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Beware of calls to ‘rescue’ India’s ‘Covid orphans’

News reports of children being orphaned by Covid-19 deaths in India raise the spectre of a generation of children without adequate parental care. But international responses that favour solutions like building orphanages and seeking adoption for these children are misguided and can lead to child exploitation. In this post, Kristen Cheney explains why, and how you can better support children orphaned during the pandemic.

Photo: Charu Chaturvedi
(Unsplash)

A year ago, my colleagues and I were already forewarning of calls to ‘rescue’ ‘Covid orphans’. As care reform advocates, we are familiar with the pattern: after every disaster—natural or manmade, instant (‘Haitian earthquake orphans’) or slow-burn (‘AIDS orphans’)—media coverage laments the situation of children left without parental care. So when Covid-19 was declared a global pandemic last year, we worried—not so much about whether as about when we would start to see calls for assistance to these orphans. It has taken a while, but now, with the horrible escalation of Covid-19 in India, these stories are starting to emerge.

Children’s advocates worry because these calls tend to take the form of ‘orphan rescue’ narratives, which usually spur desires to go to the children and build massive orphanages, as well as demands for international adoption. And yet we have known for decades that these responses, though well-meaning, are at best deeply flawed and counter to children’s overall wellbeing. Over half a century of child development research has documented the deleterious effects of institutionalisation and risks in international adoption, prompting the United Nations to adopt the Alternative Care Guidelines, which call for institutionalisation and international adoption as last resorts, favouring instead family-based care solutions.

Orphans don’t need ‘rescuing’; they need protection

At worst, ‘orphan rescue’ narratives have spurred corruption and exploitation of children, prompting perverse incentives to traffic children into institutions and even international adoptions for profit. In fact, this has profit motive been so prevalent that I have been tracking its development in what I call the global Orphan Industrial Complex.

While children are indeed losing their parents at alarming rates to Covid-19 in India, that doesn’t mean that foreigners should rush in to build orphanages or seek to adopt orphans. Care reform advocates like myself have long argued that not only are these solutions bad for children; with these good intentions inevitably comes an element of criminality. Under such circumstances, the Orphan Industrial Complex has a way of swooping in and commodifying such children, leading to exploitation (of donors and ‘orphans’ alike as ‘fake’ orphanages pop up to raise funds that line the pockets of traffickers), increasing corruption as people seeking to adopt search for loopholes to legal and child safeguarding measures, and even child trafficking into orphanages and adoption.

A recent BBC article pointed to such early warning signs occurring in India: a grandmother caring for her grandchildren orphaned by Covid-19 is quoted as saying, “A lot of people are coming to ask for adoption [of her grandchildren],” suggesting that the vultures are already descending.

Support for families of orphans and doing away with orphanages

Yet, the Indian government and NGOs have been working for many years on strengthening their child protection and alternative care policies to prevent such exploitation of ‘orphans’. For example, for the past five years, India has been working on shutting down orphanages while also strengthening their child protection systems to better prevent children’s separation from their families in the first place. Continued external support to orphanages only undermines such efforts.

When Covid-19 cases in India started spiking in April, however, so did the number of children left without parental care. Reports started rolling off the press, sometimes detailing the danger of exploitation of those children by unscrupulous traffickers hoping to take advantage of their vulnerabilities. In response, Indian advocates started posting informational memes on social media that detail legal and social advice about ‘what to do with Covid orphans’ [Fig 1]. NGOs have helped set up community helpdesks and outreach programmes to identify and assist families’ access to government schemes, medical facilities, and PPE distribution. To prevent a massive institutionalisation of children left behind, the Prime Minister’s Office declared a support and empowerment program for children affected by the pandemic that includes free education, free health insurance, and a monthly stipend for youth from 18 to 23 years old [Fig 2]. This is a commendable effort that will provide support to extended families to care for children without drastically uprooting them from all that they know. After all, the loss of one or both parents is already hard enough to deal with.

Reinvesting in communities

Whenever I warn people of the Orphan Industrial Complex and its perpetuation of inappropriate charitable responses to orphanhood, they often ask where they should direct their assistance instead. One thing that advocates have lamented is that it is so much easier to raise money for harmful orphanages or adoptions than it is to raise money for child protection and family preservation efforts. Yet we know that these are in the best interests of children.

