Contrast this with African governments' more recent emphasis on, and urgency about, the deadliness of HIV/AIDS, which—after a terrible conspiracy of silence—has led to an increase in awareness and in people taking steps to protect themselves and others. In the case of diseases like malaria, unlike with HIV/AIDS, we see the crisis mentality that colors much development assistance, as opposed to putting a priority on prevention, strengthening health systems, and implementing policies to improve the basic health of Africans, which would make them more resilient in the face of preventable yet debilitating illnesses.
While this does not mean we should abandon attempts to broaden the use of any mitigating aids like bed nets and drugs, other policies ought to be adopted that would address the causes of these diseases. One such measure that has been advocated by the Green Belt Movement (GBM) and others is to end the production of thin plastic bags. These bags break easily and are almost always thrown away after a single use. Water pools in them and can provide a breeding ground for mosquitoes. Furthermore, the bags are unsightly—discarded ones “bloom” by the millions along roadsides and in gutters, bushes, shrubs, and even national parks throughout Africa—and they pose a risk to domestic and wild animals if eaten.
It was partly to combat the increase of malaria-bearing mosquitoes in parts of Kenya that GBM and other groups began a campaign to end the production and use of these plastic bags. GBM has been encouraging people to carry groceries and goods in bags and baskets made from sisal and other materials. These containers are durable, biodegradable, and indigenous. By reducing waste and resource use, they also help the environment.
In doing this work, GBM has been careful not to say that these plastic bags cause the spread of malaria, because there is no way to prove that the malaria-infected mosquitoes are breeding in the pools provided by the bags. Nor is banning the bags (as a growing number of municipalities and countries have done on ecological grounds) on its own going to solve the problem of malaria. But it is important for African governments and peoples to preempt by all possible means the likelihood of malarial infection.
Every African schoolchild should know that standing water provides a breeding ground for mosquitoes, including those that carry malaria. However, what hasn't been created in most African nations is a practice of eliminating pools of stagnant water near homes. If communities and individuals took preventative measures, it's likely that fewer curative solutions would be needed. Similarly, African governments could revise their building codes and require that all windows and doors have permanent screens on them to keep mosquitoes (and other insects) out. Even if people have bed nets, they and their children are not shielded from malaria-carrying mosquitoes in their homes during the hours between sunset and bedtime. Since evening is also the time when mosquitoes are at their most active, screens on windows and doors would offer some immediate and affordable protection.
The lack of preventative measures and awareness around malaria and other diseases is an example of three central problems in the delivery of development aid: one, African governments and individuals themselves often aren't the active partners in development; two, aid can induce a culture of dependency; and finally, a crisis mentality persists that emphasizes immediate results over long-term prevention.
When communities are offered either technology (bed nets) or ideas about a set of positive behaviors (having all of their children, or, better yet, the whole family, sleep under bed nets), it's my experience that unless they understand the intrinsic value of what they've been given and embrace it as their own, the minute the direct assistance is withdrawn and donors go home, individuals will lapse back into their previous patterns. The boreholes and health clinics go unattended, the new tractors break down and are not repaired, and the loose taps leak or rust. Instead of a mind-set that looks to prevent problems, the culture of dependence on foreign aid continues with no one taking responsibility for communities' continued development.
Without community buy-in, donors come to be seen as Santa Claus, bringing with them money, materials, and inputs. From the governmental to the community level, individuals will throw open their doors, even when the ideas or approaches being offered by the donors are not necessarily extraordinary. The people will clap and dance in welcome, until the tap dries up, which, with donor funding, happens (as it should).
At the same time, donors' money can further corrode responsibility. Even today, among many current African governments and their citizens, an attitude exists that one doesn't have to be as responsible with, or accountable for, the use of funds or materials that have originated outside the country from a donor agency or private philanthropist. Individuals and governments completely misunderstand or subvert the donors' intention in providing the money in the first place. “If the money doesn't belong to anyone in particular,” goes the reasoning, “why should it matter how it's being used? It might as well belong to me.”
Some development analysts have suggested that requiring people to purchase an antimalarial net, for instance, creates a sense of investment that will encourage them to use it for the purposes for which it was intended—instead of, as has been reported of bed nets given out for free, employing or selling them as fishing nets or bridal veils. I disagree. It is not necessary for people to have to pay for something to care about it, or for that product to reach the specific demographic that it is intended to help. Rather, a community and individuals must recognize the utility and value of the item in question, regardless of who pays for it. Simply put, unless the people understand that they are expected to empower themselves after the donors are gone, they will not take the appropriate steps: not because they don't like what the donors are doing, or because the help was given to them for free, but because they don't see its value.
Of course, it is the perception of the threat and not the reality of malaria that I am examining. There is no question that malaria is a debilitating disease; I have seen for myself its negative effects on people and communities. While the numbers of malaria deaths in Africa have been declining in recent years since bed-net manufacture and distribution programs moved into higher gear, they remain unacceptably high.
