Dear Colleagues
There is something wrong when every government on the planet is short of money to do what needs to be done.
There are some people who are of the view that government has no business doing anything ... but this is a fringe constituency whose views are very much in conflict with the history of humanity as I understand it. Throughout history, people have self organized and created systems of governance ... in recent times it has become central to modern society and all sorts of things and services are delivered via government. Without these things and these services modern society does not work.
These things and these services have to be paid for. Accordingly, I would argue that a top job in Corporate Social Responsibility (CSR) should be paying the right amount of taxes.
There is a very legitimate debate about what things and what services a government needs to supply ... but nothing is the wrong answer ... and everything is about as bad.
There is another very legitimate debate about getting government to do things efficiently and effectively. There is ample evidence that governments are not very good at doing things efficiently, and there is every reason for society to find this unacceptable.
My work has a focus on socio-economic performance, and the quality of decision making is key to good performance ... as well as accountability. I would like to see the CSR community get interested in the efficiency and effectiveness of government goods and service delivery ... and in having all the stakeholders in the society pay their fair share ... the right amount ... of taxes.
The question about what is the right amount should be the subject of vigorous debate ... and there should be meaningful metrics that inform this debate. Far too many corporate organizations pay too little taxes while consuming the services of government ... and the metrics about these things is totally inadequate.
This is not a local problem ... it is a universal problem. It is a problem that will get worse as time goes on, and is quite irresponsible on the part of the "so-called" corporate leadership of this generation.
I am pretty mad about this ... and would like the emerging Burgess Method for Value Accounting to be helpful in addressing these matters sooner rather than later.
Sincerely
Peter Burgess
Sunday, September 26, 2010
Saturday, September 25, 2010
IMF ... and Barbados
Dear Colleagues
I just saw this ... the IMF doing a review of the economic situation in Barbados.
http://www.imf.org/external/np/sec/pr/2010/pr10355.htm
I worked in the Treasury in Barbados some 15 years ago ... and it was interesting to see this little summary of how they saw things in Barbados now.
When I was working in Barbados one of many local jokes was a Bajan comedy about the IMF ... "Is My Fault!". A great little comedy play that touched a chord!
This comedy was a response to the World Bank Group and the IMF's broad strategy for developing countries of "Structural Adjustment" ... an almost universal disaster for the intended beneficiaries ... and the beginning of the end for my consulting career. Certainly there was a need for way better economic performance of developing countries ... but the nonsense that emerged as recommendations from the experts of the World Bank and the IMF was unbelievable.
It was therefore a real pleasure to work with the Government of Barbados that had seen fit to organize itself so that it was in a position to ignore the mandates of these organizations ... and have some fun at their expense!
Though there have been calls for World Bank and IMF reform over the past twenty years of so, my impression is that very little has changed. I would like to have been in Barbados while this IMF review was going on.
The text of the press relief is below.
Peter Burgess
I just saw this ... the IMF doing a review of the economic situation in Barbados.
http://www.imf.org/external/np/sec/pr/2010/pr10355.htm
I worked in the Treasury in Barbados some 15 years ago ... and it was interesting to see this little summary of how they saw things in Barbados now.
When I was working in Barbados one of many local jokes was a Bajan comedy about the IMF ... "Is My Fault!". A great little comedy play that touched a chord!
This comedy was a response to the World Bank Group and the IMF's broad strategy for developing countries of "Structural Adjustment" ... an almost universal disaster for the intended beneficiaries ... and the beginning of the end for my consulting career. Certainly there was a need for way better economic performance of developing countries ... but the nonsense that emerged as recommendations from the experts of the World Bank and the IMF was unbelievable.
It was therefore a real pleasure to work with the Government of Barbados that had seen fit to organize itself so that it was in a position to ignore the mandates of these organizations ... and have some fun at their expense!
Though there have been calls for World Bank and IMF reform over the past twenty years of so, my impression is that very little has changed. I would like to have been in Barbados while this IMF review was going on.
The text of the press relief is below.
Peter Burgess
//////////////////////
Press Statement by IMF Article IV Mission to Barbados
September 24, 2010
Marcello Estevão, chief of an International Monetary Fund (IMF) mission to Barbados, released the following statement today in Bridgetown, at the end of the IMF team’s yearly visit to review the Barbadian economy:
“Barbados has been severely affected by the global economic crisis. The deep global recession has curbed tourism, affecting related activities such as construction and trade which, in turn, depressed aggregate demand and raised unemployment. Despite a variety of policy measures to alleviate the impact of the crisis, the level of economic activity is expected to remain broadly unchanged in 2010. The team expects a return to moderate growth thereafter, as tourism receipts remain constrained by weak consumption growth in the United States and the United Kingdom.
