Watson Institute at Brown University
Africa Initiative

Professor Nitsan Chorev discusses her newest book that addresses developmental foreign aid in East Africa

Nitsan Chorev is the Harmon Family Professor of Sociology and International & Public Affairs and currently director of the Graduate Program in Development. Chorev is the author of three books, the most recent of which, Give and Take: Developmental Foreign Aid and the Pharmaceutical Industry in East Africa, was published by Princeton University Press in early 2020. 

At a time in which it is common to attack foreign aid as inefficient or exploitative, Chorev asserts that developmental foreign aid can positively impact industrial development, if such aid provides markets, monitoring and mentoring. Comprehensively researched, the book evaluates the effect of foreign aid on the emergence of pharmaceutical firms in Kenya, Tanzania and Uganda, and studies the effects of foreign aid on the upgrading of such firms.

WI: Your first book is about U.S. trade policies and your second book is about the World Health Organization (WHO). What inspired you to focus on foreign aid this time? And why pharmaceutical companies in Kenya, Tanzania and Uganda?

NC: I didn’t mean to write about foreign aid! As I was doing research for my book about the WHO, I also looked extensively at political struggles over access to medicine – especially anti-AIDS medicine. When I was done with the WHO book, I wanted to look deeper into the political economy of access to medicine by examining drugs that make their way into sub-Saharan African markets. This is when I got interested in locally produced drugs, but I still didn’t think this was a project on foreign aid. If anything, I wanted to get away, analytically, from international politics. But then, in an interview with a very experienced pharmacist, he described how a “ration kits program” was responsible for the emergence of local manufacturing in Kenya back in the 1980s. From then on, I slowly began to realize that foreign programs were indeed central to my story.

WI: What is the book’s primary take-away message?

NC: Foreign aid is extremely problematic for a number of reasons. It doesn’t always work, it often serves donors’ interests rather than recipients’ needs, and it may lead to distortion of local priorities. The list of potential pitfalls and contradictions is long. But in the case of pharmaceutical production in East Africa, there was also clear evidence to show that foreign aid contributed to the emergence of local pharmaceutical companies back in the 1980s and to the upgrading of their production standards in the 2000s. I wanted to find out why this happened.

My main goal was to find the policies and practices that encouraged industrial production in this particular situation. I found that it was a combination of three interventions: the creation of markets encouraged local entrepreneurs to produce the kind of drugs that donors would buy; effective monitoring encouraged local entrepreneurs to follow high quality standards; and mentoring in the form of technical transfer provided local entrepreneurs the necessary know-how to do so successfully. I found it analytically reassuring that these policies were quite similar to the policies identified by the literature on the “developmental state” when they tried to identify state policies that would lead to economic growth through industrial production. It is for this reason that I call foreign aid that follows this logic, “developmental foreign aid.”

WI: Who do you hope reads this book?

NC: I hope that policy-makers will read this book. It’s not a straightforward manual explaining how to make foreign aid successful, but I believe it identifies important lessons that might be useful to foreign aid decision-makers. In addition, of course, I hope sociologists, political scientists, anthropologists and historians interested in industrial development, global health, foreign aid and politics generally will enjoy this book. 

WI: Your research indicates that pharmaceutical companies in those countries benefited from developmental foreign aid. Do you believe that your research has relevance and applicability to other industry sectors in other developing countries?

NC: Generalizability here is key, yes. When I present my work, I am often asked: Isn’t the pharmaceutical sector unique? Well, it is unique. In part, because it is relevant not only to manufacturing capabilities but also to access to medicine, which makes it a priority. But priorities are a political construct. In the book, I offer a few examples that confirm the importance of markets, monitoring and mentoring to other sectors, as well.

WI: Do you plan to conduct further research in Kenya, Tanzania, and Uganda on the long-term sustainability and growth of the pharmaceutical industries there? 

NC: Yes, and no… I’ve recently started two smaller new projects in Kenya and Tanzania that are related to the pharmaceutical sector, but not to local production. One project I’m particularly excited about focuses on how pharmacists handle competition from non-pharmacists. Another project relates to my growing interest in technologies, including healthcare technologies.   

Nancy Kirsch