Avian influenza: the political economy of disease control in Cambodia

Abstract In the wake of avian flu outbreaks in 2004, Cambodia received $45 million in commitments from international donors to help combat the spread of animal and human influenza, particularly avian influenza (H5N1). How countries leverage foreign aid to address the specific needs of donors and the endemic needs of the nation is a complex and nuanced issue throughout the developing world. Cambodia is a particularly compelling study in pandemic preparedness and the management of avian influenza because of its multilayered network of competing local, national, and global needs, and because the level of aid in Cambodia represents approximately $2.65 million per human case-a disproportionately high number when compared with neighbors Vietnam and Indonesia. This paper examines how the Cambodian government has made use of animal and human influenza funds to protect (or fail to protect) its citizens and the global community. It asks how effective donor and government responses were to combating avian influenza in Cambodia, and what improvements could be made at the local and international level to help prepare for and respond to future outbreaks. Based on original interviews, a field survey of policy stakeholders, and detailed examination of Cambodia's health infrastructure and policies, the findings illustrate that while pandemic preparedness has shown improvements since 2004, new outbreaks and human fatalities accelerated in 2011, and more work needs to be done to align the specific goals of funders with the endemic needs of developing nations.     

The Political Economy of Aid and Governance in Cambodia

The impact of massive aid on development and governance has been studied for a decade with mixed results. Using the results of an elite survey on aid and quality of governance based on Kaufmann et al.'s six dimensions (voice and accountability, political stability, government effectiveness, regulatory quality, rule of law, and control of corruption), this article offers a case-study of Cambodia. The country's challenges in light of high aid dependence and ‘Dutch disease’ in the aid sector are elaborated, and disappointing human development outcomes are examined. Despite more than five billion dollars in aid, infant and child mortality and inequality have worsened. Key informants are overwhelmingly in agreement that, save for political stability, aid has not had a positive impact on governance in Cambodia. The failure on control of corruption shows how hard it is for donors to be tough on a country with extreme poverty. On the basis of what has been accomplished to date, however, aid seems unlikely to be able to deliver large improvements in governance and in many ways may even contribute to its further deterioration.     

Letter from the Editor

ABSTRACT

Aid dependence has been linked in the literature with worsening quality of governance. Using Kaufmann et al.'s six dimensions of governance (Voice and Accountability, Political Stability, Government Effectiveness, Regulatory Quality, Rule of Law, and Control of Corruption), this article reinvestigates this relationship with new data and a more robust methodology. Under pooled Time Series Cross-Sectional (panel data) analysis, only the Rule of Law appears to have a negative relationship with aid, and at only the 0.10 significance level. To control for potential endogeneity and reverse causality, aid is lagged and subsequently instrumented. Potential omitted variables bias is controlled with a fixed effects model. Components of aid such as technical cooperation and average grant element are also explored. Findings suggest that aid can play a positive role when its components are considered and that the causal link between aid dependence and worsening quality of governance may be tenuous at best and sensitive to alternative specifications.     

Emerging Infectious Disease Surveillance in Southeast Asia: Cambodia,Indonesia, and the US Naval Area Medical Research Unit 2

Abstract

Emerging infectious diseases (EIDs) pose international security threats. What cultural, political, and economic challenges stand in the way of setting up EID Surveillance infrastructure? Are there general principles that might guide engagement with developing countries and support such infrastructure? Using the US Naval Area Medical Research Unit 2 as a common denominator, this study compares barriers to EID surveillance in Cambodia and Indonesia and presents key factors that constrain disease surveillance systems. As extensive interviews revealed, low levels of development in general are the main impediments to building EID surveillance infrastructure and are perhaps beyond the scope of health and scientific agencies at this point. Ultimately, political economy matters and promoting greater understanding of these issues is a critical first step in mitigating negative outcomes.