“With public deficits and public debt now at high levels, the emphasis has shifted to fiscal consolidation. The team strongly supports the authorities’ aim, as set out in the Medium-Term Fiscal Strategy, to put public debt firmly on a downward path. Such a correction will be crucial to maintain domestic and external stability and growth, and to support Barbados’ external credit rating, but will require substantive measures on several fronts to control current spending and increase tax revenues. These measures could be accompanied by further actions to limit the impact on the poorest. The team commends the authorities for their prudent management of foreign reserves.
“While the banking system remains well capitalized, there has been a significant rise in nonperforming loans as a result of the recession. Against this background, continued close monitoring remains appropriate, which will be aided by the recent creation of a financial stability unit in the Central Bank of Barbados and intensified bank reporting requirements. The team supports a quick resolution of CLICO Barbados. It also welcomes the authorities’ decision to strengthen supervision of nonbank financial institutions, including through consolidation of supervisory agencies into the planned Financial Services Commission, and improvements in methods and human capital in this area.”
IMF EXTERNAL RELATIONS DEPARTMENT
Public Affairs Media Relations
Phone: 202-623-7300 Phone: 202-623-7100
Fax: 202-623-6278 Fax: 202-623-6772
Friday, September 24, 2010
Water ... a high value resource ... a crisis in the making!
Dear Colleagues
I get all sorts of interesting material via email and from the Internet. The following is from a group called Energy and Capital. Some of the material ... not all ... is very good!
http://www.energyandcapital.com
The issue of water has not reached crisis proportions in the global "north" or the global "west" yet, and is generally "off the radar". For myself, I have always explained this by thinking in terms of an English mindset, because in England it rains almost every day and the problem of water shortage is rarely serious. But I learned a lot about the importance of water when I was working in the humanitarian crisis of the Ethiopian and Sahel drought of the 1980s. Without water ... people and animals die. I am very well aware of the potential for water to become a global crisis far more rapidly than most of the leadership advisors expect!
Clearly in the "more and more and more" model for economic behavior that is prevalent in our modern society, shortage of water is as likely to derail things as the shortage of energy. I am reminded that early in the last century there were some very large infrastructure projects to bring water to where populations wanted to settle ... California, for example ... irrigation in Sudan, water supply canals in South West Africa (Namibia). Little of significance has been done in decades to get water infrastructure anything like what it ought to be with some notable exceptions like the Highlands Water Project in Lesotho to serve the needs of South Africa!
The type of value analysis that I recommend would help to get resources allocated for water initiatives ... and maybe this will happen sooner than we think. My hope is that investment in water infrastructure is done based on value analysis that benefits society rather more than merely using money profit analysis. The essay that got my attention follows!
Peter Burgess
I get all sorts of interesting material via email and from the Internet. The following is from a group called Energy and Capital. Some of the material ... not all ... is very good!
http://www.energyandcapital.com
The issue of water has not reached crisis proportions in the global "north" or the global "west" yet, and is generally "off the radar". For myself, I have always explained this by thinking in terms of an English mindset, because in England it rains almost every day and the problem of water shortage is rarely serious. But I learned a lot about the importance of water when I was working in the humanitarian crisis of the Ethiopian and Sahel drought of the 1980s. Without water ... people and animals die. I am very well aware of the potential for water to become a global crisis far more rapidly than most of the leadership advisors expect!
Clearly in the "more and more and more" model for economic behavior that is prevalent in our modern society, shortage of water is as likely to derail things as the shortage of energy. I am reminded that early in the last century there were some very large infrastructure projects to bring water to where populations wanted to settle ... California, for example ... irrigation in Sudan, water supply canals in South West Africa (Namibia). Little of significance has been done in decades to get water infrastructure anything like what it ought to be with some notable exceptions like the Highlands Water Project in Lesotho to serve the needs of South Africa!
The type of value analysis that I recommend would help to get resources allocated for water initiatives ... and maybe this will happen sooner than we think. My hope is that investment in water infrastructure is done based on value analysis that benefits society rather more than merely using money profit analysis. The essay that got my attention follows!
Peter Burgess
//////////////////////////////////////
Better than Opium and Oil
By Nick Hodge | Tuesday, September 21st, 2010
Natural resources can make us do crazy things — especially when there aren't enough of them.
Take a developing story in the Pakistani tribal belt...
Despite intense flooding in part of the country, some regions are still as thirsty as ever. (You can check out another red herring flood article here.)
So thirsty, in fact, that a two-week war has broken out over water rights.
Though you probably haven't seen it in the headlines, nearly 200 people have been killed since the Mangal tribe stopped water irrigation on lands used by the Tori tribe.
The scattered reports coming from the area claim, among other things, that “five villages were torched” and that “rival tribes are intermittently targeting each other's positions with heavy and light weaponry.”
One website even reported “the situation was exacerbated after Taliban infiltrated the area” to target one of the tribes that happened to be Shia.
I've been saying for years that water is a terribly precious commodity — much more important than oil.
