African Development for the Completely Bloody Ignorant

The Commission for Africa Report doesn’t do itself any favours by calling its eighth chapter “Leaving No-one Out: Investing in People.” To anyone who’s worked at an organisation undergoing the personnel policy inspection of the same name, this just conjures up images of council busybodys measuring steps against wheelchair access standards. Mercifully, the chapter is dedicated to a slightly more urgent matter: ensuring the economic growth painstakingly planned out in the preceding chapters benefits the poor.

And what a lot of poor there are. Rather than revisiting the usual parade of misery-statistics, the Commission now waves one key one: that one in six people in Sub-Saharan Africa, more than 100 million people, are “chronically poor” (p61). Now, just to be clear, “chronically poor” is worse than “extremely poor,” the often-used $1/day standard. “Chronically poor” amounts to day-to-day subsistence, totally dependent on casual labour and with no serious chance of advancement, no resources to invest in routes to a better standard of living.

For the chronically poor, the only hope is some sort of external assistance. But, the Commission argue, many of them are excluded from such assistance by discrimination, on the grounds of sex, age, ethnicity, disability, or the stigma of AIDS. Given that more than 50% of the population is either female, young or both (p62), this isn’t just a minority issue, either.

Women & children first

It’s a jolt thinking of African poverty, which we’re used to thinking of as a sort of universal tragedy, in terms of such Western concerns as gender discrimination. But the evidence the Commission puts forward is pretty compelling. Women, they point out, contribute more economically than men - accounting, for example, for over 70% of agricultural production. And yet, when widowed, large proportions of women lose some or all of their assets to their in-laws: cattle, equipment, and rights to land are all improperly protected for widows by law. Given the death toll of young men across the country from AIDS and war, that’s a lot of mothers being left unable to feed their children - while land goes to augment other male relative’s land.

Improving the treatment of women will naturally improve the lot of children. Women not only tend to work harder, they are more likely to spend their earnings on household investments as opposed to men, who tend to spend it on “themselves” (it’s easy, but no doubt unfair, to take this as a euphemism for “booze and whores”). So discrimination against women needs to be tackled; indeed, there’s a strong economic case for “positive discrimination,” as in aid targeted straight at women and children. Small monthly payments direct to elderly carers, for example, improve children’s nutrition and school attendance, and cost less than food aid (p70). Instead of cash, free school meals, skills training and the like can be just as effective. Older people, too, make up a disproportionate share of the poor, and need special assistance.

Education, education, education

To really change children’s lives, however, the only long-term answer is education. Here, the Commission notes, the world doesn’t need convincing of the need. A pledge made in 2000, that became one of the Millennium Development Goals, commits the world to providing free primary education for every child in the world by 2015. Additional commitments were made to double adult literacy and abolish gender inequality in education by 2005. But while the commitment is there, the Commission notes, the will isn’t. The 2005 targets were missed, and the 2015 targets are looking shaky. An extra $7-8 billion a year is needed to properly fund education and see primary school fees abolished.¹ Free schooling has been, like everything else, the topic of much disagreement, with some Western economists arguing against it. But if the government can afford it - or if donors fund it - the evidence that it increases enrolment is hard to ignore. In particular, the Commission argues, abolishing school fees increases girls’ attendance most, as do measures like free school meals, because families forced to make choices will usually choose boys to be schooled. And yet, education boosts girls’ future wages substantially, lowers their fertility to more manageable levels, and reduces the likelihood of HIV infection (p65).

Apart from that, the money is needed to train more teachers to meet increased demand. Furthermore, curricula (a? ums?) need to be revised, with more vocational skills, and life skills teaching on things like avoiding HIV infection.

Clinical health

In 2001, when new Labour was in the final push towards its first re-election victory, it had a slogan: “schools and hospitals first.” Ever since, “health and education” have gone together somehow in politics, as the twin pillars of a healthy society that invests in its future. Perhaps I shouldn’t be surprised, given that the Commission’s chair is one Anthony Blair, to see that the report has the same priorities: once it’s done with education, health is next.

Healthcare in Africa, the Commission notes, is “at the point of collapse” (p66). Average spending per person is less than 1% the developed-world average. However, there is hope: many African countries have increased their health spending in the last few years. But as always, more money is needed, and the Commission takes the split approach it has in other areas, calling for $10bn a year until 2010, then if that’s proven effective, $20bn a year by 2015.¹ Three areas in particular need investment:

• Just as assistance is needed in training teachers, so with doctors and nurses: an extra one million are needed over ten years, with better salaries to stop flight to rich countries (i.e., Britain).
• Similarly like education, fees are a huge obstacle to use of health services, and investment is needed to abolish them for primary (GP-level) healthcare. Such a move more than doubled clinic attendance in Uganda, and it’s relatively cheap (p68).
• Preventable diseases are a huge part of the disease burden: 2/3 of infant mortality in the continent could be prevented with vitamins and bed-nets.² Providing the education and materials to prevent infection - including, of course, condoms - should be a top priority.

