Is Monetary Funding the Best Solution to Africa’s Impending Health Issues?
For several decades America, as well as other nations, has generously given to numerous third world countries in Africa to fight against poverty and infectious disease. Whether through canceling national debt, providing aid through healthcare, or through medical supplies and community building, countries like Uganda, Malawi, and Sudan have reaped little from these efforts. In fact, most countries in Africa are no better off then when we first decided to step in. All these efforts are of good intent and well needed, but does money address the heart of the problems that exist in Africa? It seems as though the natives that were trained a decade ago are no longer working in their local communities and villages, but have moved abroad to use their education to open the door to more opportunities.
This raises important concerns regarding our efforts to aid in the welfare of other countries. Is monetary funding the best solution to Africa’s impending health issues? I hope to answer this question by revealing the situation around Uganda’s tragic history.
War has ravaged so many countries and so many lives in Africa. The 19-year civil war in northern Uganda has resulted in the displacement of at least 1.5 million people. War has devastated the minds, hearts, and vitality of the Acholi people, an ethnic group who endure life among the harshest of circumstances. “The Acholi people have witnessed 20,000 of their children abducted to fight as child soldiers, 1,100,000 civilian deaths, and the migration of 1.8 million people into internally displaced people’s (IDP) camps.” Current international aid only meets 43% of the amount needed to provide basic humanitarian assistance. Healthcare reform was needed badly in Uganda, to bring some semblance of organization and productivity.
Health reforms based on market principles have been introduced widely in both developed and developing countries over the past 20 years. In developing countries, international donors have insisted on health reform as a precursor to providing external aid. Uganda started market based health reforms in 1994. These reforms have not only failed to improve the health of people and their community services, but have arguably been the key driving force in their demise. These reforms presented themselves in the form of decentralization of the Ministry of Health to local authorities and individuals.
Even though many praised Uganda’s decentralization, it also introduced many obstacles. This is because money given by contributors was restricted to specific uses. Decentralization has actually widened disparities in the nature and quality of health services. For instance, The availability of emergency obstetric services now varies from 4% to 42%. This is because the richer districts and those with powerful local politicians who have been able to persuade nongovernmental organizations to work in their district have done better. Performance of health services fell after the introduction of these reforms, and key health statistics from 1990-1995 to 2000-2004 have worsened.
Uganda has failed to achieve a functioning health system. In fact, almost 20 years of civil war has caused health experts to fear another impending HIV epidemic. Uganda is regarded as an HIV/AIDS success story. Uganda has become the only African country where HIV rates have declined. However, some health experts fear that the civil war with the Lord’s Resistance Army (LRA) will reverse advances made in the past several years.
The north has suffered the brunt of the war. This war is the result of tension between northern and southern Uganda that has existed since pre-colonial times. Like Rwanda, colonialism institutionalized these differences by dictating distinct occupational roles. Northern Ugandans were assigned to military positions, and southern Ugandans were given privileged public services. When Uganda gained it’s independence in 1962, radical regimes exacerbated these differences, causing tension; this tension continued to grow when the LRA was established and determined to target the Acholi people.
The majority of people affected are children. Consequently, mortality rates are high in Uganda. Children are forced from their homes, either to fight in the war, or to commute nightly to avoid capture from the army rebels.
They come in with their bedding under their arms; some are already in their uniforms ready to go to school in the morning. These ‘night commuters’ walk up to 10 kilometers to seek refuge. Many are forced to sleep on the street, increasing the risk of abuse and sexual exploitation.
Almost 15,000 children flood into town every night, sent by their parents, who fear they may be abducted, to sleep in safety. Young women who are abducted are forced to become wives to the rebels, and are savagely raped and disfigured. These actions increase HIV infection and cause increased risks for infectious diseases. How does healthcare reform save these children? How does canceling national debt keep these children safe at night? Where is education where you need it most?
