The Challenge for Africa (9 page)

It is always inspiring to watch famous or wealthy people stretch out their hands to help the poor. There are few well-known Africans who could command the same level of attention from the international media, donor agencies, or governments as Ms. Stone and others like her from the United States or Europe can. Some celebrities, such as Bob Geldof and Bono, who was also in the room that day, speak out forcefully about how current economic and political systems continue to harm Africa—views that they can take to any elected leader in the world and get some results. Nevertheless, once such international personalities have done their part, it is up to the African leadership and people to make sure the resources that result are used appropriately.

Still, while sufficient funding is important—for instance, to purchase bed nets—in my experience development success isn't only about money; if it were, Africa would have solved
many of her problems years ago. Since 1960, the Organisation for Economic Co-operation and Development (OECD), for example, has provided more than $650 billion in development assistance to sub-Saharan Africa.
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And yet, every year, approximately eighty thousand children below the age of five in Tanzania die as a result of malaria;
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one-fifth of all child deaths in Africa are caused by malaria;
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and in 2005, according to the World Health Organization, 90 percent of the nearly 900,000 deaths from malaria were in sub-Saharan Africa.
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Why is preventing and treating malaria not a major concern of African governments? Does any government or individual in Africa need to be persuaded to protect children from preventable diseases? Why do individuals not develop policies and habits that are sustainable and effective for dealing with the disease?

The reason for this examination is that much of sub-Saharan Africa has an environment conducive to mosquitoes and the malarial parasite. In fact, it's been suggested that the spread of Islam in Africa southward beyond the Sahel was curtailed by the incidence of malaria. Bed nets save lives, and they should be widely available throughout Africa; the same is the case for twelve-cent antimalarial medicines.
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Yet, up to now, it seems as if ordinary Africans have not understood the value of bed nets in preventing malaria—especially for their children—enough to purchase them, if they can afford the four dollars, or to seek them out from government health workers if they cannot. Cultural norms at the local level may dictate that only the man of the household, or only the adults, can use bed nets, even though the principal objective of making the nets available is to protect the children. Communities also may not be aware that bed nets don't offer perpetual protection: if they tear, they need to be repaired or replaced, which may put them out of the reach of poor households.

This lack of attention or understanding appears to be the case with many African governments and media as well. Why
haven't governments directed that information about the importance of bed nets in preventing childhood malaria be part of the school curriculum in the countries of Africa where malaria is common, so that children, their parents, and communities all understand that malaria is a killer and that combating it requires embracing a set of actions to protect themselves?

It is clear that a gap exists between the concern expressed about preventable diseases in Africa by development experts and that evidenced by African governments and the peoples themselves. In my experience, both middle-class urban-dwellers and rural parents have not taken seriously the need to prevent these diseases, and, if an infection occurs, to seek immediate treatment, including for children. Likewise, the leadership in Africa has not paid enough attention to these diseases, or successfully sensitized a critical mass of the African people about their deadly nature and encouraged them to take steps to reduce the toll.

Most Africans rarely hear about such illnesses from their ministers of health unless an international development expert comes bearing money or bed nets—at which point the minister is eager to talk about the particular disease the donor is concerned about. One might ask: Why do diseases seem to hit the national headlines only when there is an unusual outbreak, or a new donor-funded effort has been launched, as opposed to being a significant issue for journalists to report on regularly? Why should it take foreign experts working for foreign development agencies and funded by foreign donors to convince the majority of Africans that they should take the problem of deadly but preventable diseases seriously? There are doctors and nurses and community health workers in Africa, but one doesn't see them breaking down the doors of their respective governments to make the case for urgent action to combat malaria and other preventable diseases.

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.
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But they may not know how deadly malaria also is—and that, perhaps worse, it may even increase the progression of the HIV virus.
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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.

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.