You can't drink or cook with or bathe in oil...
But we humans seem to fall incredibly short when it comes to understanding problems of this scale.
The average person would probably tell you we have a limitless supply of water.
An infinite capacity to deny reality
Think there can't be water war in the United States? There already is... It just hasn't turned deadly yet.
In the Klamath River Basin of Oregon, farmers have been fighting the government for years about once-guaranteed but now cut-off irrigation channels. They've gone as far as breaking into the facilities that control water flow to redirect it to their farms.
Nevada infighting over water went all the way to the Supreme Court this June.
In Northern California, Chinatown II is unfolding. Three suits have been filed this month alleging illegal corporate ownership of water banks.
Georgia has sued Tennessee; Florida is fighting with Alabama.
It has led to what Robert Glennon, Professor of Law and Public Policy at the University of Arizona, calls “an infinite capacity to deny reality.”
If you can't grasp what he's talking about, just picture golf courses in Phoenix or swimming pools in Las Vegas.
More profitable than oil
Has anyone ever paid you not to use oil?
Exactly.
In Las Vegas, a $150 million initiative is underway to pay people to rip up their lush green lawns. So is a $3 billion pipeline to bring in water from a remote part of the state.
You know Lake Mead is nearly dry, right?
Projects like this are about to be commonplace, so you'd better start getting your portfolio in order...
For me, there are three main areas of water investment: transportation, treatment, and desalination.
And in the past few days, these sectors have been rallying as water woes creep into Wall Street headlines.
Mueller Water (NYSE: MWA), a pipe and flow control provider, and Pall Corp. (NYSE: PLL), a filtration and purification specialist, are each up more than 10% in the past week.
You can also play water-dependent agricultural crops with ag ETFs, or look into water-focused ETFs like the Claymore S&P Global Water (NYSE: CGW) or the PowerShares Global Water (NYSE: PIO).
But those will all be plays on moving and treating existing freshwater sources.
The real money will be made in desalination by the companies that find a cheap way to convert saltwater from the ocean into usable water.
This new video details one company on the verge of such a breakthrough, using nuclear reactors to power desalination units.
The company already has interest from around the world — including from Pakistan's neighbor, India.
Cheap, easy access to freshwater would go a long way to alleviate the problems detailed in this article. And it'll be just as lucrative as finding an untapped reserve of easy-flowing oil.
But there's only one company with several-times-your-money potential in the desalination sector. And word of it is getting out quickly, as this video starts popping up on investment sites all over the Web.
Call it like you see it,
Nick
Nick Hodge
Friday, September 17, 2010
Is investment in Africa good for Africa?
Dear Colleagues
The conventional wisdom is that foreign direct investment (FDI) is good for the place that is receiving the investment ... but value chain analysis suggests that this is rarely the case.
Africa has not been short of FDI ... the exploitation of Africa's resources by international corporations has been going on for a very long time ... and most of the people of Africa remain in abject poverty, and in many countries getting worse.
It is convenient to promote the idea that FDI is a good thing for Africa ... a lot of corporate profit can be made from these investments, and from the African side, many of the key decision makers are also able to profit from having a flow of FDI into the country.
The so called "resource curse" is a silly proposition. The curse is not the resource, it is the behavior of decision makers on the international corporate side and among leadership and decision makers on the Africa side ... with everyone looking out for their own interests, and nobody looking out for the interests of the people of Africa.
The story of telecom in Africa has been relatively benign ... investments have been made and a broad customer base has been created that has had benefit from the use of telecom services. But even in this case the story has its problems.
My numbers may not be exact ... but the idea is sound and the orders of magnitude, I believe, correct. Over a number of years an African entrepreneur invested some $700 million in telecom infrastructure around Africa ... and subsequently sold the company for (say) $3 billion to a Kuwait telecom investment company. This transaction made the initial entrepreneur very wealthy ... but this transaction also increased the cost of telecom in Africa by about four times. In the short run, the cost increase did not translate into price increase ... but in due course it will.
And now the Kuwait company has been acquired by an Indian company ... and it is likely that once again there will be a stock profit that again will translate into cost increase for African telecom operations.
These thoughts were prompted by an article in the New York Times about the Indian company contracting with IBM to upgrade the African based telecom infrastructure. Maybe the Indian company has the resources in both finance and intellectual capacity to bring operational benefit to Africa ... maybe, in the end, all of my initial argument is wrong! It could be ... simply because technology when it is well used has amazing power to lower costs and provide very substantially better performance. IBM has some important technology capacity.
The NYT article may be found at http://bits.blogs.nytimes.com/2010/09/17/i-b-m-africa-is-the-next-growth-frontier/?hpw. The text is copied at the end of this post.
