that unusual. And it has gotten so intense lately I started wondering if the intensity is overwhelming the content here.

I’m no aid expert, economist or even really that good at math. I’m just a journalist who covers this stuff. And I do love a good argument. But I’m not so sure this qualifies as a good argument anymore. Continue reading →

FILED UNDER: Basics, Center for Global Development, development, evaluation, foreign aid, Jeffrey Sachs, metrics, Michael Clemens, Millennium Villages, Philanthropy Action, Timothy Ogden
June 7, 2012 | 10:00 AM | By  | 

Q&A with Jeffrey Sachs: Why is everyone so mad at this guy? | 

Tom Paulson

Jeffrey Sachs, outside Paramount Theatre on recent visit to Seattle

Well, maybe not everyone.

But the world-renowned economist and director of Columbia University’s Earth Institute certainly has his fair share of angry critics.

Jeffrey Sachs draws fire like few others within the aid and development community. Yet it’s also fair to say he has done as much as anyone to promote the fight against global poverty and injustice.

Before he became known as an anti-poverty warrior, Sachs advised countries in Latin America and Eastern Europe on transitioning to market economies, an experience which led him to a focus on international development in general.

He’s become a vocal advocate of the power we have to end extreme poverty and a critic of the indifference of the rich world to the plight of the poor — or of policy makers who don’t take up the cause.

Sachs is perhaps mostly closely associated with the initiative known as the Millennium Development Goals, an ambitious scheme launched by the United Nations and international community in 2000 that set out eight goals aimed at reducing extreme poverty and global inequity.

To both prove the value of and learn how best to achieve these goals, Sachs launched the Millennium Villages Project (MVP) — a 10-year project based in 14 communities across Africa, involving some 500,000 people given funding to make strategic improvements in certain aspects of health, infrastructure, education and business.

Millennium Villages

It’s an investment of tens of millions of dollars over ten years that tallies out at $120 per person per year – aimed at demonstrating that key changes in health, agriculture, water, roads, education and business development can lift communities out of poverty.

And it is Sachs’ Millennium Villages Project that seems to get people hopping mad.

Continue reading →

FILED UNDER: Basics, Jeffrey Sachs, metrics, millennium development goals, Millennium Villages
May 9, 2012 | 10:36 AM | By  | 

Will new, positive findings allow Jeffrey Sachs to stop shouting back at the critics? | 

Columbia University

Jeff Sachs

The renowned economist Jeffrey Sachs, now director of Columbia University’s Earth Institute, seems to irritate people — which also seems to prompt his critics to engage in vitriolic attacks of his efforts to combat global poverty and inequity.

The debates centered around Sachs remind me of some of the people I’d meet as a boy attending church, those folks who would argue angrily, endlessly and insultingly over fundamental disagreements about how best to love thy neighbor.

Whatever one may think about Sachs’ methodology or personality, can’t we all at least agree he has done a lot to promote the causes of global health, social justice and equity? For one, Sachs helped craft the Millennium Development Goals — which, if imperfect, gave the world a strategy for improving global health, reducing poverty and improving the lives of the poor worldwide.

One of Sachs’ biggest projects today is known as the Millennium Villages Project. Not surprisingly, it has been pilloried by many aid experts who say there is no evidence the project does any good.

Well, according to The Guardian, there is now evidence of good from Sachs’ Millennium Villages Project:

Death rates among children under five at the Millennium Villages – set up in Africa to demonstrate what is possible if health, education, agriculture and other development needs are tackled simultaneously – have fallen by a third in three years compared with similar communities, according to the project’s first results.

Sachs, in characteristic form, explodes all over the media with these positive findings to announce a breakthrough in the Huffington Post and to suggest, for CNN, that these results show that we can finally achieve “the dream of health for all, even the poorest of the poor… (This) can become a reality because of recent breakthroughs in technology and health systems.”

A bit over the top, yes, but that’s just the way Jeff likes to talk. You need to keep in mind he started on his campaign against poverty and the diseases of poverty back in the days when, well, hardly anybody gave a damn. He had to shout. And he’s still shouting.

So now, finally, he has some data to back his claims up and can maybe stop shouting.

Or maybe not. As Nature News notes, the findings aren’t likely to stop the critics:

“The core of the problem is lack of transparency and careful, independent analysis,” says Michael Clemens, a migration and development researcher at the Center for Global Development, an independent research institution in Washington DC.

The aid blogger Roving Bandit notes that even if child mortality declined in the Millennium Villages, the project itself found no statistical impr0vements in poverty, nutrition, education or other child health indices.

So I guess, no, the answer appears to be the shouting is likely to continue.

FILED UNDER: Basics, child mortality, Jeffrey Sachs, millennium development goals, poverty
April 12, 2012 | 10:25 AM | By  | 

Jeffrey Sachs: Globalization and ‘corporate governance’ has fueled growing inequality between rich and poor | 

The renowned and controversial economist Jeffrey Sachs of Columbia University draws a lot of attention, and criticism, in part because he doesn’t mince words (and, lately, for nominating himself to become president of the World Bank).

While some may argue with Sach’s positions or approaches, you can hardly argue that he is your typical boring economist.

The Guardian has published an interesting and provocative video interview with Sachs here. Below is an excerpt.

FILED UNDER: Justice, Politics, Jeffrey Sachs
October 14, 2011 | 9:14 AM | By  | 

The curious case of the Millennium Villages: Arguing why we get better | 

How many Americans know and/or care about the “Greatest Promise Ever Made” — the Millennium Development Goals?

I haven’t seen a survey, but I suspect the numbers are low. That’s unfortunate because most economists and foreign policy experts say that reducing global poverty and improving people’s lives makes the world a better, safer, healthier and more prosperous place for all of us.

That’s what the eight Millennium Development Goals (MDGs) aim to achieve by 2015. The MDGs represent the international communities’ basic yardstick for measuring whether things are getting better out there. Whether the MDGs represent the best way to measure things getting better is another issue. Continue reading →

FILED UNDER: Basics, Center for Global Development, Jeffrey Sachs, Kofi Annan, millennium development goals, Millennium Villages