This savage war has deteriorated every aspect of what so many people have been working for:
Civil war disrupted agriculture and trade in Uganda and Sudan. This reduced tax revenues and drained scarce resources away from health budgets to finance increased military expenditures. Hundreds and thousands of people were driven from their homes either as internally displaced people or as refugees. Normal health service delivery systems were broken down forcing doctors, nurses and other health professionals into towns, cities or neighboring countries in search of peace and employment. Scores of hospitals, health centers and dispensaries were abandoned, destroyed or looted, rendering even the limited physical facilities useless. Preventive public health services such as immunization and provision of potable drinking water were discontinued, leaving huge populations susceptible to controllable infectious diseases and epidemics.
There are several approaches to what needs to be done in countries like Uganda to aid in improving lives and healthcare. The intent behind these ideas I believe is pure, however, we must keep in mind that we are dealing with another culture, radically different from ours. And our greatest idea may be their greatest failure.
The first of these approaches is revealed through the eyes of the celebrity. We live in an age where it is popular to be charitable. Through celebrities such as U2’s Bono, Angelina Jolie, and George Clooney, the media has opened America’s eyes to some of what goes on in these war torn countries like Uganda. Through such efforts as The One Campaign, celebrities have rallied together, urging us to sign petitions and show our government our discontent, demanding that they cancel national debt to these countries, or increase monetary aid.
Bono believes that he has the solution to Africa's problems. In fact, he is proclaiming it so loud that people seem to trust his answers. He traveled in 2002 to Africa with former Treasury Secretary Paul O'Neill, urging debt forgiveness. He recently had lunch at the White House, where he reiterated the "more money" proposal, and how African countries are “uniquely futile.”
It seems to have been Africa's fate to become a stage of empty talk and public gestures. And into this empty pit we keep throwing our money, hoping that something will change. But the impression that Africa is fatally wounded and can only be saved by outside help - not to mention celebrities and charity concerts - is a destructive and misleading idea.
Similar to this, major corporations have decided to take a similar approach to rising up the vitality of the African nation. Bill Gates has said numerous times that he wants to rid himself of his “burden of billions.” In fact, Bono is one of his trusted advisors. Mr. Gates wants to send computers to Africa. But is this what the people in Uganda, Malawi, or Sudan need? Low-income schools in America might need computers, but are they not somewhat impractical in a developing country? Wouldn’t it be more prudent to send pencils and paper for children to write with? Mops and brooms to clean with and keep things sanitary? These items are truly needed, not some desktop computer that they would do better off selling then learning how to use. How can we even think about computers when community health centers are having trouble remaining open, or potable water is nowhere to be found for miles?
The other side of the coin represents non-profit organizations. A program that has brought a great amount of change to other nations is the Peace Corps. A government operated non-profit, the Peace Corps sends Americans all over the world to help and educate people in developing countries and aid in disaster relief. But has the change brought about by this program been fruitful? Disaster relief, without question, is an amazing gift we can offer other countries, but is sending foreigners to another country for a fixed amount of time for education really beneficial? What happens when those people leave the program to move on with there day to day lives? Who is to take their place? Teaching in Africa is considered a sub-par occupation, one that is almost looked down upon.
Paul Theroux, an established author and a former Peace Corps volunteer who served in Malawi, describes the frustration that is present in so many countries in Africa:
In the early and mid-1960's we believed that Malawi would soon be self-sufficient in schoolteachers. And it would have been, except that rather than sending a limited wave of volunteers to train local instructors, for decades we kept on sending Peace Corps teachers. Malawians, who avoided teaching because the pay and status were low, came to depend on the American volunteers to teach in bush schools, while educated Malawians emigrated. When Malawi's university was established, more foreign teachers were welcomed, few of them replaced by Malawians, for political reasons. Medical educators also arrived from elsewhere. Malawi began graduating nurses, but the nurses were lured away to Britain and Australia and the United States, which meant more foreign nurses were needed in Malawi.
Now 40 years later, most of these schools lie in ruin, covered with graffiti and weeds, with windows broken. Money will not fix this.
This represents the root of disadvantage that Africa has begun to experience. Our effort to help develop Africa into a thriving continent has had the opposite effect. We have only crippled an already hurting nation. Forcing them to depend on us for aid and relief.
If debt relief and funding is not the answer to reviving these countries, then what is a viable solution? I believe this can be answered by looking at the country of Ireland. In an article in the New York Times, Paul Theroux looks at Ireland as a possible model and solution to the birthing pains seen in developing Africa.
