Let me start this review by saying that academics are underrated in business school. Everyone says that you do an MBA for the network and for the parties, but in Tulum I found myself having conversations with classmates that I didn’t expect to have 1 year ago, on topics that I previously knew little or cared about.
An appreciation of this book — on the damages inflicted by the IMF on African economies — would be lost if not for a module on business and government in international economies. In this book, Lewis provides a damning portrait of how world organisations like the UN, World Bank, G8 and IMF don’t do enough for the AIDS crisis in Africa; how a lot of good intentions are lost in bureaucracy, how there is a lot of strategy but no execution and scale. As former Permanent Representative to the UN for Canada and UN Special Envoy for HIV/AIDS in Africa, he pulls back the curtain on the workings and inefficiencies of the UN, and praises organisations like Doctors Without Borders for doing actual work. I thought essay 4 was the weakest in its lack of focus on the intersectionality of feminism and black women, but this book, written in 2005, still remains timeless, especially given that the world has lived through another pandemic, this time a global one. The stark difference is that it’s been 35+ years since AIDS was discovered and no vaccine has been developed yet; the Covid-19 vaccine came out in a year. Cue class discussions about pharma, neglected diseases, pricing strategies and the importance of cash flow management.
Finished this book in Tulum.
Quotes:
IFIS — the collection of International Financial Institutions dominated by the World Bank and the International Monetary Fund, Africa Development bank and other regional development banks. The result of the IFIS’ destructive power over Africa was to compromise the social sectors, particularly the health and education sectors.
IFIS launched the Structural Adjustment Programs (SAPS) were Reagonomics gone berserk. For almost 20 years, those rigid fundamentalist policies did extraordinary damage to African economies. They were driven by “conditionality”. The conditions ranged from the sale of public sector corporations, to the imposition of “cost sharing” (user fees imposed on health and education), to savage cut-backs in employment levels in the public service, mostly in the social sectors. […] Macroeconomic limits on the numbers of people (think nurses and teachers) who can be hired, financial limits placed on the amount of money that can be spent on the social sectors as a percentage of GNP. […] Curtail and decimate the public sector; enhanced at any cost, the private sector.
Both the Bank and the Fund were treating Africa as though it consisted of mature economies to whom western economic protocols would apply. The upper echelons of the bank and the fund talked the worldly language of “macroeconomic adjustment”, while Africa shredded its social sectors, and poverty intensified.
IMF simply doesn’t understand the combined ravaged of HIV/ AIDS and poverty; fails to understand that you can’t deny the hiring of health professionals in the face of an apocalypse, just because you adhere religiously to some rabid economic dialectic which says that no matter how grievous the circumstance, you can’t breach the macroeconomic environment. […] They we’re complaining bitterly about the limits imposed by the IMF on Malawi’s public sector pay levels and hiring intentions. It was surreal: here you had a country with huge human capacity problems that desperately wanted to retain its professionals in health and education, and increase their numbers, but the IMF wouldn’t allow (this sovereign government) to do so, […] because it would breach the macroeconomic straitjacket.
Camdessus is a learned and charming man, but I’ve seldom heard such an accomplished dissertation of disingenuous claptrap.
Many individual African countries were spending more money on serving the debt, both bilateral and multilateral, than spending on health or on education. […] It paid back $260 billion mostly in interest. Much of the bilateral debt had been cancelled, but the multilateral debt, that is, the debt owed to the World Bank, the IMF and the ADB, continued to plague the treasuries of African countries.
So much of today’s staggering debt was irresponsibly lent and irresponsibly borrowed would matter less if the consequences of such folly were falling on its perpetrators [African dictators]. Yet now, when the party is over and the bills are coming in, it is the poor who are being asked to pay.
This exercise in self-hypnosis; you get caught up in the sense of power and excitement and influence, and lose perspective.
Over 60% of ODA should be called “phantom aid”; the money goes to “technical assistance” (overpriced consultants), “tied aid” (purchase of goods and services from the donor country’s own firms); and to “administrative costs” (inflated overhead). The UK Department of International Development paid the Adam Smith Institute half a million pounds to “advise” the government of Tanzania aid (which they counted as “foreign aid”).
The problem [shortage of medical personnel] is grievously compounded by the practice of “poaching”, and the resulting brain drain from Africa to the outside world. There are more Malawian doctors in Manchester than in Malawi, more Zambian doctors in Birmingham than in Zambia.
[With orphans] The transfer of love and knowledge and values and experience from one generation to the next is gone, and with it goes the confidence and security and sense of place which children normally take for granted. Children, already traumatised by the death of their parents, are left reeling as they confront the void in the aftermath.
There is no master plan for children orphaned by AIDS. There are endless studies, and individual projects and frameworks. But nothing is yet taken to scale. The gap between analysis and action yawns like the proverbial chasm.
Prevention consists of far more than life skills classes, or learning modules; it consists of affirmative action for girls that undoes all the cumulative damage done over time, to their perceptions of themselves, their egos, self-confidence, sexuality.
Children must be able to turn to schools as places of learning, inclusion, stability and life-saving information about HIV/ AIDS. Orphan children need friends and teachers and attention, one meal a day that could come from a school feeding program, the sense of self-worth that education could bring, want so much to learn.
These annual speakathons gave credence to the proposition that if you talk about something for long enough, the illusion will be created that progress is being made. And I suppose there has been some progress in the world of reports, analyses, figures, tables, diagrams, and at least a thousand PowerPoint presentations, not to overlook thriving intellectual rumination, but very little progress that’s discernible in the lives of orphaned and vulnerable children on the ground.
The Poverty Reduction Strategy [..] First, give priority to satisfying the World Bank and the IMF and the donors, rather than the developing country; second, pay far too little attention to job creation and the need for increased incomes to alleviate poverty; third, depreciate the value of public investment; fourth, support privatisation of public services like water and electricity, with mixed records.
There were far too many [donor diplomats] who resented their posting to a minor African country, and glowered their way through every meeting. What’s more, a surprising number of Western diplomats had seldom ventured beyond the capitals; they lived lives off rumour informed by gossip. And they were so stubbornly opinionated, so omniscient. You have to ask yourself how the donors had the presumption to decide that they, and not the government, would determine public policy.
What we need is the country makes the decisions, designs the interventions and abolishes school fees of every kind, and UNICEF provides expert technical assistance on the one hand, and organises collective financial international response on the other.
The Japanese government, which had been resisting an increase in its annual contribution, suddenly promised to double aid to Africa in three years. Everyone recognised that Japan’s sudden change of heart was tied directly to its pursuit of a seat on the Security Council.
US policy requiring all NGO recipients of foreign aid to sign an agreement that they will not support prostitution. This ideological fiat has the effect of compromising projects involving commercial sex workers, who are obviously key to fighting the AIDS pandemic. No one promotes prostitution, but it’s counter productive to dismiss and isolate a group that’s so important in the fight against the pandemic. […] The disproportionate emphasis on abstinence was serving to diminish the importance of condoms.
Pavlovian obeisance to the United States. Apparently, criticism is permitted of the G8, Tony Blair’s Commission in Africa, the World Bank, the IMF, the WTO, the Government of South Africa, Zimbabwe, the King of Swaziland, and the UN itself, but almost never the sacrosanct “integrity” of the USA.