Beyond the State: Letters from Gulu

Apologies for the extremely sparse posting of late. I have just returned from a trip to Central America, including Belize, Honduras, and Mexico, which I’ll post more about soon. In the meantime, I’d like to share the first edition of a weekly column I began writing for the Independent (Rwanda edition) three weeks ago. I’ll be posting these weekly after they are published online. I look forward to your comments and feedback.

Beyond the state: letters from Gulu

Published online November 23, 2011

Health care, education, basic infrastructure, and security are some of the services the modern state seeks to provide. The success of states in delivering these goods to their far-flung populations, especially in the midst of conflict or under severe resource constraints, is quite variable. In recent years, for example, Rwanda has been lauded for implementing a health insurance scheme that covers all Rwandans and offers them a range of health services, while the reach of the state in countries like the Democratic Republic of Congo or South Sudan is much more limited. While there are important lessons to be learned from the success of the Rwandan state, which has proven itself unusually efficacious in a number of sectors, it is all too easy to overlook the ways in which information and innovation flow alongside the state, and often in spite of state failures. Tremendous opportunity lies beyond the state.

I recently unearthed letters given to me in mid-2005 by a group of primary school students in Gulu, northern Uganda’s largest city, illustrating this point. At the time, to cross Karuma Falls, where the Nile cuts the land like a scythe, was to enter a world far removed from political drama unfolding in Kampala. While Ugandan President Museveni was jostling for the removal of term limits in the capital, the terror of the Lord’s Resistance Army (LRA) in northern Uganda was still unfolding, though nearing its final days. The river dividing north from south might as well have been an ocean.

The reach and strength of the state was limited. Getting to Gulu from the capital carried its risks – tarmac fell away at the edges of the road much of the way from Kampala to Karuma, rebels lingered somewhere north of the Nile, and reaching the environs beyond Gulu was an even greater challenge. The state could not guarantee security, much less provide quality public services. Then Prime Minister, Apolo Nsibambi, in charge of public sector management, did not even set foot in the north until the mid 2000s, more than five years into his term.

When I first received the letters, I was struck by the violent images many of the children in Gulu could portray with a couple of pens and a piece of paper. Looking back, however, more striking than these images are what these youngsters wrote. “Too many children one after the other”, wrote a young boy named Geoffrey. “If a woman is not allowed to rest between children, her reproductive system can be harmfully affected, and her children will not be properly cared for”. Another, Solomon, carefully printed Ghanaian Nobel laureate Raphael Armattoe’s poem, “The Lonely Soul”, word for word. Others wrote about the effect of AIDS on their community, and a young boy named Kenneth drew a picture of “Cent 50”, the American rapper.

These letters illustrate not the failure of the Ugandan state in the north, which had evidently been unwilling or unable to stop the marauding LRA for nearly twenty years, but rather the porous nature of society, and the tremendous opportunities that lie outside the state. These students demonstrate not the dismal quality of Uganda’s educational system in an insecure region, but rather their ability to utilize the resources at their young fingertips. At ages seven to ten, they shared information about child spacing, antenatal care, infertility, the spread of infectious disease, poetry, and American pop culture. Through what channels did they initially access this information? Through school and formal state structures? Possibly, though these are likely to be only part of the story. How can we use these channels, whatever they may be, to further promote innovation and the spread of information?

Our approaches to improving public health and education have often focused on things we can touch and see – a health center, a new classroom, an operating table, a chalkboard – but ignored the social networks and flow of information that do not respect administrative boundaries and are not tied to specific politicians and policies. This bias is in part due to the fact that physical infrastructure is highly visible, and as such, plays an important role in politics. It is much harder to see the networks of common knowledge than it is to see the building of walls. It is easy to undervalue and difficult to use that which we cannot see, at least politically. We tend to privilege infrastructure over information.

How do we take advantage of the vibrant flow of information today? How can we better understand the channels through which it flows – through communities, families, churches, mosques, media, and even music? The state is not the only, or even primary, conduit of knowledge with the potential to improve health, for example. The formal structures of the state and public service provision often seem to fail us – absenteeism among civil servants, rampant corruption, poor policy implementation – but the social structures that connect society have the potential to fill in the gaps.

