Articles in vol. 21(2) and later of this journal are licensed under a Creative Commons Attribution 4.0 United States License. This journal is published by the University Library System, University of Pittsburgh as part of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. JOURNAL OF WORLD-SYSTEMS RESEARCH Book Review Give and Take: Developmental Foreign Aid and the Pharmaceutical Industry in East Africa. Nitsan Chorev. 2020. Princeton: Princeton University Press. 320 pages, ISBN 978-0-6911-9785-2 Hardcover ($95.00) Reviewed by Patricia Ward Technische Universität-Dresden patricia.ward@tu-dresden.de As the saying goes, we need to see the forest from the trees. Starting this review with such a cliché seemed only appropriate for a book on foreign aid, a topic that, as its author and many note, is the subject of an overwhelming number of publications. Yet, these texts and the conversations they often elicit have focused on the same questions for too long. That is, whether foreign aid is effective, and if so, how much? Nitsan Chorev’s Give and Take: Developmental Foreign Aid and the Pharmaceutical Industry in East Africa pushes us to move beyond these well-worn questions to understand and account for what aid actually is and entails in the first place. After all, in order to really “see” a forest in its entirety, we have to look carefully at its growth and the wide array of trees that comprise it, too. Aid takes multiple forms, but is often delivered with some conditions attached pertaining to how, where, and when it can be used and distributed, and by whom. Aid also fluctuates in its frequency and duration. It may be a one-time exchange, a multi-year transaction, or could also take the form of an installment renewed annually. “Guidance” from donors on how aid recipients can or should meet the conditions tied to aid within these periods, however, is never a guarantee. Give and Take centers these variations from its start to ask “what kind” in addition to “how much” shapes the relationship between foreign aid and development. ISSN: 1076-156X | Vol. 28 Issue 1 | DOI 10.5195/JWSR.2022.1125 | jwsr.pitt.edu Vol. 1 | DOI 10.5195/JWSR.1 http://www.library.pitt.edu/ http://www.pitt.edu/ http://www.library.pitt.edu/articles/digpubtype/index.html http://upress.pitt.edu/ https://creativecommons.org/licenses/by/4.0/ mailto:patricia.ward@tu-dresden.de Journal of World-Systems Research | Vol. 28 Issue 1 | Book Review 176 jwsr.pitt.edu | DOI 10.5195/JWSR.2022.1125 Focusing on these questions in the context of the pharmaceutical sector in East Africa, Chorev identifies at least three dimensions of foreign aid that hold important implications for local industrial development: markets, monitoring and mentoring. These three resources comprise what Chorev subsequently refers to throughout the book as “developmental foreign aid,” a particular form of aid that helps to upgrade local industry, and even facilitate its emergence in the first place. Foreign aid articulated in this way, Chorev argues, “helps create pockets of development” that are often complementary, rather than undermining of state capacities (3). However, what Chorev highlights as particularly central to these articulations are donor-recipient relations and the local conditions that inform (and are informed by) them. Unlike usual depictions of aid as donor-driven and delivered to grateful beneficiaries, Chorev highlights how recipients’ “bargain[ing]” strategies, how they simultaneously leverage contingencies within the global arena and their respective locales, reconfigure the scope and assumptions of what aid should entail in ways that hold important implications and effects on local industries and their development in turn. The book starts with a comprehensive introduction, which carefully intertwines overarching interdisciplinary debates about foreign aid with historical and contextual information related to East Africa’s pharmaceutical industry. This interplay gives the reader critical background information in an engaging, narrative form. Yet, this setup also makes it blatantly clear from the start the limitations of current questions and explanations about foreign aid effectiveness and its relationship with development (and therefore why a book like this is direly needed). In highlighting the connections and juxtapositions between scholars’ privileging of economic growth as indicative of development on the one hand, and fluctuating trajectories between three different national pharmaceutical industries on the other, Chorev’s call for a comparative-historical analysis of foreign aid seems more than appropriate. Instead, it manifests as absolutely necessary in order to account