A. Sen: The glory and the blemishes of the Indian news media

Our free media, including our largely unfettered press, are a hugely important asset for democratic India. And yet the celebration of the Indian news media can go only so far — and no further.

One of the great achievements of India is our free and vibrant press. This is an accomplishment of direct relevance to the working of democracy. Authoritarianism flourishes not only by stifling opposition, but also by systematically suppressing information. The survival and flowering of Indian democracy owes a great deal to the freedom and vigour of our press. There are so many occasions when, sitting even in Europe or in America, I have wished for something like the vigour and many-sided balance of the Indian press to confront the vilification of chosen targets.

One longstanding example of some moment is the organised mischaracterisation in the USA of the British National Health Service and similar public health arrangements in most of Europe. Despite the fact that America has some superb newspapers, such as The New York Times, the information industry has managed to undermine thoroughly the understanding of the great accomplishments of public health care in Europe, and its contribution to enhancing health security, life expectancy, and the quality of life. Rather, the National Health Service and other such medical arrangements are often seen as some kind of a “health lock-up,” generating a widespread horror of what is called “socialised medicine” (I have heard of a rumour that American children are persuaded to eat broccoli by threatening them with “socialised medicine” as a dreaded alternative).

Professionalism and accuracy

Despite the limitations of the Indian news media, some of which I will discuss presently, we have every reason to applaud our free media, including our largely unfettered press, as a hugely important asset for democratic India. And yet the celebration of the Indian media can go only so far — and no further. There are at least two huge barriers to quality that are very worth discussing: one is concerned with the internal discipline of the media and the other relates to the relation between the media and society. The first problem is that of some real laxity in professionalism in achieving accuracy, which can be harmed even without any deliberate intention to mislead or misinform. The second is the bias — often implicit — in the choice of what news to cover and what to ignore, and the way this bias relates particularly to class divisions in India.

Indian reporting can be, and often is, extremely good. I always marvel at the skill of the reporters, often very young men and women, in being able to capture and bring out the nuances of points that are hard to summarise accurately. However, Indian reporting is characterised by great heterogeneity, and sometimes serious inaccuracies can receive widespread circulation through the media (or initiating in the media). While I have been personally lucky, most of the time, I am aware of problems that others have had, and sometimes I see them in my own experience. As an Indian reader, I would like to be sure, when I open the morning newspaper, that what I am reading — that A said B — is actually accurate. It is hard to have that assurance.

Let me give a couple of examples, despite — I should re-emphasise — my generally good experience with reporting in the press. Four days ago in a public discussion I said in answer to a question about the Lokpal initiative that the solution to the extremely important problem of corruption would have to be sought within the Indian democratic system (including our courts and Parliament), and also that I had not seen the blueprint of any effective Lokpal Bill – neither from the government nor from any faction of the Opposition.

When, later on, I opened the web, I found reports with the following headlines: “Lokpal Bill well thought out: Amartya Sen” (The Times of India, India Today, Zee News, NDTV, among others); and “Lokpal Bill not well thought out: Amartya Sen” (DNA News, Money Control, The Telegraph [which did not make it a headline], among others). One paper first distributed the former story and then the latter, without noting that there is a correction here, and I was amused because it is a paper — The Economic Times — with which I am personally associated, since I was given the privilege of editing the paper for one day a few years ago (it was a great day for me, though I gather from the Editor that I drove them all mad, by rejecting entries and asking for several rewrites).

Based on another meeting in Kolkata on the same day, a lecture for the Cancer Foundation of India, I found the following headlines: “To smoke is individual option” (The Statesman) and “Curb smokers' liberty: Amartya” (Hindustan Times). All this is just from one day. Unfortunately, a misreport on one day can have quite big consequences. The Times of India said on December 15: “Amartya Sen: People on street can't deal with corruption.” I had said nothing of the sort, as the audio record of the speech confirms, but once that misreporting, coming from a news agency apparently used by many newspapers, is in the public domain, it is hardly surprising that I would be showered with rebuke and moral advice. Dozens of pages of denunciations materialised immediately. Much of the moral advice to me would be sensible enough had the statement reflected something I had said. The one I liked best said: “I think Mr. Sen should keep his mouth shut” — an eminently sensible piece of advice given the constant danger of misreporting by a careless press — or, as in this case, a careless news agency on which many papers mechanically rely.

