Commentary

A Sustainable Economy for the Arab World

WASHINGTON, DC – In recent decades, millions of people in the Arab world have been lifted out of extreme poverty. But progress is now at risk of slowing, or even reversing, owing to a vicious circle of economic failure and violent disorder. To prevent such an outcome, Arab countries must move fast to build a more sustainable economy, underpinned by greater private-sector creativity and vitality, improved public services, and the creation of regional and global public goods.


The first step toward achieving this is to recognize the scale and nature of the potential barriers to success. Arab countries today are faced with slow overall GDP growth and tightening fiscal constraints. Disparities in access to education, training, and health care – partly a reflection of those fiscal constraints – exacerbate already rising inequality.

As we have seen in the region, such circumstances can fuel political polarization and violent conflict, with the concomitant displacement, loss of life, destruction of infrastructure, and staggering economic costs. While economic development is no guarantor of peace, development failures do often contribute to extremism and violence, as popular anger combines with a loss of institutional legitimacy. The existence of nearby conflicts, which can have destabilizing spillover effects, heightens the risk of unrest.

Technological innovation can be part of the solution for Arab economies; but the accompanying disruption of markets and livelihoods raises its own challenges. Equally difficult to manage are risks like climate change and pandemics, which transcend borders and thus cannot be addressed by any single country.

Overcoming these challenges will not be easy. The key to success will be smart cooperation: between the public and private sectors; between government and civil society; among countries; and between countries and international organizations.

One of those international organizations is the World Bank Group, which engages with countries to help protect the poor and vulnerable, improve resilience to refugee and migration shocks, and ensure inclusive and accountable service delivery. We also work to strengthen the private sector, so that it can create jobs and opportunities for young people throughout the Arab world. And we promote other kinds of cooperation, particularly regional cooperation on shared public goods and in sectors like education, water, energy, and climate change.

A major goal of cooperation must also be to raise funding. Official development assistance (ODA), which last year stood at $142 billion, will never be sufficient to meet the region’s extraordinary financing needs, even if it is combined with government resources. To put this into context, ODA for 2015 amounted to just one-third of Germany’s annual health-care bill.

The United Nations trade arm, UNCTAD, estimates that, to reach the Sustainable Development Goals (SDGs), the world will have to close a $2.5 trillion gap – annually.To achieve this, we must use innovative mechanisms to leverage and mobilize global funds, especially from the private sector.

Fortunately, the private sector has trillions of dollars that it can shift toward the effort to build a more sustainable economy and, specifically, to achieve the SDGs. But it needs encouragement, which the World Bank Group has attempted to provide, using concessional financing, investment guarantees, and matching investments.We have also worked to encourage countries to improve the policy and regulatory environment for development and growth, thereby becoming more attractive destinations for private-sector resources.

But more must be done to encourage the private sector to invest in sustainable development. For starters, businesses need purpose. As a recent report by Deloitte points out, companies should be able to articulate a clear purpose that is connected to a wider social, environmental, or even economic goal. That purpose can act as a compass for the business, influencing its organizational culture and values, and guiding stakeholders’ individual and collective behavior.

Of course, a sense of purpose alone won’t drive the private sector to shift investment toward sustainability. The Business and Sustainable Development Commission (BSDC) has reported that investments in the SDGs bring enormous returns, including new opportunities, massive efficiency gains, impetus for innovation, and improved reputations.

Once companies recognize these benefits and decide to adopt a purpose-driven approach, they need help monitoring and reporting outcomes. Specifically, they need a transparent framework that enables them more easily to share information about progress on their long-term economic, social, and environmental objectives. There are efforts underway to create such a framework, but much more needs to be done to create the right incentives for businesses to participate.

The ranks of businesses supporting the transition to a sustainable economy are growing. But, to complete that transition, particularly in Arab countries, many more companies and other private-sector entities will need to step up. Of course, their pledges must be reflected and reinforced by commitments from governments, multilateral institutions, and civil society.

The road ahead is fraught with difficulties, but the Arab world has overcome similarly daunting challenges in the past. Now as much as ever, the region has the people, resources, and opportunity to thrive.

Mahmoud Mohieldin is the World Bank Group’s Senior Vice President for the 2030 Development Agenda, United Nations Relations, and Partnerships, and is a former minister of investment of Egypt.

By Mahmoud Mohieldin

The Power of Mini-Grids

HARARE – Despite impressive economic development in recent years, Africa still lags far behind on energy, with almost two-thirds of the continent’s citizens lacking access to electricity. While getting more power to the people is an important goal, extending electricity grids is expensive and slow. Meanwhile, off-grid options may not be sufficient to meet people’s energy needs. Fortunately, there is a third approach that can help fill in the gaps: mini-grids.


Mini-grids are essentially localized electricity networks that supply several users, whether households or businesses. They can be grid-connected, but they do not have to be. And, as a new report from the Africa Progress Panel (of which one of the authors is a member)shows – and as anotherreport by the Rocky Mountain Institute underscores – mini-grids are an important piece of Africa’s energy puzzle.

Mini-grids can have a major competitive advantage over grid extension in rural and remote areas, because they can provide electricity more quickly and at much lower cost. Because mini-grids require less capital investment than grid expansion, it can be easier to secure financing for them, meaning that they can electrify communities that might have to wait years for a grid connection.

Mini-grids also have a distinct advantage over off-grid systems: greater power generation. Productivity-enhancing farm machinery, for example, usually requires more power than off-grid household systems can provide.

