Is more money for global health always good news? No, I am arguing in this lead essay in Ethics & International Affairs (Carnegie Council). Many of the problems that plague decision-making in global health assistance lie not in the global South but in the North, where the monetary flows originate and where most policies are conceived.
If we want to avoid the same strategic backlash that hit us after pouring billions into foreign aid without knowing much, if anything, about its effectiveness, we need to ask critical questions about how financial resources for global health are being spent and whether or not these patterns are the most effective.
It turns out that common depictions of ‘limited capacities’ in developing regions are only one factor in explaining suboptimal allocation. Conversely, organizational incentives, interorganizational dynamics and the sweet talk of global partnerships account have been looked at much less. I contend that they are the key aspects in need of investigation if we seek to understand the political economy of global health today.
The key questions that I am posing in this article are: how can we explain city-level politics in two countries located at the very fringes of global capitalism, and how can a resulting reconfigured theoretical framework be integrated into an international comparative urban research agenda.
Contemporary Sierra Leone and Afghanistan present major structural differences compared to highly industrialized settings, as their main cities have not been sites of capitalist production. At the same time, both countries have recently experienced major international interventions in the context of intra-state wars. I show how these two characteristics render the explanatory power of established theories of urban politics deficient.
I then examine key features of recent political restructuring in Freetown and Kabul. I pay specific attention to the incentive structures that have resulted from recent international interventions and how they shape urban politics. I illustrate how these incentives steer resource flows and forge new poles of accumulation and control—both within the respective settings and outside of them—to the detriment of local policy space.
I thus show that while the starting point for theory reformulation remains the urban context, a crucial conceptual challenge is to capture the alliances between national and international institutions and organizations, and to examine how they influence city-level politics. I ultimately argue that multiscalar governance as a theoretical approach is applicable to cities in conflict zones only if it integrates an analysis of international politics as a major determinant of local urban politics.
For the Swedish speakers among you, check out Marcus Hansson’s 20-minute feature on Afghanistan’s botched reconstruction, broadcast on September 2, 2009 on Swedish Radio 1.
It includes interviews with several international observers. For instance, Antonio Donini at the Fletcher School comments on the aid industry and the discrepancy between its global mobility and its lack of effectiveness.
In my contribution (16min 52sec – 18min 08sec), I focus on the local dimension, highlighting how supposedly ‘bottom up’ processes of ‘local empowerment’ were in reality almost entirely driven by donors.