I am the Five College Assistant Professor of Government at Smith College, and my focus is on African Politics. I received my Ph.D. in Political Science at UCLA and was a member of the faculty at Texas A&M University from 2010-2013. From 2008-2009, I was a Fulbright Scholar in Malawi conducting research on the political economy of HIV/AIDS interventions. I have also collected data in Ghana and Tanzania. I study a variety of topics including African politics, health (particularly HIV/AIDS), identity, and research methods. Methodologically, I am interested in the systematic analysis of qualitative data, field experiments, social network analysis, and anything that can be learned from longitudinal household-level data. My current research includes studies of ethnicity-of-interviewer effects in Africa and same-sex politics in Africa.I blog at The Monkey Cage and at my personal blog, haba na haba. You can find me on Twitter as @dadakim.
This book manuscript details the local realities of the global intervention against AIDS in Africa. On a continent where 68% of the 33 million people infected with HIV in the world live, and where only 43% of AIDS patients in desperate need of treatment have access to it, what facilitates the gross failures of HIV/AIDS interventions in Africa? When a mobilized international community spends billions of dollars to intervene against a disease, what impedes its efforts to reach intended beneficiaries? With globalization, disease spreads easily across national boundaries, requiring state actors concerned with public health to engage public health problems beyond their own borders, usually delegating responsibilities to far-away agents. Such endeavors require coordination of multiple actors, not just across borders, but also across levels of governance within the target country, creating multiple principal-agent problems in the pursuit of providing for public health. I use a political economy approach that emphasizes the multiplicity of actors involved in a global intervention against disease to bring attention to the incentives and motivations of actors across levels of governance. I focus in particular on the agents implementing interventions. I provide evidence that a major component of the failure of HIV/AIDS programs in Africa is the disconnect in the preferences of providers and receivers. I argue that HIV/AIDS interventions usually fail because local agents actually implementing interventions on the ground act in ways congruent with both their policy preferences and the policy preferences of local citizens. I analyze original data to demonstrate ordinary Africans give relatively low priority to HIV/AIDS interventions, even in the world's highest prevalence countries.
The Role of Executive Time Horizons in State Response to AIDS in Africa, published in Comparative Political Studies
Abstract: In this article the author argues that politicians’ time horizons affect the differing levels of state intervention against AIDS. Using data measuring government spending, AIDS policy, and political constraints, the author tests the presumption that the leader of a country can determine a country’s level of AIDS intervention. She looks at countries in eastern and southern Africa to explore the relationship between political institutions that constrain an executive’s time horizon (i.e., competitive elections) and the level of the state’s efforts in the fight against AIDS. Her primary hypothesis is that an executive with a shorter time horizon is less likely to create policy or devote resources to intervene against AIDS. The author finds that lengthening an executive’s time horizon increases the level of government spending on health but that executives with shorter time horizons tended to have more comprehensive AIDS policy than their counterparts with longer time horizons.
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An Offer You Can't Refuse? Provider-Initiated HIV Testing in Antenatal Clinics in Rural Malawi (with Nicole Angotti and Lauren Gaydosh), published in Health Policy and Planning.
Abstract: International organizations promote provider-initiated, "routine" HIV testing of pregnant women seeking antenatal care as an effort to curb mother-to-child transmission. We offer an account of the perceptions of HIV testing at antenatal clinics in rural Malawi. Although it is both international and Government of Malawi policy that women must be explicitly informed of their right to refuse testing, analysis of in-depth interviews paired with evidence from a collection of observational field journals show that rural Malawians do not perceive HIV testing as a choice, but rather as compulsory to receive antenatal care. This study illustrates dissonance between global expectations and local realities of the delivery of HIV testing interventions.
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Local Demand for a Global Intervention: Policy Preferences in the Time of AIDS, published in World Development
Abstract: The success of global health and development interventions ultimately depends on local reception. This paper documents local demand for HIV/AIDS interventions in Africa and seeks to explain patterns of demand using data from a country hard-hit by AIDS. As international agencies and national governments scale up HIV/AIDS interventions in Africa, I find HIV-positive respondents more highly prioritize HIV/AIDS programs, however, cross-national opinion data paired with interviews of villagers and their headmen in rural Malawi show weak prioritization of HIV/AIDS. The data illustrate a misalignment of policy preferences in the global-to-local hierarchy, highlighting the import of studying preferences of intended beneficiaries.
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AIDS Exceptionalism: Another Constituency Heard From (with Patrick Gerland and Susan Watkins), published in AIDS and Behavior
Abstract: Amidst current debates over resources for AIDS, we examine the policy preferences of the people who are navigating AIDS in their daily lives. Survey and ethnographic data on the prioritization of HIV/AIDS interventions were collected in a longitudinal cohort study in rural Malawi. Study participants gave higher priority to problems other than AIDS. Confining analysis to HIV-positive survey respondents only weakly raises the prioritization of HIV/AIDS services. The ethnographic data are consistent with these findings: although rural Malawians are fully aware of the risk of dying from AIDS, other problems are perceived as more pressing for their community.
