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Context  The effect of global health initiatives on population health is uncertain. Between 2003 and 2008, the US President's Emergency Plan for AIDS Relief (PEPFAR), the largest initiative ever devoted to a single disease, operated intensively in 12 African focus countries. The initiative's effect on all-cause adult mortality is unknown.

Objective  To determine whether PEPFAR was associated with relative changes in adult mortality in the countries and districts where it operated most intensively.

Design, Setting, and Participants  Using person-level data from the Demographic and Health Surveys, we conducted cross-country and within-country analyses of adult mortality (annual probability of death per 1000 adults between 15 and 59 years old) and PEPFAR's activities. Across countries, we compared adult mortality in 9 African focus countries (Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, Tanzania, Uganda, and Zambia) with 18 African nonfocus countries from 1998 to 2008. We performed subnational analyses using information on PEPFAR's programmatic intensity in Tanzania and Rwanda. We employed difference-in-difference analyses with fixed effects for countries and years as well as personal and time-varying area characteristics.

Main Outcome Measure  Adult all-cause mortality.

Results  We analyzed information on 1 538 612 adults, including 60 303 deaths, from 41 surveys in 27 countries, 9 of them focus countries. In 2003, age-adjusted adult mortality was 8.3 per 1000 adults in the focus countries (95% CI, 8.0-8.6) and 8.5 per 1000 adults (95% CI, 8.3-8.7) in the nonfocus countries. In 2008, mortality was 4.1 per 1000 (95% CI, 3.6-4.6) in the focus countries and 6.9 per 1000 (95% CI, 6.3-7.5) in the nonfocus countries. The adjusted odds ratio of mortality among adults living in focus countries compared with nonfocus countries between 2004 and 2008 was 0.84 (95% CI, 0.72-0.99; P = .03). Within Tanzania and Rwanda, the adjusted odds ratio of mortality for adults living in districts where PEPFAR operated more intensively was 0.83 (95% CI, 0.72-0.97; P = .02) and 0.75 (95% CI, 0.56-0.99; P = .04), respectively, compared with districts where it operated less intensively.

Conclusions  Between 2004 and 2008, all-cause adult mortality declined more in PEPFAR focus countries relative to nonfocus countries. It was not possible to determine whether PEPFAR was associated with mortality effects separate from reductions in HIV-specific deaths.

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Eran Bendavid
Grant Miller
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Abstract
The manifestations of 'open' are permeating the society enabled by the rise of participatory culture and improved communication technologies. In her research, Tanja Aitamurto examines the impact of openness on traditionally closed processes such as journalism, policy-making and design. Aitamurto draws on several case studies, in which collective intelligence is harnessed through crowdsourcing, open innovation and co-creation. Her work is based on data from 150 in-depth interviews and about 8,000 data points recorded by netnography. Aitamurto's research is situated in social sciences, informed by organization studies and management science and engineering. She finds that the 'open' challenges the incumbent power structures when participatory mechanisms become a means to practice social control.

Tanja Aitamurto is a visiting researcher at the Program on Liberation Technology at the Center on Democracy, Development and the Rule of Law at Stanford. In her PhD project she examines how collective intelligence, whether harvested by crowdsourcing, co-creation or open innovation, impacts incumbent processes in journalism, public policy making and design process. Her work has been published in several academic publications, such as the New Media and Society. Related to her studies, she advises the Government and the Parliament of Finland about Open Government principles, for example about how open data and crowdsourcing can serve democratic processes.

Aitamurto has previously studied at the Center for Design Research and at the Innovation Journalism Program at Stanford. She is a PhD Student at the Center for Journalism, Media and Communication Research at Tampere University in Finland, and she holds a Master’s Degree in Public Policy, and a Master of Arts in Humanities. Prior to returning to academia, she made a career in journalism in Finland specializing in foreign affairs, doing reporting in countries such as Afghanistan, Angola and Uganda. She has also taught journalism at the University of Zambia, in Lusaka, and worked at the Namibia Press Agency, Windhoek. More about Tanja’s work at www.tanjaaitamurto.com and on Twitter @tanjaaita.

