Reading Qatar

Qatar National Library

The Creation of Qatar (1979) Zahlan

Histoire et Changements Sociaux au Qatar (1982) Montigny-Kozlowska

Oil and Politics in the Gulf (1990) Crystal

Qatar, A Modern History (2012, 2017) Fromherz

Small State, Big Politics (2013, 2015) Kamrava

Policy-Making in a Transformative State (2016) Tok, Alkhater, Pal

The Global Majlis (2016) Al Kawari

Doha Experiment (2017) Wasserman

The Gulf Crisis (2018) Miller

Teach for Arabia (2019) Vora

Warriors in a Time of Sacrifice (2019) Sandoval 

Changing Qatar (2020) Harkness

Beyond Exception (2020) Kanna, Le Renard, Vora

Qatar and the Gulf Crisis (2020) Ulrichsen

Contemporary Qatar (2021) Zweiri and Al Qawasmi

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213 Hits

Reading that should be more common...

Ibn Khaldun (2015 translation, 1377 original) Al Muqaddimah 

Cesaire, A. (1950) Discourse on Colonialism

Fanon, F. (1952) Black Skin, White Masks 

Fanon, F. (1959) A Dying Colonialism

Baldwin, J. (1962) The Fire Next Time

Fanon, F. (1963) The Wretched of the Earth 

Fanon, F. (1964) Toward the African Revolution

Memmi, A. (1965) The Colonizer and the Colonized

Ture, K. (1965) Stokely Speaks

Ture, K. and Hamilton, C. (1967) Black Power

Nkrumah, K. (1968) Revolutionary Warfare

Freire, P. (1970) Pedagogy of the Oppressed

Nkrumah, K. (1970) Class Struggle in Africa

Rodney, W. (1972) How Europe Underdeveloped Africa 

Nkrumah, K. (1973) The Struggle Continues

Gaddafi, M. (1975) The Green Book

Amin, S. (1976) Unequal Development 

Biko, S. (1978) I Write What I Like 

Said, E. (1978) Orientalism

Thiong'o, N. (1981) Decolonizing the Mind 

Amin, S. (1985 French, 1990 English) Delinkine

Amin, S. (1988 French, 2009 revision) Eurocentrism

Sankara, T. (1988) Thomas Sankara Speaks

Mazrui and Mazrui (1998) The Power of Babel

Thiong'o, N. (1993) Moving the Centre

Said, E. (1993) Culture & Imperialism

Amin, S. (1997) Capitalism in the Age of Globalization

Mills, C. W. (1997) The Racial Contract

Smith, L. T. (1999) Decolonizing Methodologies 

Ahmad, E. (2000) Confronting Empire

Mamdani, M. (2001) When Victims Become Killers

Mbembe, A. (2001) On the Postcolonly

Neocosmos, M. (2001) Thinking Freedom in Africa

Chang, H.-J. (2002) Kicking Away the Ladder

Mutua, M. (2002) Human Rights

Asad, T. (2003) Formations of the Secular

Amin, S. (2004) The Liberal Virus

Taiaiake, A. (2005) Wasase

Kiros, T. (2005) Zera Yacob

Mamdani, M. (2005) Good Muslim, Bad Muslim

Ahmad, E. (2006) The Selected Writings of Eqbal Ahmad

Shivji, I. (2007) Silences in NGO Discourse

Eze, E. C. (2008) On Reason

Tandon, Y. (2008) Ending Aid Dependence

Thiong'o, N. (2009) Something Torn and New

Ho Chi Minh (2011) Selected Works

Mignolo, W. (2011) The Darker Side of Western Modernity

Amin, S. (2011) Ending the Crisis of Capitalism

Thiong'o, N. (2012) Globalectics

Mamdani, M. (2012) Define and Rule

Abu-Lughod, L. (2013) Do Muslim Women Need Saving?

Ndlovu-Gatsheni, S. (2013) Empire, Global Coloniality and African Subjectivity

Ware, R. (2014) The Walking Qur'an

Dabashi, H. (2015) Can Non-Europeans Think?

