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A Few Good Signs for Africa

September 20, 2007


The United Nations Children’s Fund recently announced that for the first time since 1960 (when records started being kept) the annual death total for children around the world has dipped below the 10 million mark [“Child Mortality at Record Low; Further Drop Seen,” by Donald G. McNeil, Jr., New York Times, 13 September 2007]. Considering how much the global population has grown over the last 50 years, that statistic is all the more remarkable. McNeil contributes the drop in the mortality rate to a number of actors.

“The most important advances, Unicef said, included these:

  • Measles deaths have dropped 60 percent since 1999, thanks to vaccination drives.
  • More women are breast-feeding rather than mixing formula or cereal with dirty water.
  • More babies are sleeping under mosquito nets.
  • More are getting Vitamin A drops.

In 1960, about 20 million children died annually, but the drop since then has been steeper than 50 percent because the world population has grown. If babies were still dying at 1960 rates, 25 million would die this year.”

The reason that analysts believe the mortality rate will drop even further is because the data just released was all collected in 2005. Since then there has been a “huge influx of money that has poured into third world health … from the Global Fund to Fight AIDS, Tuberculosis and Malaria; the Gates Foundation; and the Bush administration’s twin programs to fight AIDS and malaria.”  As in many other things, the news is not as good for Africa as other regions.

“There are still wide disparities. The highest rates of child mortality are found in West and Central Africa, where more than 150 of every 1,000 children born will die before age 5. In the wealthy countries of North America, Western Europe and Japan, the average is about six. The most rapid progress has been made in Latin America and the Caribbean, in Central and Eastern Europe, and in East Asia and the Pacific. Despite the improvement, two sets of countries have worsened, Unicef said: those in southern Africa that have been hit hardest by AIDS, and those that have been at war recently, like Congo and Sierra Leone.”

But even across Africa there is some good news. Morocco has made particularly rapid progress since 2000 cutting its child deaths by more than one-third. Madagascar did even better cutting its deaths by 41 percent despite going to the brink of civil war in 2002, and São Tomé and Principe beat the rest of the world by cutting its deaths by 48 percent. Ethiopia has also made great strides by training “30,000 community health workers for tasks like weighing babies, advising on breast-feeding, giving shots, testing for malaria and handing out mosquito nets.” A similar grass roots program approach is taking hold in the Congo [“In the land of the blind,” The Economist, 1 September 2007].

“Self-sufficiency is a way of life in the Democratic Republic of Congo’s rural expanses. It has to be. Even the most accessible of the many villages that dot the dense rainforest—the ones connected to regional towns by spindly tracks that pass as main roads—get little government support. Yet in these unpromising conditions, one of Africa’s more successful public-health programmes is not only surviving but thriving. The idea is to harness people’s existing culture of self-help and get subsistence farmers to carry out simple medical tasks which are beyond the capacity of a pathetically inadequate health system. In Congo alone, the organisation has recruited more than 35,000 community workers for its river-blindness project; they get nothing for their labours except the knowledge that they are protecting their families from disease. Volunteers from each village are taught how to measure out the annual drug doses, fill in the obligatory record forms, and watch out for side-effects. WHO supplies the drugs and the villagers do the rest themselves. WHO was forced to devise the strategy after it received an offer from Merck, a pharmaceutical firm, of free supplies of a drug to people at risk of river blindness. For the Geneva-based masters of the World Health Organisation (WHO), encouraging self-help (by people with no formal training in medicine or nursing) is at once a lofty principle, to be expounded in academic journals and conference papers, and the only approach that has a hope of succeeding in chaotic circumstances like those of Congo. For a decade, WHO has been applying the concept of self-help to one specific problem: the elimination from Africa of river blindness, or onchocerciasis, a disease caused by parasitic worms, spread between humans by blackflies. But if the lessons were properly applied, the idea could have a much broader application for places where war, anarchy or simply poverty make it impossible to set up a formal medical system.”

Clearly, if volunteers can handle a single preventive medical program, they can be trained to handle multiple pro-active healthcare problems. At some point, such people change from being unpaid volunteers to valuable, compensated members of the community. Such a shift would not only improve health it would create jobs. This sounds great, but the article points out that making this vision a reality has its challenges.

“[C]ommunity workers … could do a lot more; they could distribute vitamin supplements, deworming drugs, vaccines and malaria treatments to villages that have hitherto been deemed beyond the reach of medical help. This approach would free up paid health staff to do the urgent or complex work that needs special training. … Margaret Chan, WHO‘s director-general, has said as much herself. She has given vocal support to what she calls “horizontal” approaches that improve general health in poor countries—as opposed to glamorous top-down programmes that focus on one disease. … Putting more emphasis on general health and ‘amateur’ care might sound like common sense, but advocates like Dr Chan or Dr [Uche] Amazigo [who runs the riverblindness program] may well have some tough arguments ahead. For some African governments, single-disease efforts may seem like a more tempting focus when hard choices have to be made. And the self-help school has problems. To train, and maintain, hundreds of thousands of community workers takes time, patience and money. APOC‘s mandate is for river blindness alone; it lacks the funds to expand the project to other diseases. Only if African governments endorse the idea will it have any future. Some have; in Uganda, where APOC has operated for over ten years, the government was impressed by the ability of community workers to supplement the health system, and has changed its policy accordingly. APOC stopped providing any funding two years ago, but the Ugandan authorities stepped in and kept the network of community workers going.”