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Tanja Aitamurto Visiting Researcher, Program on Liberation Technology, CDDRL Speaker Stanford University
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Glwadys_profile_pic.jpg MS, PhD

Glwadys Aymone Gbetibouo is a citizen from Côte d’Ivoire (Ivory Coast) where she received an Ingénieur Agronome degree in 2000 at the Institut National Polytechnique Houphouët Boigny. She then joined the University of Pretoria to pursue post-graduate studies in agricultural and environmental economics and policy analysis. She obtained both a MSc degree in Agricultural Economics in 2004 and a PhD in Environmental Economics in 2011 from the University of Pretoria. Her research interests include global warming and agriculture. Her area of expertise is on measuring the impacts of climate change on agriculture and the adaptation behavior and vulnerability of rural communities to climate change and variability.

Prior to joining FSE, Glwadys has been working as an international climate change consultant at C4EcoSolutions, a private consulting firm based in South Africa. During her time at C4 EcoSolutions, she has been involved in developing climate change adaptation project documents for the United Nations Agencies for funding under the Global Environmental Fund (GEF) Least Developing Countries Fund (LDCF) and Special Climate Change Fund (SCCF). Also she has provided technical guidance and advisory services for the implementation of climate change projects in countries such as Djibouti, Lesotho. Mozambique, Niger and Zambia.

Glwadys’s current research is on small scale irrigation technologies and adaptation to climate change.

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Visiting Researcher
Aitamurto_HS1.jpg

Tanja Aitamurto was a visiting researcher at the Program on Liberation Technology at the Center on Democracy, Development and the Rule of Law at Stanford University. In her PhD project she examined how collective intelligence, whether harvested by crowdsourcing, co-creation or open innovation, impacts incumbent processes in journalism, public policy making and design process. Her work has been published in several academic publications, such as the New Media and Society. Related to her studies, she advises the Government and the Parliament of Finland about Open Government principles, for example about how open data and crowdsourcing can serve democratic processes. Aitamurto now works as a postdoctoral fellow at the Brown Institute for Media Innovation at Stanford.

Aitamurto has previously studied at the Center for Design Research and at the Innovation Journalism Program at Stanford University. She is a PhD Student at the Center for Journalism, Media and Communication Research at Tampere University in Finland, and she holds a Master’s Degree in Public Policy, and a Master of Arts in Humanities. Prior to returning to academia, she made a career in journalism in Finland specializing in foreign affairs, reporting in countries such as Afghanistan, Angola and Uganda. She has also taught journalism at the University of Zambia, in Lusaka, and worked at the Namibia Press Agency, Windhoek.

She also actively participates in the developments she is studying; she crowdfunded a reporting and research trip to Egypt in 2011 to investigate crowdsourcing in public deliberation. She also practices social entrepreneurship in the Virtual SafeBox (http://designinglibtech.tumblr.com/), a project, which sprang from Designing Liberation Technologies class at Stanford. Tanja blogs on the Huffington Post and writes about her research at PBS MediaShift. More about Tanja’s work at www.tanjaaitamurto.com and on Twitter @tanjaaita.

 

 

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 Abstract:

Systemic corruption undermines state capacity, imperils socio-economic development, and diminishes democracy. In his Nairobi speech as a U.S. senator in August 2006, Barack Obama described the struggle to reduce corruption as "the fight of our time". An international conference in Lagos, Nigeria, in September 2011 was devoted to Richard Joseph's influential 1987 book, Democracy and Prebendal Politics in Nigeria: The Rise and Fall of the Second Republic.Transforming prebendalist systems must be at the center of strategies to strengthen democracy and achieve poverty-reducing economic growth in Africa and other regions.

