- Doomed Interventions: The Failure of Global Responses to AIDS in Africa by Kim Yi. Dionne
In Doomed Interventions: The Failure of Global Responses to AIDS in Africa (2017), Kim Yi Dionne makes the case that the global response to HIV/AIDS in Africa has been a failure. This claim is contentious and controversial, especially given the billions of dollars spent by major multilateral and bilateral donors over the past several decades and trends that suggest that prevalence rates have declined over time. Dionne uses a couple of examples of global interventions that have failed in implementation in Botswana and Mozambique to motivate the book’s core puzzle. Where other authors, such as Lieberman (2009), have analyzed cross-national variation in government response to the crisis, Dionne’s contribution is her effort to unpack the process of implementation on the ground.
This is not an easy task, but Dionne does it effectively by focusing on the dynamics within one country case over time. After providing a brief summary of the disease dynamics in the global and African contexts, she concentrates on Malawi, where international funds constitute 99 percent of the response to the disease. Her analysis is based on impressive fieldwork in three districts in each of the three administrative regions of Malawi between 2006 and 2010. Her data collection was part of a large, NIH-funded study on citizen perceptions and behaviors, and it included a survey of village headmen. [End Page 144]
Drawing on a principal–agent theoretical framework, Dionne argues that these AIDS response efforts have failed because of problems of adverse selection and preference misalignment. She backs up this argument, about the disconnections between international donors and Malawians, with a wealth of quantitative survey data from citizens and original interview data from village headmen and other key informants. She convincingly shows how Malawians do not identify HIV/AIDS as their top priority. Her findings also highlight how survey question wording profoundly influences the answers elicited and that HIV/AIDS services are not necessarily perceived as a public good for all, but as an excludable good. In the chapter on village headmen, Dionne then further probes how village leaders may be influenced by their constituents and mediate between citizen and global perspectives. The most compelling theme that runs throughout the book is her call for greater attention to African perspectives and citizen viewpoints on international development policies.
This book will interest scholars in political science, public policy, public administration, development studies, public health, sociology, and anthropology. Its chapters provide an excellent and provocative introduction to the challenges and shortfalls of the AIDS response that would be suitable for undergraduate or graduate classes.
The book is very much framed in terms of African politics, but it has important insights that would be relevant for scholars, practitioners, and policymakers working in other regions of the developing world. For example, the book highlights the importance of traditional leadership at the local level in brokering between donors and their constituents. The questions about principal–agent problems in the implementation of international development policy are much broader and would be valuable for scholars studying Asia, Latin America, and the Middle East. Dionne leaves room for further exploration of the theoretical and policy implications of her findings, which have the potential to be far reaching.