What I had, in fact, said was that the judgment and penalty for corruption cannot be a matter for street justice, and must come through the democratic procedures that we cherish in India, including the courts and Parliament. I believe the Indian people are fully committed to that democratic priority, rather than “summary justice.” What they really complain about is that the democratic procedures are not being applied sufficiently vigorously and stringently to corruption. This is indeed an important demand, and this understanding is very far from any dismissal of the ability of “street people” to comprehend the political challenge arising from corruption. Since I have taken part in street demonstrations myself, complaining about many injustices in India (one recent activity of this kind was related to the public agitation for the right to food), I must stand up for the right of ordinary folks — what the news agency called the “street people” — to be heard loud and clear.

On enhancing accuracy

So what can the media do to deal with the lapses from accuracy in reporting? I don't know the answer — my main intention here is to raise the question — but one thought that is fairly straightforward is to get all the newspapers to agree to publish corrections of their own stories as a regular feature (and highlight them online, along with the corrected accounts). This is done with much effectiveness by The Guardian and The New York Times, and some Indian papers already have such a section (the host of this essay, The Hindu, has had this for many years), but the practice can be made more universal among the papers, and also more active and more well-known.

There is also an issue of journalistic training. Taking notes in a rush is never easy, and it has become harder still since most reporters today, unlike those in the past, do not know shorthand. But there are marvellous recording devices in our modern world, and they can perhaps be used more uniformly, rather than the reporters tending to rely on memory, as many still seem to do. There are surely other ways of reducing inadvertent inaccuracy, and it would be nice to see more discussion on it. But now I must move to the second problem to which I referred.

Class bias

If greater accuracy is mainly an internal challenge for the media, avoiding — and fighting — class bias involves an external challenge that relates to the divisiveness of the Indian society. Of course, class divisions are present elsewhere as well. The “Occupy Wall Street” movement has drawn attention to what it sees as the contrast between the very prosperous — the 1 per cent at the top — and the rest of the 99 per cent in the United States. I will not comment here on the veracity of this 1%-99% contrast, as applied to the United States, but relying on a similar division in India would miss the mark by a long margin. There are, of course, many divisions in India — and some apply to newspaper ownership as well — but the division that introduces a generic bias in Indian news coverage, related to the interest of the newspaper reading public, is more like one between a fortunate fifth of the population who are doing just fine on the basis of the economic progress that is taking place in India, and the rest who are being left firmly behind.

There is, in fact, a substantial part of the Indian population — a minority but still very large in absolute numbers — for whom India's economic growth is working well, along with those who were already comparatively privileged. An exaggerated concentration on their lives, which the Indian media tend typically to display, gives an unreal picture of the rosiness of what is happening to Indians in general. There tends to be fulsome coverage in the news media of the lifestyles of the fortunate, and little notice of the concerns of the less fortunate. To refer to three of many unfortunate facts (the list can be quite long): (1) India has the highest percentage of undernourished children in the entire world, measured in terms of the standard criteria; (2) India spends a far lower percentage of its GNP than China on government-provided health care and has a much lower life expectancy; and (3) India's average rank among South Asian countries — India, Pakistan, Bangladesh, Sri Lanka, Nepal, and Bhutan — in the standard social indicators, varying from life expectancy and immunisation to infant mortality and girls' schooling, has dropped over the last twenty years from being second-best to second-worst (even as India has surged ahead in terms of GNP per capita).

The problem here does not, of course, originate in the media, for it is social division that feeds this bias in coverage. But the media can play a more constructive part in keeping the reality of India persistently in the view of the public. The bias in coverage, even though it is by no means unpleasant to the reader, contributes quite heavily to the political apathy about the urgency of remedying the extreme deprivation of the Indian underprivileged. Since the fortunate group includes not only business leaders and the professional classes, but also the bulk of the country's intellectuals, the story of unusual national advancement gets, directly or indirectly, much aired — making an alleged reality out of what is at best a very partial story.

What is probed and what ignored

The group of relatively privileged and increasingly prosperous Indians can easily fall for the temptation to assume that given the high rate of economic growth, there is no particular need for special social efforts to enhance the lives of people. When, for example, the government introduced, as it did recently, its plan of providing subsidised food for the Indian poor, an enormous number of critics pointed immediately to the fiscal problems involved, and some even talked about the sheer “irresponsibility” that is allegedly reflected in the Food Security Bill.

