Ethiopia, Healthcare, and NGOs

The Ethiopian NGO, People to People, asked me to make remarks on 27 November 2012 at a symposium on medical education and healthcare in Africa hosted by the University of Kentucky. My remarks cover the massive health care challenges in Africa, the role of NGOs in healthcare coordination and advocacy and the impact of the brain drain.

Click here to read the remarks.

Human Rights Watch report on Ethiopia, Part 2

See part one here.

After reading the Human Rights Watch report, I shared the following comments with a reporter:

The Human Rights Watch (HRW) report is well documented in the case of the three regions that it investigated. The report concludes that in these three regions HRW "found that the government is systematically using government services as a tool of repression."

According to HRW, repression often seems to mean that the EPRDF uses government programs to ensure support of the EPRDF. I have no doubt that this happens.

HRW then documents large donor financial support for the government's development and service programs and concludes that the donor community is aiding and abetting "repression" in Ethiopia. There is an element of truth to the charge if you accept that government services and programs for ensuring support of the EPRDF constitute "repression" and that donor aid is largely responsible for the existence of these programs. The more you string out this line of argumentation, the more tenuous the HRW allegation becomes.

In any assistance program as large as the one in Ethiopia, there will be cases of abuse. It is up to the donor community to make every effort to minimize the abuse. The Development Assistance Group (DAG) Ethiopia implicitly acknowledged the existence of abuse when it said the programs "we support are not immune to the potential for aid misuse and have therefore included safeguard measures to address these risks."

The DAG explicitly disagreed with the HRW allegation that there is widespread systematic abuse of development aid in Ethiopia. The truth is probably somewhere between the HRW conclusions and the DAG denials.

HRW noted that "Ethiopia is one of the most challenging countries in the world to carry out human rights research...." I have no doubt that is true.

On the other hand, it is fascinating that the HRW "findings are based on interviews with more than 200 individuals during three separate research missions in Ethiopia between June and December 2009." I wonder how many developing countries would deny HRW access to even carry out such a study.

As for your question about the impact of the Ethio-China relationship on this situation, I don't think it has a major role. While China provides assistance without reference to human rights and democratization concerns, it provides very little grant aid to Ethiopia. Most Chinese aid consists of loans, albeit low interest, which do not compete with predominantly grant aid from the western donor community.

On the other hand, Ethiopia may look at Chinese aid as a substitute for loans from the World Bank, IMF and regional development banks.

Human Rights Watch report on Ethiopia

An EPRDF billboard. Creative commons licensed Flickr content.

A representative of the media asked me to comment on very short notice on the Human Rights Watch report on Ethiopia and the conclusion that foreign aid contributes directly to political repression in the country. I am posting my tentative response based solely on having read the summary of a 100 plus page report.

The Human Rights Watch (HRW) report is very long; I can't take time to read all of it at the moment. I will make a few comments based only on a reading of the summary.

I am not in a position to question the accuracy of HRW's research. It usually does a pretty good job. You can certainly make the case for repression and EPRDF efforts to marginalize the political opposition.

Based solely on the summary, the HRW report is less persuasive in making the link between development assistance and political repression. Unless the study breaks down development aid from humanitarian assistance, it may be something of a false argument. The vast majority of U.S. aid to Ethiopia consists of food aid and assistance to combat HIV/AIDS, malaria and TB.

This is NOT development assistance. Other donors may provide a higher proportion of their assistance in the form of development aid. Certainly, most World Bank aid is for development. I still suspect HRW is being a little too loose in making the link between development aid and political repression.

The summary says "the government has used donor-supported programs, salaries and training opportunities as political weapons to control the population, punish dissent, and undermine political opponents." Does the report say what percent of total aid is used for this purpose? I suspect it does not and suspect it is a tiny percentage of total assistance.

It is true that Ethiopia is high on the list for receiving donor aid. It is also one of the poorest and at 81 million people most populous developing countries in the world. The only fair way to look at aid figures is on a per capita basis. If you do so, for example, you will find that in 2008 Eritrea received $29 per capita in foreign assistance as compared to $41 for Ethiopia -- not a huge difference.

There is plenty to criticize on the human rights front in Ethiopia. It is equally important, however, to put the situation in context. I am not sure HRW has done that.

Assistant secretary of state for African affairs speaks at GW

Image: Ambs. Shinn and Carson. Photo by Jessica McConnell/GW. Ambassador Johnnie Carson, assistant secretary of state for African affairs, addressed some 200 students and members of the public at the Elliott School of International Affairs on February 18, 2010. The Elliott School is just a short sprint from the State Department. Ambassador Carson had a 37-year career in the Foreign Service that included ambassadorships to Kenya, Zimbabwe and Uganda and as principal deputy assistant secretary of state for African Affairs. Following an introduction by the dean of the Elliott School, Michael Brown, Ambassador Carson focused his remarks on U.S. policy towards Africa in the Obama Administration. He identified five priorities in U.S. policy towards Africa.

