Spotlight: Mustafa Basij-Rasikh

Oct. 3, 2022

On August 15, 2021, Mustafa Basij-Rasikh, an affiliate at Princeton University’s Center for Health and Wellbeing (CHW), walked through the streets of Kabul as word spread that the Taliban had seized control of the city. He vividly recalls the sights, the sounds, and the sea of emotion he experienced while reflecting upon his life in Afghanistan and grappling with an uncertain future.

Months later, Basij-Rasikh and his family arrived in the United States, where he found a home in Princeton and launched a new chapter in his career. During a recent interview he reflects upon his journey, offering a poignant look back while expressing hope for the future. He discusses his interests in international development and policy, and his passion for designing education-focused interventions to improve health outcomes in fragile, conflict-affected settings across the world.

Q. Global health has been central to your career. When did you first recognize the presence and effects of health inequities, particularly those faced by the developing world?

A. Disparities in health are a global challenge. However, they are probably more visible and felt more deeply in contexts where drivers of fragility impede access to health services.

On a personal level, I saw those inequities as a young teenager, when I was working as an apprentice at a pharmacy in Afghanistan. The country has one of the highest levels of out-of-pocket spending on health care; there is no health insurance, and rarely are services provided for free. At that time, during the first regime of the Taliban (from 1996 through 2001), Afghanistan also had a very poor economy and people were suffering from the economic downfall. I remember how disadvantaged families had to make tough decisions about filling their prescriptions. Quite often, they would only buy some of their medications or a portion of the recommended dose because they could not afford to pay for the full amount. This would prevent their recovery and increase resistance to the medicine in most cases. Over time, it became normal for the pharmacist to help these families distinguish essential drugs from supplementary drugs, but the dilemma left an impression.

As a sweet accident of fate, I was able to revisit this issue later in life.

Q. Can you elaborate on that?

A. Several years later, in a professional capacity, I led a project assessing the effectiveness of a nationwide campaign to increase awareness about the importance of taking the full dose of a prescribed antibiotic.

This work revealed a complicated challenge. While it was true that knowledge about proper medicine use was low in underserved communities, the underlying assumption that disadvantaged families often decide to take a portion of treatment due to a lack of information was not entirely sound.

There are two irreconcilable realities in Afghanistan. On the one hand, you want the public to know about this problem. On the other hand, you’re assuming that families can afford the full dose of medication. Unfortunately, that is not always the case. Education is only the first step. Improving access must also be addressed to impact compliance and successful treatment.

Q. Taking a few steps back, you earned a Bachelor of Arts degree in Politics from Bates College in the United States before launching your career with IBM. Can you tell us about these early pursuits?

A. My parents supported the value of a good education, so when I had the opportunity, I came to the United States for one year of high school and then college, where I first studied economics. After taking a few classes in politics, however, I was exposed to a different world of thinking – one that looked beyond the numbers. It was very freeing for me and led to an interest in development and policy, under the umbrella of foreign aid.

After graduating from Bates, I was offered a consulting position with IBM, which was based in Afghanistan and focused on business investments. At the time, I felt as though I’d landed my dream job. But my perspective soon changed and affected the trajectory of my career.

Q. What inspired that change in direction, and where did it take you?

A. I initially hoped to strengthen Afghanistan through the private sector. But after visiting dozens of business facilities across the country and speaking with traders, manufacturers, and entrepreneurs, I realized that an economy largely dependent on donor funding requires more urgent fixes before private sector development can have the desired impact. I saw the need for methodic, honest discussions about how foreign aid is channeled in countries where cyclical violence impedes economic progress or sometimes reverses development outcomes.

A combination of fate and personal deliberation brought me to the QARA Group, also in Afghanistan, where I transitioned to public-sector work. In this fast-paced world, if your job feels like the equilibrium of passion and profession, you’ve hit the jackpot. That’s how I felt at QARA. The work environment was joyous because of the amazing team. We were united, like family, and I eagerly looked forward to working every day.

During my time there, I collaborated with private companies, international organizations, and universities to collect data and support the implementation of large-scale development initiatives within the areas of governance, health, and education.

Q. At QARA, you conducted research on several issues related to health and wellbeing, particularly within the context of Afghanistan. Were any of these projects especially fulfilling?

A. One of the projects that is very close to my heart is a nutrition campaign we developed in Afghanistan. The campaign targeted pregnant women and children under the age of five, with a focus on increasing protein consumption. This project was so important because it gave me insight into the issue of malnutrition, helping me realize how little we know about dietary habits and how they can affect a child’s future. The lasting impact of malnutrition is not always visible. And sadly, in a context like Afghanistan, which is grappling with numerous challenges, problems that are not tangible often go unnoticed or unaddressed. For example, we can’t see how malnutrition affects cognitive development, so that issue flies under the radar. Children with functional difficulties still struggle for their rights and social inclusion.