So, I encourage people to support care reforms that keep children in families or family-based care whenever possible. This ensures children’s rights to family, community life, name, nation, and identity (as enshrined in the Convention on the Rights of the Child); families are where children grow best. But we also need to build the capacities of these systems by, for example, training social workers and supporting communities with services like education, health, and parenting support to help them to take care of their own children.

Finally, we can urge our friends, families, and governments to divest from orphanages (after all, there is a reason why we no longer have orphanages in Europe and North America; why do we consider warehousing children in institutions an appropriate response to crises abroad??) and support moratoria on international adoption such as that recently issued by the Dutch government.

Instead, now is the time to reinvest in communities, such as those in India that bear the burden of the Covid pandemic and lockdowns. We can strengthen them to enact proven care reforms that allow children—even those who find themselves in adverse circumstances like India’s new ‘Covid orphans’—to flourish.

Opinions do not necessarily reflect the views of the ISS or members of the Bliss team.

About the author:

Kristen Cheney is Associate Professor of Children and Youth Studies at ISS. She is author of Crying for Our Elders: African Orphanhood in the Age of HIV and AIDS (2017) and co-editor of the volume, Disadvantaged Childhoods and Humanitarian Intervention: Processes of Affective Commodification and Objectification (2019).

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COVID-19 | How exclusionary social protection systems in the MENA are making the COVID-19 pandemic’s effects worse

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[vc_row css=”.vc_custom_1592900783478{margin-right: 0px !important;margin-left: 0px !important;}”][vc_column css=”.vc_custom_1592900766479{margin-right: 10px !important;margin-left: -10px !important;}”][vc_column_text]The COVID-19 pandemic has made the majority of people living in the MENA region even more vulnerable, adding to existing structural problems that include under-resourced public health services, a high degree of labour informality, and high poverty and unemployment rates. Temporary social and economic support measures to mitigate the pandemic’s effects are not sufficient, however – the region has to go beyond piecemeal policies. Countries need to expand the scope and scale of social provisioning and social protection as well as the quality of and access to public health services by moving towards a universalist approach to social policy, writes Mahmoud Messkoub. [/vc_column_text][vc_separator color=”custom” accent_color=”#a80000″ css=”.vc_custom_1594895181078{margin-top: -15px !important;margin-bottom: 10px !important;}”][vc_single_image image=”19534″ img_size=”full” add_caption=”yes” alignment=”center”][vc_separator color=”custom” accent_color=”#a80000″ css=”.vc_custom_1594895181078{margin-top: -15px !important;margin-bottom: 10px !important;}”][vc_column_text]In the Middle East and North Africa (MENA), the COVID-19 pandemic has thrown into sharp relief the importance of state-centred approaches in managing pandemics and mitigating their socio-economic impacts on the population. But public health services in most MENA countries are underfunded and inadequately designed to cope with the pandemic. The MENA population has suffered, especially those people living in low-income and non-oil-exporting countries.

Here, as elsewhere in the world, to mitigate the impacts of the pandemic, states have taken a number of measures ranging from temporary cash payments to the poor and vulnerable, furlough schemes, and financial support to employers and industries to the relaxation of regulations governing financial market support to companies and individuals through lower interest loans. Most MENA countries adopted a combination of these measures (OECD, 2020).

However, these short-term measures cannot deal with the long-term structural insecurity and vulnerability facing the majority of people in the MENA who live precarious lives in highly unequal societies, where the top 10% of the population takes 64% of the total income (Alvaredo et al., 2017). Their vulnerability to a large extent can be ascribed to the concentration of economic activity and employment in the informal sector, which is usually overlooked in social security and regulatory measures that tend to focus more on formal employment sectors (ILO, 2019; O’Sullivan et al., 2012). The exclusionary character of the countries’ social protection programmes is a great cause for concern, as even in ordinary circumstances vulnerable populations working informally do not have adequate social protection against health problems, a loss of income, and other contingencies.