Moreover, mini-grids can be used to increase the resilience of existing electricity systems. Power cuts on the main grid can affect a large number of businesses and households, and it can be difficult to restore services quickly. Mini-grids can ensure that consumers retain access to power when the grid suffers interruptions.

Despite these benefits, the potential of mini-grids to help address Africa’s energy challenge has yet to be tapped. Reliance on mini-grids is expanding more slowly than in other world regions, with Africa being more likely to implement off-grid systems. One obstacle is the lack of proven commercial business models and adequate and appropriate forms of financing. Another is that policy frameworks often are not accommodating. And many developers and operators lack the requisite knowledge and experience.

The situation is ripe for change. With the United Nations sustainable development agenda ambitiously targeting universal access to energy by 2030, policymakers are paying more attention to electrification, and development-finance institutions and partners are making more funding available. Meanwhile, the cost of renewable energy is falling; energy efficiency is improving, both for generating equipment and for the machines to be powered; and innovative digital technologies are facilitating the management of electricity services.

A flexible solution like mini-grids is well suited to this context. As it stands, mini-grids in Africa are mostly diesel or hydropower systems. Yet mini-grids can – and increasingly do –take the form of solar PV and hybrid systems, with hybrid systems being particularly promising. Diesel systems face the risk of fuel-supply disruptions or cost increases, while renewable-energy generation can vary according to weather and season. Hybrid systems that combine diesel with solar or wind power mitigate these risks.

Mini-grids are flexible in other ways, too. Mini-grids may or may not be connected to the national grid. They can be operated privately, by utilities, on a community basis, or according to a public-private model. And they can sell electricity to retail consumers, utilities, or both.

So how can African governments use the potential of mini-grids to help expand energy access? As recent experience in the United States has shown, early adoption of technical innovations, particularly of digital management tools, could enable mini-grid business models to become more cost-efficient. New technologies could even enable mini-grid providers to develop entirely new organizational models for electricity systems that are more effective and resilient than the conventional utility-based approach.

Experience in the US, as well as in Asia, also underscores the importance of favorable government policy and regulations, including capital subsidies. The challenge, of course, will be for each African government to design a mini-grid strategy around the options and models that work locally. That means setting appropriate tariffs and establishing a coherent framework of technical, financial, and procedural regulations. It also requires building up the necessary skills and capacities in the labor force.

In developing their electricity systems, most African countries will have to consider and combine many different models and options. For many, mini-grids can play an important role. If African governments embrace diversity in the way electricity is generated and distributed, they could provide modern energy to millions of people, while placing the continent at the forefront of a global energy transformation.

Strive Masiyiwa, a member of the Africa Progress Panel, is the founder and chairman of Econet Wireless. He is also the co-Chair of GROW Africa, and Chairman of the Board of the Alliance for a Green Revolution in Africa. Richard Branson, founder of the Virgin Group, is an investor and philanthropist.

Standing Up for Europe

BRUSSELS – Today’s European Union needs both salvation and radical reinvention. Saving the EU must take precedence, because Europe is in existential danger. But, as French President Emmanuel Macron emphasized during his election campaign, reviving the support that the EU used to enjoy is no less essential.


The existential danger the EU faces is partly external. The Union is surrounded by powers that are hostile to what it stands for – Vladimir Putin’s Russia, RecepTayyipErdoğan’s Turkey, Abdel Fattah el-Sisi’s Egypt, and the America that Donald Trump would create if he could.

But the threat also comes from within. The EU is governed by treaties that, following the financial crisis of 2008, became largely irrelevant to conditions prevailing in the eurozone. Even the simplest innovations necessary to make the single currency sustainable could be introduced only by intergovernmentalarrangements outside the existing treaties. And, as the functioning of European institutions became increasingly complicated, the EU itself gradually became dysfunctional in some ways.

The eurozone in particular became the exact opposite of what was originally intended. The EU was meant to be a voluntary association of like-minded states that were willing to surrender part of their sovereignty for the common good. After the 2008 financial crisis, the eurozonewas transformed into an arrangement whereby creditor countries dictated terms to debtor countries that couldn’t meet their obligations. By dictating austerity, the creditors made it practically impossible for the debtors to grow their way out of their liabilities.

If the EU carries on with business as usual, there is little hope for improvement. That is why the Union needs to be radically reinvented. The top-down approach that Jean Monnet used to launch European integration in the 1950s carried the process a long way, before losing momentum. Now Europe needs a collaborative effort that combines the EU institutions’ top-down approach with the bottom-up initiatives needed to engage the electorate.

Consider Brexit, which is certain to be immensely damaging to both sides. Negotiating the separation with Britain will divert the EU’s attention from its own existential crisis, and the talks are bound to last longer than the two years allotted to them. Five years seems more likely – an eternity in politics, especially in revolutionary times like the present.

The EU should therefore approach the Brexit negotiations in a constructive spirit, recognizing the unpredictability of the future. During the prolonged “divorce” process, the British public could decide that being part of the EU is more attractive than leaving it. But this scenario presupposes that the EU transforms itself into an organization that other countries such as Britain want to join, and that people on both sides of the English Channel have a change of heart.

The chances that both conditions will be met are slim, but not zero. It would require EU-wide recognition that Brexit is a step toward European disintegration – and thus a lose-lose proposition. By contrast, making the EU attractive again would give people, particularly the younger generations, hope for a better future.