In Afghanistan, which has one of the highest stunting rates in the world, the outlook for children is very poor. There are many challenges associated with sparking behavioral change linked to diet, but there are things we can do.

Q. What was the primary goal of the nutrition campaign? Was it successful?

A. The campaign was designed to raise awareness about healthy diets. Again, we faced a seemingly irreconcilable dilemma. We were telling families to eat healthy when they could barely afford to buy food. Combatting malnutrition in this environment required an innovative approach. Our team provided education and worked with food processors to promote the use of local harvests. We organized a series of town halls and food exhibitions to share information and inspire changes in behavior. And we encouraged influencers and community elders to join forces with us, helping us share the educational content. These strategies worked. The data we collected supported several measures of success. For example, at the end of the intervention, the percentage of people who understood the benefits of eating protein increased by 43 precent.  

On a more personal level, the nutrition campaign served another important purpose. For me, and for many people in Afghanistan, focusing on healthy diet during an intense period of violence and uncertainty offered a sense of normalcy.

Q. Last August, you made the difficult decision to leave Afghanistan, as its government fell to the Taliban, and moved with your family to the United States. Is there anything you would like to share about this transition?

A. I have always felt that the least I could do is to pause and reflect, along with other Afghans who were forced to leave the country and those who were part of the political decision-making process. As citizens, government officials, and political appointees, we need to think about what we could have done differently. We must go through this process with humility and honesty, rather than rushing into prescribing change. This is especially important for the political establishment and those who failed to safeguard the rights and interests of the Afghan people.

Personally, I could not have found a better place than Princeton University for these reflections and my transition.

Q. What is the focus of your work at the Center for Health and Wellbeing?

A. While I’ve never worked in academia, I bring a decade of practical experience and field research knowledge. I am using that expertise to develop a research portfolio concentrated on health service delivery, collaborating with students and colleagues to explore questions related to international development and aid architecture.

My first project, funded by CHW, is with Alyssa Sharkey [CHW affiliate and lecturer at the Princeton School of Public and International Affairs]. We’re looking into what prevents disruption of health services during crises.

We should not be surprised that chronic violence and other drivers of fragility impede successful program implementation in certain contexts. These are constant factors in many high-risk environments. We need to shift the conversation. Our focus should be on identifying the enabling factors that contribute to health service disruption, and then figuring out ways to prevent the disruption. Our research is focused on Afghanistan, which is an unfortunate example of a fragile, conflict-affected setting. The project will probably produce more questions than answers, but it’s a start. We hope the findings will advance our understanding of this global problem and inform recommendations for future interventions.

Q. How are you engaging with students?

A. Last semester, Dean Amaney Jamal invited me to speak to her class focused on the role of institutions in authoritarian regimes. I led a discussion examining how state and international actors have approached development over the past 20 years. I also guest lectured for Professor Jennifer Widner, who has an interesting class on making government work in hard places. For this class, I presented some of my previous work to promote discussion and questions at the forefront of foreign aid architecture and its impact on health service delivery.

When we think about humanitarian intervention, we often think about short-term, life-saving relief that is provided in response to a natural disaster. But 80 percent of humanitarian needs are conflict-induced. One of the issues that we’re grappling with now is how governments and humanitarian agencies can distribute aid most effectively. How do they help when the conflict is protracted? How can they continue development and move beyond stop-gap solutions in countries that are under restrictive measures, or in places where there is a fundamental misalignment of values with the authorities?

These are the conversations we should be having, especially with students who may be future policymakers faced with some of these dilemmas.

Q. What are your plans for the upcoming academic year?

A. I’m really excited about what comes next. This year, I’ll be developing my research portfolio and exploring new things. In addition to my project with Alyssa Sharkey, I’m working on a manuscript summarizing findings from the nutrition campaign that we discussed earlier. The paper presents a case study, demonstrating how we can use data to advance the conversation about this issue in Afghanistan and other developing countries in a more constructive way. What are the best modalities for increasing awareness about nutrition, and how do you motivate people to change their behavior? The paper will be published later this year.

Next semester, I’ll be working with Salam Fayyad [visiting senior scholar and Daniella Lipper Coules ’95 Distinguished Visitor in Foreign Affairs] on a new course for the School of Public and International Affairs.

Q.  What has been most rewarding about your Princeton experience so far?

A. I have found the Princeton community to be very accessible. My transition would have been extremely difficult without the support of my colleagues, especially those at CHW. Everyone has been so welcoming and helpful.

I walked into a different life here in the United States, with a lot of “baggage” and emotion associated with what I left behind. But life continues. I feel extremely fortunate for the collaborations I have established and look forward to forging more friendships that will last beyond Princeton.