 Speaker Bio: 

Richard Joseph is John Evans Professor of International History and Politics at Northwestern University and Non resident Senior Fellow in Global Economy and Development at the Brookings Institution. As a Fellow of The Carter Center, he participated in democracy and peace initiatives in Ghana, Zambia, Ethiopia, Liberiaand Sudan. He has written extensively on issues of democracy, governance and political economy. His books include Radical Nationalism in Cameroun (1977), Democracy and Prebendal Politics in Nigeria (1987) and edited books, Gaullist Africa: Cameroon under Ahmadu Ahidjo (1978), State, Conflict and Democracy in Africa (1999), and (with Alexandra Gillies), Smart Aid for African Development (2009). He served as Principal Investigator of the Research Alliance to Combat HIV/AIDS (REACH), a collaborative program in Nigeria, 2006–2011. His current writing and policy projects concern growth, democracy and security. To address these issues, he is designing a collaborative project, AfricaPlus (http://africaplus.wordpress.com/), whose first focus country is Nigeria.

Here is the link to Richard Joseph remarks and the PowerPoint for the talk.

http://africaplus.wordpress.com/author/africaplus/

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Richard Joseph John Evans Professor of International History and Politics Speaker Northwestern University
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Abstract

Background

Survival to old ages is increasing in many African countries. While demographic tools for estimating mortality up to age 60 have improved greatly, mortality patterns above age 60 rely on models based on little or no demographic data. These estimates are important for social planning and demographic projections. We provide direct estimations of older-age mortality using survey data.

Methods

Since 2005, nationally representative household surveys in ten sub-Saharan countries record counts of living and recently deceased household members: Burkina Faso, Côte d'Ivoire, Ethiopia, Namibia, Nigeria, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. After accounting for age heaping using multiple imputation, we use this information to estimate probability of death in 5-year intervals (5qx). We then compare our 5qx estimates to those provided by the World Health Organization (WHO) and the United Nations Population Division (UNPD) to estimate the differences in mortality estimates, especially among individuals older than 60 years old.

Findings

We obtained information on 505,827 individuals (18.4% over age 60, 1.64% deceased). WHO and UNPD mortality models match our estimates closely up to age 60 (mean difference in probability of death -1.1%). However, mortality probabilities above age 60 are lower using our estimations than either WHO or UNPD. The mean difference between our sample and the WHO is 5.9% (95% CI 3.8–7.9%) and between our sample is UNPD is 13.5% (95% CI 11.6–15.5%). Regardless of the comparator, the difference in mortality estimations rises monotonically above age 60.

Interpretation

Mortality estimations above age 60 in ten African countries exhibit large variations depending on the method of estimation. The observed patterns suggest the possibility that survival in some African countries among adults older than age 60 is better than previously thought. Improving the quality and coverage of vital information in developing countries will become increasingly important with future reductions in mortality.

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We estimated the effectiveness and cost-effectiveness of changes in concurrent sexual partnerships in reducing the spread of HIV in sub-Saharan Africa. Using data from Swaziland, Tanzania, Uganda and Zambia, we estimated country-specific concurrency behaviour from sexual behaviour survey data on the number of partners in the past 12 months, and we developed a network model to compare the impact of three behaviour changes on the HIV epidemic: (1) changes in concurrent partnership patterns to strict monogamy; (2) partnership reduction among those with the greatest number of partners; and (3) partnership reduction among all individuals. We estimated the number of new HIV infections over 10 years and the cost per infection averted. Given our assumptions and model structure, we find that reducing concurrency among high-risk individuals averts the most infections and increasing monogamy the least (11.7% versus 8.7% reduction in new infections, on average, for a 10% reduction in concurrent partnerships). A campaign that costs US$1 per person annually is likely cost-saving if it reduces concurrency by 9% on average, given our baseline estimates of concurrency. In sensitivity analysis, the rank ordering of behaviour change scenarios was unaffected by potential over-estimation of concurrency, though the number of infections averted decreased and the cost per HIV infection averted increased. Concurrency reduction programmes may be effective and cost-effective in reducing HIV incidence in sub-Saharan Africa if they can achieve even modest impacts at similar costs to past mass media campaigns in the region. Reduced concurrency among high-risk individuals appears to be most effective in reducing HIV incidence, but concurrency reduction in other risk groups may yield nearly as much benefit.