Such a Europe would differ from the current arrangement in two key respects. First, it would clearly distinguish between the EU and the eurozone. Second, it would recognize that the eurozone is governed by outdated treaties, and that its governance cannot be altered because treaty change is impossible.

The treaties assert that all member countries are expected to join the euro if and when they qualify. This has created an absurd situation where countries like Sweden, Poland, and the Czech Republic have made it clear that they have no intention of joining the euro, yet they are still described and treated as “pre-ins.”

The effect is not purely cosmetic. The EU has become an organization in which the eurozone constitutes the inner core and the other members are relegated to an inferior position. This must change. The euro’s many unresolved problems must not be allowed to destroy the EU.

The failure to clarify the relationship between the euro and the EU reflects a broader defect: the assumption that various member states may be moving at different speeds but are all headed toward the same destination. In fact, a rising proportion of member states have explicitly rejected the claim of “ever closer union.”

Replacing a “multi-speed” Europe with a “multi-track” Europe that allows member states a wider variety of democratic choices would have a far-reaching beneficial effect. As it stands, member states want to reassert their sovereignty, rather than surrendering more of it. But if cooperation produced positive results, attitudes might improve and objectives pursued by coalitions of the willing might attract universal participation.

Meaningful progress is indispensable in three areas: territorial disintegration, exemplified by Brexit; the refugee crisis; and the lack of adequate economic growth. On all three issues, Europe starts from a very low base of cooperation.

That base is particularly low when it comes to the refugee crisis, and the trend is downward. Europe still lacks a comprehensive migration policy. Each country pursues what it perceives to be its national interest, often working against the interests of other member states as a result. German Chancellor Angela Merkel was right: the refugee crisis could destroy the EU. But we must not give up. If Europe could make meaningful progress on alleviating the refugee crisis, the momentum would change to a positive direction.

I am a great believer in momentum. Even before Macron’s election, beginning with the convincing defeat of the Dutch nationalist Geert Wilders in the Netherlands’ general elections in March, one could see momentum developing that could change the EU’s top-down political process for the better. And with Macron, the only pro-European candidate, winning in France, I am much more confident about the outcome of Germany’s election in September. There, many combinations could lead to a pro-European coalition, especially if support for the anti-European and xenophobic Alternative für Deutschland continues to collapse. This growing pro-Europe momentum may then be strong enough to overcome the biggest threat: a banking and migration crisis in Italy.

I am also encouraged by the spontaneous, grassroots initiatives – most supported mainly by young people – that we see nowadays. I have in mind the “Pulse of Europe” movement, which started in Frankfurt in November and spread to some 120 cities across the continent; the “Best for Britain” movement in the UK; and the resistance to the ruling Law and Justice Party in Poland, and to Prime Minister Viktor Orbán’sFidesz party in Hungary.

The resistance in Hungary must be as surprising to Orbán as it is to me. Orbán has sought to frame his policies as a personal conflict with me, making me the target of his government’s unrelenting propaganda campaign. He casts himself as the defender of Hungarian sovereignty and me as a currency speculator who uses his money to flood Europe with illegal immigrants as part of some vague but nefarious plot.

But the truth is that I am the proud founder of Central European University, which, after 26 years, has come to rank among the world’s top 50 universities in many of the social sciences. By endowing CEU, I have enabled it to defend its academic freedom from outside interference, whether by the Hungarian government or anyone else (including its founder).

I have learned two lessons from this experience. First, it is not enough to rely on the rule of law to defend open societies; you must also stand up for what you believe. The CEU and my foundations’ grantees are doing so. Their fate is in the balance. But I am confident that their determined defense of academic freedom and freedom of association will eventually set in motion Europe’s slow-moving wheels of justice.

Second, I have learned that democracy can’t be imposed from the outside; it needs to be achieved and defended by the people themselves. I admire the courageous way Hungarians have resisted the deception and corruption of the mafia state Orbán has established, and I am encouraged by the European institutions’ energetic response to the challenges emanating from Poland and Hungary. While the path ahead is perilous, I can clearly see in such struggles the prospect of the EU’s revival.

George Soros, Chairman of Soros Fund Management and of the Open Society Foundations, is the author of The Tragedy of the European Union: Disintegration or Revival?

By George Soros

Jobs in the Age of Artificial Intelligence

WASHINGTON, DC – The world has no shortage of pressing issues. There are 1.6 billion people living in acute poverty; an estimated 780 million adults are illiterate. Serious problems are not confined to the developing world: “deaths of despair,” for example, are raising mortality among white males in the United States. Even when advanced economies grow, they are not lifting all boats. Higher-income groups thrive while lower-income households and minority groups are consistently left behind.


And now some analysts suggest that new forms of computer programming will compound these developments, as algorithms, robots, and self-driving cars destroy middle-class jobs and worsen inequality. Even the summary term for this technology, Artificial Intelligence, sounds ominous. The human brain may be the “most complex object in the known universe,” but, as a species, we are not always collectively very smart. Best-selling science fiction writers have long predicted that we will one day invent the machines that destroy us.

The technology needed to create this dystopian future is not even on the horizon. But recent breakthroughs in AI-related technologies do offer enormous potential for positive advances in a range of applications from transportation to education and drug discovery. Used wisely, this boost in our computational abilities can help the planet and some of its most vulnerable citizens.

We can now find new patterns that are not readily evident to the human observer – and this already suggests ways to lower energy consumption and carbon dioxide emissions. We can increase productivity in our factories and reduce food waste. More broadly, we can improve prediction far beyond the ability of conventional computers. Think of the myriad activities in which a one-second warning would be useful or even lifesaving.