Informality and unemployment rates are high in the MENA

According to OECD (2020), in the MENA the informal sector employs some 68% of the workforce, while in individual countries such as Yemen and Lebanon the portion rises to 74% and 71%, respectively. Another structural problem is persistently high unemployment rates that have particularly hit the youth as well as educated women across the MENA  (O’Sullivan et al., 2012). In 2018, the youth unemployment rate was around 30% in the MENA – the highest in the world (Kabbani, 2019). And large-scale poverty and vulnerability are also high in the MENA despite its riches. MENA countries are heterogeneous in terms of their resource base. The headcount poverty rates of a-dollar-a-day (or more) are high in the labour-abundant and resource-poor countries like Egypt. But poverty is also present in the populous, resource-rich and industrializing countries of Iran and Algeria. The other aspect of poverty is its regional spread: rural headcount poverty rates are higher in rural areas than in urban areas (Messkoub, 2008).

The most vulnerable are being overlooked, also during the pandemic

It is against this backdrop of poverty and vulnerability that the pandemic emerged, plunging the weakest countries in the region into a deeper crisis, with very limited social protection measures to help protect vulnerable populations. Whilst all countries in the region had some kind of social protection programmes before the pandemic, and in some cases extensive ones, coverage in most middle- and low-income MENA countries is limited to members of the civil service, police, and military, as well as those in the modern, regulated private sectors of manufacturing and services. The majority of the population working in agriculture, the informal sector, and other unregulated activities have very limited access, if any, to state social protection programmes. To start with, entitlement to most of these programmes requires a formal labour contract. But entitlement and access vary depending on the area of social protection: health, old age, unemployment, work injury, or family allowance.

Regarding health services, there is an urban-rural divide in favour of the former, in addition to high out-of-pocket expenditure and a general neglect of primary and preventive healthcare. High spending on expensive diagnostic and curative health care can be observed, and low-income/low-status migrants, displaced people, refugees, and ethnic minorities have limited access to public health services (WHO, 2010; Loewe, 2019).

The fragmentation of health insurance and service provision also limits the coverage and adequacy of social policies. In most MENA countries, there are different public and private health insurance programmes and health service providers. If these were integrated into a common national health insurance programme, the result could be increased coverage and an improvement of the services provided by reducing administrative costs and rationalising overlapping services (Loewe, 2019). Other complementary public health measures should also be placed on the agenda: the provision of clean water, improved sanitation, and a greater emphasis of preventative health care (Karshenas et al., 2014).

Why universal social protection is needed now more than ever

Thus, countries in the region are in urgent need of increasing expenditure on public health to manage the current pandemic as well as strengthening the health system to improve entitlement and access to health services. Reform and re-organisation of the health system beyond the public sector is part of this agenda. The region needs to return to the ideals of universal entitlement and access to health and other social services that are essential to the social policy agenda of developmental states. Selectivity and exclusion in terms of who qualifies for social protection benefits will only harm these countries, as responses to the pandemic have shown.


References and further readings

Alvaredo, R., Assouad, L. and Piketty, T. (2017) Measuring lnequality in the Middle East 1990 2016: The World’s Most Unequal Region? Reprinted  2020. [https://halshs.archives-ouvertes.fr/halshs-02796992/file/2017-15_.pdf] [Accessed: 10 September 2020.]

ILO, 2019. Working Poor or how a job is no guarantee of decent living conditions. April.

Kabbani, N. , 2019. Youth Employment in the Middle East and North Africa: Revisiting and Reframing the Challenge. Brookings Institution. [https://www.brookings.edu/wp-content/uploads/2019/02/Youth_Unemployment_MENA_English_Web.pdf ][Accessed: September 2020]

Karshenas, M., Moghadam, V. and R. Alami (2014), ‘Social Policy after the Arab Spring: States and Social Rights in the MENA Region,’ World Development, Vol. 64, issue C, pp.726-739.

Loewe, M. (2019), ‘Social Protection Schemes in the Middle East and North Africa: Not Fair, Not Efficient, Not Effective,’ in Jawad, R., Jones, N. and M. Messkoub (eds., 2019), pp.35 60.

Messkoub, M. (2008), Economic Growth, Employment and Poverty in the Middle East and  North Africa, Geneva: ILO Working Paper Series, No. 19.

Messkoub, M. (2021, Forthcoming), ‘Social Policy in the MENA Region,’ in H. Hakimian, ed.(2020) Routledge Handbook on Middle Eastern Economy. London: Routledge.

OECD, 2020. COVID-19 crisis response in MENA countries. Updated 9 June [https://read.oecd-ilibrary.org/view/?ref=129_129919-4li7bq8asv&title=COVID-19-Crisis-Response-in-MENA-Countries] [Accessed: 10 September 2020.]