Although it may seem an obvious point, it is worth noting that Africans have been dealing with diseases like malaria for a very long time, perhaps upward of fifty thousand years. Although malaria, no doubt, has exacted a heavy cost in deaths of family members and lost productive hours, the peoples of sub-Saharan Africa have nevertheless learned to live with it and do not seem to be alarmed by it. Indeed, if you asked average Africans what the continent's most pressing health issue is, they would probably say HIV/AIDS—not least because it is a new disease in comparison with malaria, and many people are dying of it. Even in the slums that are all too common in African cities, where people live packed tightly together, surrounded by the pools of stagnant water that are ideal habitats for mosquitoes to breed, more individuals are likely to consider unemployment, poverty, or HIV/AIDS greater problems than malaria. They wouldn't necessarily be wrong: HIV/AIDS remains the leading cause of death in sub-Saharan Africa, claiming the lives of 1.6 million adults and children in 2007.8 But they may not know how deadly malaria also is—and that, perhaps worse, it may even increase the progression of the HIV virus.9
Just as it is essential that the people be engaged in the development process, so governments need to take the lead. In the context of aid, there is a big difference between asking donor agencies, philanthropic foundations, or individuals for help—for instance, to prevent and treat malaria—and only being persuaded to do so when funds are available from the outside. Africa's leaders cannot continue to wait for the international community to provide financing before doing the right thing. Half a century after independence, it is incumbent upon African governments to work for the good of their people without the need for “carrots” coming from donors to persuade them to do it. In the long run, of course, Africa needs to move beyond aid and the culture of dependency it has helped create in Africa's
leaders and her people. While I applaud the motives of the international community in providing technical and financial assistance to developing countries, including those in Africa, I do question how much good aid does versus how much damage it may do to the capacity of the African peoples to engineer their own solutions to their many problems.
GOALS FOR DEVELOPMENT
In a nod to the five species white hunters wanted to “bag” while on safari in Africa (a rhino, a leopard, a lion, a buffalo, and an elephant) in the reserves they set aside for this purpose, economist Jeffrey Sachs, director of the Earth Institute at Columbia University in New York City, has identified what he terms the “Big Five,” a set of multipronged investments in development that can help communities climb the ladder out of extreme poverty. They are agricultural inputs; investments in basic health; improvements in education; more efficient and regular power, transport, and communication services; and the provision of clean drinking water and proper sanitation.
Professor Sachs is heading a group that includes the Earth Institute, the United Nations Development Programme (UNDP), and the Millennium Promise in establishing a number of what are called “millennium villages” in ten African countries as part of an effort to realize the Millennium Development Goals.10 Eleven of the villages are in Kenya, in the Sauri district of Nyanza Province, not far from Kisumu on the shores of Lake Victoria in the west of the country. Progress in the Sauri millennium villages on key development indicators, including those within the Millennium Development Goals, has been made since the initiative began there in 2004. Incidents of malaria in Sauri, for instance, have dropped by 50 percent. Students came in second rather than 108th out of 253 in district school examinations.11 And corn production has, on average, tripled, enabling farmers to sell some of their harvest in the market and retain some for their families.12
These are significant achievements. The people in Sauri and the other millennium villages are, like those I have worked closely with through the Green Belt Movement, poor, largely outside of the mainstream development agenda, and stuck in a cycle of powerlessness and marginalization. The immediate results from the millennium villages indicate that when financial resources, including aid, are properly targeted and well spent, they have the potential to transform the lives of the world's poorest people.
Even as I welcome this progress, however, the very fact that the Big Five are needed raises a number of questions, some of which are uncomfortable, and several that touch on the same problems as the situation with malaria and bed nets. All of these questions lead to issues of leadership and governance, which may be defined as the way a country establishes its priorities, holds its officials accountable for their actions, makes decisions, empowers its citizens to feel invested in and engaged with their government and civil service, and communicates its vision to the people.
What was being done—or not being done—by African governments in Sauri and the other seventy-odd millennium villages throughout Africa before the team of international professionals conceived of helping the local people through these interventions? In the case of Kenya, the member of parliament who represents the region where Sauri is located is a professor of political science and economics, and was a minister for economic planning and development in Kenya's ninth parliament (2002-07). Given Sauri's low development status, one could conclude that either the MP didn't understand the policy prescriptions and economic conditions that the millennium village project identifies, or he didn't have the funds to implement a program like the Big Five, or, perhaps, he wasn't serious about dedicating funds to such purposes or implementing a holistic development plan.