And yet the fear remains: Won’t these same improvements entail giving up all of our jobs – or most of our good jobs? In fact, there are three reasons why the jobs apocalypse is on hold.

First, Moravec’s paradox applies. Hans Moravec and other computer scientists pointed out in the 1980s that what is simple for us is hard for even the most sophisticated AI; conversely, AI often can do easily what we regard as difficult. Most humans can walk, manipulate objects, and understand complex language from an early age, never paying much attention to the amount of computation and energy needed to perform these tasks. Smart machines can perform mathematical calculations far exceeding a human’s capabilities, but they cannot easily climb stairs, open a door, and turn a valve. Or kick a soccer ball.

Second, today’s algorithms are becoming very good at pattern recognition when they are provided with large data sets – finding objects in YouTube videos or detecting credit card fraud – but they are much less effective with unusual circumstances that do not fit the usual pattern, or simply when the data are scarce or a bit “noisy.” To handle such cases, you need a skilled person, with his or her experience, intuition, and social awareness.

Third, the latest systems cannot explain what they have done or why they are recommending a particular course of action. In these “black boxes,” you cannot simply read the code to analyze what is happening or to check if there is a hidden bias. When interpretability is important – for example, in many medical applications – you need a trained human in the decision-making loop.

Of course, this is just the state of technology today – and high rates of investment may quickly change what is possible. But the nature of work will also change. Jobs today look very different from jobs 50 or even 20 years ago.

And new computer algorithms will take time to penetrate the economy fully. Data-rich sectors such as digital media and e-commerce have just begun to unleash the capabilities AI has created. The multitude of narrow AI applications that could affect jobs in sectors such as health care, education, and construction will take much longer to spread. In fact, this may come just in time – an aging population in developed economies implies a smaller workforce – and greater need for personal care services – in the coming decades.

Public policy decisions will shape the AI era. We need opportunity and competition, not the growth of powerful monopolies, in order to promote technological progress in a way that does not leave a large number of people behind. This requires improving access to all forms of education – and at low or zero cost.

With developed economies’ competitors, including China, investing heavily in AI, policymakers should be increasing support for basic research and ensuring that their countries have the physical and human resources they need to invent and manufacture everything connected with this major new general purpose technology.

We should not underestimate humans’ abilities to inflict damage on their community, their environment, and even the entire planet. Apocalyptic fiction writers may one day be proved correct. But, for now, we have a powerful new tool for enabling all people to live better lives. We should use it wisely.Simon Johnson and Jonathan Ruane teach the Global Business of Artificial Intelligence and Robotics at MIT’s Sloan School of Management.

By Simon Johnson and Jonathan Ruane

We Need an International Environmental Criminal Court

NAIROBI – The announcement of the winners of this year’s Goldman Environmental Prize is an opportunity to celebrate activist leaders. But it is also a moment to recognize just how much courage their efforts (and those of a great many others) can demand.


When my dear friend Berta Cáceres and I won the prize in 2015, Berta said in her acceptance speech, “I have given my life for the service of mother earth.” Not long after, Berta was assassinated in Honduras. Her story is tragic, but not unique. Indeed, just months later, Isidro Baldenegro López, another Goldman Environmental Prize recipient, was shot dead.

There has never been a more dangerous time to be an environmental activist. Consider the violence unleashed against the environmental defenders protesting the Dakota Access Pipeline in the United States. Police were accused of using excessive force to try to disperse members of the Standing Rock Sioux Tribe and their supporters, who argued that the project would contaminate water and damage sacred burial sites.

Fortunately, no one was killed during those protests. But elsewhere, in more fragile democracies, environmental campaigners who stand up to polluters are paying with their lives. A Global Witness report documented 185 killings across 16 countries in 2015 alone. That is almost double the number of journalists killed that year.

My own experience highlights the dangers facing environmental crusaders. For eight years, my community in rural Kenya, Owino Uhuru, has been exposed to toxic lead poisoning caused by the operations of a state-licensed smelter. The World Health Organization’s measure of lead poisoning is five micrograms per deciliter. The highest lead level recorded in Owino Uhuru was 420 micrograms per deciliter. In the highly publicized contamination case in Flint, Michigan, the readings were 35 micrograms per deciliter.

When my community found out that we were being poisoned, we fought back. We wrote letters to the government and organized peaceful protests. With the support of my community, I founded the Center for Justice, Governance, and Environmental Action (CJGEA) to hold the state and corporations accountable for ensuring a clean and healthy environment.

In February 2016, the CJGEA went to court against six state agencies and two corporate entities. Nothing happened. One year later, when we published public notices in local newspapers of our intention to sue the two corporations, all hell broke loose.

Despite the murders of Berta and Isidro and so many others, I did not fully recognize the danger of challenging a powerful government-backed operation. Soon, I received a chilling phone call warning me to watch over my son carefully. Environmental activists within the community were attacked, their houses surrounded by thugs wielding machetes. The son of a close ally was abducted – and, fortunately, later released – by unidentified men.

You might expect that the state would protect its citizens from such tactics, if not from being poisoned in the first place. We broke no laws; on the contrary, we have been upholding Kenya’s constitution, which guarantees citizens’ rights to a safe and healthy environment. But perhaps we should not be surprised by the state’s behavior. After all, in 2015, Kenya’s government voted in the UN General Assembly, along with just 13 others, against a United Nations resolution calling for the protection of human-rights defenders.

