Things I learned this week in Abidjan

Notes from this past week:

• Animals are harder to remove from day-to-day life here.  There seems to be a lizard living in my air conditioner.  As I write this, there is a centipede crawling up the wall across the room from me.  My roommate found a lizard in her bed the other day.  If you look closely at any table or counter, you'll likely see very tiny African insects crawling around on it.  Happily, mosquitoes haven't been much of a problem though.  
• In a way, it's cheaper and easier to eat healthy here.  Processed supermarket food costs significantly more than fresh food from nearby markets.  The animals are always locally grown (there are chickens waddling around just about every block) and presumably antibiotic free.  The policies that create this -- lack of local food processing companies, high tariffs on foreign imports of processed food, tons of local food producers and sellers willing to earn low margins, lack of food safety monitoring -- aren't really replicable in a developed country.  
• All that being said, vegetable-based meals are not common and portion size is not helpful to the calorie conscious.  
• Eating out at a local restaurant (a maquis) is generally cheaper than making a meal at home, particularly if you're using western ingredients for your meal at home.  The main expense of going out to eat is time; you should count on spending at least 45-90 minutes for a meal.  
• Vietnamese spring rolls (nems) have been adopted into Ivorian culture.  They are cheap and plentiful here, and some Vietnamese places are run by Ivorians.  
• In the same way that a crepe in Washington, DC is expensive and of poor quality, a hamburger or pizza here is always (relatively) overpriced and disappointing.  The extra money that you're paying for a burger here isn't because you're paying for a deluxe burger but because you're paying for the cultural experience of "American food."  
• The lack of activity options doesn't really hurt my quality of life.  In DC, there are several soccer leagues, basketball leagues, kickball leagues and a dozen other sports that I could be playing any day of the week.  Here there is soccer on Wednesday in Deux Plateaux, volleyball on Thursdays at the American embassy and ultimate frisbee on Sundays at the Lycée Classique.  I would never play volleyball or frisbee over basketball in the U.S., but they are 90% as fun and the lack of choice can be liberating (I always just assume that Wednesdays here are for soccer, rather than trying to decide which day to play).  Likewise, with the social scene.  The plethora of nice bars and social activities in DC could be stressful, as it was disappointing not to choose the most fun Saturday night activity.  Here, there are a handful of ex-pat bars and usually just one or two activities per weekend, often with many of the same people.  You may or may not like going to see Diego's blues band, but that's what people are doing most Friday evenings here.  If you want to see people, you go and make the best of it.  
• I suppose this is all just a readjustment of my hedonic baseline.  I suppose that when I move back to DC, I'll enjoy the variety of options for the first couple of months, but then re-adapt.  

Why bureaucracy matters

This is my latest intellectual trip, especially the topic of public service delivery. It combines a lot of things I’m interested in – institution building, rule of law, making government work. I also like it because it touches on the existential question of all policy: what does government do well and how can it do this better? Where should government be involved and where not, and how can it function well where it exists? In the same way that people are starting to realize that the first rule of development should be to do no harm, I like applying this idea to all policymaking.  My current fellowship/job gives me a terrific platform to view this within the context of a developing country government.

Happily, I'm not alone here.  Chris Blattman thinks "'bureaucracy' will be the most topical development topic in five years," so I might as well get an early start.

Here’s a good passage from one of the foundational articles in this topic:

It is now widely appreciated that government failure may be as important as market failure, and the mere existence of the latter does not necessarily justify government intervention.  To the extent government intervention is called for, this does not automatically mean direct involvement of the state in economic activity and could entail indirect involvement through partnership with the private sector, and the “third sector” consisting of voluntary and community organizations.

And another:

The traditional model of state provision assumes away incentive problems, assuming that the government can stipulate and enforce a level of provision. It implicitly assumes that individuals who work in the public sector need little direct motivation to pursue the social good. Rewards therefore depended little on performance. The implicit assumption was that teachers, health care professionals and bureaucrats are publicly spirited and that this was enough. 

The article has lots of other little tidbits worthy of further exploration.  For instance:

Persson and Tabellini argue that proportional representation and parliamentary systems provide better  incentives for provision of public goods. 

