At Congress2016 as a SSHRC Storyteller

Presented at Congress2016 on May 30th as a SSHRC Storyteller Finalist.

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New Publication [In Press] In the International Journal of Drug Policy

Cochrane, L. and O'Regan, D. (2016) Legal Harvest and Illegal Trade: Trends, Challenges and Options in Khat Production in Ethiopia. International Journal of Drug Policy.


  • The production of khat in Ethiopia has boomed over the last two decades, making the country the world's leading source. Khat is now one of Ethiopia's largest crops by area of cultivation, the country's second largest export earner, and an essential source of income for millions of Ethiopian farmers. Consumption has also spread from the traditional khat heartlands in the eastern and southern regions of Ethiopia to most major cities. This steady growth in production and use has unfolded under negligible government support or regulation. Meanwhile, khat, which releases a stimulant when chewed, is considered an illicit drug in an increasing number of countries. Drawing on government data on khat production, trade, and seizures as well as research on the political, socioeconomic, and development effects of plant-based illicit narcotics industries, this commentary identifies possible considerations and scenarios for Ethiopia as the country begins to manage rising khat production, domestic consumption, and criminalization abroad. Deeply embedded in social and cultural practices and a major source of government and agricultural revenue, Ethiopian policymakers have few enviable choices. Criminalization abroad raises a small but not insignificant possibility that previously nonexistent linkages between khat and transnational organized crime and trafficking networks will emerge. Likewise, more stringent regulation of khat in Ethiopia could merge with lingering political cleavages and anti-government sentiments, exacerbating corruption and/or low-level domestic conflicts.

The full article is gated. Abstract and further publication details available via the link above. If you would like a copy of the article, send me an email.

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Facilitating Systematic 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 systematic 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 systematic 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 systematic 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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U.S. Development as Foreign Policy in Ethiopia (McVety, 2012)

On US foreign aid:

  • "In its most optimistic moments, the U.S. government truly believed that by doing good it could indeed do well. The problem is that foreign aid seems to have done more harm than it has good, which means that the United States has not done nearly as well as it hoped." (p. 4)
  • "American policymakers were aware from the very beginning that their plans to enhance standards of living, halt the spread of communism, expand the global economy, and encourage the spread of democracy were often not compatible. In such cases, it was democracy that was the most easily forgotten and the people on the ground most easily forsaken." (p. 121)

Expectations of "development":

  • "Haile Selassie did not want a nation of farmers; he wanted a nation of industrialists. That put him at odds with the United States, which wanted Ethiopia to be the breadbasket of the Middle East. Breadbaskets, however, as everyone involved well knew, cannot permanently sustain the massive economic growth required to earn the adjective "wealthy." Haile Selassie was no one's fool and he did not intend to place any limitations on his nation's future progress, at least its future economic progress. Its political progress was another question entirely, but then, no one seemed particularly worried about that anyway." (p. 146)
  • "Ethiopia badly needed an agricultural revolution, but neither the United States nor Haile Selassie were willing to dedicate the resources necessary to making that happen. Ethiopia got a political revolution instead. The terrible repercussions of that tragedy became evident in the early 1980s, when the Ethiopian people, once famous for their independence became famous for their starvation. Their fall from grace testified to the limitations of a foreign aid agenda that put international politics before international development." (p. 193-194)

On Ethiopia's quasi-colonial experience:

  • "Having played a vital role in reclaiming Ethiopia from the Italians, the British remained hesitant to exit and maintained military occupation through the British Military Mission to Ethiopia. Haile Selassie struggled to regain the authority he had lost in 1935 and ostensibly got it with the 1942 Anglo-Ethiopian Agreement, which recognized his nation as "a free and independent state," but all was not as it seemed. In return for a loan, the emperor was forced to grant the British minister "precedence over any other foreign representative" and to allow British advisors a dominant role in the nation's finances... Britain allowed it semi-independence, nodding to the emperor's authority while monopolizing the country's railroads, air service, and economy. The also, although they would deny it for decades, stripped the nation of 80 percent of all the industries built by the Italians during their long occupation of Eritrea and brief occupation of Ethiopia. British troops dismantled factories, packed up the parts, and shipped them to India and Kenya." (p. 71)

On the politics of famine:

  • "In the specific case of Ethiopia, the 1982 harvest was the largest ever recorded and the main harvest of 1983 was the third largest on record, though both were still far below the nation's potential. Yet, more than 1.5 million people starved to death in the provinces of Wollo, Tigray and Eritrea between 1983 and 1985. The vulnerability of Ethiopia's peasants stemmed from decades of missed agricultural development opportunities. Their actual deaths were the result of a deliberate government policy to use their vulnerability to its advantage. Most of the victims came from areas that resisted the Derg's tyrannical control. At the height of the famine, Mengistu Haile Mariam was spending 46 percent of the national budget on armaments and used international food aid to fill bellies in his 3-million-man army" (p. 196)

One historian's recommendation for reforming aid:

  • "If the world's wealthiest nations truly wanted to help the world's poorest nations, they would curb domestic agricultural subsidies, support global disease eradication efforts, and cut off most of their government-to-government assistance. Economic growth has to come from within. Under such a framework, there would still be room for grassroots-focused aid institutions to provide medical assistance, microfinancing, and education programs. The point is not to keep help from reaching the people who desperately need it, but to force vital changes in government policies that will help those people achieve better lives through their own initiatives. As Amartya Sen has perceptively argued, the end of development is "the capability to choose a life one has reason to value." Development cannot come from foreign aid, because development is fundamentally about the power of autonomy… Keeping bad governments in power through foreign aid is not the path to freedom. Neither is keeping poor farmers poor through subsidies to wealthy conglomerates. Change will not be easy, but it is certainly not impossible." (p. 220)
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Logan Cochrane

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