for aid’s multiplicities in both its forms and effects on society. In the following chapters, Chorev rises to this tumultuous task through a comparative exploration of pharmaceutical industries in three East African countries—Kenya, Tanzania and Uganda—during the 1980s–1990s and in the post-2000 period. Her case selections are not arbitrary, but rather strategically and thoughtfully selected: in order to examine the contradictions embedded within aid’s economic and social objectives, and how they shape aid’s forms and effects on development. That is, “how aid is used” and why. Drawing upon an impressive corpus of archival and interview data, Chorev subsequently provides multi-layered accounts of pharmaceutical production in East Africa in the context of the broader global industry, first at the regional level (Ch. 2), followed by chapters on each countries’ pharmaceutical sectors in the two specified time periods (Ch. 3-8). What is particularly notable about this part of the book is its structure: the careful and thoughtful balance between rich empirical data and clear interventions into the main debates pertaining to foreign aid. Chapters 3, 4, and 5 on Kenya, Tanzania, and Uganda in the 1980s–1990s, for example, provide detailed historical information on each national context that center the roles and legacies of colonialism and industrialization (already introduced in Ch. 2), as well as assumptions pertaining to “the local,” state capacities, and donor-recipient relations as critical to foreign aid patterns and processes. Journal of World-Systems Research | Vol. 28 Issue 1 | Ward 177 jwsr.pitt.edu | DOI 10.5195/JWSR.2022.1125 Chorev shows the ways in which these dimensions vary and inform how these countries can and do access the three developmental foreign aid resources she identifies in her introduction: markets, monitoring, and mentoring. In so doing, she highlights how local conditions (e.g. human capital, market structures, and government relations) co-constitute “global” dynamics within the transnational pharmaceutical industry (e.g. standards and regulations, business partnerships and investments) in ways that are often linked and undergirded by colonial relations and patterns of power as well. Yet, what is particularly striking in these chapters is Chorev’s attention and acknowledgement of these “local-global” relations as complex and multi-directional, and her insistence on engaging with them as such. In so doing, Chorev strengthens her case yet again as to why more questions need to ask “what kind” of aid from comparative-historical perspectives that acknowledge how various articulations of “the local” pattern aid processes and effects. Like the preceding chapters, the conclusion is also rich in providing even more information to the reader on pharmaceutical production in East Africa today. The current divergences between national pharmaceutical markets in the region evidently strengthen Chorev’s argument that markets, monitoring and mentoring matter, while also providing a platform for her to offer what she describes as “cautious optimism” regarding the effectiveness of foreign aid. Give and Take ends on this hopeful tone, yet remains critical of key issues central to debates on the latter. For example, the role of the state features prominently in the book’s final pages, with Chorev calling for particular attention to how donors’ assumptions of them not only lead to aid that targets “countries that are less in need of support,” but also pattern scholars’ accounts of foreign aid as helping or hindering state capacities as well. Give and Take offers a refreshing “take” and perspective on aid and why it matters. In identifying markets, monitoring, and mentoring as three resources critical to developmental foreign aid, Chorev provides an important opportunity for future research to operationalize and account for aid effectiveness in a way that does not ignore, but in fact centers aid’s multiplicity and complexity. Any review of this book also cannot forego mentioning its impressive empirical basis, which is premised upon extensive archival data from the World Health Organization and 240 interviews with pharmaceutical firms, manufacturers, managers, pharmacists, international and local NGOs, trade representatives, and government and development agencies in Tanzania, Uganda, Kenya, India, China, South Africa, Germany, Austria, and Switzerland. In a discipline that “generally ignores the question of foreign aid” (7), Give and Take is a welcomed contribution to sociology particularly, but undoubtedly expands the scope of current debates on development among practitioners and scholars beyond the discipline as well.