Nature provides enough for everyone’s needs, but not for everyone’s greed. As natural resources become scarcer, Africa’s lush, mineral-rich lands are becoming more lucrative for investors seeking to maximize profits. But, while governments should welcome opportunities for economic growth and job creation, they should not allow companies to damage the environment and threaten residents’ health and livelihoods.

As stories like Berta’s, Isidro’s, and mine demonstrate, we can no longer rely on state bodies, such as national law enforcement, to ensure this outcome, much less to investigate and prosecute crimes against the planet and those who fight for it. That is why the world needs an independent, internationally recognized legal body to which communities and activists can turn to address environmental crimes.

The appointment in March 2012 of the first-ever UN special rapporteur on human rights and the environment was a positive step. But we need a system with teeth. Twenty years ago, the International Criminal Court was established to prosecute war crimes and crimes against humanity. A similar court should do the same for crimes against the environment and its defenders.

Silencing the voices fighting to uphold environmental laws and regulations is self-defeating. People and the planet are dying. Those who are fighting to prevent those deaths deserve protection, not to become further casualties.Phyllis Omido, a Kenyan environmental activist and a winner of the 2015 Goldman Environmental Prize, is a 2017 Aspen New Voices Fellow.

By Phyllis Omido

Too Many Health Clinics Hurt Developing Countries

FREETOWN, SIERRA LEONE – Donors like the World Bank and the World Health Organization often urge developing countries to invest in national health systems. But while rushing to construct clinics and other medical facilities in even the remotest regions may seem like a straightforward approach to ensuring universal health coverage, that has not turned out to be true.


The recent Ebola epidemic in West Africa highlighted the urgent need for stronger, more efficient, and more resilient health-care systems in developing countries. But when countries rush to build more clinics, the resulting facilities tend to be hastily constructed and lacking in the equipment, supplies, and staff needed to deliver vital health services effectively.

In my frequent visits to rural areas of my native Sierra Leone, I have seen more than a few health facilities that communities could do without. A newly refurbished facility in Masunthu, for example, had scant equipment and no water in the taps. The facilities in nearby Maselleh and Katherie had cracked walls, leaky roofs, and so few cupboards that supplies like syringes and medical registers had to be stacked on the floor.

This situation is the direct result of a piecemeal and hurried approach to investment in health-care infrastructure. At the end of the civil war in 2002, Sierra Leone had fewer than 700 health facilities, according to the 2004 Primary Health Care Handbook. In 2003, the cash-strapped government decided to “decentralize” various public services to the district level, fueling fierce competition for limited resources.

Local councils, seeking to grab the biggest possible slice of the pie, began to push forward new projects, leading to rapid and uncontrolled expansion of the health system. Today, Sierra Leone – with a population of just seven million – has nearly 1,300 health facilities. The Ministry of Health has been unable to equip all of these new facilities and cover staff and operational costs, as its budget has not risen to match the system’s expansion. In fact, very few (if any) of the African countries that signed the 2001 Abuja Declaration to allocate 15% of their budget to health have been able to do so.

Last September, Sierra Leone conducted an assessment of the distribution of public-health facilities and health workers in the country, in order to guide discussions on the Human Resources for Health Strategy 2017-2021. The results were stark: only 47% of the country’s health facilities employed more than two health workers, including unsalaried workers and volunteers. Seven percent of health facilities had no health workers assigned to them at all – an empty promise in physical form.

This situation is not unique to Sierra Leone – or to Africa. In Indonesia, the government invested oil revenue in the massive and rapid expansion of basic social services, including health care. But today an insufficient number of doctors plagues many of these facilities, particularly in remote areas, where absenteeism also is high. There are many nurses, but most are inadequately trained. Still, they are left to run remote facilities on their own.

Beyond personnel, remote health facilities in Indonesia lack adequate supporting infrastructure: clean water, sanitation, reliable electricity, and basic medicine and equipment. Decentralized local governments, which have little authority over remote clinics, cannot supervise their activities. Small wonder that Indonesia has one of the highest rates of maternal mortality in East Asia.

An excess of poorly equipped health facilities is not only ineffective; it can actually make matters worse, owing to factors like poor sanitation and weak emergency referral systems. During the recent Ebola crisis, underequipped facilities caused even more deaths, not just among patients, but also among the health workers committed to helping them.

Rather than continuing to pursue the uncontrolled proliferation of poorly equipped and operated health-care facilities, policymakers should consider a more measured approach. Of course, people living in remote areas need access to quality health care, without having to navigate rough and dangerous roads that can become virtually inaccessible during some periods of the year. But outreach services and community health workers could cover these areas much more effectively. The value of such an approach has recently been demonstrated in Ethiopia, where health outcomes have improved.

While most of the Sierra Leone facilities were built with donor funds, the government has gone along with plans to accelerate the construction drive. The government and donors have a joint responsibility to pursue a more cautious approach that guarantees quality service delivery.

At the WHO’s World Health Assembly this month, participants should shine a spotlight on this responsibility and begin to rethink current strategies for achieving universal health coverage. With a more measured approach, it will take longer to build the same number of clinics. But more lives will be saved. And that’s the only indicator that should count.

Samuel Kargbo is Director of Policy and Planning in Sierra Leone, a member of the UHC2030 Steering Committee, and a 2016 Aspen Institute New Voices fellow.

