Djibouti, a tiny former French colony on the Red Sea, has a problem. The country's health system, while it is the pride of northeast Africa and draws patients from neighboring Ethiopia, Eritrea and Somalia, has spiraling costs. The question: how to better manage those costs without adversely affecting patient care?

A case study for a class in health economics? It could be. But for Qaiser Khan '77, it's on the to-do list. A senior economist and task team leader with the World Bank, Khan traveled to Djibouti earlier this year as part of his ongoing work with health officials there. Remedies for the excessive health-care costs include a referral system and a switch from brand-name drugs to generics. Khan and his team are also looking at the spread of HIV/AIDS through traffic moving through the country's port on the Gulf of Aden.

"The social funds and education projects--you can actually see an impact," Khan said, at his Washington office before a return trip to Djibouti in February. "Health is a little more difficult to see."

While the gratification may not be instant, that hasn't kept Khan from wearing a path between the U.S. and North Africa, the Middle East, Europe and Central Asia as he implements and tracks social welfare and education projects underwritten by the World Bank. This spring he expected to visit Iran, the West Bank and India. He has worked on transportation problems in Madagascar and school building in Yemen, and he headed a study of the flagging economy of the Seychelles, the Indian Ocean archipelago. His report led to a story in the International Herald Tribune, but most of Khan's work goes unnoticed in the popular press.

For instance, Iran has been in the news in the U.S. as part of President Bush's "axis of evil," but Khan is in the middle of a study of the effectiveness of Iran's social protection programs, including welfare and pensions for the elderly and disabled. "The mission in Iran is very different from going to other places," Khan said, "because Iran feels totally isolated in many ways from global trends. So when we go to Iran, we spend a lot of time doing seminars, almost like running a graduate school."

Critics, including those in the anti-globalization movement, would prefer that the World Bank close down that graduate school. They charge that the World Bank has too often put Western-style globalization and economic interests first.

Others, including Jan Hogendorn, Grossman Professor of Economics, point out that only one part of the World Bank's tasks is to design tighter budgets for countries where fiscal policy is believed to be out of control. The human development side of the World Bank is a "leading light" in addressing social problems, Hogendorn said.

"Being able to do this kind of work for the World Bank gives you the clout to really accomplish something. Many a volunteer goes out with nothing that they can really accomplish beyond generating good will. . . . People like Qaiser are in a position to make a real impact and I think that's impressive."

Khan, in fact, acknowledges that some criticisms of the World Bank are based in fact, though some date back to situations decades old.

"[Subsequent] events may have changed the facts but there is an internal debate within the bank between those of us who work on poverty and social and human-development issues and those who are financial sector specialists who still believe in trickledown," he said. "We have that internal debate within us but I think our side has won that internal debate."

Not that he believes the critics will go away.

"The bank will make new mistakes and somebody will have to point that out and we will have to address it," Khan said, adding that the bank will continue to support globalization but will work to address the social costs associated with it.

A native of Bangladesh, Khan earned a doctorate in economics at the University of Pennsylvania, studying with Amartya Sen, who won the Nobel Prize in economics in 1998. Khan went on to teach at Bowdoin, then became a development consultant in Nepal, the Philippines and Barbados.

He now lives in suburban Virginia with his wife, Habeeba, and their two children, Zainab, 7, and Jibran, 11, and describes his global life as a balance like yin and yang. "When you come [home] from rural Yemen or rural Madagascar, this is a huge contrast," Khan said.

Though he travels 150,000 miles or more every year on business, he says his World Bank development work leaves him "mentally at peace."

"I hope I'm having a wide impact," Khan said. "That's what keeps me going."

--Gerry Boyle '78