One could also ask, given the demonstrable successes documented in Sauri, and the elementary nature of many of the interventions—ensuring that farmers have fertilizers, decent seeds, and markets, that villagers have access to clean drinking water, and that children receive good nutrition to support, in part, their academic studies—why the government hadn't made them a priority for all Kenyans. Why did implementation of the Big Five require the coordination of a range of international organizations and considerable infusions of donor aid? (In Kenya, to provide the Big Five to all those who, in Sachs's analysis, need them would cost about $1.5 billion a year.)
It is not because the Kenyan administration and other African governments are unaware of the validity of the components of the Big Five. Kenya, for instance, has a minister of agriculture, a minister of health, a minister of education, a minister of energy, a minister of roads and public works, a minister of information and communication, and a minister of water, all of whom are mandated to tackle the myriad development deficits facing Kenyans, including the Big Five. Rarely, however, does one find African governments genuinely emphasizing these ministries. In general, they are more concerned with funding and staffing ministries of defense, provincial administration, finance, and security. Nonetheless, one can still legitimately question why it is necessary for a raft of international agencies to inform African governments that the Big Five are important to combating the poverty that is killing their people, and why, in turn, the international experts are establishing mechanisms to deliver the interventions—a function that surely should fall to the governments themselves.
One measure that could be immediately undertaken, for instance, is in the provision of latrines. Three hundred million Africans—a third of the continent's population—do not have access to clean water and sound sanitation.13 If the governments of Africa individually and collectively made it their mission to provide a latrine in every household and teach basic hygiene, particularly in schools and churches, countless lives would be saved, especially those of children, many of whom die from diarrhea and parasitical infections. In addition, this would provide all Africans with a degree of dignity that millions currently do not have. This would not have to be exorbitantly expensive, and the people themselves could provide the labor. The only reason I suspect this has yet to be done is because the elites who make these decisions have lived for many years with modern toilet facilities, and this level of privation is now outside their realm of experience. Nevertheless, they cannot say they do not know. If such a situation is unacceptable to donors, why should it not be for the elites?
It is true that the budgets of many African governments are stretched thin because substantial portions are being used to service their international debts (a topic I discuss in more detail in the next chapter). But it is also the case that for at least a century, Africa has been told that it is poor, and too many Africans have come to accept this as an unchangeable truth—even though the continent remains richly endowed with natural resources, despite decades of ecological degradation. Africa is also wealthy in human resources. The challenge for its leaders, both governmental and nongovernmental, is to acknowledge and then channel Africans' capabilities and energies into effective action for development.
Unfortunately, too many African governments have used their budgets, and their natural resources, not to invest in their people, but in precisely the opposite manner. Most likely, the millennium villages' initiative has instituted management systems that ensure that the funds budgeted for Sauri and the other villages throughout Africa are used efficiently, accountably, and responsibly—making sure the monies are not stolen or data deliberately falsified. This recognition leads to further questions about the prospects for devolving programs such as those being piloted in Sauri to national and local governments—which must, surely, be the ultimate goal.
How are the governments of Malawi, Ethiopia, Nigeria, Senegal, and Kenya—to name a few of the countries in which millennium villages have been established—to be persuaded to continue to support these development investments when the aid flow ends or is insufficient in future years? The International Monetary Fund reports that the commitments made by the G-8 nations in 2005 to increase bilateral development assistance for Africa by $22 billion, for a total by 2010 of nearly $38 billion each year, are “unlikely to materialize.” As of June 2008, the non
governmental organization DATA—Debt AIDS Trade Africa—founded by Bono reported that only 14 percent of the additional funds pledged by the G-8 nations had been provided.14 Only a handful of industrialized nations have reached the benchmark they set in 1992 to provide 0.7 percent of their gross national products as development assistance.
Given this scenario, what kind of financial and logistical commitment will the African governments make to ensure that the millennium village models are self-sustaining and also templates for future development without requiring yet more donor aid to continue? And if the funds to support millennium village-like interventions are used efficiently, accountably, and responsibly but are still not enough to reach all who could benefit, are the long-term prospects for such development approaches realistic?
While it is necessary to challenge the governments, the citizens of African countries also have a role to play in demanding development that discourages dependency. Why didn't they prioritize investments like the Big Five? Or if similar programs were in place, such as an effective agricultural extension service that advised farmers on preventing soil erosion and capturing rainwater, why did they allow them to collapse? Why was the emphasis on development lost?
Certainly, after independence, most Africans had the expectation that their societies, and they themselves, would become wealthier. Instead, Africa as a whole became poorer and more dependent on an infusion of aid from the very regions that had colonized and exploited the continent. Such assistance was welcomed with little skepticism and, in my view, helped further internalize Africans' sense of their inferiority when compared to the rest of the world. If postindependence aid had been provided to Africa in a manner designed to empower the economies and institutions of the continent and not to instill a long-term dependency, the future of Africa might have been very different, and the Big Five initiative unnecessary.
The Challenge for Africa Page 7