O’Sullivan, A., Rey, M-E and Galvez Mendez, J. (2012) Opportunities and Challenges in the MENA Region. OECD.[/vc_column_text][vc_separator color=”custom” accent_color=”#a80000″ css=”.vc_custom_1594895181078{margin-top: -15px !important;margin-bottom: 10px !important;}”][vc_column_text]An earlier version of this blog titled ‘COVID-19, Public Health and Social Policy in MENA’ was first published by the Alternative Policy Solutions, a public policy research project at the American University of Cairo.[/vc_column_text][vc_separator color=”custom” accent_color=”#a80000″ css=”.vc_custom_1594895181078{margin-top: -15px !important;margin-bottom: 10px !important;}”][vc_column_text css=”.vc_custom_1614791812480{margin-top: 0px !important;}”]About the author:

Mahmoud Messkoub (PhD Econs, University of London) is based at the International Institute of Social Studies (ISS, Erasmus University of Rotterdam, NL). He has researched and taught economics of development, social policy and population (mobility/migration, age structure and ageing) at universities of London (Queen Mary), Leeds and Erasmus (ISS). His current research interests are in the areas of economics of: social policy and population ageing, migration and universal approach to social provisioning. His recent publications are related to social policy, poverty and employment policies, cash transfers and evaluation of unpaid household work. He has acted as a consultant to ESCWA, ILO and the UN (DESA, UNFPA). He is currently working with an EU and African consortium on an EU funded – Horizon 2020 research project : ‘Crisis as Opportunities: towards a Level Telling Field on Migration and a New Narrative of Successful Integration 

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How COVID-19 is tragically exposing systemic vulnerabilities in Peru

Despite early assessments that Peru was faring well in the COVID-19 pandemic and that its preparedness was due to its strict application of austerity and reforms over the last 30 years, these quickly turned out to be tragically premature as the country emerged over the summer as one of the worst impacted globally in terms of confirmed deaths per capita. While much of the blame has been focused on people’s behaviour, the crisis ultimately points to deep overlapping structural inequalities within the social protection, employment, and health systems, which austerity and reform have not resolved and in some cases worsened.

COVID testing in Peru
COVID-19 testing in Peru. Credit: Ministerio de Defensa del Perú on Flickr.

Precocious optimism followed by demise

Peru was one of the first countries to adopt strict measures to cope with COVID-19 in Latin America. A week after the first COVID-19 case was reported on 6 March, the country closed its borders on 13 March and declared a mandatory immobilization, allowing the population to go out only for acquiring essential services. At the same time, it launched an economic plan equivalent to 12% of the GDP, considered by experts as unprecedented – the greatest economic stimulus in Latin America against COVID-19. The plan included cash transfers for the vulnerable population, subsidies for services and salaries, food provisioning, financial aid for companies, and a large budget allocation for the health system, among other measures.

The current Minister of Economy and Finance, Maria Antonieta Alva, argued that the last 30 years of good fiscal behaviour – as a result of the strict application of austerity measures – allowed the country to face this health and economic crisis. These statements and international news coverage created a positive narrative that seemed to vindicate the country’s economic and social policies in recent decades. Even as recently as 21 July, an article in the Financial Times presented Peru as better prepared for the crisis compared to other countries in the region that were in worse fiscal and macroeconomic positions, such as neighbouring Ecuador.

However, this congratulatory assessment was tragically premature, as has now become evident. As of 24 August, Peru has the highest number of confirmed COVID-19 deaths per capita in Latin America and second only to Belgium globally (and soon to overtake), at 842 per million people, versus 542 for Brazil or 468 for Mexico. It also has the sixth largest number of confirmed cases in the world, with 600,438 confirmed cases. Per capita, it has slightly more confirmed cases than Brazil and more than four times than Mexico.

After initially controlling a sharp spike in cases in late May, daily confirmed cases first plateaued at between 3,000 to 4,000 per day, and after removing the nationwide quarantine on 30 June, they again surged since the beginning of August to surpass the peak levels reported in May (see Figure 1). Confirmed deaths have been running at about 200 deaths a day since July after a peak of about 300 a day in June (see Figure 2).[efn_note]All data from https://www.worldometers.info/coronavirus/ (last accessed 24 August 2020).