Such an argument may help to explain (among other reasons) why Americans seem to get so little bang for their taxpayer dollar compared to, say, Germany.

Improving human resources in the health sector

The focus of my work conference this past week was on "how to improve human resources in the health sector."

There are several problems with human resources in Cote d'Ivoire's health system, but the main one is that there simply aren't enough people.  Not enough doctors, nurses, midwives, or health officials.  A lot of people left during the crisis this past decade, and the existing schools and training institutions are poorly equipped to fill the gap.

The schools are already overburdened and there is concern that increasing the ratio of students to teachers would decrease quality to unacceptable levels.  The Ministry of Health would like to create more schools and hire more staff for existing schools, but there are a lot of competing demands for funding.  They will probably be able to open a couple of schools and hire some more teachers, but not enough to produce the number of health sector personnel that is needed.  So what to do?

One option that was discussed is accrediting private schools to train health workers.  But a number of people were skeptical that this could work in a country of Cote d'Ivoire's level of development.  They cited recent privatizations of health training in Senegal and Benin as examples of why accrediting private institutions would not work in Cote d'Ivoire.  I was curious about the factual basis for these concerns.  Does a country need to attain a certain level of economic development or administrative sophistication before such public-private partnerships can function effectively?  Information on this topic is not easy to unearth.  The Center for Global Development discusses in a recent report on Partnerships with the Private Sector in Health:

Policies, such as those related to contracting or accreditation, that engage and influence the private sector are complex and challenging They require specialized skills and new practices built on experiences in other countries and basic principles of economics, regulation, business, and other fields The technical assistance available to public officials in developing countries, however, typically offers little support and expertise on private-sector engagement. 

The language is quite general, but it suggests that accreditation can be challenging for less experienced administrative bodies.  The opposing (libertarian) argument would be that it's unclear why the government should be so much better at creating effective schools and training institutions for health workers.  I don't yet have enough experience in developing country economies to know how strong this argument is.  On the one hand, if a private institution is churning out poor quality workers, won't hospitals and clinics stop hiring such workers?  On the other hand, I imagine the picture is much more complex than that.  From what I've seen, the Ivorian bureaucracy has a complex relationship with diplomas, trainings and other qualifications that I don't yet understand at all.  

I will revisit this question in a couple of months.  It seems that there are two main questions to be answered: 1) Could private accreditation of health worker training improve the human resources situation in Cote d'Ivoire? 2) And if so, what is the best way to institute a private accreditation program for health workers in a developing country?  This ASCP article provides some useful background on the latter question.  

Working at the Ivorian Ministry of Health

Notes from my first week of work at the Ministry of Health:

• I arrived at work on Tuesday morning and the electricity was out.  They didn’t really know what to do with me, but one of the women in the office was about to leave for a week-long conference, so they sent me with her.  The conference was in Agboville, 90 minutes north of Abidjan.  I was told to go home and pack my bags and Noelle would pick me up in two hours. 
• The conference was about how to improve human resources in the Ivorian health system.  There were officials there from several different branches of the Ministry of Health, as well as from the WHO and Abt Associates, who sponsored the meeting. 
• The meetings were a bit stressful at first, as my French comprehension is still not totally up to par, and I had trouble following some of the more technical conversations.  Also, I’m the only non-African here.  It’s an odd feeling; I attract a lot of attention whenever I walk into a room.  Everyone is polite enough to pretend like it’s nothing out of the ordinary, but it’s interesting to feel the vibe of the room change when I enter.  It’s a bit of a lonely feeling and I imagine it will increase my empathy for outsiders when I return to the U.S. 
• It’s worth noting that Abidjan doesn’t feel like this.  White people are noticed, but there they are common enough that you usually don’t get more than a brief second glance.  This is supposedly rare for Africa.  Sheila says that even in Accra she attracted significantly more attention. 
• By the end of the week, everyone had become much more comfortable with me.  I got invited out to dinner in town on our last night, and I had some nice conversations on Thursday and Friday. 
• There was a refreshing and admirable level of honesty at these meetings  -- it is common for government officials at an official meeting to say something like “our system of financial motivation for health workers is completely worthless,” and everyone will nod in agreement.  U.S. government would function better if public officials were so honest.  
• On Wednesday morning, we had a presentation on “Results-Based Management” (“Le Gestion Axée sur les Resultats”).  The presenter attributed the concept to Peter Drucker and his 1964 book “Managing for Results.”  The presentation cited the fact that the Canadian government adopted this concept in the early 1990s. 
•  We seem to be writing the official 3-year plan for how to improve human resources in the health sector. 
• In French, to make a text comprehensible to the population is to "vulgarize" it, which says everything.  
• At lunch, I found a hair on my plate.  I spent a moment trying to decide if it was mine before realizing that I was the only person within 25 miles with hair like that. 