What is remarkable is not how far we have to go in ensuring a minimum standard of living, which can seem like a daunting journey, but how far we have come, even in the midst of conflict and severe resource constraints. The state can and should play an important and perhaps guiding role in providing public services, but we should also try to understand and take advantage of the opportunities to improve health, education, and other social services already at our fingertips.

thoughts on the U.S. troop deployment in Uganda

I am gathering here some opinions regarding Obama’s announcement that 100 U.S. troops will be/have been sent to Uganda to help fight the Lord’s Resistance Army, a rebel group who have been operating for the past several years in the Democratic Republic of Congo, the Central African Republic, and South Sudan and in northern Uganda before that. There seems to be a dearth of good analysis on this topic (I realize the news just came out yesterday), but I will try to add more as they become available/are brought to my attention. Anyone have any additions?

US deploys special forces in Uganda, but why? Angelo Izama

Obama’s troops in Central Africa to fight LRA; will they deliver? Rosebell Kagumire

Did Obama make the right call on Kony? James Lindsay

And here is a very neat link to the US cables mentioning the LRA. It’s interesting that there were practically no cables on the LRA before 2006, despite the fact that the group was most active in Uganda from the 1990s to around 2005. (h/t Washington Post*)

*I should note, however, that in general I feel this post doesn’t really capture the politics or even essence of the LRA.

Updates:

A new one not to be missed: Rush Limbaugh “Obama invades Uganda, targets Christians“. Foreign Policy post on Limbaugh’s blindly ideological and shockingly uninformed statements here.

NYT article here. US has provided $33 million in the region to fight the LRA since 2008.

Voter behavior: does information matter?

The findings of Banerjee et al. (2011) from a field experiment in India using politician report cards seem to suggest yes:

Each report card contained information about incumbent performance along three dimensions – legislative activity, committee attendance and spending of discretionary constituency development funds across eight public good categories. It also provided information on the wealth, education and criminal record of the incumbent and the two main challengers in that jurisdiction. In a random sample of 200 slums, households received a pamphlet on legislator responsibilities and a free copy of a newspaper that featured the report card for their jurisdiction. Households in the 575 control slums did not receive any informational material.
Relative to control slums, we observe several significant changes in voter behavior in treatment slums. First, average voter turnout increased by 3.5 percent, or two percentage points (from 57.5% to 59.5%). Second, cash-based vote-buying was 19 percent less likely to occur in treatment polling stations. Third, while the campaign did not influence the average incumbent vote share, worse performing incumbents and those facing better qualified challengers received significantly fewer votes. The increases in turnout were relatively higher in treatment slums located in jurisdictions where the incumbent was a worse performer.

A similar study has been undertaken in Uganda, using the parliamentary scorecards, by Macartan Humphreys and Jeremy Weinstein. Results linking the scorecard to the most recent 2011 elections forthcoming. There are a number of other studies underway around the world looking at the relationship between information and voter behavior, but the findings are far from being universally conclusive.

Prof. Banerjee will be presenting at the Political Economy Faculty Seminar at the Stanford GSB tomorrow.

Happy Independence Day, Uganda

The game yesterday didn’t go well, but it’s Uganda’s Independence Day today, so let’s celebrate anyway. Happy 49th.

I want to devote some upcoming posts to discussing where Uganda has come since 1962, and what lies ahead. Many today hold a dreary outlook for the country both politically and economically, especially in light of where they imagined Uganda might be nearly 50 years after Independence. While I am confident there will be major bumps in the road ahead (I think it is safe to say we are in smack in the middle of one at the moment), unmitigated pessimism is unwarranted, and ultimately, self-defeating.

Between disappointments, mistakes, and even despicable actions by some of those who shall remain nameless for now, there are equally many hopes, dreams, innovations, and breakthroughs made by ordinary citizens, entrepreneurs, and leaders alike. Perhaps the most amazing is seeing people come together to demand policies that serve the interests of the public, or whose support of a team converts them, however briefly, from individuals into a nation. Occasionally the goal is missed, but the spirit remains. It is this spirit, for lack of a better word, that will make the difference — little by little, day by day.

And so, today we celebrate another such day. One where disappoints are squarely and painfully faced, but also where millions of small steps are made, many in the right direction.

Happy Independence Day, Uganda.

if you get stuck in a lift

Call these guys. Spotted in a prominent Ugandan government office, where the lifts stop on a programmed set of floors. Don’t get in the wrong one, otherwise you’ll have the accidental pleasure of elevator surfing. And they don’t move that fast. Unfortunately I have recently been in multiple such government office buildings, so this description is not even a give-away.

