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Good Governance, A Clinical Macro-economic Approach

Good Governance, A Clinical Macro-economic Approach
-Learning from Jeffrey Sachs-

Iwan Darmansjah, MD

Jeffrey Sachs, the author of the provoking book ‘The end of poverty’, stirred-up a lot of wisdom for macro-economists and politicians. Much of Jeffrey’s initial failure in his beginning career in 1985 in his work to elevate Bolivia’s economy and the subsequent successes he obtained in the next 20 years is a phenomenal research exercise to learn from. He likened the today’s development economics with the professionalism of clinical medicine in the eighteens century when doctors used leeches to treat hypertension. This is a serious accusation, but in some ways there may be truth in it. Consider the leading role of the IMF and the World Bank that advocated treatment for poor nations how to overcome poverty and bad governance (despite stark criticisms from many smart people), that we just realized how intangible absurd they were. It took economists in developing countries 20 years to realize and decide to reform.

Part of Jeffrey Sachs’ success was due to how he learned from his wife, who is a smart pediatrician, to tackle a sick child from beginning to end. Applying this to economics, Jeffrey calls it ‘Clinical Economics’, which is filled with the speed, urgency, and accountability by which a child is managed, coming with an emergency to the hospital. Today’s medicine has indeed come to a stage of perfection, it follows research outcomes, rules, hierarchy and guidance protocols as never before. Evidence is the busz-word of managing and treating patients. Everything needs scientific evidence: the diagnosis and treatment of patients’ needs substantial proof to follow, diagnosis must be ascertained with modern technology and only drugs that exhibit proof of evidence for a certain disease by clinical trials should be used. Although this can only happen at a cost; the above is only valid in countries like North America or EU and Japan. Developing countries and notably Indonesia is still far from that kind of perfection and accountability, but there are lessons that can be acquired. Some medical technologies are on the forefront, but good medical management and rational thinking is way lacking behind. The timelines applied to a patient of course cannot be used for reformation of bad governance; therefore a strategic planning has a goal of 10-25 years. But the hierarchy of patient management applied to governance is quite logical and rational to guide our ultimate goals in economics.

I will just do that: when a sick patient comes to a doctor than a hierachy of actions are followed, that I will synchronize with treating a sick governance:

1. History taking
2. Examination
3. Diagnosis
4. Treatment
5. Follow-up
6. Post-mortem

History taking is an important initial step to manage a sick patient, whatever the sickness implies. Some cases can be made short like when one doctor observes a dermal complaint. Still, a short history from the patient is needed, such as finding the cause of a simple dermatitis on the skin. If one knows the causative agent that has caused the dermatitis, it would be important that this is recognized by the doctor in order to tell the patient at the end how, and what not to do to prevent it from further happening. When the patient is severely ill with complications, like a country in distress, then a complicated scanning of the situation should be mapped.

If a doctor has a patient in front of him, he should take out anything the patient may have to tell. For this, not only do we have to guide with questions, but have an open ear for what he/she tells and allow enough time for this anamnesis (history taking). Very often with a good anamnesis that patient tells you the clue of the diagnosis. So, what people say and write in media should be observed and understood to be screened whether usable in The Plan. Again, there is a disclaimer: to judge whether what is publicly said and written is indeed good and true. These primary factors should be taken as a knot in the brain; when politics provide a better civil outcome than the truth - when politics has greater power than truth - than this would be a primary strategy to invert the situation, at all cost. That means that accountability is a prime pivotal issue, a conditio sine qua non. (See next page)

But, this is only the beginning of the process; we cannot just circle around and analyze the problems of that country. We need urgency, like the patient in distress. A solution of the analyzed problems of what ought to be done should be a macro-economist outcome goal. But before going to action plans from the initial scanning (SWOT analysis) one should further do an examination and make a diagnosis, in order to make a proper treatment.

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