When it comes to less preventable diseases, donors should legally commit to buy remedies for the worst African diseases, should they be developed - for example a microbicide gel, worn by women and invisible to men, to prevent HIV infection.³ At present, pharmaceutical companies focus research almost entirely on western conditions such as heart disease, unsure if governments will be able to buy any new medicines developed for African health problems.

In addition, to make sure the money is as effective as possible, more work is needed to get donors working together effectively. Short-term, uncertain funding, with different donors pursuing different priorities, can waste large sums of money. A long-term, co-ordinated approach is needed, with donors contributing according to an arranged plan.

Public health

Of course, the doctor’s surgery and hospital mark the end, not the beginning, of the health journey (or something). Health starts with nutrition, good housing, and especially sanitation. This one is particularly crucial because it’s something governments have to be involved in providing - simply getting better off won’t get you clean water if your village has no pipe.

300 million Africans still don’t have safe water. Remember those stately Ethiopian women carrying water on their heads, an emblem of the famine of 1984-5? Well, even now, women and girls across Africa walk an average of six km to get water each today. And it’s not just exhausting, it’s unsafe; clean water reduces malaria prevalence, makes HIV treatment more effective, and allows HIV-positive mothers to use powder milk to prevent transmission to their children. And yet - in one of those really depressing statistics - aid to irrigation and sanitation projects had, by early 2005, dropped by 25% since 1996. Commitments are in place, they need to be honoured.

AIDS

The Commission lets loose with a barrage of statistics about the AIDS pandemic so unpleasant it’s hard to even feel jadedly blasé about it. 25 million Africans dead from the disease so far; another 25 million infected.

What’s worse, the report notes, AIDS affects many more people than just those infected. Maybe 90% of HIV+ people in Africa are aged 15-49, most likely to be working and supporting family members; the economic consequences for a country of 40% of its workforce succumbing to disease are hard to imagine. Saving, investment and education are all lower in HIV-affected households, with further consequences for general development.⁴ And thanks to a mixture of biological and social factors, the disease attacks women most. The result is a growing population of AIDS orphans.

Until recently, the report notes, donors hadn’t focussed on HIV/AIDS, but that’s starting to change (this good news story brings us up to date). Still, more needs to be done, not just in providing medicines but in tackling cultural and social factors. Health workers need to pay more attention to African traditions and beliefs about sex, gender, and death, and may need to make alliances with traditional leaders and healers to get their message across.

To fund both medicines and training, an extra $10bn a year is needed; and like in other areas, donors need to collaborate more effectively and commit more long-term to see the money have maximum effect.

Making growth work

Almost half the money the Commission calls for in total, an eventual $75bn a year, is for health and education. Investment in these areas, it’s suggested, is essential if growth is to benefit everyone in society. But to ensure the money isn’t wasted, monitoring processes are needed, and local communities need a say in how it’s spent.

The Commission’s proposals on health and education aren’t revolutionary, and they perhaps don’t express clearly enough how investments in these areas relate to, and work with, economic growth. But it’s a comprehensive bird’s eye view of the main challenges, and its emphasis on women and children is striking. Indeed, in many ways it’s interesting how similar the policies needed in Africa are to those we have in Europe - aid to mothers with children, free healthcare and education, and so on. Of course, the fact that these policies are similar to ours should make it harder for us to welch on the money. But it’s by no means clear if that’s the case. So, having laid out its multi-billion-dollar shopping list, the Commission turns next to the question on everybody’s lips: “Where will the money come from?”

1. The thought’s just occurred to me that the multiple spending requests included in this document don’t seem to have an end-date. The intention is to achieve the MDG’s, so naturally they focus on up till 2015. But after? I’ll look to see if it’s addressed directly anywhere.
2. There’s a whole massive thing about bed-nets. We’ll get into it more later on. Suffice to say, some people don’t think giving them away is a good idea, but most people do.
3. This, in fairness, is now in development, but slowly.
4. I hated it when, sometime around 2000, politicians and journalists suddenly started talking about the economic impact of AIDS. “Millions are dying,” they’d intone, “but also growth is set to be seriously impaired.” “Who gives a hell about growth?” I’d think. “You had me on ‘millions are dying.’” But, I can see now the point. Because this long-term affect on growth is what makes AIDS serious for all the people who aren’t infected; it’s why it’s a problem for the whole of Africa.