In other news, Uganda Cranes oye! We go, we go, Uganda Cranes we go, WE GO!

Best of luck tomorrow, and everyone stay safe!

P.S. Looking forward to your photos @echwaluedward!

books on my reading list

At the beginning of every school year I am invariably overly ambitious about what I can realistically accomplish, including the number of books that can reasonably be read in a day week. Nevertheless, let me begin a list here of the books I hope to tackle (required reading not included) in the next couple of months.

  • The Escape from Hunger and Premature Death, 1700-2100, by Robert Fogel.                                                                                                                       “Technophysio evolution and its implications are the central themes of this volume. The term describes the complex interaction between advances in the technology of production and improvements in human physiology. The interaction is synergistic, which means that the total effect is greater than the sum of its parts. This interaction between technological and physiological improvements has produced a form of evolution that is not only unique to humankind but unique among the 7,000 or so generations of human beings who have inhabited the earth.” This book sounds remarkably like the dissertation I hope to write. Only that I almost surely will never win a Nobel Prize in economics …details, details.
  • African Development: Making Sense of the Issues and Actors, by Todd J. Moss (@moss_dc)                                                                                                  “This book aims for a simple, but hopefully not simplistic, introduction to the main themes, trends, and players in contemporary African development.” This book seems to be doing the rounds in development circles and is probably a good resource for both teachers and students of African politics and development.
  • The Drunkard’s Walk: How Randomness Rules Our Lives, by Leonard Mlodinow                                                                                                               “Offering readers not only a tour of randomness, chance and probability but also a new way of looking at the world, this original, unexpected journey reminds us that much in our lives is about as predictable as the steps of a stumbling man fresh from a night at the bar.” Recommended by a brilliant and enterprising friend whose reading recommendations can only be totally worthwhile. And it has a great title!
  • Decentralization in Uganda: Explaining Successes and Failures in Local Governance, by Gina M.S. Lambright.                                                                  Just discovered this one in a political science “new books” publication.
  • Museveni’s Uganda: Paradoxes of Power in a Hybrid Regime, by Aili Tripp       Also recently discovered this one, has anyone read it?
  • Decision Points, George W. Bush                                                                        Because political autobiographies are fascinating.

More to be added as we go along. What are you reading?

UPDATE:

See, I’m already getting ahead of myself. So far I have read 1.1 of the above books (specifically Fogel, and a bit of Bush and Moss), and I’ve already added more. Recent additions:

I also recently read Rational Ritual: Culture, Coordination and Common Knowledge, by Michael Suk-Young Chwe, which I recommend and hope to write about soon.

review this: Kampala online

Well, after 24 hours of the worst flu I’ve had since childhood, I’m back. There is a serious virus(es?) going around this town (Kampala that is); several people are reporting symptoms on twitter and a number of friends have been taken ill. Wash those hands! The good news is the worst symptoms (namely, high fever with the usual chills and aches) seem short-lived. But that’s not much comfort when you’re in the middle of the thing.

Anywayyyy… what I really wanted to share is an email I got from TripAdvisor after reviewing Endiro (coffee shop in Kisementi) online. After I wrote a post on Uganda’s online tourism presence, I decided I should do my part in sharing information online about the places I frequent. Ideally, there should be a forum other than TripAdvisor to do this, but I had a feeling more people would read reviews on that popular platform than elsewhere. It might be useful for the managers/owners of the restaurants/hotels/etc. to see what others are saying about them online as well (the second review of Endiro, for example, is rather scathing).

Yesterday, I got this email from TripAdvisor:

What I found most interesting, of course, was that there were “3,105 travelers looking for information about Kampala this week”.

I don’t know how they calculate the number of “travelers” (as opposed to clicks on Kampala-related sites on their page) but at least this gives us a clue as to how many people are seeking information about Uganda online. First of all, this figure is only for Kampala, and second of all, it is only for TripAdvisor, suggesting that the number of folks looking for information online on Uganda is in the multiple thousands every week.

I had not previously found data regarding online searches for Uganda tourism, but this at least gives us a rough idea, and provides further evidence that Uganda’s online tourism presence matters! Over to you, UTB.