There are indeed many serious problems with the Food Security Bill that has been tabled, and the Bill can be much improved and one hopes it will be. Furthermore, fiscal responsibility is certainly a serious issue and the financing of food subsidies, like other social programmes, demands critical examination. But it is worth asking why there is hardly any media discussion about other revenue-involving problems, such as the exemption of diamond and gold from customs duty, which, according to the Ministry of Finance, involves a loss of a much larger amount of revenue (Rs.50,000 crore per year) than the additional cost involved in the Food Security Bill (Rs.27,000 crore). The total “revenue forgone” under different headings, presented in the Ministry document, an annual publication, is placed at the staggering figure of Rs.511,000 crore per year. This is, of course, a big overestimation of revenue that can be actually obtained (or saved), since many of the revenues allegedly forgone would be difficult to capture — and so I am not accepting that rosy evaluation. And yet it is hard to understand why the cost of the Food Security Bill should be separated out for fiscal gloom without examining other avenues of fiscal soundness. An active media can draw attention to what is being probed and what remains underdiscussed and underexplored.

The impact of India's division between the privileged and the non-privileged can also be seen in the political power of the advocates of continuing — and expanding — subsidies on fuel use, even those that go particularly to the relatively rich (such as petrol for car owners), or of fertilizers, which yield major transfers of a regressive kind, even as they help with agricultural production. It is possible to redesign these fiscal arrangements to introduce more economic rationality, greater environmental awareness, and the demands of equity with efficiency. The political support for tolerating — and defending — the present profligacy in catering to the relatively better off contrasts sharply with the fiscal alarm bells that are sounded whenever proposals for helping the poor, the hungry, the chronically unemployed come up.

If the first problem I referred to, that of accuracy, is one of improving the performance of the news media through better quality control, the second, transcending class bias, concerns the media's role in reporting and discussing the problems of the country in a balanced way. The media can greatly help in the functioning of Indian democracy and the search for a better route to progress including all the people — and not just the more fortunate part of Indian society. What is central to the functioning of the news media in Indian democracy is the combination of accuracy with the avoidance of bias. The two problems, thus, complement each other.

(Amartya Sen, the Thomas W. Lamont University Professor, and Professor of Economics and Philosophy at Harvard University, won the Nobel Prize in Economics in 1998. The Bharat Ratna was conferred on him in 1999.)

(US) Physicians Highlight Overlooked Connection Between Social Needs and Health

Link to webpage with full report / story and additional resources. http://www.rwjf.org/vulnerablepopulations/product.jsp?id=73646
This is a story from and about the USA.

Physicians Highlight Overlooked Connection Between Social Needs and Health

National survey indicates physicians believe addressing patients’ social needs is as important as addressing medical conditions.

Four in five physicians say patients’ social needs are as important to address as their medical conditions, according to a new survey conducted by Harris Interactive on behalf of the Robert Wood Johnson Foundation. For physicians serving patients in low-income communities, nine in ten physicians believe this is true.

In this national survey of primary care providers and pediatricians, 85 percent believe that unmet social needs — things like access to nutritious food, reliable transportation and adequate housing — are leading directly to worse health for all Americans. Furthermore, 4 in 5 physicians do not feel confident in their capacity to meet their patients’ social needs, and they believe this impedes their ability to provide quality care.

This is health care’s blind side: Within the current health care system, physicians do not have the time or sufficient staff support to address patients’ social needs.
Physicians surveyed feel so strongly about the connection between social needs and good health that 3 in 4 wish the health care system would pay for the costs associated with connecting patients to services that address their social needs if a physician deems it important for their overall health. Results also revealed that, if physicians had the power to write prescriptions for social needs, they would prescribe fitness programs, nutritional food and transportation assistance. Physicians whose patients are mostly urban and low-income also wish they could write prescriptions for employment assistance, adult education and housing assistance.

We know that our zip code is more powerful than our genetic code when it comes to our health. Indeed, the conditions we face day in, day out, where we live, learn, work and play, have a greater impact on our health and life expectancy than our medical conditions and the health care we receive.

Promising models, such as Health Leads, bridge this gap by empowering health care providers to help remove the social barriers that keep people from taking the actions they need to be healthy. Such models need to continue to be invested in and evaluated. Nevertheless, more can be done. While models that address social needs are a step in the right direction, leadership and commitment from health care decision makers is required to create system-wide and lasting change.