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International Journal of STD & AIDS
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Eran Bendavid
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About the Program

Launched in 2005, the Draper Hills Summer Fellowship on Democracy and Development Program  is a three-week executive education program that is hosted annually at Stanford University's Center on Democracy, Development, and the Rule of Law. The program brings together a diverse group of 25-30 mid-career practitioners in law, politics, government, private enterprise, civil society, and international development from transitioning countries. This training program provides a unique forum for emerging leaders to connect, exchange experiences, and receive academic training to enrich their knowledge and advance their work.

For three weeks during the summer, fellows participate in academic seminars that expose them to the theory and practice of democracy, development, and the rule of law. Delivered by leading Stanford faculty from the Stanford Law School, the Graduate School of Business, and the Departments of Economics and Political Science, these seminars allow emerging leaders to explore new institutional models and frameworks to enhance their ability to promote democratic change in their home countries.

Guest speakers from private foundations, think tanks, government, and the justice system, provide a practitioners viewpoint on such pressing issues in the field. Past program speakers have included; Carl Gershman, president of the National Endowment for Democracy; Kavita Ramdas, former president and CEO of the Global Fund for Women; Stacy Donohue, director of investments at the Omidyar Network; Maria Rendon Labadan, Deputy Director of USAID; and Judge Pamela Rymer, United States Court of Appeals for the Ninth Circuit. Fellows also visit Silicon Valley technology firms to explore how technology tools and social media platforms are being used to catalyze democratic practices on a global scale.

The program is funded by generous support from Bill and Phyllis Draper and Ingrid von Mangoldt Hills.

About the Faculty

The program's all-volunteer interdisciplinary faculty includes leading political scientists, lawyers, and economists, pioneering innovative research and analysis in the fields of democracy, development, and the rule of law. Faculty engage the fellows to test their theories, exchange ideas and learn first-hand about the challenges activists face in places where democracy is at threat. CDDRL Draper Hills Summer Fellows faculty includes; Larry Diamond, Kathryn Stoner-Weiss, Stanford President Emeritus Gerhard Casper, Erik Jensen, Francis Fukuyama, Steve Krasner, Avner Greif, Helen Stacy, and Nicholas Hope.

About our Draper Hills Summer Fellows
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Our network of 186 alumni who graduated from the Draper Hills Summer Fellows program hail  from 57 developing democracies worldwide. Their professional backgrounds are as diverse as the problems they confront in their home countries, but the one common feature is their commitment to building sound structures of democracy and development. The regions of Eurasia, which includes the former Soviet Union and Central Asia, along with Africa constitute over half of our alumni network. Women represent 40% of the network and the program is always looking to identify strong female leaders working to advance change in their local communities.

Previous Draper Hills Summer Fellows have served as presidential advisors, senators, attorneys general, lawyers, journalists, civic activists, entrepreneurs, academic researchers, think-tank managers, and members of the international development community. The program is highly selective, receiving several hundred applications each year.

Please see the alumni section of the website for a complete listing of our program alumni.

Our Summer Fellows include:

  • The former Prime Minister of Mongolia
  • Political activists at the forefront of the 2011 Egyptian revolution
  • Advocate for the high court of Zambia
  • Deputy Minister of the Interior of Ukraine
  • Peace advocate and human rights leader in Kenya
  • Journalists advocating for a greater role for independent media
  • Leading democratic intellectual in China
  • Social entrepreneur using technology for public accountability in India

 

 Funding

Stanford will pay travel, accommodation, living expenses, and visa costs for the duration of the three-week program for a certain portion of applicants. Participants will be housed on the Stanford campus in residential housing during the program. Where possible, applicants are encouraged to supply some or all of their own funding from their current employers or international nongovernmental organizations.

 

 




 
 
 
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In reaction to the arrest of Dominique Strauss-Khan for allegations of rape in May, Kavita Ramdas and Christine Ahn argue in a piece for Foreign Policy in Focus that gender bias is embedded in the global policies and practices at the IMF, which unfairly target women. Kavita Ramdas is the former president and CEO of the Global Fund for Women and a visiting scholar at the Center on Democracy, Development, and the Rule of Law.