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Constitutional Provisions and Executive Succession: Malawi’s 2012 Succession in Comparative Perspective, (with Boniface Dulani) published in African Affairs
Summary: In this paper, we offer a first attempt at describing and understanding the constellation of factors that together led to the constitutional succession in Malawi after Mutharika's death and try to assess what it means for democratic consolidation. Following a detailed account of the context preceding Mutharika's death, we describe and analyze the events surrounding the subsequent transition. Then we look more broadly at succession, examining data on all transitions in Africa during the previous three years and on successions following deaths in Africa since the independence period. We also draw on comparisons to the 2010 succession in Nigeria and 2008 succession in Zambia, both of which experienced constitutional successions following presidential deaths. We conclude with some discussion of Malawi's political future, in which we show that while Malawi’s 2012 succession is an example that democracy is consolidating in Africa, the transition also highlights challenges to party institutionalization. Our analysis focuses on the constitutional provisions for successions, the key actors shepherding the succession process, and succession precedents in Africa. Malawi, like Nigeria and Zambia, has constitutional provisions for succession in the case of presidential incapacity or death. We assert that constitutional provisions on executive succession are necessary in precipitating peaceful transitions but highlight the periods of delay (particularly in cases of incapacity) as indicators that such provisions are insufficient on their own. We demonstrate that in the case of Malawi it was the actions of a number of key players, particularly the army, independent media, and legal/judicial actors, that put pressure on conspirators and prevented them from usurping the presidency from Vice President Banda. Factors such as public rejection of military or authoritarian rule, and the growing precedent for constitutional succession in Africa provided a context for the eventual, peaceful transition.
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Democratization and Universal Health Coverage: A case comparison of Ghana, Kenya, and Senegal (with Karen Grepin), published in Global Health Governance
Abstract: This article identifies conditions under which newly established democracies adopt Universal Health Coverage. Drawing on the literature examining democracy and health, we argue more democratic regimes – where citizens have positive opinions on democracy and where competitive, free and fair elections put pressure on incumbents – will choose health policies targeting a broader proportion of the population. Comparing Ghana to Kenya and Senegal, two other countries which have also undergone democratization, but where there have been important differences in the extent to which these democratic changes have been perceived by regular citizens and have translated into electoral competition, we find that Ghana has adopted the most ambitious health reform strategy by designing and implementing the National Health Insurance Scheme (NHIS). We also find that Ghana experienced greater improvements in skilled attendance at birth, childhood immunizations, and improvements in the proportion of children with diarrhea treated by oral rehydration therapy than the other countries since this policy was adopted. These changes also appear to have translated into changes in health outcomes: both infant and under-five mortality rates declined rapidly since the introduction of the NHIS in Ghana. These improvements in health and health service delivery have also been observed by citizens with a greater proportion of Ghanaians reporting satisfaction with government handling of health service delivery relative to either Kenya or Senegal. We argue that the democratization process can promote the adoption of particular health policies and that this is an important mechanism through which democracy can improve health.
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Ethnic Identity, Region, and Attitudes toward Male Circumcision in a High-HIV Prevalence Country (with Michelle Poulin), published in Global Public Health
Abstract: We study how considerations of male circumcision (MC) as both a favourable practice and as protective against HIV are linked with ethnicity in sub-Saharan Africa, where many ethnic groups do not traditionally circumcise. We focus on Malawi, a country with a high HIV prevalence but low MC prevalence. Survey data from a population-based random sample in rural Malawi (N =3400) were analysed for ethnoregional patterns in attitudes towards MC. We used logit regression models to measure how reported circumcision status, region of residence and ethnic identity relate to attitudes towards circumcision. Overall, Malawians reported more negative than positive opinions about MC, but attitudes towards circumcision varied by ethnicity and region. The implications for agencies and governments aggressively scaling up the provision of MC are clear; acceptance of circumcision as a tool for HIV prevention could be low in societies divided by ethnoregional identities that also shape the practice of circumcision.
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The Politics of Local Research Production: Surveying in a Context of Ethnic Competition
Abstract: Using observations from rural Malawi in 2010, this paper describes and studies a significant challenge to measurement in survey research: surveying in a context of ethnic competition. First, I provide an empirical account of the local reality of ethnoregional competition as demonstrated in local research assistant selection. Analysis of quantitative data of research assistant job applicants suggests research assistants' regional background was not a significant predictor for employment despite qualitative data offering local perceptions to the contrary. Qualitative data also suggests spurned applicants generated study refusals. Second, I use subsequent survey data to demonstrate nuanced findings on ethnicity-of-interviewer effects: overall item non-response patterns are not associated with interviewer-respondent ethnic matching; refusal to respond to questions about sexual behavior was higher in co-ethnic interview settings; and respondents inconsistent about reporting their ethnic identity often reported their ethnicity to match that of the interviewer. The findings are critical for individual-level research conducted in divided societies, especially but not exclusively in situations where scholars are studying the causes and effects of social division.
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The May 1 Marchers in Los Angeles: Overcoming Conflicting Frames, Bilingual Women Connectors, English-Language Radio, and Newly-Politicized Spanish Speakers (with Michael Suk-Young Chwe, Darin DeWitt, and Michael Stone)
Abstract: In this paper, we study protest participants in the May 2006 immigration rights marches in Los Angeles. Analysis of original survey data of 876 march participants yields five main results. First, despite substantial dispute among organizers on how to frame the marches, we find protest participants were similar across march locations organized by different coalitions. Second, we find Spanish-English bilingual participants seemed to benefit from being in two media environments, as they reported more information sources about the protest events than monolingual participants. Thirdly, women reported hearing about the protest events from more information sources, and Spanish-English bilingual women reported hearing from more information sources than any other group, suggesting they acted as social connectors behind the massive participation. Fourth, we confirm the importance of Spanish-language radio as an information source, but our data also point to the significance of television and English-language radio. Finally, analyzing data of first-time protesters, we estimate the immigrant rights marches newly politicized 125,000 people in Los Angeles who spoke Spanish and not English.
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Updated: July 2014