To publish or not publish man-made 'super flu' articles

From Laurie Garrett, Council on Foreign Relations

December 20, 2011

Dear Friends and Colleagues,

Today, December 20, 2011, the National Science Advisory Board for Biosecurity (NSABB) released its decision regarding publication of two scientific papers claiming to have made a “super-flu” variant of the H5N1 avian virus. Two research teams, from the Netherlands and Wisconsin, separately claimed in September to have man-made genetic variants of the widely circulating H5N1 virus, rendering the flu not only transmissible man-to-man, but also more than 50 percent lethal.

As I described last week, the research sparked a range of fears, including concern that what amounts to the most dangerous human pathogen ever known to have existed could escape its laboratory confines, with disastrous repercussions; that publication of the “how-to” aspects of the experiments could constitute handing a catastrophe cookbook to terrorists or malevolent individuals; and that recent proliferation in high security biology labs worldwide has increased the risk of both lab accidents and untraceable bioterrorism research.

The NSABB faced three basic options regarding publication of papers by Ron Fouchier of Erasmus University in Rotterdam and Yoshi Kawaoke of the University of Wisconsin in Madison:

1)      Advise all credible scientific publications to decline release of the papers, essentially censoring the work;

2)      Allow full and free publication of both papers;

3)      Advise publication, but with key passages related to how the feats were performed, deleted.

The NSABB essentially opted for number three, suggesting to Science, Nature, and other major journals that they agree to publish the two studies, but omit some of the materials and methods sections, allowing scientists to know what was done, but not how:

Due to the importance of the findings to the public health and research communities, the NSABB recommended that the general conclusions highlighting the novel outcome be published, but that the manuscripts not include the methodological and other details that could enable replication of the experiments by those who would seek to do harm. The NSABB also recommended that language be added to the manuscripts to explain better the goals and potential public health benefits of the research, and to detail the extensive safety and security measures taken to protect laboratory workers and the public.

The U.S. Department of Health and Human Services released a statement today, responding to the NSABB (which technically is an advisory board to the HHS):

The NSABB recommended that the general conclusions highlighting the novel outcome be published, but that the manuscripts not include the methodological and other details that could enable replication of the experiments by those who would seek to do harm.

The NSABB also recommended that language be added to the manuscripts to explain better the goals and potential public health benefits of the research, and to detail the extensive safety and security measures taken to protect laboratory workers and the public.

HHS agreed with this assessment and provided these non-binding recommendations to the authors and journal editors.

One of the journals likely to publish the research is Science magazine. Science Editor-in-Chief Dr. Bruce Alberts issued a statement today:

Science editors will be evaluating how best to proceed. Our response will be heavily dependent upon the further steps taken by the U.S. government to set forth a written, transparent plan to ensure that any  information that is omitted from the publication will be provided to all those responsible scientists who request it, as part of their legitimate efforts to improve public health and safety.

The British journal Nature is also likely to publish one or both papers, and today its Editor-in-Chief Philip Campbell said:

We have noted the unprecedented NSABB recommendations that would restrict public access to data and methods and recognize the motivation behind them. It is essential for public health that the full details of any scientific analysis of flu viruses be available to researchers. We are discussing with interested parties how, within the scenario recommended by NSABB, appropriate access to the scientific methods and data could be enabled.

Where does this leave us? The papers will be published, and smart scientists working in virology or allied professions will read between the lines, reckoning exactly how the super-flus were created. The University of Wisconsin released a statement this week insisting that Kawaoke has not made a “super-flu” and welcoming the opportunity to clear the air on his research. Rotterdam’s Fouchier, however, has made a form of bird flu that is readily transmitted airborne between mammals (presumably including humans) with a lethality of about 60 percent: the work will be eagerly digested by scientists all over the world.

The NSABB decision will satisfy almost nobody. Advocates for scientific openness will bristle at any censorship, whether it involve a few sentences or an entire article. Conversely, those that fear bioterrorist use of such information will scoff at the notion that deleting a few paragraphs of methodology will in any way deter dedicated miscreants.

In the end the most important, and alarming aspect of this tale is that human beings were able to turn a fairly harmless (to mammals) virus into possibly the worst microbe to have ever co-existed with our species, and did so inside academic facilities. There was considerable debate inside the NSABB regarding whether it should recommend that all future work on the virus be conducted exclusively inside BioSafety-Level 4 (BSL-4) labs, the highest security facilities – significantly more stringent environs than those in which Fouchier and Kawaoke’s teams toil. It seems the Board punted, avoiding the question.