With good management of its resources, the African people can progress out of poverty. For most of the last half century the management of African resources by its leadership has been disastrous and only a few Africans have seen much, if any, benefit. This is preposterous state of affairs ... facilitated by international corporate leadership looking out for their stockholders and failure of any and all oversight mechanisms.
It would be nice if the story reported in the NYT is an indicator of change ... we should watch this closely over time. It might be the beginning of a paradigm change ... maybe?
Peter Burgess
The conventional wisdom is that foreign direct investment (FDI) is good for the place that is receiving the investment ... but value chain analysis suggests that this is rarely the case.
Africa has not been short of FDI ... the exploitation of Africa's resources by international corporations has been going on for a very long time ... and most of the people of Africa remain in abject poverty, and in many countries getting worse.
It is convenient to promote the idea that FDI is a good thing for Africa ... a lot of corporate profit can be made from these investments, and from the African side, many of the key decision makers are also able to profit from having a flow of FDI into the country.
The so called "resource curse" is a silly proposition. The curse is not the resource, it is the behavior of decision makers on the international corporate side and among leadership and decision makers on the Africa side ... with everyone looking out for their own interests, and nobody looking out for the interests of the people of Africa.
The story of telecom in Africa has been relatively benign ... investments have been made and a broad customer base has been created that has had benefit from the use of telecom services. But even in this case the story has its problems.
My numbers may not be exact ... but the idea is sound and the orders of magnitude, I believe, correct. Over a number of years an African entrepreneur invested some $700 million in telecom infrastructure around Africa ... and subsequently sold the company for (say) $3 billion to a Kuwait telecom investment company. This transaction made the initial entrepreneur very wealthy ... but this transaction also increased the cost of telecom in Africa by about four times. In the short run, the cost increase did not translate into price increase ... but in due course it will.
And now the Kuwait company has been acquired by an Indian company ... and it is likely that once again there will be a stock profit that again will translate into cost increase for African telecom operations.
These thoughts were prompted by an article in the New York Times about the Indian company contracting with IBM to upgrade the African based telecom infrastructure. Maybe the Indian company has the resources in both finance and intellectual capacity to bring operational benefit to Africa ... maybe, in the end, all of my initial argument is wrong! It could be ... simply because technology when it is well used has amazing power to lower costs and provide very substantially better performance. IBM has some important technology capacity.
The NYT article may be found at http://bits.blogs.nytimes.com/2010/09/17/i-b-m-africa-is-the-next-growth-frontier/?hpw. The text is copied at the end of this post.
With good management of its resources, the African people can progress out of poverty. For most of the last half century the management of African resources by its leadership has been disastrous and only a few Africans have seen much, if any, benefit. This is preposterous state of affairs ... facilitated by international corporate leadership looking out for their stockholders and failure of any and all oversight mechanisms.
It would be nice if the story reported in the NYT is an indicator of change ... we should watch this closely over time. It might be the beginning of a paradigm change ... maybe?
Peter Burgess
September 17, 2010, 2:00 AM
I.B.M.: Africa Is the Next Growth Frontier
By STEVE LOHR
Samuel J. Palmisano, I.B.M.’s chief executive, doesn’t jet around the world to make an appearance every time the technology giant wins a services contract. But the announcement Friday morning in Nairobi is different, says I.B.M.
Bharti Airtel
Samuel J. Palmisano, I.B.M.’s chief executive, left, with Sunil Bharti Mittal, the chairman of Bharti Airtel.
I.B.M. will supply the computing technology and services for an upgraded cellphone network across 16 nations in sub-Saharan Africa. Its customer is India’s largest cellphone operator, Bharti Airtel, which paid $9 billion a few months ago for most of the African assets of Kuwait’s Mobile Telecommunications Company, or Zain.
Under the 10-year agreement, I.B.M. will handle customer service for Bharti and provide the hardware, software and services to run everything from billing and call-traffic management to delivering new services like music and video. The deal takes the broad partnership between Bharti and I.B.M., begun in 2004, beyond India. I.B.M. is not disclosing the dollar size of the deal, but analysts estimate it at more than $1.5 billion over the decade-long span.
The Bharti contract also punctuates I.B.M.’s Africa strategy. The company’s presence in Africa dates back 50 years, but in the last five years I.B.M. has invested $300 million in the region to build data centers, add country offices and foster technology training programs — and it plans to expand aggressively in the region.
“This is a huge step forward for I.B.M. in what we think is the next major emerging growth market — Africa,” said Bruno Di Leo, general manager for growth markets for I.B.M.
Though it looms small in the global technology market today, Africa is primed for growth, according to Frank Gens, an analyst at IDC. “And I.B.M. is, as it’s done before, getting in on the ground floor,” Mr. Gens said.
The company’s strategy calls for the growth markets — not only the well-known BRIC countries, Brazil, Russia, India and China, but also dozens of others — to increase as a share of I.B.M.’s revenue from 19 percent to 25 percent by 2015. That is the equivalent of $1 billion in new sales a year.