Things I learned this week in Abidjan

Observations from last week in Abidjan:

• Taxi drivers have been much more honest than I had been led to believe.  One negotiates their cab fare here, and to hear some tell it, they will skin you alive if you let them.  My experience has been that they usually start a dollar or two above the market rate, and negotiate down quite easily. 
• On Wednesday night, my cab driver was listening to a country music CD.  The juxtaposition between Dan Williams' music and the drive across Abidjan at rush hour (we drove on the sidewalk for several blocks -- I know this must seem like an exaggeration but it isn't) was one of the cooler moments I've had here.  It would have made a great scene for a film.   
• The climate is waaaay better than I had been expecting.  There hasn't been an oppressively hot day since my arrival and most days it's actually pretty pleasant.  Apparently, the dry season is much hotter, but I had expected every day to be unreasonably hot, and that is certainly not the case.   
• I moved into my new house last weekend with the three other Fulbrighters.  It’s a spacious four-bedroom house, with a small yard on a pleasant residential street.  We’re in Deux Plateaux, a couple of blocks from Rue des Jardins, one of the more fun streets in Abidjan. 
• Rue des Jardins is fun because it has restaurants (particularly Vietnamese and Lebanese), as well as cafes, an ice cream shop, a supermarket and a very decent French pastry shop. 
• Rent is less than half of what one would pay for a similar place in DC, but still supposedly quite expensive by developing country standards.  
• Moving in was complicated by the lack of social capital and the lack of trust in the legal system.  We didn’t want to pay anything until basically the moment we moved in and I felt stressed that perhaps it was all a scam and our money would be stolen.   For their part, they made us pay nine months of rent up-front -- six months of rent, along with three months of security deposit. 
• Lots of lizards here, some with brilliant orange stripes along their backs. 
• The ravens have white breasts. There are an extraordinary number of them here, particularly at sunset when they all take to the sky and downtown Abidjan looks like it’s in the middle of an apocalyptic bird uprising. 
• Most streets here don’t have names, just numbers that nobody knows or bothers with. To get somewhere, you have to know a landmark nearby and direct your driver from there.  
• The local furniture makers here don’t have stores or warehouses; they occupy patches of land in throughout the city where they display their wares.  We bought all our furniture for our house from one of these carpenters.  It was a mostly painless and effective process.  They built several beds, desks, chairs and desks for us, according to our specifications and delivered them; however, the one problem – and it is a significant problem – is that my bed smells like mold.  Trying to figure out how to get this fixed.  

Things I learned this week

Observations from my 2nd week in Abidjan:

• This is apparently common to all developing countries, but there is no better feeling than breaking a large bill here.  Change is almost impossible to come by, and one is in a constant state of worrying about having enough small bills.  
• In meetings, Ivorians clap to demand silence.  
• The internet is a bit slower than in the U.S., but usually stable and completely adequate for my daily needs.  Netflix and Hulu do not work here; iTunes and Spotify work as normal.
• The traffic here reminds me a lot of Santa Cruz.  There aren't a ton of cars on the road, but neighborhoods are spaced far apart and there are not enough roads to link it all.  
• There is a lack of rules here that is both liberating and terrifying.  On the good side, one can basically go wherever one wants with no consequences.  I don't think an authority figure has told me not to do something since I arrived here two weeks ago.  On the bad side, renting a house is terrifying; on Wednesday, we'll pay nine months of rent for our house, and we're concerned about the lack of legal recourse.  
• There is a startling amount of conflicting and sometimes just bad information that circulates among ex-pats.  Our housing search has been absolutely ludicrous.  We'll find a house at a given price, and some people will tell us that the price sounds too good to be true, while others will be scandalized at how much we're overpaying.  We likewise get contrasting information from our fellow ex-pats on acceptable modes of transportation, good/fun/safe neighborhoods, and the need for security guards.  
• Two weeks into my stay here, I see poor neighborhoods differently.  In my first few days, I would drive or walk through a poor neighborhood (and most neighborhoods are poor) and feel worried for my safety.  Mostly though everyone is just going about their daily lives.  Crime exists here, but I've yet to be targeted, and I've yet to have a legitimate reason for concern.   
• Sheila tells me that people are far more accustomed to white people here than they were in Ghana or Burkina Faso.  Most people don't look twice at us, although cab drivers honk at us in the hope that we're interested in a taxi (which we often are to be fair).  
• There seems to be a decent quality pick-up basketball game at the Lycée Classique in Cocody.  

Things I learned this week

Things I learned during my first week in Abidjan:

• Abidjan is less dense than I had imagined.  I imagined something closer to slums packed with humanity.  Instead, there is a shocking amount of open space.  Wealthy and middle class neighborhoods have huge swaths of basically undeveloped land.  Even in fully developed areas, Abidjan looks more like L.A. than New York. 
• Human labor is very cheap here in Abidjan.  You can rent somebody's car for $50/day.  Car and driver = $60/day.  
• As a result, most things are very cheap here.  Lunch on Friday (fried fish, cous cous and some chopped tomatoes and onions) cost $1 from a street vendor.  We were given a bowl of water to rinse our hands before eating.  It is customary to eat with our hands, although when I was hesitant, they brought me a spoon.  
• I did not get sick from the street vendor food and I've yet to have any stomach problems.  All meat that I have eaten has looked and tasted how it was supposed to look and taste.  
• Taxi rides are also very cheap.  Petrol must be heavily subsidized, since cars are apparently very expensive.  
• Apparently, cars and most other imports are quite expensive.  Multiple people have said that you can buy a car in the U.S., have it shipped to Cote d'Ivoire, and sell it for double the original price in the U.S.  
• There is something very feudal and mercantile about the economic system here.  There are apparently check points throughout the country where police officers (or gangsters) demand a "toll" from vehicles carrying cargo.  It reminds me of Paul Bairoch's description of 17th century Europe where a merchant would have to pay a toll every 5 miles on average.  
• I have been pleasantly surprised by the food, both West African and "ethnic" (e.g., Vietnamese) -- much better than Sheila had led me to believe based on her experience in Ghana.  I'm tempted to think it's a difference between ex-English colonies and ex-French colonies, but that is probably lazy.  West African food does not have much in common with French food so far.  
• That being said, one can get croissants and baguettes here.  The croissants aren't as good as in Paris, but are better than the median croissant in Washington, DC.  I haven't yet tried the baguettes.  
• Many areas of Abidjan smell faintly (or strongly) of human waste.  
• The embassy community seems pretty isolated from Ivorian culture.  Several ex-pats have expressed a degree of condescension about embassy lifestyle on issues ranging from transportation to antimalarials.  
• Houses of embassy staff in Abidjan are amazing.  They live in large villas with multiple bedrooms, spacious living rooms, cozy furniture, air conditioning, multiple security guards, and large backyards that sometimes have swimming pools.  We are staying with a foreign service officer and his wife and they have been extremely hospitable, providing us with food, lodging and even a driver most days.  
• Help or "domestiques" seem to be a staple of ex-pat life.  We are considering hiring someone once we have our own apartment.  We like the idea of being able to supply someone with consistent and stable income over several months, and an above market rate daily wage would be very affordable for us. Sheila also likes the idea of being able to work on her French. Needless to say, having someone help with daily errands sounds nice as well.  
• We went to dinner on Saturday night at a restaurant in an open field with a band playing.  The band played West African music and latin salsa.  They played for more than 90 minutes without a break.  Afterwards, they passed around a survey asking how they could improve (and also asking for a donations).  
• There are fewer rats in Abidjan than in Washington, DC.