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)
I have decided to leave Zimbabwe via Voices of Africa.
A few paragraphs are worth replicating:
…In fact, when all my peers and former school mates left I stayed because I was patriotic to the land. I saw a future where others couldn’t see one. I told myself that whatever we were going through as a country would soon come to an end and that in no time things would be better…
…Then I started realising something about the republic.
No one cares for the public. We have dirty water in the taps and no one cares. We have erratic supply of electricity and no one cares. The roads are in shambles and no one is doing anything about it. Fuel prices go up and we can’t do anything about it. New taxes are introduced and we can only comply. Internet is very expensive. The public hospitals, the ones which we can afford, provide crappy service and people are dying because the nurses don’t care. I know because I watched my mother-in-law die at the hands of poor service delivery. And no one cares. Not them, not you, not the minister of health. No one. The company CEOs get treated outside the country now. But what about me? What about my kids?
…And guess what, my children have to grow up in such an environment and go to schools whose teachers don’t even know why they are doing what they do.
I am sick and tired of it all.
Surely I wasn’t born to suffer. I just want a better life, that’s all.
**The article first appeared on 263chat**
Remember my post here about 10 things President Peter Mutharika could do to help Malawians? Remember the part about the Malawian government applying for a developmental loan from the African Development Bank and / or a few select countries?
Well, look at what Kenya has done:
Or as the African Development Bank (AfDB) itself puts it on their website,here, US$133 million when the loan was approved. Still a decent sum I think, which if properly utilised can go a long way.
According to the AfDB:
..the funds will finance the Last Mile Connectivity Project that aims to maximise the use of the Kenya Power and Lighting Company’s (KPLC) 35,000 existing distribution transformers spread across the country. The total project cost is estimated at US $147 million, with the Government of Kenya contributing the remaining US $14 million.
The Last Mile project has three components: (i) construction of the distribution network including installation of energy meters for the connection of residential and commercial customers; (ii) project supervision and management; and (ii) capacity-building activities, which include training KPLC technical staff to operate and maintain the distribution system.
The proposed project will cover the entire country with selected transformers in 47 counties and expected to directly benefit low income groups, largely in counties with the lowest penetration rate. At least 314,200 customers, which would translate into approximately 1,571,000 people, will have access to electricity. By providing increased electricity access, the project will contribute to improved living standards among targeted households in terms of education, health and access to information. As for small businesses within the project area, the project will also help increase their competitiveness and ability to expand activities.
Excellent. A connected and powered Africa is a stronger Africa. Great stuff. Good for them!
On the day that I saw the above message on Facebook, I also saw this, titled “Malawi, Africa Countries Snub ‘Un-African’ Proposals At UN CSW Meeting” which has the following two paragraphs:
“There were issues of comprehensive sexuality education, and abortion among others and it was proposed that a child should be taught about issues surrounding sexual life from the age 0 – 4, and that the girl child should not be restrained from having sexual intercourse as long as she is old enough,” explained Makungwa.
She added, “So as Africans, we stood our grounds because we found such proposals very un-African and as for other proposals such as that of homosexuality, we clearly told the meeting that as a country, the matter was referred to the public for debate.”
While conservative leaning churches would probably be pleased with these kinds of headlines, to me a more pressing issue is troubling.
Who gets to decide who makes the law? Or rather, who gets to decide who dictates public policy? Is it the people of an African country, its government or the donors and financial backers who must map public policy?
As a black person living in Britain, I’m always appalled when the rights of minorities are denied by popular sentiment, or by religious / perceived pseudo-religious beliefs of the majority. But in this case, I find it extremely difficult to reconcile the fact that when less than 50 years ago the law in the UK forbade homosexuality, you now have what amounts to ‘carrot demands’ by what are probably western organisations pushing young African democracies to legislate or support similar laws to those which in the West took hundreds of years (and murderous mistakes) to properly form. Irrespective of African culture and other considerations.
It’s a bit hypocritical isn’t it? In my terribly (un)imaginative mind, it sounds a bit like a man mouthing off in the London Underground voice ( ‘Mind the Gap’) : It took us 500 years to overturn these laws, it must stake you less than 40…” Tasteless.
Further, on the list of what should be priorities (hunger, disease, poverty, education, rights of women, etc) of African leaders, where does LGBT rights feature? Is it really sensible to ask a presidential candidate to support gay rights when half his country’s population is starving, when the country has poor public health facilities, hospitals without medicines, when crime is compratively high (than in most western countries), when illiteracy levels are high, when there are poor educational prospects in the country, an unacceptably high number of women continue to die in childbirth, when unemployment is high, and when corruption is rife in both the public and private sector?
Wouldn’t it be wiser to allow the political leaders of African countries some leeway for what will probably be a slow but organic natural transition? As opposed to applying forced catalysts whose motives are not entirely clear.
Mystery surrounds proceeds from Madonna’s Malawi health projects via Malawi Today
Last week a well written article appeared on Al Jazeera arguing against the false and somewhat misleading picture of Corruption that is often put out by the western media. In it, it was suggested that over $900 billion a year is lost from developing to developed nations through tax evasion and illicit financial outflows. While this is a major problem for Africa, as was pointed out several years ago by Kofi Annan here, another reason which results in these outflows is that very few major industry (million dollar revenue generating) in Africa is in fact owned by Africans.
The combination of imperialist colonial legacies, poverty, a lack of capital, insufficient education, corruption, plain hypocrisy and other factors has resulted in a state of affairs whereby even capable Africans find it hard to buy into and run their continent’s biggest industries. While there are many Africans doing well in business throughout Africa, they are by far in the minority, and comparatively too few of them on the ground, than say the number of Canadians who own and control multi-million pound ventures within Canada, or say the number of Portuguese who own and control multi-million dollar companies in Portugal.
