Unless Africa dramatically decreases its rates of malnutrition and premature mortality, it will not achieve the productivity levels necessary to compete in the global marketplace, according to US philanthropist and Microsoft cofounder Bill Gates.
He was speaking at the Addis Ababa University on Wednesday, where he received an honorary doctorate.
“The reason for this is straightforward: there is no path to lasting growth in Africa that is not widespread growth. It’s not possible. If Africa seeks prosperity, it must provide for the health and nutrition of all – including the poorest,” Gates said.
He elaborated that if African countries wanted to rise from low-income to middle-income status, health and agricultural development was vital. “In fact, any sensible definition of what it means to be a middle-income country should go beyond the per capita income numbers and include some measure of achievement on basic human needs like health and nutrition.”
Gates quoted a recent global commission of leading economists that found a strong connection between health and national prosperity. “About 11% of the economic growth in low-income and middle-income countries from 1970 to 2000 resulted from reductions in adult mortality,” he said.
The malaria catastrophe
As an example of the catastrophic impact of diseases that have not yet been eradicated in Africa, Gates referred to malaria. “Malaria kills more than 600?000 people a year … But it actually understates the problem – including the calamitous economic costs of the disease.”
Malaria infects about 200-million people, of whom probably more than 99% survive.
At best, the survivors have to miss school or work for extended periods. At worst, they suffer lifelong disabilities, including cognitive impairment that virtually guarantees they’ll never reach their full potential.
Even when malaria and other diseases don’t take children’s lives, they can steal their future – and slow the progress of a nation,” said Gates.
According to him, Ethiopia has set the example for investment in health by tripling its health expenditure since 2000, and investing significantly in agriculture. The evidence of this, Gates added, can be seen in the country’s per capita income that has tripled over the past decade and a half.
Ethiopian health ministry figures show that the country’s under-five mortality rate fell by 67% from 1990 to 2012, meaning that the country met this millennium development goal before the required deadline of 2015.
Millennium development goals are eight goals with measurable targets and clear deadlines for improving the lives of the world’s poorest people. In 2000, 189 countries committed to achieving these goals.
The development goal for child mortality is to reduce the number of children dying before the age of five by two thirds, in each of the countries, between 1990 and 2015.
In 1990, Ethiopia’s under-five mortality rate was one of the highest in the world at 204 for 1 000 live births; by 2012 this rate had been slashed to 68 for 1 000 live births, according to government figures.
According to the South Africa’s 2013 Millennium Development Country Report, the country’s under-five child mortality rate increased from 38 for 1?000 live births in 1998 to 67 for 1 000 in 2007.
However, between 2007 and 2010 it declined to a level of 57 deaths per 1 000 live births. In order to reach this millennium development goal, South Africa would have to reduce this figure to 20 for 1 000 by 2015.
Decrease in Aids deaths
A study published in the Lancet medical journal this week highlighted that the number of South African children who died due to Aids-related illnesses has decreased 10 times over the past decade and HIV infections in children under five have dropped by more than three quarters.
Experts believe this would have impacted visibly on the country’s under-five child mortality rates when Statistics South Africa releases its mortality report later this year.
Community workers’ roles
Many analysts, including Gates, have ascribed Ethiopia’s success in decreasing its under-five mortality rates to the country’s introduction of community health workers through its Health Extension Programme in 2004.
“The federal government recognised that if it was going to make good on the millennium development goals, it was going to have to expand access to primary healthcare across this large, predominantly rural country,” Gates said.
“It identified the geographical gaps in health coverage, and went about filling those gaps, deploying more than 38 000 health-extension workers [community health workers] – nearly all of them women – in over 16 000 health posts nationwide.”
According to the Ethiopian government, the country has a severe shortage of doctors. Health extension workers are therefore assigned to “local health posts” to provide “essential interventions to meet population health needs at this level”.
These workers are recruited among high school graduates and undergo a one-year training programme. They provide family health services, disease prevention and control and health education in even the most remote parts of the country.
No thanks to ‘ghost workers’
In sharp contrast, South Africa’s Free State health MEC Benny Malakoane dismissed the province’s 3?800 community healthcare workers in April, declaring them “ghost workers” and claiming the province can’t afford them.
According to the Aids and HIV lobby group the Treatment Action Campaign, the workers earned R1 400 a month.
“We know that if a country in Africa is not improving in health, or not producing enough food, its first reaction should not be to seek excuses, or scapegoats, or rationalisations,” said Gates.
“No, the first reaction should be to learn from your neighbour. Because that country has as many challenges as you do – but it also has good ideas that you can adapt to your own circumstances. The rise of this continent will depend on whether its leaders – here in Ethiopia and all across Africa – are open to learning from each other, and from their own people.”
Mia Malan is Bhekisisa's editor-in-chief and executive director. Under her leadership, Bhekisisa’s online readership increased 30 fold and its donor funding eightfold between 2013 and 2019. Malan has won more than 20 African journalism awards for her work and is a former fellow of the Reuters Institute for the Study of Journalism at Oxford University.