It is now up to federal authorities in the U.S., Netherlands, and elsewhere to decide whether to sequester the deadly microbes, and experiments conducted on them, inside BSL-4 confines.

Sincerely,

Laurie Garrett

Senior Fellow for Global Health

KING’S College London, ESRC STUDENTSHIPS IN HEALTH POLICY, EFFECTIVENESS & EVALUATION

KING’S ESRC STUDENTSHIPS IN HEALTH POLICY, EFFECTIVENESS & EVALUATION

ESRC Studentships for September 2012 are available at King’s College London, in the thematic area of health policy, effectiveness and evaluation (HPE) (http://www.kcl.ac.uk/study/pg/school/DoctoralTrainingCentres/KISS-DTC/KISS-DTCHealth.aspx) .

HPE is part of the King’s Interdisciplinary Social Science Doctoral Training Centre (KISS-DTC), and it encompasses three broad pathways:

 *   Health care effectiveness
 *   Health policy
 *   Health economics


You can either apply to one or other of these areas, or you can apply with a project that works across them. You should have very good qualifications and a clear research idea, and to apply, there are a number of steps to follow:

1) Identify a potential supervisor (discuss your project with admissions tutors, academic staff etc. in the relevant school/department if don't already have a specific person in mind).

2)  Email the person you have identified, providing detailed information about your background, your qualifications, prior research methods training, and a research proposal.  If after a very careful look, you are unsure about who to contact, please send the material to me at anita.patel@kcl.ac.uk writing ‘ESRC Studentship’ in the Subject.

3)  If the person you have contacted encourages you, follow the application procedures outlined at www.kcl.ac.uk/study/pg/funding/sources/esrc.aspx.  Check your eligibility very carefully, and confer with your potential supervisor if you’re unclear whether your project qualifies for funding from the ESRC.

4)  As well as writing your studentship application – the ‘Case for Support’ – you need to apply for an ordinary/non-funded doctoral place through the online admissions portal: https://myapplication.kcl.ac.uk/.  You’ll need to include a research proposal in the ordinary application, but do note the difference between this and the Studentship Case for Support.  The CfS form asks specific questions and you can’t use more than 2 sides of A4.

5)  The closing date for the ESRC Studentship applications is Wednesday 1 February 2012, 17.00hrs.  If you’re encouraged to apply, start working on the forms well before this deadline. You will also need to contact your referees well in advance, to ensure that they have submitted their references by the deadline.

For general queries related to studentships and doctoral places, please see the KCL graduate school website: http://www.kcl.ac.uk/study/pg/school/index.aspx.

Best wishes
Anita Patel
HPE Theme Leader, KISS-DTC

King's College London more than 6 fully funded PhD positions in philosophy

SIX fully-funded PhD positions in Philosophy at King's College London

- The Department of Philosophy at King's College London is delighted to
announce SIX KCL - AHRC studentships for UK/EU students in philosophy for
2012/3.

- Candidates may also apply for the following:
* Medieval Studies KCL Graduate School studentship (to include Medieval
philosophy) UK/EU only.
* International PhD doctoral award - for applicants applying to study
jointly with a King's partner institution (National University of Singapore,
Hong Kong University, Humboldt University (Berlin) or Stuttgart University,
or where they have an agreed secondary supervisor at our other strategic
partner institution, the University of North Carolina (Chapel Hill).)
       > http://www.kcl.ac.uk/artshums/study/Funding/gradfund.aspx

* Further studentships are available (UK, EU and international/overseas) via
the KCL Graduate School:
    > http://www.kcl.ac.uk/study/pg/funding/sources/pgr.aspx

The deadline for applications for these awards -for both, programmes and
funding-  is February 1st 2012: all application materials must be received
by this date.

*  In addition, the Department of Philosophy has funds available, up to
£12,000 annually, to assist graduate students in the Department:
       >
http://www.kcl.ac.uk/artshums/depts/philosophy/study/funding/sorabji.aspx
       >
http://www.kcl.ac.uk/artshums/depts/philosophy/study/funding/stebbing.aspx

How to apply
Full details of how to apply can be found via the above links, and the
Department of Philosophy website:
       > http://www.kcl.ac.uk/artshums/depts/philosophy/study/pgr/index.aspx

Queries?
* Contact the Centre for Arts & Sciences Admissions at King's:
casa_pgr@kcl.ac.uk
* Contact the Department of Philosophy via: philosophy@kcl.ac.uk

Messages to the list are archived at http://listserv.liv.ac.uk/archives/philos-l.html.