Massad, J. A. (2015) Islam in Liberalism

Lumumba, P. (2016) May Our People Triumph

Thiong'o, N. (2016) Secure the Base

Cabral, A. (2016, translation) Resistance and Decolonization

Mills, C. W. (2017) Black Rights / White Wrongs

Woldeyes, Y. G. (2017) Native Colonialism 

Mbembe, A. (2017, English translation) Critique of Black Reason

Asad, T. (2018) Secular Translations

Ndlovu-Gatsheni, S. (2018) Epistemic Freedom in Africa

Mamdani, M. (2018) Citizen and Subject

Mignolo, W. and Walsh, C. (2018) On Decoloniality 

Ibhawoh, B. (2018) Human Rights in Africa

Mbembe, A. (2019, English translation) Necropolitics 

Getachew, A. (2019) Worldmaking after Empire

Mamdani, M. (2020) Neither Settler Nor Native

  664 Hits
664 Hits

Facilitating Systemic Change: PEPFAR and Healthcare in Ethiopia

Academics tend to focus on the negatives in international development, not giving as much attention and space to reflect on what has worked well. I previously wrote about a small-scale agricultural project. Here is a brief overview of a large-scale, long-term project that facilitated systemic change:

The same year that I first arrived in Ethiopia, in 2006, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and a range of implementing partners began working with the Government of Ethiopia to increase access to testing and treatment for HIV/AIDS. At the time, there were significant challenges. For example: 24,400 people were being treated, of more than 250,000 than required it, making ART coverage less than 9%; only 21% of women were accessing PMTCT services while an estimated 75,000 women living with HIV were giving birth annually, resulting in a large number of children being born with HIV.

During my first two years in the country I worked with facilities supporting orphaned children, often affected by and/or living with HIV. At the time, an HIV diagnosis was considered a death sentence. Treatment was largely not available. Mothers would drop off their children at orphanages after being diagnosed. Children born with HIV had a short life expectancy, often less than five years. One of the facilities in our network was a home designed to meet the needs of children living with HIV, but due to a lack of treatment their supportive role was to ensure children had a positive and happy experience in their short lives.

I have been in and out of Ethiopia during the last decade , and since 2013 have worked for a PEPFAR-supported implementing partner. Significant progress has been made, and PEPFAR as facilitated systemic change in the healthcare system.

Healthcare Facilities (total and service-specific), 2006-2015

Today, HIV treatment is widely available, and provided freely. Patients on treatment are living normal healthy lives. Fewer and fewer children are being born with HIV, and those that are born with the virus have access to treatment. In 2005 there were more than 1,000,000 people living with HIV, more than a quarter of whom required treatment but only 24,400 had access to it. By 2015, the coverage for those requiring treatment has risen from under 9% to over 80%. The number of people receiving treatment rose from 24,400 to more than 344,000. The percent of women accessing PMTCT services rose from 21% to 57%. HIV prevalence has declined from 4.4% in 2003 to 1.5% in 2015.

Service coverage improvements are just one part of the story. The expansion of the healthcare system that enabled these changes is remarkable. The number of healthcare facilities increased from 775 to 3,447; PMTCT-providing facilities increased from 500 to 2,495, ART-providing facilities increased from 25 to 1,047, lab monitoring sites increased from 106 to 326. With the support of PEPFAR, and a host of other donors and organizations, the Government of Ethiopia has transformed the healthcare system in the span of a decade.

Lots of work remains to be done, and significant challenges are yet to be addressed. That said, it is healthy to occasionally step back and recognize what has been accomplished. HIV/AIDS is now considered to be a chronic, yet treatable, disease. A diagnosis is no longer a time for questioning the care of ones children, and treatment is freely available and widely accessible to prevent mother-to-child transmission. Ethiopia is steadily progressing toward complete treatment coverage. There have been no reported treatment interruptions during the last decade. Many leaders within Ethiopia, from government leaders to religious institutions, are speaking about HIV/AIDS. The work has facilitated systemic change, and will have a lasting legacy: not only will it have changed the lives of those living with or affected by HIV, it has contributed to the development of a public healthcare system that will serve the needs of Ethiopians now and in the future.

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1991 Hits

Viewing Complexity Through Life Histories

Thinking about people and objects as components in interconnected, non-linear and dynamic systems, rather than as compartmentalized and independent actors, began to take shape during the early 1900s with work by the biologist Von Bertalanffy. Throughout the last century, the systems approach was applied in a wide range of areas of inquiry, and has been used as an approach to understand how systems work, and therefore engage with the system in a way that recognizes its interrelated components. As it relates to understanding and explaining change, systems-based thinking is concerned with how dynamic interactions and interconnected relationships affect one another in systematic ways. In other words, individuals are embedded within complex adaptive systems.