I’ve discussed the value of public-private partnerships and communities of interest before. Grass roots healthcare in Africa is just one example of how successful they can be. Other intriguing approaches to improve health are also being tried. A Malaysian-based non-governmental organization, WorldFish Centre, is helping people in southern Africa fight AIDS by developing fish ponds [“Fish versus AIDS,” The Economist, 1 September 2007].

“The WorldFish Centre has helped 1,200 families who have lost breadwinners to AIDS to dig and run fish ponds in southern Malawi’s Zomba district. The small landlocked southern African country relies heavily on subsistence farming. But HIV/AIDS, erratic rains, overpopulation and soil erosion are taking a big toll, making it hard for farmers on tiny plots to survive. With Malawi’s main lake overfished, people are losing a big source of protein. In the 1970s they ate 14 kilos of fish per person a year; now they consume just four kilos. The ponds, which are easy to maintain, cost only $200 to make and $10 to stock with fish. They are filled from the water table or by nearby streams; rain keeps them going. The fish are fed from farm waste and by-products, such as chicken manure and maize bran. According to WorldFish, families with fish ponds have doubled their income and now eat 150% more fresh fish. Malnutrition among children under five has apparently dropped from 45% to 15% in three years. Mrs Kanyema passes on the training she has received on fish-breeding and on how to use her pond for agriculture to her neighbours. Pond owners sell most of their fish and vegetables locally, where there is enough demand to keep everything fresh. But they are also being taught to smoke fish, which keeps it for two weeks. Daniel Jamu, WorldFish’s regional director, says that the next step is to help farmers club together to market their produce in the towns, where prices are higher. Many poor farmers are starting to view aquaculture as easier and cheaper than raising cattle. WorldFish is expanding the project to reach another 26,000 families in neighbouring Mozambique and Zambia, as well as Malawi.”

Interesting things are also happening on the economic front in Tanzania now that it has abandoned its failed socialist experiment [“President Kikwete’s hard road ahead,” The Economist, 1 September 2007].

“Two years into his presidency, Jakaya Kikwete is being heralded as one of Africa’s rising stars, while Tanzania, after decades of sluggish growth and near-bankruptcy, is at last being lauded as a modest success. Its economy is expected to grow by 7% this year and perhaps a bit more next year. Thanks to sounder management and Mr Kikwete’s embrace of the free market, foreign donors and investors have started to put in more cash. The country is feeling perkier.”

As I have so frequently noted, when a country establishes the right conditions for attracting foreign direct investment good things start to happen. When Tanzania received its independence in 1962, it was led by its ardently socialist founder, Julius Nyerere, who ran the show until 1985. His successors have slowly moved the country away from that failed legacy and inched toward development. Kikwete is taking the next steps forward. He sees a great need to create jobs and that means attracting investment. The current push is to build up Tanzania’s gold mining production. The country also has an agricultural sector (although it is mostly subsistence farming), as well as diamond mining and, of course, tourism. President Kikwete is also investing in infrastructure. On a recent presidential trip reported on in the Economist, Kikwete opened “new roads, cattle stations, cotton gins, gold dealerships, co-operative banks, clinics and a Chinese-built project costing $85m that pumps water 170km (106 miles) from Lake Victoria.” But is he also investing in Tanzania’s human capital.

“The most striking development is in education. In the past year, the government boldly claims that no fewer than 187 secondary schools have been built in Shinyanga region alone. In the few that Mr Kikwete opens, he particularly encourages girls to stay on in education—to seek opportunities, not to make babies. Some of these new schools have been paid for by foreigners. But, as a mark of trust in the relative probity of Mr Kikwete’s government, many of Tanzania’s biggest donors, led by Britain, now give their money directly to support the budget.”

Despite all that is going well, problems do persist in Tanzania. “Tanzania’s budget is only half-covered by state revenues. Nearly half of Tanzanians are under 17. Unemployment is rife.”  Corruption also remains a problem. Connectivity, however, is on the rise.

“Another hopeful development is the faster flow of information, especially to Tanzania’s poorest communities. Mr Kikwete’s own mobile phone is a good example. Even in Bukombe, with its streets of dust and brothels lit with kerosene lamps, the presidential phone, set on silent, lights up like a firefly with text messages, several of which he reads out at random.”

