The other day, i saw this – news headline in one of the local papers in Malawi
“I did it out of desperation,” said Devi, 25, as she lay on the concrete floor recuperating at the clinic in the state of Bihar. “We’re so poor, we need the money. Health officials came to our home. They told us it would be best.” India’s Poorest Women Coerced Into Sterilization, More here
In 1982 the Malawi government under Dr Hastings Kamuzu Banda approved the introduction of the National Child Spacing Programme as part of an overall Maternal and Child Health Programme. The goal of the Programme was to reduce maternal, infant and child mortality by lengthening birth intervals thereby promoting the health of mothers and children.
The lengthened birth intervals were a population growth management strategy designed to reduce the number of children born to a woman, which in theory would result in smaller families across the country. Health NGO such as Banja La Mtsogolo (BLM) fronted campaigns including the ‘Man to Man’ campaign as a way of creating awareness among men about their responsibility in family planning.
Recently, an increased population has created challenges for governments across Africa as to how they will best serve their ballooning populations. Such challenges include the need to create sufficient jobs, the need for adequate healthcare services to cater to the people, and the need to mitigate against hunger and drought in the event of insufficient or late rainfalls, or in the event of flooding as has happened in Malawi this year. Further, there is a need for infrastructure development in the form of houses, hospitals and schools to serve such a population.
In Malawi, with a population that has grown from around 10.38 million in 2000 to 16.36 million in 2013 (an increase of about 36.5 % in 13 years), it’s easy to see how the issue is problematic in the long run, because Malawi is a small country which is already struggling to properly serve its current inhabitants, the majority of whom live in rural areas. So if the country is currently struggling to serve its current population, how will it cope with millions more added each year?
While I’ll admit that there are many facets to the issue of population growth and planetary resources – some not so pleasant, refusing to acknowledge that a large population in Africa could have negative consequences upon our economies across the continent if not managed properly, is tantamount to ignoring the problem, if not living in denial.
And you can’t compare with other continents for example Europe or Asia because Africa has faced different dynamics to those which built Europe, or helped the likes of China expand economically.
On World Population Day last year, Tighisti Amare, a manager of the Africa programme at Chatham House, writing for the Guardian posed a question whether population wasn’t to blame for Africa’s high youth unemployment? He concluded his article by saying:
“The relationship between population and youth unemployment is complex. As populations expand, a concerted effort needs to be made to avoid the destabilising factors that result from youth exclusion and lack of equitable growth. To do this, African countries need to address the systemic issues behind the problem through transformative economic policies and social sector spending.”
Transformative economic policies and social sector spending…
I believe it is the responsibility of African governments (already burdened by relatively small economies that contribute comparatively little to their tax coffers) to begin instituting transformative measures of population management now as a way to ease the added pressure population growth has on African countries, just as China did in 1979 with its one child policy in regards to its population (a policy that is said to have averted at least 200 million births between 1979 and 2009).
In particular, I think Women empowerment policies fall within the social sector that could be used to achieve this aim.
For example, what about a women’s empowerment initiative whereby a woman who had given birth no more than 3 times would be eligible for a government grant of say between $200 – $400 a year, for a maximum of 7 years? The less children a woman had, the more money they would be eligible to claim.
In Malawi where the average salary is less than $200 (some estimates puts it between $160 to $170 a month), the funds would go some way to enable women in the rural areas to better their lives be it to start a microbusiness, invest in better crops that demand higher prices in the markets, or generally supplement their incomes.
It wouldn’t be a free lunch, because there would be a need for certain conditions to protect the initiative against abuse.
Off the top of my head, the initiative would need to be managed by Aid Agencies and Civil Society Organisations, and not directly by the government:
(i) Each recipient must live in the rural areas, and not in the major cities. The reason is that the project should be designed to help those people in the rural areas, who are in worse economic situations, often plagued by acute poverty, and not people who live in the cities. Further, people who live in the rural areas are more likely to have many children, than their compatriots in cities.
(ii) This initiative will apply only to those women who have not given birth more than 3 times.
(iii) The money must be used sustainably (and not given to husbands – to waste on Kachasu). Here I think some kind of checks would need to be established by the facilitators of the scheme to ensure that the grants are not being squandered.
(iv) The funds will be paid to each eligible person over four instalments. The eligible women must attend classes four times a year on topics such as balancing family and work, managing money, sustainable agriculture and related topics before receiving each instalment, so there would be an educational angle to the scheme.
(v) Each woman would be assisted to open a bank account (if they don’t already have one), and the funds would be paid directly into the bank account. This could help bring banking services to the unbanked, so the project has an added advantage to the government and the financial sector. Alternatively the initiative could use mobile money as a means of disbursing funds.