In these nations, I.B.M. is targeting the linchpin industries of economies including telecommunications, banking, transportation, health care and energy.
Mr. Di Leo, speaking on Thursday from his office in Shanghai, noted that mobile phones in developing regions like Africa were used not only for talking and texting, but for many other day-to-day activities like banking. He said only 23 percent of Africans have access to banking services, but already 8 million Africans use their cellphones for payments.
So that technology application alone, Mr. Di Leo said, was “a huge opportunity.”
Monday, September 6, 2010
Does anyone remember the Alma Ata Declaration?
Dear Colleagues
A lot of big commitments were made at a UN conference on world health at Alma Ata in 1978. Twenty years later, there were many lessons to be learned about big commitments and tiny progress ... and the biggest lesson of the lot is that conference commitments and talk do not get much accomplished.
Twenty years later ... 1998 ... instead of addressing this lesson of history the high command of the UN and the international official relief and development assistance (ORDA) industry did something even bigger in terms of conference and commitment, they came up with the idea of the Millennium Development Goals (MDGs) with a whole range of things that were going to get done, on a timetable that was then, way into the future!
Surprise surprise ... the commitments associated with the MDGs have not proved much more solid than the old Alma Ata commitments. The ORDA community loves long term goals that are really easy to talk about, and need nothing done right now ... it is very easy to "kick the can down the road" rather than getting to real grips with the problem.
This was the e-mail message that reminded me of the Alma Ata commitments of 1978 and the tiny amount of accomplishment that was achieved compared to what was promised.
Why do we not learn? Perhaps the answer is that there is no need ... we have little memory ... and the necessary metrics are missing.
Peter Burgess
Peter
A lot of big commitments were made at a UN conference on world health at Alma Ata in 1978. Twenty years later, there were many lessons to be learned about big commitments and tiny progress ... and the biggest lesson of the lot is that conference commitments and talk do not get much accomplished.
Twenty years later ... 1998 ... instead of addressing this lesson of history the high command of the UN and the international official relief and development assistance (ORDA) industry did something even bigger in terms of conference and commitment, they came up with the idea of the Millennium Development Goals (MDGs) with a whole range of things that were going to get done, on a timetable that was then, way into the future!
Surprise surprise ... the commitments associated with the MDGs have not proved much more solid than the old Alma Ata commitments. The ORDA community loves long term goals that are really easy to talk about, and need nothing done right now ... it is very easy to "kick the can down the road" rather than getting to real grips with the problem.
This was the e-mail message that reminded me of the Alma Ata commitments of 1978 and the tiny amount of accomplishment that was achieved compared to what was promised.
The declaration of Alma Ata still relevant to primary health care!Perhaps the MDGs are even worse than the Alma Ata commitments ... they have been used to mobilize a lot of development money. But, since the metrics about performance and effective use of money are missing, this has been a bonanza for the ORDA industry participants without moving much towards satisfying the needs of beneficiaries!
Gillam S: British Medical Journal 336:536-538, 8 March 2008
http://www.bmj.com/cgi/content/extract/336/7643/536
After years of relative neglect, the World Health Organization has recently given strategic prominence to the development of primary health care. This year sees the 30th anniversary of the declaration of Alma Ata. Primary health care 'based on practical, scientifically sound and socially acceptable methods and technology made universally accessible through people's full participation and at a cost that the community and country can afford' was to be the key to delivering health for all by the year 2000.
Primary health care in this context includes both primary medical care and activities tackling the social determinants of ill health.
PHM hopes this WHO prominence will result in recommendations that will respect the views of civil society.
Why do we not learn? Perhaps the answer is that there is no need ... we have little memory ... and the necessary metrics are missing.
Peter Burgess
Peter
Friday, September 3, 2010
Malaria ... some dialog from 2008!
Dear Colleagues
One of my interests is the challenge of malaria control. The good news is that there has been a lot more funding in the last five years than perhaps in the last five decades. The bad news is that the funds may well have been used ineffectively and are not going to deliver sustainable results.
The following exchange of messages goes back to March 2008. The following message was the start of the short dialog.
Around the same time there was a New York Times articles that raised a lot of issues about malaria and the possibility of eradication. The URL is:
http://www.nytimes.com/2008/03/04/health/04mala.html?ref=healthIn response to these messages I wrote the following. Nothing I said then needs to be revised ... I could write almost the same message today and it would be entirely relevant. In the meantime some $2 billion has been disbursed with rather little metrics of performance.
One of my interests is the challenge of malaria control. The good news is that there has been a lot more funding in the last five years than perhaps in the last five decades. The bad news is that the funds may well have been used ineffectively and are not going to deliver sustainable results.
The following exchange of messages goes back to March 2008. The following message was the start of the short dialog.