In reaction to the arrest of Dominique Strauss-Khan for allegations of rape in May, Kavita Ramdas and Christine Ahn argue in a piece for Foreign Policy in Focus that gender bias is embedded in the global policies and practices at the IMF, which unfairly target women. Kavita Ramdas is the president and CEO of the Global Fund for Women and a visiting scholar at the Center on Democracy, Development, and the Rule of Law.

As Dominique Strauss-Kahn, head of the world’s most powerful financial institution, the International Monetary Fund (IMF), spends a few nights in Rikers Island prison awaiting a hearing, the world is learning a lot about his history of treating women as expendable sex objects. Strauss-Kahn has been charged with rape and forced imprisonment of a 32-year-old Guinean hotel worker at a $3,000-a-night luxury hotel in New York.

While the media dissects the attempted rape of a young African woman and begins to dig out more information about Strauss-Kahn’s past indiscretions, we couldn’t help but see this situation through the feminist lens of the “personal is political.” 

For many in the developing world, the IMF and its draconian policies of structural adjustment have systematically “raped” the earth and the poor and violated the human rights of women. It appears that the personal disregard and disrespect for women demonstrated by the man at the highest levels of leadership within the IMF is quite consistent with the gender bias inherent in the IMF’s institutional policies and practice.

Systematic Violation of Women’s Human Rights

The IMF and the World Bank were established in the aftermath of World War II to promote international trade and monetary cooperation by giving governments loans in times of severe budget crises. Although 184 countries make up the IMF’s membership, only five countries—France, Germany, Japan, Britain, and the United States—control 50 percent of the votes, which are allocated according to each country’s contribution.

The IMF has earned its villainous reputation in the Global South because in exchange for loans, governments must accept a range of austerity measures known as structural adjustment programs (SAPs). A typical IMF package encourages export promotion over local production for local consumption. It also pushes for lower tariffs and cuts in government programs such as welfare and education. Instead of reducing poverty, the trillion dollars of loans issued by the IMF have deepened poverty, especially for women who make up 70 percent of the world’s poor.

IMF-mandated government cutbacks in social welfare spending have often been achieved by cutting public sector jobs, which disproportionately impact women. Women hold most of the lower-skilled public sector jobs, and they are often the first to be cut. Also, as social programs like caregiving are slashed, women are expected to take on additional domestic responsibilities that further limit their access to education or other jobs.

In exchange for borrowing $5.8 billion from the IMF and World Bank, Tanzania agreed to impose fees for health services, which led to fewer women seeking hospital deliveries or post-natal care and naturally, higher rates of maternal death.  In Zambia, the imposition of SAPs led to a significant drop in girls’ enrollment in schools and a spike in “survival or subsistence sex” as a way for young women to continue their educations.

But IMF’s austerity measures don’t just apply to poor African countries. In 1997, South Korea received $57 billion in loans in exchange for IMF conditionalities that forced the government to introduce “labor market flexibility,” which outlined steps for the government to compress wages, fire “surplus workers,” and cut government spending on programs and infrastructure. When the financial crisis hit, seven Korean women were laid off for every one Korean man. In a sick twist, the Korean government launched a "get your husband energized" campaign encouraging women to support depressed male partners while they cooked, cleaned, and cared for everyone.

Nearly 15 years later, the scenario is grim for South Korean workers, especially women. Of all OECD countries, Koreans work the longest hours: 90% of men and 77% of women work over 40 hours a week.  According to economist Martin Hart-Landsberg, in 2000, 40 percent of Korean workers were irregular workers; by 2008, 60 percent worked in the informal economy. The Korean Women Working Academy reports that today 70 percent of Korean women workers are temporary laborers.