Thus, this picture inevitably creates an opportunity or gap for foreign corporations and investors to come in, and sweep away ownership of the whole lot – armed with huge amounts of capital. No surprise the profits end up everywhere else but in Africa…
In my view, far from the land grabs of Robert Mugabe (which others have tried to justify – see here and here), another reason in support of more Africans owning their continent’s industry is that doing so could mean that large amounts of money remain on the continent, to be used for education, health -building hospitals and providing good wages for doctors, eliminating poverty, fighting corruption, policing and security, building infrustracture, improving the plight of women, investment in the youth, creating jobs, etc. It means essential capital is not being wired out to already rich countries. This in my view is a better strategy against poverty, than aid and handouts, whose monies are comparatively miniscule to the monies being siphoned from Africa.
According to the website of Britannia Mining Inc (a US company with operations in Canada and Malawi) here, the Nthale Iron Ore surface deposits which they found before 2009 are estimated from their geological survey to be at least 4.6 million tonnes in quantity. As often happens with these things, especially if we focus on the word ‘Surface’,in practice the deposits can be far larger than the estimate.
Last Friday, on the 7th of February 2014, before close of trading the price of Iron Ore on the international market was hovering around $125 per ton (see latest figures here). Whichever way this price goes (whether up or down) the next few years, 4.6 million tonnes at $125 per ton is still worth at least $575 million, a hefty sum by any measure. Even if we go with the 68% iron ore component indicated on their website, that’s still worth $391 million
Suppose Britannia Mining invested $100 million into Malawi, to cover processing the Ore, overheads including construction, logistics, wages, corporate governance activities, etc, (and it was proved that they had indeed invested such sums because sometimes businessmen overestimate the level of investment when the truth is much lower) I’d think the benefit to the Britannia would be significantly higher and disproportionately in their favour than in the favour of Malawians. Looking at previous examples of resource conflicts involving corporations in Africa, I seriously doubt that first they would invest such sums. Further, I doubt that Malawians or the Malawian government would benefit equally or at least proportionally from the resource. Which begs the question, who actually owns the resource?
As many others have opined elsewhere (see this for example), the unrestrained greed and unguarded capitalism of western businesses in Africa is causing a lot of damage and harm to Africa, and Africans. And that’s even before we get to what China is doing…
Even if the market price of Iron Ore dropped to say below $100, (say it dropped to $65, which is highly unlikely – the last time it hit $100/ ton was back in Aug 2012, and that was only for a very brief period of time), there would still be at least $300 million worth of deposits to be mined.
Don’t you think if the company that was exploiting the deposit was owned or part-owned (say 50%) by the Malawian government, or a group of Malawians, that the majority of the benefit of the resource would remain in the country, as opposed to being wired out of Malawi?
Post Paladin, and the tax outrage they caused when it was revealed that the Malawian tax authorities were missing out on tax revenues worth $200 million, how much tax have Britannia paid to the Malawian government so far, and how much have they made out of Nthale? The reason that question is crucial is because no level-headed Malawian is keen to see Malawi descend into a chaotic easy target where rich corporations (which are already wealthy and well resourced) come into the country and make billions, while the local population remains poor.
And if governments across the world do not speak against unrestrained greed, who will, seeing most governments in Africa are headed by people who have neither the will nor inclination to do so…?
In my view, Africa needs trade partners who will help rebuild the continent, and not those looking for a quick buck, irrespective of the ethics of the means of acquiring that buck.
If you are looking to make money quick, stay away from Malawi. We don’t want get rich quick capitalists or investors. What Malawi needs are Responsible Capitalists, as opposed to a Liberal and unguarded Capitalists – a badge which brings to mind Halliburton’s Iraq heist (or even ILLOVO’s tax avoidance fiasco – ILLOVO [which is British owned via Associated Foods Limited] is company that last year posted a 43% rise in profits per share), an incident which it is fair to say has probably been responsible for not only much suffering, but also global unrest.
Depending on who you ask, its undeniable that corporate wrongdoing is currently happening, and the continent of Africa is being systematically ripped off. Yet there has to come a time when the tide turns, and the wrongdoing is forced to stop (sadly it’s not going to stop voluntarily). In the words of the African Development Bank president Donald Kaberuka here:
“The reality is, Africa is being ripped off big time …“Africa wants to grow itself out of poverty through trade and investment – part of doing so is to ensure there is transparency and sound governance in the natural resources sector”
In my view this means rectification, and possibly includes learning lessons from those whose policies do not exacerbate the already bad situation; lessons from the likes of Brazil instead of blindly accepting unfair and discriminatory terms from organisations such as the IMF – whose policies towards the poor countries couldn’t be said to be favourable for local ownership of industry.
Maybe Malawi’s mining sector has more to learn from the likes of Vale and Debswana. Debswana is 50% owned by the Botswana government and 50% owned by De Beers. Vale is the world’s biggest producer of Iron Ore, and their profits recently doubled (Interestingly, in the same article Vale says the price of Iron Ore would hit $130 per ton, which it did, confirming the plausibility of my above little theory). They’ve seen an increase in production, which last year hit 73.4 million tonnes of Iron Ore. They are also a major tax contributor to the Brazilian government, with recent tax payments of $9.6 billion, far greater than anything any corporation have had to pay to an African government.
- Inequality in post-apartheid South Africa
- Sugar Coating Exploitation
- UK businesses prepare to cash in
- Playing with Children’s Lives: Big Tobacco in Malawi
- Brazil – Repression against indigenous peoples has become a systematic practice
- Mandela’s Unfinished Revolution