One of the ways to understand change that builds upon systems theories is a complexity-based perspective founded in the idea that all change occurs within complex adaptive systems. Complexity theorists suggest that change takes place within complex and dynamic contexts and that actors cannot be understood in isolation. As such, understanding change requires analyses of the entire system, its interactions, relationships and feedback mechanisms. Ramalingam suggests that thinking about change as occurring within complex adaptive systems can foster more flexibility, creativity and innovation. However, it also poses practical challenges as a theory in practice. For example, it is not clear how much needs to be known in order to sufficiently understand the dynamics of non-linear systems, which are themselves embedded within layers of uncertainties.

(Image from aidontheedge.info)

In his advocacy of thinking about change as operating within complex adaptive systems, Ramalingam presents an example familiar to ecological anthropologists: Balinese agricultural terracing systems. As identified by Lansing et al, resource management in this traditional agricultural system was practically optimal. External pressure that was exerted during the 1970s sought to modernize and improve the system, the result of which was a system failure. Rather than understanding the agricultural setting as a complex adaptive system, external parties suggested that specific changes would increase yields, while in the process significantly underestimating potential risks. Ramalingam suggests that it was Lansing's work in understanding the Balinese setting as a complex adaptive system that enabled "teasing out what had made the old system work so well for so long." As such, viewing change within agricultural systems as one component of a complex adaptive system, as Ramalingam advocates, enables change to be viewed as part of a larger system in order to put 'best-fit' before 'best-practice'.

The challenge with complexity in international development is trying to pull all the important pieces together. We have the value of hindsight in seeing the complexity in the Balinese terracing system. How do we apply complexity theory to international aid for the present and future?

(Diversity of NGOs, activities and locations; Image from UN OCHA)

While life histories will not provide specific direction for international development planning or implementation, they may provide insight into the ways in which unrelated components interact over the long term, and help us answer think about better answers to those challenges. Consider:

Asha was born in a small town. Her father passed away, her mother struggled to keep the family afloat. She went to live with extended family. As a seven year old girl, Asha was abused by an uncle. In addition to the physical and psychosocial trauma, she acquired HIV. At the time, Asha did not know of her status and the country within which she lived did not provide treatment, had she known. At the time, stigma and discrimination were fueled by a lack of information and fear. After a serious illness Asha went to the doctor, which is when she learned of her status. Due to the fear and stigma, her extended family forced to leave. Asha'a brother arranged for her to enter a care facility, which he learned about via a government counseling and support service. Beginning in 2006, the government began to freely provide antiretroviral treatment for AIDS, with the support of a range of partners (including the World Health Organization, USAID and PEPFAR funding, the Global Fund and others). Before this time, most children living with HIV/AIDS lived short lives.

Asha entered a children's home, designed specifically to support children living with HIV/AIDS. The home was a partnership between a locally-based organization and a US-based charity. From the age of 11 until 17, Asha lived in this care home, which provided her basic needs. Asha's medical care was provided by another NGO, specializing in treating children living with HIV/AIDS. An independent psychologist provided her with counseling. Asha gained experience with a range of volunteers while growing up. She was supported in her passion to advocate for children living with HIV/AIDS, resulting in numerous speaking engagements, including at United Nations conference.

As someone excelling her in academic studies, Asha was offered a scholarship to attend a prestigious private school, where she completed high school. According to national law, children cannot live in home care facilities after the age of 18, so in preparation for that shift, Asha shifted to live with a couple working for an international organization, a connection developed via the network of individuals supporting the care home. This network supported Asha to apply for university scholarships, and she is currently completing a degree in a western country.

Asha'a story highlights how an individual organization, or project activity, can play an important role in the life on an individual and the direct impact can be quantified. However, the unrelated organizations and activities, as a collection of dynamic interactions and interconnected relationships, affect one another in systematic ways. It was not one intervention that impacted her life. It was individuals, community-based organizations, NGOs, universities, governments and international agencies, collectively, that enabled Asha to be the amazing success story that she is.

For systems and complexity theorists, the life story narrative enables us to analyze how a range of unknown actors, unanticipated changes, and  unrelated activities connect within the life of an individual. It is unlikely that we will ever be able to know or predict all these factors and engage with them in a systematic, modelable fashion. Thus the challenge, and potentially the limit, of systems and complexity theories in international development; there are too many unknown, unpredictable and unrelated factors. That said, Asha's story also shows the value of systems and complexity theories in seeking to understand how change happens. In addition to the theoretical and programmatic value, mapping change backwards using life stories might enable us to think about organizations and activities in new ways. It may also enable us to engange in complex adaptive systems recognizing the limitations of complexity theories in explaining them, while using them to help understand how change happens, and keeping in mind that a particular NGO or project activity may not have all the required components to reach the desired result, but the complex adaptive system might.

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