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Last Updated:  Thursday, 6 March, 2003, 00:48 GMT
Africa's aid plan seeks healthy growth

by Adam Lusekelo
in Dar-es-Salaam

Woman patient with Aids
HIV/Aids has cut life expectancy by 20 years
Africa's ambitious new development plan, Nepad, must confront the huge tasks of improving health and education.

"Good health is an essential pre-requisite for equitable development and fair globalisation," says Tanzanian President Benjamin Mkapa.

Africa remains by far the world's poorest continent, with millions of its people living on less than $1 a day.

As well as killing many Africans each year, infectious diseases pose a devastating threat to economic development.

Economic blow

Malaria costs Africa up to $100bn (62.4bn) a year in lost productivity, five times more than annual development aid received.

Health is no longer considered as a black hole that you're pouring money into, but actually is considered as a critical element of a country's growth
Alex Preike, World Bank

The disease kills 1 million Africans a year, consumes 40% of the continent's health expenditure, and accounts for half of all hospital admissions.

"A lot of absenteeism is due to malaria at school and at work," says Ann Kichoi, a Kenyan health worker with Amref, which provides such simple preventatives as mosquito nets.

But there are welcome signs that policy makers in Europe and Washington are taking a more positive view of spending on health and education.

This a shift from their past focus on making health and education ministries balance their books by charging fees.

Western indifference?

"Health is no longer considered as a black hole that you're pouring money into, but a critical element of a country's growth", says Alex Preike, World Bank health department chief economist.

The task of tackling diseases of poverty is huge, matched only by the lack of research into them.

Pharmaceutical firms have developed 1,700 medicines approved for clinical use in the last 15 years.

Gold miner working below ground
Nearly 10% of South Africa's work force has HIV

Yet only 11 were targeted at tropical diseases.

The cost of the HIV/Aids epidemic is incalculable.

As a song by Zimbabwean musician Oliver Mtukudzi says, "Everyone around us is dying. Who will be left to mourn?

"Who will feed us when all the breadwinners are dying?"

The only imaginable catastrophe bigger than this "is the end of the world," says Dr Tom Mboya Okeyo, who heads Kenya's national Aids control programme.

About 28 million Africans are now living with HIV/Aids, which has become the biggest cause of death in sub-Saharan Africa, the UNAIDS agency calculates.

Fighting disease

But some countries, notably Uganda and Senegal, have shown that determined efforts can bear fruit.

Nigerian president Olusegun Obasanjo with G8 leaders, June 2002
African leaders fear G8 nations have other priorities

John Rwomushana, deputy director general of Uganda's Aids Commission, says levels of infection have dropped to 8% of adults from 19% a decade ago.

The secret of Uganda's success has been "political commitment at the highest level coupled with an openness about the problem", he says.

Globalisation means "this problem will not just be restricted to Africa", says Dr Okeyo.

"It will spill over to the other continents," he says.


If there is one single intervention that will bring about change in Africa, it is getting a generation of children educated.

African governments are increasingly ready to recognise this by ditching school fees written into past macroeconomic policies agreed with international donors.

Kenya's newly-elected government has become the latest government to abolish primary school fees, following the example of Uganda in 1996 and Tanzania in 2002.

Children playing in a school yard, Democratic Republic of Congo
Cutting primary school fees is boosting class sizes

"We came to the conclusion that this is such a fundamental matter that we have to go straight away and implement free education," says Kenyan education minister George Saitoti.

But although better education boosts economic growth, it can stretch budgets in the short term.

At one primary school I visited in Dar-es-Salaam, the popularity of free schooling means up to 180 pupils in each class.

For now, the policy means more spending.

"We are trying to recruit teachers, we are trying to construct the classrooms," says city education officer Winnifreda Kalyo.

And there is no guarantee that educating people will bring benefits to Africa unless something is done about the brain drain that is stripping the continent of skills and talent.

"It costs 100,000 or more to train a doctor - if you lose thousands of those you are actually giving foreign aid to another country," says Patrick Wilmott, a Nigerian academic who works in London.

While he likens the situation to an anaemic patient giving blood, Malawi's Aids director uses stronger language.

He says British hospitals who hire Malawian nurses are "killing this country".

Corruption stranglehold

There is less consensus about how to halt the flow of talent abroad.

The challenge is not getting people to be against corruption, it's getting them to start with themselves
John Githongo, Kenyan presidential advisor

Rather than blame developed nations, Africa must tackle the corruption which stifles talent, says Kenyan political scientist Professor Ali Mazrui.

"The policies of our governments, they make it really difficult for people to feel....that they are being recognised, and some of them feel harassed," Mr Mazrui says.

In a vicious circle, this loss of talent also encourages corruption, he believes.

"The challenge is not getting people to be against corruption, it's getting them to start with themselves," says John Githongo, the head of Kenya's newly appointed anti-corruption unit.

African leaders have put tackling corruption centre-stage in Nepad, a partnership with developed countries in which they have pledged to meet Western codes of transparency in exchange for aid and investment.

Through Nepad, African leaders have asked the developed nations for up to $64bn of aid.

The challenge in the months to come will be to make sure that Africa's needs do not get sidelined once more by war and humanitarian crises elsewhere in the world.

BBC World Service Radio will broadcast the final programme in Adam Lusekelo's series, "A Fresh Start for Africa?" on Thursday 6 March.

Africa's ambitious reform agenda
21 Feb 03 |  Business
UN targets Africa's poverty
16 Sep 02 |  Business
Africa fine-tunes development plan
05 Jun 02 |  Business

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