Source of both figures: https://www.worldometers.info/coronavirus/country/peru/ (last accessed 24 August 2020).

The dire comparison with its neighbours is partly due to a much higher level of testing (besides Chile), which is also reflective of at least one aspect of greater capacity in the health system (and it also underscores the certain underestimation of the severity of the crisis in Mexico and Ecuador). However, this statistic is also problematic because the Peruvian numbers include both PCR as well as serology tests, with the large majority being serological, whereas other countries only include PCR tests. As a result, the numbers are not comparable, although this being said, Peru’s positivity rate is also one of the highest in the world, meaning that far more testing is needed relative to the current prevalence of infection.[efn_note]

The Peruvian numbers include both PCR as well as serology tests, with the large majority being serological. For instance, about three quarters of the total confirmed cases were detected through serology as of 16 August. In contrast, other countries in the region only count PCR tests, as recommended by the WHO. As a result, the numbers are not comparable.

This also results in some confusion. Our World in Data (OWID) does not even report testing numbers for Peru given the lack of up-to-date data on how much of the current testing involves PCR tests, whereas the positivity rate reported in the John Hopkins University site, at over 50%, is linked to the OWID data and appears outdated. The government itself reports a positivity rate of 19%, although given that this includes serology tests, the rate that is comparable to other countries would be much higher, giving Peru one of the highest positivity rates in the world. (Note that the WHO recommends a positivity rate of 5-12%).

The problem with serology tests is also that they have a high rate of false negatives and antibody responses typically only develop one or more weeks after the onset of symptoms. Hence, while they are more effective than PCR tests for studying population prevalence, they are of relatively little use for diagnostic purposes of detecting cases with sufficient time to stop contagion, or what is known as epidemiological vigilance. The political decision of using predominantly serology tests is considered as one of the biggest mistakes of the COVID-19 response of the government and the new Minister of Health changed the strategy by gradually replacing serology with PCR tests in the second week of August.[/efn_note]

Proximate explanations of failure: mobility and behaviour

The lack of success in controlling the pandemic was partially due to an inability to restrict peoples’ mobility despite the lockdown, which has been widely reported in media and noted by commentators. This became more evident following the initial 15-day quarantine period, even despite the extension of this initial period. As in many parts of the world, migrant workers in places such as the capital city of Lima began returning to their places of origin by foot. Specialists also noted that the lack of refrigerators in households and the habit of buying fresh products caused people to go out to markets frequently. Social protection measures to help vulnerable people ironically made this situation worse. For instance, a monetary grant of 760 soles (about 214 USD) was one of the measures intended to help people without a formal income and who lost their job because of COVID-19. However, the payment of the grant caused people to crowd in the banks. Indeed, markets and banks became the main hot spots of infection.

As a result, many experts claimed that people’s behaviour was the main factor that undermined the COVID-19 response, that lack of education about health care and respect for rules was aggravating the spread of the virus, especially among poor people. However, the discussion generally revolves around proximate reasons rather than highlighting fundamental structural inequalities that in fact point back to the legacy of social and economic policies over the last 30 years.

More fundamental structural reasons

Although the COVID-19 response at first seemed to be strong and promising, it actually quickly exposed the deep and overlapping structural problems within the social protection system, the employment structure, and the health system, which 30 years of reform did not resolve and in some cases worsened.

One crucial problem, as noted above, is the high degree of informality, which is estimated at 72.5% of the economically active population (16.511 million people), with no access to any formal social security. Poverty was estimated at about one-fifth of the national population in 2018, based on a money-metric poverty line of 344 soles (roughly 98 USD) per person per month (the extreme poverty line was 183 soles). This means that about half of employed people were informal but not considered poor by this metric, even though they might have been just above the poverty line.

Moreover, only a fraction of those deemed poor receive assistance. For instance, before the lockdown, only about 725,000 households were affiliated with the main cash transfer programme (Juntos), or less than 9% of households in the general household register that is used for poverty targeting. Those uncovered and working informally become part of the ‘missing middle’ given that they are also not covered by any social protection.