From: The Malaria Roundtable is a community space where individuals and organizations dedicated to policie
To: malariaroundtable@listserve.com
Sent: Tuesday, March 4, 2008 8:59:15 AM
Subject: [malariaroundtable] OneWorld Health Malaria Partnership Announcement
Dear Colleagues,
On Monday, March 3, The Institute for OneWorld Health will lead a project to develop semisynthetic artemisinin using synthetic biology and has signed a Development Agreement with Sanofi-Aventis. A copy of the release is attached.
The scope of the development agreement is to continue R&D work to optimize the microbial fermentation system and apply Sanofi's significant expertise in pilot scale fermentation and process development to the project. In order to develop a viable industrial scale production process, the expertise of a pharmaceutical partner is required at this stage of the program.
If technical benchmarks are achieved, sanofi-aventis will commercialize the semisynthetic artemisinin and make it available to other high quality ACT manufacturers and derivatizers as well as incorporating this pharmaceutical ingredient into their own ACT products.
Please let me know if you have any questions or need any addition information.
Sincerely,
Jim Hickman
James H. Hickman
Vice President, Communications & Fund Development
Institute for OneWorld Health
50 California Street, 5th Floor
San Francisco , CA 94111
www.oneworldhealth.org
Around the same time there was a New York Times articles that raised a lot of issues about malaria and the possibility of eradication. The URL is:
http://www.nytimes.com/2008/03/04/health/04mala.html?ref=health
New York Times, March 4, 2008
Eradicate Malaria? Doubters Fuel Debate
By DONALD G. McNEIL Jr.
Last year, challenging global health orthodoxy, Bill and Melinda Gates called for the eradication of malaria.
That is, for exterminating the parasite everywhere and forever, except perhaps in laboratory storage, as has thus far happened to just one disease in history, smallpox.
Their call, delivered at a malaria conference that they had convened in Seattle, was, in Mrs. Gates's language, "audacious." Her husband went further, asking, "Why would anyone want to follow a long line of failures by becoming the umpteenth person to declare the goal of eradicating malaria?"
To many public health leaders, that remains a good question. While some, including the heads of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President's Malaria Initiative, have lauded the Gateses' call as inspirational, others call it noble but quixotic, because the tools to eradicate malaria do not yet exist. A few, including the combative chief of malaria for the World Health Organization, have even argued that it could do harm.
Dr. Margaret Chan, director general of the W.H.O., backed the call, telling the audience from the dais in Seattle, "I dare you to come along with us."
Last month on his swing through Africa, President Bush implicitly endorsed the idea without mentioning the Gateses, saying the United States would lead the eradication effort.
The Bill & Melinda Gates Foundation has spent $1.2 billion to fight malaria, which is thought to cause as many as 500 million infections a year in 107 countries, a million of them fatal.
Virtually no experts expect it to be eradicated in the lifetimes of the Gateses or the Bushes. Dr. Regina Rabinovich, the foundation's head of infectious disease, said the Gateses knew it was a long-term undertaking, not possible without more money, better health systems and probably a
vaccine, which is still far off.
Dr. Arata Kochi, the W.H.O. malaria chief, went further than other skeptics, arguing that the specter of eradication is counterproductive. With enough money, he said, current tools like nets, medicines and DDT could drive down malaria cases 90 percent.
"But eliminating the last 10 percent is a tremendous task and very expensive," Dr. Kochi said. "Even places like South Africa should think twice before taking this path."
False hopes, he said, lead governments to hope for miracles instead of accepting the mundane budget-draining control policies that he endorses. For example, health officials from Rwanda and Zanzibar, having drastically cut malaria within their borders, have asked him about seeking money for elimination.
Even relatively wealthy countries rarely succeed at that. South Africa, Saudi Arabia and Mexico all control cases but see new ones imported — from Mozambique, Yemen and Guatemala, respectively, he said.
Dr. Awash Teklehaimanot, director of the malaria program at the Earth Institute of Columbia University, said he worried that calls for eradication raised expectations too high, inviting frustration and a loss of political will. "Maybe 10, 15 years from now, we should consider this," he said.
This debate occurs more in the hallways of malaria conferences than in public, because some scientists fear that a zeal for eradication is now compulsory.
Dr. Rabinovich denied that, saying foundation decisions were not based "on whether or not people agree with public statements made by Bill and Melinda."
Nonetheless, nervousness persists. One week after the Gates announcement, the head of an organization financed by the foundation joked in front of a small audience that eradication was "the new marching order."
"Go along with it if you want to get funded," he said, adding that it was viable only if linked "to a date like 2050, or far enough in the future so that none of us can be held accountable."
Asked about that afterward, he asked that he not be quoted. In subsequent forums, he stopped joking and repeatedly said eradication was his organization's goal. The history of eradication, however, favors the skeptics.
The International Task Force for Disease Eradication at the Carter Center in Atlanta lists candidates for extinction. Malaria is not even near the top.