By Samuel Kargbo

Manchester’s Bright Future

MANCHESTER – I am a proud Mancunian (as the people of Manchester are known), despite the fact I haven’t lived there permanently since I left school for university when I was 18. I was born in St. Mary’s hospital near the city center, was raised in a pleasant suburb in South Manchester, and attended a normal primary and junior school in a nearby, tougher neighborhood, before attending Burnage for secondary school. Thirty-eight years after I attended Burnage, so, apparently, did Salman Abedi, the suspected Manchester Arena bomber.


The atrocity carried out by Abedi, for which the Islamic State has claimed credit,is probably worse than the dreadful bombing by the Irish Republican Armythat destroyed parts of the city center 21 years ago, an event that many believe played a key role in Manchester’srenaissance. At least in that case, the bombers gave a 90-minute warning that helped avoid loss of life. Abedi’sbarbaric act, by contrast, killed at least 22 people, many of them children.

In recent years, I have been heavily involved in the policy aspects of this great city’s economic revival. I chaired an economic advisory group to the Greater Manchester Council, and then served as Chair of the Cities Growth Commission, which advocated for the “Northern Powerhouse,” a program to link the cities of the British north into a cohesive economic unit. Subsequently, I briefly joined David Cameron’s government, to help implement the early stages of the Northern Powerhouse.

I have never attended a concert at the Manchester Arena, but it appears to be a great venue for the city.Just as Manchester Airport has emerged as a transport hub serving the Northern Powerhouse, the arena plays a similar role in terms of live entertainment. As the sad reports about thoseaffected indicate, attendees came from many parts of northern England (and beyond).

In the past couple of years, Manchester has received much praise for its economic revival, including its position at the geographic heart of the Northern Powerhouse, and I am sure this will continue. Employment levels and the regional PMI business surveys indicate that, for most of the past two years, economic momentum has been stronger in North West England than in the country as a whole, including London.Whether this is because of the Northern Powerhouse policy is difficultto infer; whatever the reason, it is hugely welcome and important to sustain.

To my occasional irritation, manypeople still wonder what exactly the Northern Powerhouseis. At its core, it represents the economic geography that lies within Liverpool to the west, Sheffield to the East, and Leeds to the northeast, with Manchester in the middle. The distance from Manchester to the center of any of those other cities is less than 40 miles (64 kilometers), which is shorter than the London Underground’s Central, Piccadilly, or District lines. If the 7-8 million people wholive in those cities – and in the numerous towns, villages,and other areas between them – can be connected via infrastructure, they can act as a single unitin terms of their roles as consumers and producers.

The Northern Powerhouse would thenbe a genuine structural game changer forBritain’s economy.Indeed, along with London, it would be a second dynamic economic zone that registers on a global scale. It is this simple premise that led the previous government to place my ideas at the core of its economic policies, and why the Northern Powerhouse has become so attractive to business here in the United Kingdom and overseas.

It is a thrilling prospect, and, despite being less than three years old, it is showing signs of progress.In fact, given the broader economic benefits of agglomeration, the Northern Powerhouse mantra can be extendedto the whole of the North of England, not least to include Hull and the North East. But it is what I often inelegantly call “Man-Sheff-Leeds-Pool”thatdistinguishes the Northern Powerhouse, and Manchester, which sits at the heart of it, is certainly among the early beneficiaries.

Despite this, I have frequently said to local policy leaders, business people, those from the philanthropic world, and others that unless the areas lying outside the immediate vicinity of central Manchester benefit fromregional dynamism, Greater Manchester’s success will be far from complete. Anyone wholookslittle more than a mile north, south, east,or west of Manchester’s Albert Square – never mind slightly less adjacent parts such as Oldham and Rochdale – can see that much needs to be improved, including education, skills training, and inclusiveness, in order to ensure long-termsuccess.

Whatever the warped motive of the 22-year-old Abedi,who evidentlyblew himself up along with the innocent victims, his reprehensible act willnot tarnish Manchester’s bright, hopeful future. I do notclaimtounderstand the world of terrorism,but I do know that those who live in and around Manchester and other cities need to feel part of their community and share its aspirations. Residents who identify with their community are less likely to harm it – and more likely to contribute actively to itsrenewed vigor.

Now more than ever, Manchester needs the vision that the Northern Powerhouse provides. It is a vision that other cities and regions would do well to emulate. Jim O’Neill, a former chairman of Goldman Sachs Asset Management and a former UK Treasury Minister, is Honorary Professor of Economics at Manchester University and former Chairman of the British government's Review on Antimicrobial Resistance.

By Jim O’Neill

The Six-Day War at 50

NEW YORK – The world is about to mark the 50th anniversary of the June 1967 war between Israel and Egypt, Jordan, and Syria – a conflict that continues to stand out in a region with a modern history largely defined by violence. The war lasted less than a week, but its legacy remains pronounced a half-century later.

The war itself was triggered by an Israeli preemptive strike on the Egyptian air force, in response to Egypt’s decision to expel a United Nations peacekeeping force from Gaza and the Sinai Peninsula and to close the Straits of Tiran to Israeli shipping. Israel struck first, but most observers regarded what it did as a legitimate act of self-defense against an imminent threat.

Israel did not intend to fight on more than one front, but the war quickly expanded when both Jordan and Syria entered the conflict on Egypt’s side. It was a costly decision for the Arab countries. After just six days of fighting, Israel controlled the Sinai Peninsula and the Gaza strip, the Golan Heights, the West Bank, and all of Jerusalem. The new Israel was more than three times larger than the old one. It was oddly reminiscent of Genesis: six days of intense effort followed by a day of rest, in this case the signing of a cease-fire.