1. To help build strong and stable democracies on the continent. Sustainable economic development and the prevention of armed conflict must be coupled with the development of accountable government institutions.
2. To support economic growth and development. This must include the full inclusion of women in all areas of the economy. The centerpiece of this policy is the Millennium Challenge Account and the Africa Growth and Opportunity Act. In addition, the Obama Administration has pledged $3.5 billion for a food security program that will provide critical tools to African farmers to build local capacity.
3. To strengthen public health systems so that they can deal with the ravages of HIV/AIDS, malaria, cholera, tuberculosis and hepatitis. The Obama Administration has pledged to continue the President’s Emergency Plan for AIDS Relief (PEPFAR).
4. To help prevent, mitigate and resolve armed conflicts. There are new special envoys for Sudan and the Great Lakes Region to focus attention on these two especially troubled areas. The United States will work closely with the African Union in this effort.
5. To work with America’s African partners to address transnational challenges such as narcotics trafficking, trafficking in persons, climate change and violent extremism. Extremist groups include local movements aligned with al-Qaeda.

A lively question and answer period followed. The summary that follows constitutes my recollection of the discussion. It has not been vetted with Ambassador Carson. Image: Ambs. Shinn and Carson and Michael E. Brown, dean of the Elliott School. Photo by Jessica McConnell/GW. Several of the questions dealt with the coup in Niger that removed President Mamadou Tandja from office fewer than 24 hours before Ambassador Carson gave his remarks. While Ambassador Carson condemned the extra-legal overthrow of the government in Niger, he also strongly criticized the manner in which Tandja extended his time in office. Tandja not only ignored the term limit provision in Niger’s constitution but then refused to abide by decisions of both the legislature and judiciary that upheld those term limits. The best solution now, Ambassador Carson said, is for a speedy return to civilian rule and an early free and fair election. One participant asked why the United States had taken a prominent role in urging the United Nations Security Council to impose sanctions against Eritrea and why it had not done more to ensure implementation of the Algiers Agreement that defined the border between Ethiopia and Eritrea. Ambassador Carson responded that Washington’s door remains open to Eritrea. The United States would like to have better relations with Eritrea, and it also stands by implementation of the Algiers Agreement. He said he personally had reached out to Asmara on several occasions but was rebuffed each time. He emphasized that Eritrea’s actions in the region, especially Eritrea’s support for spoiler groups in Somalia, were hostile to several of its neighbors and in conflict with U.S. policy. In response to a question about the crisis of governance in Nigeria, Ambassador Carson was generally optimistic. President Umaru Yar’Adua has been ill for months and is being treated at a hospital in Saudi Arabia. His prolonged absence from Nigeria raised questions about his ability to govern the country. When the president becomes incapacitated, the Nigerian constitution calls for the vice president to become acting president. Although Nigeria’s institutions delayed in taking this action, they ultimately did so. As a result, former Vice President Goodluck Jonathan is now acting president of Nigeria. Ambassador Carson explained that the constitutional process worked in Nigeria as it should. A number of persons who asked questions expressed concern about setbacks in the democratic process in Africa. Ambassador Carson acknowledged that there had been some backsliding as underscored most recently in Niger and has also occurred recently in Guinea-Bissau, Guinea-Conakry, Madagascar and Mauritania. He was quick to point out, however, that there are also many governance success stories. He cited the cases of South Africa, Botswana, Namibia, Malawi, Mali, Benin, Ghana, Tanzania and Mauritius, among others. One questioner asked what has happened to the Africa Command (AFRICOM). The United States announced it with such fanfare and suggested it would be a very different kind of military command with significant policy engagement. In the meantime, it seems to have disappeared from view. Ambassador Carson responded that until the creation of AFRICOM, Africa was the only large region of the world that did not have a separate military command. The European Command in Stuttgart had responsibility for Europe and most of Africa. The Central Command in Tampa, Florida, watched over much of the Middle East and Northeast Africa and the Pacific Command in Hawaii had responsibility for the Pacific region and several Indian Ocean Islands that are part of Africa. AFRICOM placed all of Africa except Egypt, which remains with the Central Command, under its jurisdiction. U.S. foreign policy is, however, the purview of the State Department. The military commands support U.S. policy and bring some additional resources to those parts of the world where they have responsibility. In the case of Sub-Saharan Africa, the African Bureau of the State Department has primary policy responsibility.

Pres. Obama lays out general Africa themes, but we still need the details.

I participated in the BBC radio "Focus on Africa" program today concerning the visit to Ghana by President Obama. Most of the participants focused on the president's call to Africans to take control of their own future and the need for good governance. I noted that he also emphasized a willingness by the United States to support development that offers real benefits to more people, especially the improvement of agriculture and food security. Although he did not use the term in his speech in Ghana, he has called elsewhere for a green revolution in Africa. He also stated that the United States would continue the effort of President Bush to fight HIV/AIDS, malaria, and TB in Africa. He added to this list the eradication of polio and neglected tropical disease. Finally, he stated that the United States would step up its efforts to prevent and mitigate conflict in Africa, noting in particular the on-going problems in Darfur, Somalia, and the Congo. When asked what was left out of the speech, I suggested that I missed more emphasis on private American investment in Africa, as this could provide the most positive impact on improving African economies.