As noted above, the government has created different monetary subsidies and adapted the existing cash transfer programmes to address the vulnerability of these uncovered populations. As of 21 August, these have been extended in principle to more than 8.5 million households, with transfer values from 160 soles to 760 soles (it is unclear whether these are monthly or one-off payments). However, the government has not yet completed paying many of these households and for many it would amount to only one transfer within the six-month period from March to August. Beyond such limited support and facing unemployment with little or no savings, adhering to mobility restrictions were quite simply unrealistic or impossible for a large majority of the population.

In addition, although Peru is in a better fiscal or financial position compared to other Latin American countries, this position was achieved by austerity and reforms that have undermined the public health system. Health specialists have noted the lack of historical investment in this system, as well as fragmentation and inequality, all of which have hampered the COVID-19 response effectiveness.[efn_note]In effect, Peru has had one of the lowest levels of investment in health as percentage of GDP in Latin America (5% versus 6.6% on average) and this level increased only 0.27 percentage points between 2010 and 2016 despite rapid economic growth. It also has lower per capita spending on health ($679 USD), but with higher capital investment in health as percentage of GDP (0.32%), above the Latin American average (0.19%) – see pages 121, 127 and 139 here.[/efn_note]

Austerity clearly contributed to critical deficiencies in terms of infrastructure, human resources and medical supplies, and also constrained the composition of health spending, producing inefficient combinations of spending and thus impacting negatively on the implementation of services. For instance, Peru has a higher number of beds per capita compared with Ecuador and Mexico, but a lower number of doctors (see here). The distribution has also been historically uneven among the regions.[efn_note]For instance, in terms of the number of health professionals per 10,000 people, Lima (41.4), Callao (50.1), Arequipa (41.5), Tacna (44.3), Apurimac (48.9) have more than double to number of Piura (21.4), San Martin (21.8), Loreto (22.3), which have the lowest rates (see p.22 here).[/efn_note]

Acknowledging this situation, the lockdown helped the government to gain time to increase the supply of beds, intensive care units, personal protective equipment, health staff, and to improve the infrastructure and also allocate financial resources to the sector. It has also generated alliances between the different health subsystems (public and private) to improve the availability of beds and intensive care units.

Despite the efforts, the number of cases exceeds the capacity of hospitals, the number of health personnel is insufficient, and there is a scarcity of essential supplies. Health professionals and local authorities have recently reported the collapse of the health system in different regions including Loreto, Piura, Lambayeque, Ucayali, Ica, Lima, Huánuco and Arequipa due to lack of human resources and key medical supplies, including scarcity of medicinal oxygen.[efn_note]For some insights on this situation, see here, here, here, here, here, here and here.[/efn_note]

Realities exposed

In sum, COVID-19 has exposed a reality that is distant from what the government and the international news media celebrated at the beginning of the pandemic. In a short period of time, Peru went from being heralded as better prepared to having the world’s worst performance in coping with the crisis. This has been in large part because of deep structural inequalities in Peruvian society, exacerbated by the high cost of austere policy choices that, despite producing strong economic performance according to conventional measures, did not solve the most pressing social problems of the last decades and exacerbated the crisis.

COVID-19 exposed an illusion. A political commitment to redefine the last 30 years of policies is required, alongside an allocation and distribution of resources to make it happen.

About the authors:

Kattia Talla CornejoKattia Liz Talla Cornejo lives in Lima, Peru. She has been working as a consultant monitoring a health project aimed at strengthening the COVID-19 response in Ancash, one of the Peruvian regions most impacted by the pandemic. This allows her to observe the critical situation of the health system and the COVID-19 response from the inside. She holds an MA in Development Studies from ISS with a major in Social Policy, and degree in Economics and International Business. She has experience in public finance, policy advocacy and monitoring within the fields of social policy, health and childhood, and has worked in governmental and non-governmental organizations in Peru.

Andrew FischerAndrew M. Fischer is Associate Professor of Social Policy and Development Studies at the ISS and the Scientific Director of CERES, The Dutch Research School for International Development. His latest book, Poverty as Ideology (Zed, 2018), was awarded the International Studies in Poverty Prize by the Comparative Research Programme on Poverty (CROP) and Zed Books and, as part of the award, is now fully open access (http://bora.uib.no/handle/1956/20614). Since 2015, he has been leading a European Research Council Starting Grant on the political economy of externally financing social policy in developing countries. He has been known to tweet @AndrewM_Fischer

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