The top two, polio and guinea worm, both cling stubbornly on. The last push on polio, begun in 1988 with the funeral planned for 2000, has consumed $5 billion.
In the early 1900s, another of the world's richest men, John D. Rockefeller, tried to wipe out hookworm and yellow fever. In the American South, he was victorious. Globally, he was not.
Malaria, a parasite that changes shape and hides in multiples organs in mosquitoes and humans, is fiendish compared with polio, a short virus that can be blocked in the gut.
And its death has been predicted before. In 1600, cinchona bark, the source of quinine, was found in the New World. Struggles to monopolize cinchona and sales of counterfeit bark, problems that bedevil drug companies today, quickly emerged.
The best opportunity probably existed in 1955, the year Mr. Gates was born and the year the W.H.O. said it would eradicate malaria. With weapons then new, DDT and chloroquine, a fast-acting synthetic quinine, annual deaths were driven down below 500,000.
But as an old bitter joke among parasitologists goes: "We didn't wipe out malaria. We wiped out malariologists." It was working so well that young scientists chose other fields.
Then, slowly, it fell apart. Chloroquine-resistant parasites and pesticide-resistant mosquitoes emerged. Rachel Carson's 1962 book "Silent Spring" made DDT a pariah.
And the world changed. Before the 1960s, colonial governments and companies fought malaria because their officials often lived in remote outposts like Nigeria's hill stations and Vietnam's Marble Mountains. Independence movements led to freedom, but also often to civil war, poverty, corrupt government and the collapse of medical care.
The best-known example of defeat snatched from the jaws of victory is Sri Lanka, which went from one million malaria cases in 1955 to a mere 18 in 1963. Spraying was cut back, and cases surged to 537,000 by 1969. By 2005, the country was again down to 1,640 cases. The civil war's cease-fire of 2001 has broken down, and the disease could surge again.
Sir Richard G. A. Feachem, former director of the Global Fund and now head of the Global Health Group, a policy institute at the University of California, San Francisco, founded with Gates Foundation money, says malaria can be squeezed to death by moving control downward from southern China, up from southern Africa and up across the South Pacific. He hopes for elimination by 2050. "We'll use today's tools today," he said, "and tomorrow's tools tomorrow."
By contrast, Clive J. Shiff, a malaria expert at the Johns Hopkins Bloomberg School of Public Health who fought malaria in the 1950s in what was then Rhodesia, says flatly that unless Africa can end both its poverty and its civic strife, "eradication is a pipe dream." With smallpox or measles, he explained, a single childhood bout usually confers lifetime immunity. Vaccines, made from weakened virus, confer the same.
With malaria, however, children who survive multiple bouts receive just a quasi-immunity. Adults become mildly ill. Without repeated "doses" from mosquitoes, that fades. If an adult leaves for a few years and returns, a single bite can kill. So creating a lifelong vaccine may be impossible.
Malaria is also a tempting political weapon. In southeastern Rhodesia, Dr. Shiff said, local eradication failed because nearby South Africa and Mozambique would not cooperate. In Nyasaland, now Malawi, rebels against the white government ejected or fought spraying teams. Nowadays, African tribal rivalries have replaced black-white conflicts.
Most countries finally suppress malaria only when wealth arrives. Their houses have windows, and their swamps are not just treated but paved for malls. The disease could return even to the United States. There are susceptible mosquitoes from Florida to Canada.
Re: New York Times Article and Performance Metrics for Malaria
3/5/08
Dear Colleagues
It is good to see malaria in the news ... but it would be better to see reports about reduction of the burden of malaria in Africa rather than these opinion pieces and reporting about academic dialog.
Or is this dialog academic?
There is virtually no accounting and performance metrics in the present day malaria industry, so the allocation of funds that are becoming available ... and are now getting to be serious money
approaching $billions if not already there ... has become serious business. Winning the opinion debate has big economic consequences, and has very little to do with the eradication of malaria or the reduction in malaria burden in the real world that is seriously affected by malaria.
Without accounting and performance metrics the money is going to be allocated for activities that have the best argument. From my accounting perspective this is appalling. Funds should be allocated to be used in ways that are going to do the most (social) good. While there is scope for opinion and disagreement within this accounting arithmetic ... it will serve to avoid gross abuse of the funds and the way they are allocated.
A starting point for getting meaningful performance metrics has to be some fairly broad commitment in the malaria industry that performance metrics are needed and there is a responsibility on the part of everyone to "get on board". Up to now there is some rather quiet talk about performance metrics, but not very much of the walk. To the extent that there are performance metrics, it seems that they are closely guarded secrets. This has to change.
But the change will be disconcerting ... and the blunt fact is that some programs and projects will be seen to be failing ... and worse, some careers will be on the line. Welcome to the world!