Now, I must state that I’m not a big fan of using monetary incentives to enforce public policy any more than I’m a fan of using threats, fear and intimidation to do the same. Further, each woman must have the right to decide on what size family they want.
But with the current financial situation in Malawi, maybe monetary incentives such as described here could be used to achieve a number of aims collectively, including fighting poverty. As always, the big question is who will fund it? Where will the money come from? And I must say that is something the authorities will need to look at.
But I think in a deeply religious country such as Malawi where some religions preach against contraception, and where H.I.V has had a destructive effect on communities the last 30 years, an empowerment initiative in the lines described above which has a potential to bring some sections of the informal sector into the formal sector could go some way towards encouraging smaller and healthier families.
However, I’m not a healthcare specialist so this is a purely theoretical exposition. To what extent such an initiative would be effective is an entirely different question, although I’m certain such an initiative is far more humane than some of the other population management policies documented elsewhere.
- THE GOAT AS A TOOL IN POVERTY ALLEVIATION (cop-ppld.net)
- Why China’s Second-Baby Boom Might Not Happen (bloomberg.com)
Protecting Moms and Babies in Malawi (Infographic) – (Partners in health)
Save the Children 2015 report: A Wake Up Call: lessons from Ebola for the world’s health systems
You can be a Christian, Muslim, Hindu, Budhist or Atheist, or none of these, but one thing you will all agree to is this: that there is no justification whatsoever for a leader of a country (his family, his ministers and families) to go overseas to a wealthy country to seek medical treatment, while his country’s people – who elected him to power, and most of whom are poor – make do with underresourced, understaffed and in some cases dangerous hospital facilities at home.
Yet this is what has been happening in Africa for at least 50+ years. Yes, thats right: 50 bloody fat years. Dictators and the anti-colonialist strongmen of the colonial and post-colonial era did it, at considerable public expense. Now their successors – politicians of governments in multiparty democracies who like to dress up in expensive western clothing and are accustomed to lavish lifestyles are doing exactly the same. While their poor countries continue sliding down, becoming poorer.
To the list of Zimbabwe, Malawi, Ethiopia and Zambia, add all the others you know of, whose leaders are guilty of this behaviour.
Emmanuel Fru Doh, in his book Africa’s Political Wastelands:The Bastardization of Cameroon puts it like this:
‘Another area that shows how a people with resources end up exploited and deprived by their own government primarily, is health. Like Everything else in Africa, the health facilities have continued to shrink such that today one cannot even tell if anyone cares any longer about the system – its perpetrators and the victims, government officials and the public. One cannot help wondering then why all in Africa must keep rotting away in spite of the quality manpower and all else that the continent has to offer in every area of society, if not because of a system of government, borrowed from imperialists, that alienates instead of uniting the citizens. But then it dawns on one again, that this decay in the area of health is the case because the corrupt leaders can afford to fly to foreign nations for medical check-ups while the wretched of their nations are left to make do with sub-standard medical care. Why must a president, his clients, and members of the their families leave their country for medical consultation overseas instead of investing wisely by building and equipping hospitals that would benefit their nations? The answer is simple: most African leaders are not patriots and are unfortunately equipped with a weird sense of self-importance that only has meaning when they see others around them without the facilities they enjoy, albeit criminally in most cases. Ofcourse, but for greed, it would be easy for the World Health Organization and other international institutions making so much ado about helping poor African countries to start by making it impossible for African leaders to get medical treatment anywhere else but in their own countries. …’
Instead of trekking to Asia, Europe or the US for treatment, why not spend your country’s meagre resources upgrading its healthcare infrastructure, so that it is on par or better than the health services in Europe, Asia or the US? If Cuba can achieve that, with all the pressure their economy has been under the last 50+ years, why can’t African countries do the same.
Surely, medical equipment is not the obstacle, because there are many sources of alternative approved medical equipment which is cheaper yet just as functional as much of the equipment in first class hospitals around the world.
Money also is not the issue because most of these governments lose hundreds of millions (if not billions) to corruption and other factors, meaning the money is there, it’s just being mismanaged.
So what then is the problem? Ian Taylor, Extraordinary Professor at the University of Stellenbosch, South Africa, writing on the South African Foreign Policy Initiative (SAFPI) website has this to say:
Of the ten African heads of state that have died of natural causes in office since 2000, only two actually passed on in their own countries. And of these two, both had been receiving medical care abroad and effectively returned home to die. In other words, not a single African head of state who has died in the last ten years of natural causes had any confidence in his own country’s healthcare.