Ireland was characterized for centuries by famine, religious conflict, civil tension, unruly families, overbearing clan chiefs, malnutrition, failed crops, ancient orthodoxies, dental problems and fickle weather. This describes numerous countries in Africa. And like Ireland, absentee European landlords colonized many of these African countries. For many years the Irish were fleeing from their country in droves. Emigration was horrendous during times of famine and disease. In fact, only recently were you legally allowed to buy condoms in Ireland, or divorce. Yet, just like in Malawi, beer is easily available. Ireland, in essence, was the Malawi of Europe.
After centuries of wishing themselves onto other countries, the Irish discovered, like other nations, that education, rational government, people staying put, and diligence could turn Ireland from a crippled, isolated country into a prosperous nation. The Irish found that there was something to be said for staying home. And, when stripped to the basics, this is what Africa needs.
It does not occur to anyone to encourage Africans themselves to volunteer in the same way that foreigners have done for the past 40 years. There are many well-educated and capable adults in Africa who could have a much greater impact and push change to a greater extend then any Peace Corp volunteer.
Therefore, sending more teachers would be futile. I would expect Africans themselves to stay and teach. Theroux presents a great idea on how to encourage people to do this: “There ought to be an insistence in the form of a bond, or a solemn promise, for Africans trained in medicine and education at the state's expense to work in their own countries.” This is a widely used method here in the United States to insure small, rural communities of local doctors available in their towns. Medical schools will often give students full-ride scholarships in exchange for staying locally to practice medicine.
If they say that all roads lead to Rome, then in the case of Uganda and many neighboring countries, it seems that all roads lead out of Africa. It is depressing to think that it is easier for many Africans to travel to New York or London than to their own homelands. “Much of northern Kenya is a no-go area; there is hardly a road to the town of Moyale, on the Ethiopian border. Western Zambia is off the map, southern Malawi is terra incognita, and northern Mozambique is still a sea of land mines.” However, it is pretty easy to leave Africa. According to a recent World Bank study, the emigration to the West of skilled people from small to medium-sized countries in Africa has been disastrous.
I believe that Africa does not have a shortage of capable people, or even money. And dumping more money in the same way we have for years is not only wasteful, but also harmful. We are not the solution to Africa’s problems; the African people are the solution. We must merely act as enablers not saviors. Doing so has tarnished Africa’s belief in itself.
Africa is a beautiful nation, more beautiful, more peaceful, more resilient, and more self-sufficient than we give it credit for. Only the people of Africa can sustain their nation. Without seeing the worth and greater good of empowering them to change, our efforts are useless. Money does not accomplish this, but only a strong resolve among the African people to promote change and educate generations to come so that one day the potential that rests in their hands will be achieved.
Christian Aid. Uganda’s war against HIV/AIDS threatened by continuing civil war.
http://www.christian-aid.org.uk/index.htm. November 24, 2003.
Dodge CP, Health implications of war in Uganda and Sudan. www.PubMed.gov. PMID:
2122523, Soc Sci Med. 1990;31(6):691-8.
Government of Uganda. Status of emergency obstetric care in Uganda. A national needs
assessment of EMOC indicators. Kampala: Ministry of health, 2003.
Health Action in Crises, Uganda: Saving Lives and Reducing Suffering, World Health
Organization, Geneva, 2006
Okuonzi, Sam Agatre. Learning from failed health reform in Uganda. www.bmj.com.
November 13, 2004.
Theroux, Paul, The Rock Star’s Burden. The New York Times. Dec. 15, 2005
Westerhaus, Michael. Uganda: and uncivil war. BMJ Publishing Group Ltd. April 2006.
At Urbana '06, an African pastor shared his experience at a Walmart: “You Americans like to solve problems. I was amazed to see a toilet drainer solution. You have product dedicated to fix a specific problem. You do good job at it, but you can’t fix our problems. You fail to listen to us. We need you to understand our problems.”
May be a little off-topic, but I thought I'd share.
Posted by: Ryan Hsia - yet another Asian kid | March 14, 2008 at 03:28 AM