Selling Mother Earth

IMF policies have also raped the earth by dictating that governments privatize the natural resources most people depend on for their survival: water, land, forests, and fisheries. SAPs have also forced developing countries to stop growing staple foods for domestic consumption and instead focus on growing cash crops, like cut flowers and coffee for export to volatile global markets. These policies have destroyed the livelihoods of small-scale subsistence farmers, the majority of whom are women.

“IMF adjustment programs forced poor countries to abandon policies that protected their farmers and their agricultural production and markets,” says Henk Hobbelink of GRAIN, an international organization that promotes sustainable agriculture and biodiversity. "As a result, many countries became dependent on food imports, as local farmers could not compete with the subsidized products from the North. This is one of the main factors in the current food crisis, for which the IMF is directly to blame."

In the Democratic Republic of Congo (DRC), IMF loans have paved the way for the privatization of the country’s mines by transnational corporations and local elites, which has forcibly displaced thousands of Congolese people in a context where women and girls experience obscenely high levels of sexual slavery and rape in the eastern provinces. According to Gender Action, the World Bank and IMF have made loans to the DRC to restructure the mining sector, which translates into laying off tens of thousands of workers, including women and girls who depend on the mining operations for their livelihoods. Furthermore, as the land becomes mined and privatized, women and girls responsible for gathering water and firewood must walk even further, making them more susceptible to violent crimes.

We Are Over It

Women’s rights activists around the globe are consistently dumbfounded by how such violations of women’s bodies are routinely dismissed as minor transgressions. Strauss-Kahn, one of the world’s most powerful politicians whose decisions affected millions across the globe, was known for being a “womanizer” who often forced himself on younger, junior women in subordinate positions where they were vulnerable to his far greater power, influence, and clout. Yet none of his colleagues or fellow Socialist Party members took these reports seriously, colluding in a consensus shared even by his wife that the violation of women’s bodily integrity is not in any sense a genuine violation of human rights.

Why else would the world tolerate the unearthly news that 48 Congolese women are raped every hour with deadening inaction? Eve Ensler speaks for us all when she writes, “I am over a world that could allow, has allowed, continues to allow 400,000 women, 2,300 women, or one woman to be raped anywhere, anytime of any day in the Congo. The women of Congo are over it too.”

We live in a world where millions of women don’t speak their truth, don’t tell their dark stories, don’t reveal their horror lived every day just because they were born women.  They don’t do it for the same reasons that the women in the Congo articulate – they are tired of not being heard. They are tired of men like Strauss-Kahn, powerful and in suits, believing that they can rape a black woman in a hotel room, just because they feel like it. They are tired of the police not believing them or arresting them for being sex workers. They are tired of hospitals not having rape kits. They are tired of reporting rape and being charged for adultery in Iran, Pakistan, and Saudi Arabia.

Fighting Back

For each one of them, and for those of us who have spent many years investing in the tenacity of women’s movements across the globe, the courage and gumption of the young Guinean immigrant shines like the torch held by Lady Liberty herself. This young woman makes you believe we can change this reality. She refused to be intimidated.  She stood up for herself. She fought to free herself—twice—from the violent grip of the man attacking her. She didn’t care who he was—she knew she was violated and she reported it straight to the hotel staff, who went straight to the New York police, who went straight to JFK to pluck Strauss-Kahn from his first-class Air France seat.

In a world where it often feels as though wealth and power can buy anything, the courage of a young woman and the people who stood by her took our breath away. These stubborn, ethical acts of working class people in New York City reminded us that women have the right to say “no.”  It reminded us that “no” does not mean “yes” as the Yale fraternities would have us believe, and, most importantly that no one, regardless of their position or their gender, should be above the law.  A wise woman judge further drove home the point about how critically important it is to value women’s bodies when she denied Strauss-Kahn bail citing his long history of abusing women.

Strauss-Kahn sits in his Rikers Island cell. It would be a great thing if his trial succeeds in ending the world’s tolerance for those who discriminate and abuse women. We cannot tolerate it one second longer.  We cannot tolerate it at the personal level, we must refuse to condone it at the professional level, and we must challenge it every time it we see it in the policies of global institutions like the International Monetary Fund.

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