The phenomena of African presidents dying abroad is truly a disgrace and reflects the failure of Africa’s leadership to seriously invest in healthcare provision. Quite simply, in many African states the elites have not bothered to provide public health leadership and management, have not invested in sufficient health-related legislation and the enforcement of such laws, have proven inefficient in resource allocation and use, and have systematically undermined the provision of adequate national health information and research systems.
A failure to invest in national healthcare systems has then led to extreme shortages of health workers, exacerbated by inequities in workforce distribution (with a strong urban bias) and subsequent brain drain.
Leaders haven’t bothered to fix hospitals or bring in legislation that will protect those hospitals, to ensure that they are well resourced and well-funded, or otherwise up to scratch. Taylor goes on to note that:-
Rampant corruption in procurement systems and inefficient supply systems then combine with unaffordable international prices to produce shells of “hospitals” where one has a greater chance of contracting something extra than being cured of one’s existing ailment.
So then, why haven’t African people taken their leaders to task about all this? Taylor again:
Elite survival comes from access to rents to distribute to patronage networks and thus retain key support, not on investing in services. Investment in such national infrastructure and the advancement of policies that benefit broad swathes of the population is not required in many of Africa’s neo-patrimonial regimes.
This has a direct impact on policy formulation. Why bother spending money on building and maintaining hospitals (or schools or universities) when one can fly to European hospitals to be treated—or send one’s kin abroad for education? Within the logic of many extant African regimes, it makes no sense to invest in public ventures. That’s what the gullible donors are for!
So African politicians know that even if they don’t fix hospitals or bad infrastructure, so long as they pay chiefs and other power brokers who help them maintain popular support, their hold on power is not threatened. Further, their irresponsible logic takes their people for granted by assuming that donors should be the ones fixing the hospitals? As if the people in those countries voted for donors…
But if not impunity and contempt for their own people, what else explains leader’s like Mugabe’s actions (see this silly speech here, which he gave after returning from a holiday in Asia – where he and with his family received medical check-ups and underwent treatment)?
What explains Mugabe’s behaviour when others, including one ZANU PF politburo member and former Midlands governor, Cephas Msipa, have refused to seek medical treatment abroad:
“Do we really have to go outside the country for treatment? We should be proud of our own health care services,” he said during the official handover ceremony of a US$1 million casualty ward at Gweru Provincial Hospital last year. He went on to say that:-
“Our doctors and nurses are capable and compete well with other health professionals in other countries. There is no need for people to go to India and other countries to seek medical attention because our own practitioners are equally competent.”
Now, I’m not saying that circumstances will not arise that necessitate the expertise of an overseas specialist in a particular medical area to be sought. Indeed expertise from specialists in various medical fields must be sought. But that’s not what is happening across Africa.
Another commentator who goes by the name Dr Given Mutinta says that medical trips abroad are ‘used as an opportunity to thank ‘good’ bootlickers to the big shots in government.’ Writing on the Zambian Watchdog he says:
If truth be investigated, how many government officials would want to use personal money to pay for medical treatment abroad when they leave office, if at all they would still have the money they are stealing? Besides, how many before coming into power sought medical treatment abroad? What has changed in the past three years they have been in power that they cannot be treated locally?’ noting that ‘These medical vacations are also a scheme government officials are using to embezzle public funds‘ an allegation I have encountered numerous times. He poses the question: ‘What are the kingpins at the Minister of Health, Dr. Joseph Kasonde and Dr. Chitalu Chilufya doing to promote local capacity, strengthen the health sector, improve fiscal policy on medical equipment and monitor medical tourism?’
I think Africans must ask such questions to their public officials. Upcoming and progressive African leaders need to take note of these repugnant anomalies in African politics, and find effective and sustainable ways of preventing what is not only a wanton waste of public resources, but also a violation of the trust of African people. To do this obviously means enacting legislation that will not only protect the healthcare sector, but will ensure that doctors and nurses are paid living wages that remunerates them adequately.
- The Dying Abroad of African Leaders (Mail & Guardian)
- Meles Zenawi: Is It Wise for African Presidents to Go Abroad to Die (African Sun Times)
Sometimes when you read a foreigner’s experience in your country, it helps you appreciate the scale of the problem you (and your country folk) are faced with…
Improving care in the NHS, as well as Africa Cure International hospitals such as the one in Blantyre, Malawi, not only transform locals’ lives – they also afford British medics invaluable experience.
Hit-and-run victims, children with catastrophic burns, a train crash that saw 40 passengers brought into A&E – life for Jim Harrison as a registrar in Blantyre, Malawi, in 1999 sounds like a particularly intense episode of ER.