The one-sided battle and its outcome put an end to the notion (for some, a dream) that Israel could be eliminated. The 1967 victory made Israel permanent in ways that the wars of 1948 and 1956 did not. The new state finally acquired a degree of strategic depth. Most Arab leaders came to shift their strategic goal from Israel’s disappearance to its return to the pre-1967 war borders.

The Six-Day War did not, however, lead to peace, even a partial one. That would have to wait until the October 1973 war, which set the stage for what became the Camp David Accords and the Israel-Egypt peace treaty. The Arab side emerged from this subsequent conflict with its honor restored; Israelis for their part emerged chastened. There is a valuable lesson here: decisive military outcomes do not necessarily lead to decisive political results, much less peace.

The 1967 war did, however, lead to diplomacy, in this case UN Security Council Resolution 242. Approved in November 1967, the resolution called for Israel to withdraw from territories occupied in the recent conflict – but also upheld Israel’s right to live within secure and recognized boundaries. The resolution was a classic case of creative ambiguity. Different people read it to mean different things. That can make a resolution easier to adopt, but more difficult to act on.

It thus comes as little surprise that there is still no peace between Israelis and Palestinians, despite countless diplomatic undertakings by the United States, the European Union and its members, the UN, and the parties themselves. To be fair, Resolution 242 cannot be blamed for this state of affairs. Peace comes only when a conflict becomes ripe for resolution, which happens when the leaders of the principal protagonists are both willing and able to embrace compromise. Absent that, no amount of well-intentioned diplomatic effort by outsiders can compensate.

But the 1967 war has had an enormous impact all the same. Palestinians acquired an identity and international prominence that had largely eluded them when most were living under Egyptian or Jordanian rule. What Palestinians could not generate was a consensus among themselves regarding whether to accept Israel and, if so, what to give up in order to have a state of their own.

Israelis could agree on some things. A majority supported returning the Sinai to Egypt. Various governments were prepared to return the Golan Heights to Syria under terms that were never met. Israel unilaterally withdrew from Gaza and signed a peace treaty with Jordan. There was also broad agreement that Jerusalem should remain unified and in Israeli hands.

But agreement stopped when it came to the West Bank. For some Israelis, this territory was a means to an end, to be exchanged for a secure peace with a responsible Palestinian state. For others, it was an end in itself, to be settled and retained.

This is not to suggest a total absence of diplomatic progress since 1967. Many Israelis and Palestinians have come to recognize the reality of one another’s existence and the need for some sort of partition of the land into two states. But for now the two sides are not prepared to resolve what separates them. Both sides have paid and are paying a price for this standoff.

Beyond the physical and economic toll, Palestinians continue to lack a state of their own and control over their own lives. Israel’s objective of being a permanent Jewish, democratic, secure, and prosperous country is threatened by open-ended occupation and evolving demographic realities.

Meanwhile, the region and the world have mostly moved on, concerned more about Russia or China or North Korea. And even if there were peace between Israelis and Palestinians, it would not bring peace to Syria, Iraq, Yemen, or Libya. Fifty years after six days of war, the absence of peace between Israelis and Palestinians is part of an imperfect status quo that many have come to accept and expect.

Richard N. Haass is the president of the Council on Foreign Relations and the author, most recently, ofAworld World in Disarray: American Foreign Policy and the Crisis of the Old Order.

By Richard N. Haass

The Promise of Digital Health

BASEL – Africa has changed remarkably, and for the better, since I first worked as a young doctor in Angola some 20 years ago. But no change has been more obvious than the way the continent has adopted mobile technology. People in Africa – and, indeed, throughout low- and middle-income countries – are seizing the opportunities that technology provides, using mobile phones for everything from making payments to issuing birth certificates, to gaining access to health care.


The benefit of mobile technologies lies in access. Barriers like geographical distance and low resources, which have long prevented billions of people from getting the care they need, are much easier to overcome in the digital age. And, indeed, there are countless ways in which technology can be deployed to improve health-care access and delivery.

Of course, this is not new information, and a growing number of technology-based health initiatives have taken shape in recent years. But only a few have reached scale, and achieved long-term sustainability; the majority of projects have not made it past the pilot phase. The result is a highly fragmented landscape of digital solutions – one that, in some cases, can add extra strain to existing health systems.

The first step to addressing this problem is to identify which factors breed success – and which impede it. Here, perhaps the most important observation relates to how the solution is linked to the reality on the ground. After all, technology is an enabler for the innovation of health-care delivery, not an end in itself.

Solutions that focus on end-users, whether health practitioners or patients, have the best chance of succeeding. Fundamental to this approach is the recognition that what users need are not necessarily the most advanced technologies, but rather solutions that are easy to use and implement. In fact, seemingly outdated technologies like voice and text messages can be far more useful tools for the intended users than the latest apps or cutting-edge innovations in, say, nanotechnology.

Consider the Community-based Hypertension Improvement Project in Ghana, run by the Novartis Foundation, which I lead, and FHI 360. The project supports patients in self-managing their condition through regular mobile medication reminders, as well as advice on necessary lifestyle changes. This approach is successful because it is patient-centered and leverages information and communication technology (ICT) tools that are readily available and commonly used. In a country where mobile penetration exceeds 80% but only a few people have smartphones, such simple solutions can have the greatest impact.