Discussions should be moved to chora: enrol via
http://listserv.liv.ac.uk/archives/chora.html.

Other philosophical resources on the Web can be found at http://www.liv.ac.uk/pal.

OECD Report: Divided We Stand: Why Inequality Keeps Rising

For full report, link below.

http://www.oecd.org/document/51/0,3746,en_2649_33933_49147827_1_1_1_1,00.html

In the three decades prior to the recent economic downturn, wage gaps widened and household income inequality increased in a large majority of OECD countries. This occurred even when countries were going through a period of sustained economic and employment growth. This report analyses the major underlying forces behind these developments:

- An Overview of Growing Income Inequalities in OECD Countries (free .pdf)

- Special Focus: Inequality in Emerging Economies (free .pdf)

- Part I. How Globalisation, Technological Change and Policies Affect Wage and Earnings Inequalities

- Part II. How Inequalities in Labour Earnings Lead to Inequalities in Household Disposable Income

- Part III. How the Roles of Tax and Transfer Systems Have Changed

Global Fund cancels next round of grants..

http://www.guardian.co.uk/society/sarah-boseley-global-health/2011/nov/23/aids-tuberculosis

http://www.ft.com/cms/s/0/b7392674-1a7c-11e1-ae4e-00144feabdc0.html#axzz1fSesKEKN

November 30, 2011 4:42 pm

Global Fund: reform needed to regain credibility

By Vicky Hausman, Prashant Yadav, Daniella Ballou-Aares and Brad Herbert

The Global Fund to Fight Aids, Tuberculosis and Malaria, one of the major funders for HIV/Aids programmes around the world, is facing an unprecedented moment of crisis as it announced last week that it has run out of funding to pay for new grant programmes for the next two years.

Tight economic conditions and recent reports of fraud, theft and corruption among its grantees set the stage for this dramatic decision by its board on November 23 – a decision that is likely to impact poor Aids patients around the world. Recovering from this setback and continuing to pursue its ambitious mission will require bold action by the Fund and significant shifts in what it requires from grant recipients, how it tracks progress and how it ensures accountability for results.

A decade after its founding, the Fund is the largest financier in the fight against these three killer epidemics and has not only saved millions of lives directly through its grants but has shifted market dynamics for antiretroviral medications (ARVs) in ways that make treatment more affordable in the long run. As it now seeks to right its course, it has already taken important steps to chart a new course with an emphasis on accountability, efficiency and additionality – i.e., ensuring that its funding doesn’t displace existing financial resources.

Earlier in October a high-level independent review panel on fiduciary controls and oversight mechanism (HLP) had recommended major changes to the accountability structures at the Fund. The panel’s recommendations, most of which have been adopted by the Fund, were centred on shifting it to focus on outcomes instead of inputs, instituting tiers of grant requirements, and creating better accountability structures within the Fund by repurposing committees, empowering middle managers, and adding positions with an explicit focus on risk management. These recommendations are likely only to create a slow, costly and rigid bureaucracy that delivers only marginal benefits to accountability and effectiveness.

The challenges faced by the Fund today present an important window of opportunity for it to drive reform while preserving its lean design principles that will make it not only more transparent and accountable, but also more agile, responsive and efficient. This can be achieved by driving data-based accountability from the bottom-up, empowering the Fund’s ultimate recipients and partners to provide real time feedback on the performance of the programmes it supports.

One of the most obvious places to achieve this change is in the supply chains its recipients use for delivering medicines and other health products. Through better information collection, particularly using mobile telephony, and enabling a multiplicity of players to participate in those supply chains, efficiency and transparency could be radically improved.

The inclusion of recipient feedback could be part of a lean multi-channel platform which would allow the Fund to make better use of information, create greater transparency, and have more effective tools to manage performance. Previously, incorporating feedback from end-recipients, village councils, professional bodies, fragmented civil society organisations and so forth was prohibitively expensive. But with the spread of mobile and broadband networks within developing countries there is now an unprecedented opportunity to improve the transparency, tracking and evaluation of the Fund’s programmes by collecting data and opening channels of communication between it, its suppliers, the end-users of its products and services, and the intermediaries.

Creating this multi-platform system would require the Fund to rethink its overall accountability architecture, creating new channels for communication not only with end recipients, but also with actors and stakeholders throughout supply and distribution chains.