Speaking of mobile phones, I wrote a recent post about Relief, Development, and the Digital Divide that discussed how mobile phones are being used in relief operations. In that post, I noted how important standards were so that mobile phone users could connect with one another. A recent note in BusinessWeek points out that mobile phone standards are not what they could be [“Global Glitch,” by Elizabeth Woyke, 17 September 2007].

“Is it possible to make a truly global phone? Perhaps not, based on the frustrations of some who bought the new BlackBerry 8830 ‘World Edition’ phone. Sprint Nextel and Verizon Wireless promote it as perfect for globe trotting because of features allowing it to negotiate conflicting cellular standards. ‘Get ready to take on the world,’ proclaims Verizon’s ad. The catch? The phone actually works only in limited fashion—or not at all—in several major business hubs, including Japan, India, and South Korea. Verizon and Sprint say customers should check for coverage areas on their Web sites. But that hasn’t kept some, like Neil Kozarsky, who took his 8830 to Tokyo, from griping they were misled.”

Those are the kinds of problems you face when you don’t have truly international standards. I’ve run into similar problems in my journeys overseas. Such is life. Let me close with one final story about Africa from the pages of The Economist [“The transcendental crusader,” 1 September 2007]. It is a story about one man’s investment in South Africa’s human capital.

“In his early years there was little to suggest that Taddy Blecher would end up in Johannesburg’s inner city, surrounded by youngsters from poor backgrounds. An actuary turned management consultant, Mr Blecher first stepped into a township by mistake. ‘I was terrified and thought I was going to die,’ he remembers. In 1995 he was on the point of emigrating to America, but at the last minute he decided to stay and make a difference. He spent the next four years teaching transcendental meditation in township schools. This was quite a stretch from his upbringing as a ‘white Jewish guy in Johannesburg’, but he describes it as the best time of his life. He and three partners then started CIDA City Campus, an almost-free business university for students who cannot afford mainstream higher education. (Students are charged only $21 per month in tuition, and some also receive additional financial help.) In a country where poverty and poor skills remain endemic, he has become a local hero.”

I mentioned communities of interest above. That is exactly what Blecher managed to do — set up a community of interest around his university.

“Mr Blecher turned to local companies for help. A bank made its old office building in downtown Johannesburg available free. Mr Blecher’s former employer gave him a desk and a phone line at its offices. CIDA City Campus opened its doors in 2000. Today 80% of CIDA‘s income comes from donations, amounting to about 50m rand ($7m) a year. Sponsors include Dell, JPMorgan, Sir Richard Branson and Oprah Winfrey, plus an impressive list of local firms. Students help to run the school, providing them with experience and keeping costs down. Many teachers are professionals who offer their services free. Today about 1,500 students are enrolled at CIDA. The business school offers a general Bachelor in Business Administration (BBA) course, as well as practical specialities such as information technology, construction and entrepreneurship for those who qualify. In July CIDA‘s School of Investments opened its doors, complete with a simulated trading room. But the central philosophy is to provide a lot more than education. Mr Blecher describes CIDA as ‘a whole ecosystem created to support kids.’ Many students come from very poor rural backgrounds, and moving to Johannesburg means a huge adjustment and often extreme financial hardship. Some start with a residential one-year foundation course to plug academic holes before enrolling in the BBA degree. Counsellors are provided and a wardrobe is also at hand for those who need to smarten up for job interviews.”

Blecher wants others to catch his improving-the-world-one-person-at-a-time vision and he is starting with those he is helping.

“Students are … required to volunteer for community work when they go back home during the holidays. Some teach, while others mentor teenage orphans responsible for looking after younger siblings. But all of them have to give something back to their communities, furthering Mr Blecher’s dream of healing South Africa. Often the first members of their families to go to university, graduates then step into a life that was previously out of reach. The former actuary points out that CIDA‘s graduates will collectively earn 150m rand in salaries this year, which by his calculations amounts to a net present value of 5 billion rand over their 40-year careers.”

These students represent the a new cadre of people moving from poverty into what is becoming known as the lower middle class — an economic group that is essential for sustaining economic growth in developing countries. There are fears, however, that Blecher’s dream will die when he departs.

“Mr Blecher’s odd mixture of new-age earnestness and hard work has made CIDA a beacon of hope, both at home and abroad. As well as adding further specialist courses, CIDA hopes to open new schools elsewhere in South Africa. But behind its success linger some concerns. CIDA remains intimately associated with its founder and chief executive, and there are questions about whether it would survive without him. … CIDA‘s fast growth has overwhelmed its administrative systems. And although the specialist degrees are by most accounts excellent, some employers are said to have been disappointed by the general BBA graduates they have hired. The quality of education will need to improve if CIDA‘s degree is to compare with that of mainstream universities. There is no shortage of goodwill or ability within the school to sort these things out. But sorted out they must be, if CIDA is to live up to its inspiring vision.”

With the reams of bad news coming out of Africa, it is refreshing to read about the good things that are happening there. Problems certainly remain, but a growing number of people are starting to see hope and opportunity where once only chaos and heartbreak could be found.

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