On a related note, Bernard Tabaire (@btabaire) has an interesting column on Uganda’s tourism sector in last Sunday’s Daily Monitor, link here.

felled by fever

As my partner-in-crime was felled by a fever this weekend, I got to wondering how often people treat themselves for malaria when they really have a nasty virus, flu or otherwise. If you don’t have the time, resources, or energy, it might seem like a good idea to pop some anti-malarials (assuming you can get them) just in case.

I gave a presentation about health services and malaria in Uganda several weeks ago, in which, among other things, I bemoaned the lack of attention malaria receives from government. Browsing various publications, studies, and policy reports, I mentioned several stats, including the following:

  • Malaria is the cause of 32% of child deaths in Uganda (DHS Child Verbal Autopsy 2007)
  • 42% of children tested positive for malaria during the DHS Malaria Indicator Survey 2009 , compared to 0.7% in Ethiopia, 2.6% in Rwanda, 7.6% in Kenya, and 18% in Tanzania.
  • Malaria is responsible for 30-50% of all outpatient visits, 15-20% of all admissions, and 9-14% of all inpatient deaths
  • Uganda ranks third in the world in terms of malaria deaths

One of the audience members asked about the accuracy of reporting of malaria cases in Uganda. While malaria is undeniably one of the most important health challenges Uganda faces, it is important to acknowledge that the capacity to diagnose malaria is generally weak, and many if not most of the malaria cases and deaths are not laboratory confirmed. There is probably a sizable chunk of these “malaria cases” that are not actually malaria, but rather a flu or some other virus or infection.

The 2009 Malaria Indicator Survey found that of the 3,727 children included in the survey, 44.7% were reported to have had a fever in the preceding two weeks. While 70% of children with fever were taken to a health facility or health provider, only 17% were reported as having been tested for malaria through a finger or heel prick. 60% of children with fever ended up taking anti-malarials, and 15% took antibiotics.

I’m still astounded that 42% of the children in the survey tested positive for malaria (62% were anemic). This figure is especially high when you compare it with other countries in the East African region (see above). Prevalence varies quite a bit by region as well.

Source: Uganda Malaria Indicator Survey 2009, page 61.

The internet has slowed to a crawl, but I’ll post some more links on this soon.

Uganda’s entrepreneurs

In Uganda it seems like everyone and their mother (I do mean that literally) has their own business. In fact, the 2010 Global Entrepreneurship Monitor Report on Uganda finds that 31 of every 100 working age Ugandans are involved in some kind of entrepreneurial activity, making Uganda the 6th highest in terms of entrepreneurship out of the 59 countries surveyed.

Interestingly, there appears to be a strong relationship between GDP per capita and entrepreneurial activity, as can be seen below.

Source: 2010 GEM Uganda report, page 32. Download here.

So what does this mean?

High TEAs [Early Stage Entrepreneurial Activity] are mainly registered in developing countries. And there’s a group of scholars that have argued that the greater the poverty, the higher the TEA of the country concerned. GEM Uganda team does not wholly agree with these scholars as its number of entrepreneurs motivated by opportunity is also high and so is that of Ghana, Zambia and Angola.

Although the team believes that necessity is a factor in Uganda’s high TEA, some entrepreneurs are keen to pursue business opportunities in the country. The positive relationship between economic growth and entrepreneurship is unquestioned; it is the causality, the measures used, and the role of the state that need to be explored further.

I’m curious about the relationship between the Doing Business scores and entrepreneurship as well. I would imagine that while it may be difficult to set up a business formally (i.e. following all the rules/wading through bureaucracy) in countries like Uganda, the relative lack of regulation encourages entrepreneurs to try their luck in business, especially in the informal sector.

Your thoughts?

141,000 child deaths in Uganda per year

That according to the recently released 2011 UN report, “Levels and Trends in Child Mortality“. For a relatively small country of around 32 million inhabitants, Uganda gets a terribly large chunk of the pie, as seen below (page 8 of the report). Uganda is the 10th largest contributor to child deaths worldwide.

The good news?

In Sub-Saharan Africa the average annual rate of reduction in under-five mortality has accelerated, doubling from 1990-2000 to 2000-2010. Six of the fourteen best-performing countries are in Sub-Saharan Africa, as are four of the five countries with the largest absolute reductions (more than 100 deaths per 1,000 live births).

The six best performers for a reduction in the rate of mortality are Madagascar, Malawi, Eritrea, Liberia, Niger, and Tanzania. The countries with the greatest reduction in child deaths in absolute terms are Niger, Malawi, Liberia, and Sierra Leone. What are they doing right?

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