Give and Take: Developmental Foreign Aid and the Pharmaceutical Industry in East Africa by Nitsan Chorev

Abstract

Reviewed by: Give and Take: Developmental Foreign Aid and the Pharmaceutical Industry in East Africa by Nitsan Chorev Jennifer Tappan Nitsan Chorev. Give and Take: Developmental Foreign Aid and the Pharmaceutical Industry in East Africa. Princeton Studies in Global and Comparative Sociology. Princeton, N.J.: Princeton University Press, 2019. xii + 305 pp. Ill. $29.95 (978-0-691-19784-5) Nitsan Chorev’s Give and Take is an in-depth and well-researched comparative historical analysis of the kind of foreign aid that facilitated the development and growth of the pharmaceutical industry in East Africa. The study is framed as a contribution to debates over foreign aid and its efficacy. Shifting from a focus on quantity and statistical evaluations of success and failure, Give and Take instead [End Page 605] considers what kind of aid proves to be what Chorev terms “developmental.” Through an examination of the pharmaceutical sector, Chorev identifies the kind of assistance, which has the capacity to be developmental, as aid that specifically creates markets, provides monitoring as well as the mentoring needed to meet quality standards and market demand. One of the strengths of the analysis is the close attention to the specific economic, social, and political contexts, and local conditions. The value of education and global networks was, for example, featured throughout. Nor did the author ignore the importance of power. Rather, Chorev argues that the evidence from the pharmaceutical industries in Kenya, Tanzania, and Uganda illustrate just how crucial it is for aid recipients to actively negotiate, albeit from within the “shadows of power” (p. 10). The question of power is further implicated in the final discussion of why foreign aid must work with, rather than bypass, the state. The introductory chapter is followed by an examination of the shift toward generic drugs in East Africa and the Global South, focusing specifically on the rise of Indian pharmaceuticals in East Africa and multinational pharmaceutical companies’ unsuccessful attempts to maintain their market dominance. The rest of the book is divided into six chapters (followed by a conclusion), which document and compare the emergence and upgrading of pharmaceutical companies in Kenya, Tanzania, and Uganda, respectively. The first set of chapters examine the period from the 1970s/1980s through the 1990s, and the second set focus on the initial decades of the twenty-first century—when global activism led to lowered costs and increased funding. Numerous insights emerge from Chorev’s close analysis of data collected from an array of sources, including interviews conducted in all three countries. The central findings support the argument that developmental aid was instrumental in both the emergence and growth of pharmaceutical industries in East Africa. The comparative analysis illustrates how distinctions between Kenya and Tanzania (particularly in the earlier period) led to very different outcomes and how those patterns continued to play out in more recent decades. For example, the decision to purchase locally manufactured drugs for “rations kits” in Kenya, but not in Tanzania or Uganda, was instrumental in the growth of the Kenyan industry and equally detrimental to the fledgling Tanzanian and virtually nonexistent Ugandan pharmaceutical sectors. Moreover, Chorev shows how this creation of a market, which expands significantly in the wake of HIV/AIDS, was only part of the equation. By monitoring to ensure quality standards, aid agencies helped to upgrade the industry, particularly in the context of limited state regulatory capacity. Mentorship and technology transfer were equally crucial for the companies that were able to expand and improve their production thereby increasing their market share and, in a few cases, reaching the highest international quality standards. My critiques are few and are offered with the caveat that I approach the text as a historian, not a sociologist. Although, the organization of the text features the specific trajectory of individual pharmaceutical companies, dividing the comparative case studies across two sets of individual chapters led to some redundancy [End Page 606] and diminished the force of the narrative. Specific facets of the pharmaceutical sector make it a more unique case than the author contends, potentially limiting the general applicability of the findings. The terminology monitoring and mentoring are unfortunate given the colonial history of development in Africa. Finally, the...