For health practitioners, digital solutions must be perceived as boosting efficiency, rather than adding to their already-heavy workload. Co-creating solutions with people experienced in delivering health care in low-resource settings can help to ensure that the solutions are adopted at scale.

For example, the telemedicine network that the Novartis Foundation and its partners rolled out with the Ghana Health Service was a direct response to the need, expressed by health-care practitioners on the ground, to expand the reach of medical expertise. The network connects frontline health workers with a simple phone call to consultation centers in referral hospitals several hours away, where doctors and specialists are available around-the-clock. From the outset, the project was a response to an expressed need to expand the reach of medical expertise, and was fully operated on the ground by Ghana Health Service staff, which made this model sustainable at scale.

To realize the full potential of digital health, solutions need to be integrated into national health systems. Only then can digital technology accelerate progress toward universal health coverage and address countries’ priority health needs.

Collaboration across the health and ICT sectors, both public and private, is essential. Multidisciplinary partnerships driven by the sustained leadership of senior government officials must guide progress, beginning at the planning stage. Intra-governmental collaboration, dedicated financing for digital health solutions, and effective governance mechanisms will also be vital to successful strategies.

Digital technologies offer huge opportunities to improve the way health care is delivered. If we are to seize them, we must learn from past experience. By remaining focused on the reality of end-users and on priority health needs, rather than being dazzled by the latest technology, we can fulfil the promise of digital health. Ann Aerts is Head of the Novartis Foundation and Chair of the Broadband Commission for Sustainable Development Working Group on Digital Health.

By Ann Aerts

Energy, Economics, and the Environment

LONDON – To secure a low-carbon future and begin to address the challenge of climate change, the world needs more investment in renewable energy. So how do we get there? No system of power production is perfect, and even “green” power projects, given their geographic footprint, must be managed carefully to mitigate “energy sprawl” and the associated effects on landscapes, rivers, and oceans.


Hydropower offers one of the clearest examples of how the location of renewable energy infrastructure can have unintended consequences. Dam-generated electricity is currently the planet’s largest source of renewable energy, delivering about twice as much power as all other renewables combined. Even with massive expansion in solar and wind power projects, most forecasts assume that meeting global climate mitigation goals will require at least a 50% increase in hydropower capacity by 2040.

Despite hydropower’s promise, however, there are significant economic and ecological consequences to consider whenever dams are installed. Barriers that restrict the flow of water are particularly disruptive to inland fisheries, for example. More than six million tons of fish are harvested annually from river basins with projected hydropower development. Without proper planning, these projects could jeopardize a key source of food and income generation for more than 100 million people.

Consequences like these are not always apparent when countries plan dams in isolation. In many parts of Asia, Latin America, and Sub-Saharan Africa, hydropower is an important source of energy and economic development. But free-flowing rivers are also essential to the health of communities, local economies, and ecosystems. By some estimates, if the world completes all of the dam projects currently underway or planned without mitigation measures, the resulting infrastructure would disrupt 300,000 kilometers (186,411 miles) of free-flowing rivers – a length equivalent to seven trips around the planet.

There is a better way. By taking a system-scale approach – looking at dams in the context of an entire river basin, rather than on a project-by-project basis – we can better anticipate and balance the environmental, social, and economic effects of any single project, while at the same time ensuring that a community’s energy needs are met. The Nature Conservancy has pioneered such a planning approach – what we call “Hydropower by Design” – to help countries realize the full value within their river basins.

Even one dam changes the physical attributes of a river basin. Multiplied through an entire watershed, the impact is magnified. Hydropower projects planned in isolation not only often cause more environmental damage than necessary; they often fail to achieve their maximum strategic potential and may even constrain future economic opportunities.

As a result, even dams that meet their power-generation goals may fail to maximize the long-term value of other water-management services such as flood control, navigation, and water storage. Our research shows that these services add an estimated $770 billion annually to the global economy. Failure to design dams to their fullest potential, therefore, carries a significant cost.

In the past, some developers have been resistant to this sort of strategic planning, believing that it would cause delays and be expensive to implement. But, as the Conservancy’s latest report – The Power of Rivers: A Business Case – demonstrates, accounting for environmental, social, and economic risks up front can minimize delays and budget overruns while reducing the possibility of lawsuits. More important, for developers and investors, employing a holistic or system-wide approach leverages economies of scale in dam construction.

The financial and development benefits of such planning enable the process to pay for itself. Our projections show that projects sited using a Hydropower by Design approach can meet their energy objectives, achieve a higher average rate of return, and reduce adverse effects on environmental resources. With nearly $2 trillion of investment in hydropower anticipated between now and 2040, the benefits of smarter planning represent significant value.

System-scale hydropower planning does not require builders to embrace an entirely new process. Instead, governments and developers can integrate principles and tools into existing planning and regulatory processes. Similar principles are being applied to wind, solar, and other energy sources with large geographic footprints.

Completing the transition to a low-carbon future is perhaps the preeminent challenge of our time, and we won’t succeed without expanding renewable-energy production. In the case of hydropower, if we plan carefully using a more holistic approach, we can meet global goals for clean energy while protecting some 100,000 kilometers of river that would otherwise be disrupted. But if we don’t step back and see the whole picture, we will simply be trading one problem for another.GiulioBoccaletti is Chief Strategy Officer and Global Managing Director for Water at The Nature Conservancy.

By GiulioBoccaletti

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