I have been surprised recently to see reporting that the Bill & Melinda Gates Foundation has spent $1.2 billion to fight malaria. That is an impressive number. However, I have not been able (easily) to find how this money has been used and how much of results have been achieved. When I was taught practical auditing, one of the things I learned was that when it is difficult to find the data, the data are usually bad ... so my initial conclusion is that most of this money has produced rather little ... or, in other words, it has been wasted.
The good news is that there are fund flows for malaria ... the good news is that there is dialog ... now we need some accounting and performance metrics that stand up and some decisions about allocation of resources that will make the performance metrics as good as they can be.
Sincerely
Peter Burgess
Single silver bullets, like ICT, do not work on their own!
Dear Colleagues
This is an old e-mail message from October 2008. The conference could have been at any time from say 1990 to now, and its theme would still have been relevant.
The point being made is that with Information and Communication Technology (ICT) it is possible for important things to be done remotely ... especially the building of political systems and gathering of information. It is argued that with information, then many of the constraints on development and the reasons for poverty will be resolved. Without ICT, it follows, that this information cannot be obtained and therefore problems will remain.
This is an elegant argument ... but I do not see it having much connection with real world reality.
Success in socio-economic development requires more than one silver bullet ... everything that is needed must work to have success. This is a simple idea ... but national government and the relief and development community is not organized to engage in this way!
Sincerely
Peter Burgess
This is an old e-mail message from October 2008. The conference could have been at any time from say 1990 to now, and its theme would still have been relevant.
The point being made is that with Information and Communication Technology (ICT) it is possible for important things to be done remotely ... especially the building of political systems and gathering of information. It is argued that with information, then many of the constraints on development and the reasons for poverty will be resolved. Without ICT, it follows, that this information cannot be obtained and therefore problems will remain.
This is an elegant argument ... but I do not see it having much connection with real world reality.
ICT is a Means to Achieve Development and DemocracyThe problems of progress and performance in socio-economic development are multiple, and solutions have to address all the issues simultaneously in order for progress to be achieved. This is very difficult at the national level, but easier in a smaller setting. There have been great successes at the community level ... but often not sustainable because the national level elements of the economy have been so badly broken. One of my examples of this is the success of community development in Shenge, Sierra Leone during the 1980s. Because of the completely dysfunctional national economy and politics of the country, very little of the progress could be sustained without perpetual external intervention!
10/8/08
Information and Communication Technology (ICT) is a means to achieve development and democracy, through supporting political, economic and social transformation, the Commonwealth Director of Legal Affairs told delegates at the Sixth Commonwealth ICT Summit in Abuja, Nigeria yesterday (6 October).
Betty Mould-Iddrisu was speaking at the opening of the two-day summit organized by the Commonwealth Telecommunications Organisation (CTO), in collaboration with the Ministry of Information and Communications and the Nigerian Communications Commission (NCC). She made the address on behalf of Commonwealth Secretary-General Kamalesh Sharma.
"Without a robust telecommunications network citizens cannot access health services remotely or obtain a good education for their children who are located in remote communities. We must help lift the smallest and most vulnerable and most in need off the bottom rung," she said.
Experts in the field of telecommunications and ICT, private sector representatives, international aid agencies and civil society organisations are meeting discuss the theme: "Ensuring Effective Connectivity for a Socially Inclusive and a Commercially Vibrant Africa."
The term digital divide refers to the gap between those people with effective access to digital and information technology and those without
This summit also offers participants the opportunity to explore Africa as a fertile emerging market for ICT business, to gain up-to-date insights into current trends in technological advances, and compare national ICT strategies.
The Secretary-General is encouraging the global network of Commonwealth member governments and associations such as the CTO, COMNET-IT and the CBC to work in partnerships with the wider
international community to help Africa to reduce its digital divide
Ms Mould-Iddrisu reiterated this by saying: "The Commonwealth is not a resource-rich organisation, in money terms. But its networks, and the goodwill that it generates, can be worth a great deal."
Over the coming months the Commonwealth Secretariat will be delivering a series of workshops designed to build capacity in the Development and Implementation of National ICT Strategies, a necessary pre-requisite before any major investment in ICT can be made.
Top government officials from more than 58 countries, including non-Commonwealth countries are attending the meeting to discuss Africa's march towards ICT development.
The CTO is an international development partnership between Commonwealth and non-Commonwealth governments, business and civil society organisations. It provides the international community with effective means to help bridge the digital divide and achieve social and economic development, by delivering to developing countries unique knowledge-sharing programmes in the use of information and communication technologies (ICT) in the specific areas of telecommunications, IT, broadcasting and the Internet. It has a specific focus on private-public partnerships.
Source; Commonwealth News and Information Service (London)
Success in socio-economic development requires more than one silver bullet ... everything that is needed must work to have success. This is a simple idea ... but national government and the relief and development community is not organized to engage in this way!
Sincerely
Peter Burgess
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