Rethinking Africa's Health, Part I

The Future of American Power
May 28 2012 5:03 AM

Rethinking Africa's Health, Part I

makoko slum
A mother navigates her family through waterways in the Makoko slum in Lagos. Venice it ain't.

Photograph by Pius Utomi Ekpei/AFP/Getty Images

To anyone familiar with the back streets of Dakar or Nairobi – or countless other of sub-Saharan Africa’s mega-cities – a disconnect between the “macro” story and hard-scrabble reality is always top of mind. World Bank historical data sets for Nigeria, for instance, paint a very positive story if one confines the examination to the Nigeria country page on the Bank’s website.

·         Primary school enrollment, life expectancy and per capital gross national income all follow an upward trajectory since the 1980s.


·          The percentage of Nigerians living above the poverty line has improved from 43 percent in 1985 to nearly 55 percent today.

·         Where only 30 percent of the rural population had access to a decent water supply in 1990, 43 percent are judged to have it today.

As with statistics that told Europeans and Americans that their respective recessions ended in 2009, however, these numbers can ring rather hollow in African ears.

Float in a makeshift boat through the Lagos Lagoon in the slum district Makoko, for instance, and you confront the scale of this disconnect. Some 90,000 Lagosians live in Makoko, a former fishing village now comprising tens of thousands of jerry-built stilt houses. Waste goes directly into the lagoon, and with the nearest water source a three kilometer paddle away (and costing up to 3p for a 10 liter bucket), too often the lagoon also serves residents’ potable needs. Medical care is virtually nonexistent, and except in severe cases, on a fee-for-services basis.

The "basket case" image is a distorting one, however, and increasingly professionals at the policymaking level, development field workers and AID recipients themselves want this changed. For one thing, it has created a “silo” approach to Africa’s health problems, walling off particular diseases (malaria, HIV-AIDS) at the expense of dull, long-term capacity building that must happen if the continent is to avoid stumbling from one epidemic to another.

If one's sole window into the continent is the western media, basically you'll get mostly bad news about African health care, of course. The imperatives of selling newspapers (or attracting clicks) requires a certain degree of drama, and the NGOs and charities that often form the primary sources for this reporting are incentivized to highlight the negative. This is as it should be: They do ‘God’s work,’ in a strictly catholic sense. But frankly it is not nearly the full picture.

Indeed, as I keep saying, clumping the unique and often contradictory trends of sub-Saharan Africa’s 48 countries is statistically nonsensical and risks missing enormously important trends. For instance, the World Bank’s commercial arm, the International Finance Corporation, is helping highlight the investment opportunities in certain African health care sectors, a sector growing quickly and more open than many to foreign investment. Not much ink on that.

Foreign Affairs last week published a deeply interesting article by Thomas Bollyky, a Gates Foundation advisor and former US trade negotiator, marvelous job of squaring these two realities. It’s behind a pay wall, but in summary, Bollyky argues coordinated action to confront communicable crises like HIV-AIDS, malaria or tuberculosis must be part of the world’s approach to global health. But by ignoring far greater, non-communicable problems, he says, we doom Africans to low life expectancies and fail to create the impetus for reform and behavioral changes that could be transformational.

“When most people in developed countries think of the biggest health challenges confronting the developing world, they envision a small boy in a rural, dusty village beset by an exotic parasite or bacterial blight. But increasingly, that image is wrong. Instead, it is the working-age woman living in an urban slum, suffering from diabetes, cervical cancer, or stroke – non-communicable diseases (NCDs) that once confronted wealthy nations alone,” Bollyky writes.

Charities know that raising money for exotic disease eradication in the west is a good deal easier than, say, funding upgrades to substandard cardiac facilities. Yet the later is the real win in the long run. Unless you’re a card-carrying member of the late Jesse Helms’ “foreign rat holes” school of development aid, it is blindingly obvious that Africa must be helped to help itself, not kept alive on a drip feed of pennies collected in UNICIF milk cartons.

The epidemics are horrific, of course. But a billion people live on this continent, many of them in countries increasingly able to invest in their own capacities As western aid drops – and drop it already has since 2008 – neither the US nor Europe can afford any longer to allow their hearts to dictate priorities. Time for the brain to take charge.

Part II Tomorrow: The “Silo” Effect



Crying Rape

False rape accusations exist, and they are a serious problem.

Scotland Is Just the Beginning. Expect More Political Earthquakes in Europe.

I Bought the Huge iPhone. I’m Already Thinking of Returning It.

The Music Industry Is Ignoring Some of the Best Black Women Singing R&B

How Will You Carry Around Your Huge New iPhone? Apple Pants!

Medical Examiner

The Most Terrifying Thing About Ebola 

The disease threatens humanity by preying on humanity.


The Other Huxtable Effect

Thirty years ago, The Cosby Show gave us one of TV’s great feminists.

Lifetime Didn’t Find the Steubenville Rape Case Dramatic Enough. So They Added a Little Self-Immolation.

No, New York Times, Shonda Rhimes Is Not an “Angry Black Woman” 

Brow Beat
Sept. 19 2014 1:39 PM Shonda Rhimes Is Not an “Angry Black Woman,” New York Times. Neither Are Her Characters.
Sept. 19 2014 1:11 PM An Up-Close Look at the U.S.–Mexico Border
  News & Politics
Sept. 19 2014 6:22 PM Blacks Don’t Have a Corporal Punishment Problem Americans do. But when blacks exhibit the same behaviors as others, it becomes part of a greater black pathology. 
Sept. 19 2014 6:35 PM Pabst Blue Ribbon is Being Sold to the Russians, Was So Over Anyway
Inside Higher Ed
Sept. 19 2014 1:34 PM Empty Seats, Fewer Donors? College football isn’t attracting the audience it used to.
  Double X
The XX Factor
Sept. 19 2014 4:58 PM Steubenville Gets the Lifetime Treatment (And a Cheerleader Erupts Into Flames)
  Slate Plus
Slate Picks
Sept. 19 2014 12:00 PM What Happened at Slate This Week? The Slatest editor tells us to read well-informed skepticism, media criticism, and more.
Brow Beat
Sept. 19 2014 4:48 PM You Should Be Listening to Sbtrkt
Future Tense
Sept. 19 2014 6:31 PM The One Big Problem With the Enormous New iPhone
  Health & Science
Medical Examiner
Sept. 19 2014 5:09 PM Did America Get Fat by Drinking Diet Soda?   A high-profile study points the finger at artificial sweeteners.
Sports Nut
Sept. 18 2014 11:42 AM Grandmaster Clash One of the most amazing feats in chess history just happened, and no one noticed.