There are several examples which demonstrate the potential of this bottom-up accountability. For example, years of investment and top-down planning and accountability structures have not been able to address stock-outs at the health facility level. A new programme, SMS for Life, has cut stock-outs of malaria medicines in regions of Tanzania to extremely low levels by linking health facilities to district medical offices through mobile phone-based communication. Using the data collected from health facilities and internet mapping software, the district offices have been able to redistribute stock in the most efficient way possible, saving time and transport costs.

Similarly, the Stop Stock-Outs Campaign, which covered four countries in southern and eastern Africa, used a combination of Ushahidi crowdsourcing software and the FrontlineSMS communication platform to collect reports of stock-outs of essential medicines for six months in 2009 and 2010. It received hundreds of reports, providing a template for consumer monitoring of health services. Admittedly, these examples may not be usable in their current form and structure for the scale required by the Fund. However, they do demonstrate that citizens and end-beneficiaries can be fertile sources of rich and highly granular information about medicine availability and that efficient mechanisms can be created for incorporating end-beneficiary feedback to drive bottom-up accountability.

Similarly, drug regulation is another area that is traditionally governed by top down accountability with national drug regulatory authorities having the responsibility of ensuring safety, efficacy and quality of medicines. The birth of applications such as Sproxil, Pharmasecure, and mPedigree, which allow consumers and pharmacists to send codes marked on products to central databases via text messages to check the products’ authenticity, demonstrates the power of bottom-up accountability in combating counterfeits. They also show how bottom-up mechanisms can work in concert with top-down accountability structures, linking consumer actions and input to governance and oversight bodies. The same kind of communication would allow the Fund to verify the delivery of commodities purchased by grantees.

These kinds of bottom-up accountability mechanisms will need to be institutionalised – covering all suppliers and grantees – if they are to realise their potential. In the private sector, large corporations with the most sophisticated monitoring and control systems that measure multiple metrics at all levels in a system, invest heavily in tools which allow them to tap into the voice of the customer, as this creates a direct link for feedback. This process need not be burdensome, though; the appropriate system would be one that is focused on lean structures, savvy uses of technology, and has a relentless focus on incorporating the voice of recipients – the Fund’s “customers” – to drive accountability and to improve overall performance.

Similarly, there will need to be a move away from exclusively government-run medicine distribution systems. Inefficiency and corruption is inevitable in a system where the government has near monopoly over delivery of drugs and health services, government employees who run the programmes are lowly and irregularly paid, and there is lack of granular data to hold anyone accountable. Transport, warehousing and distribution of drugs, and the data systems that enable supply chains to operate efficiently, are not core strengths of any government. Even the most publicly funded health systems in OECD countries use private sector entities to manage their supply chains.

To ensure that products procured from the Fund’s grants reach the end-beneficiaries effectively and efficiently, the locus of accountability has to become more dispersed; it has to shift from government offices alone to end-beneficiaries and private sector entities. Creating accountability “pressure points” outside the government and removing the government’s monopoly on distribution to the extent possible, will be vital in making delivery systems more responsive, efficient and accountable.

New accountability mechanisms will require new sanctions, too, otherwise they will be short-lived. Bottom-up accountability without top down enforcement is futile. The availability of data collected from bottom-up mechanisms, especially, will increase the accessibility of performance metrics and may strengthen the feasibility of bold performance-based funding. Equally important, it will allow the Fund to focus more on the needs of its intended beneficiaries, with whom it has had limited direct communication to date.

The Fund was formed with the recognition that the old ways of development aid – top-down, tightly controlled efforts, steeped in bureaucratic controls and dependent on large numbers of international staff – didn’t work, and too often built programmes that were poorly matched to local needs, lacked local leadership and were ultimately unsustainable. The Fund risks going down that path in the name of accountability. With more timely, robust and better-utilised bottom-up information on its supply chain and ultimate recipients, it doesn’t have to.

Vicky Hausman is an associate partner at Dalberg Global Development Advisors in New York and leads the firm’s global health practice.

Prashant Yadav is the director of healthcare research at the William Davidson Institute at the University of Michigan (Corresponding author).

Daniella Ballou-Aares is a partner at Dalberg Global Development Advisors in New York and is director of its North American Business.

Brad Herbert is an independent consultant and was formerly the chief of operations at the Global Fund to Fight Aids, TB and Malaria.