Sustaining inequities in Global Health funding

GLOBAL HEALTH

We have reached in that phase of life where our imagination of foreign cultures, traditions, and certain practices should have changed for good. Technology boom in the last two decades has fused the world, bringing international boundaries and communities to a close proximity. We now have command of what we want to know and when we want it. We know events world over the moment they happen and share our emotions of happiness or empathy of it as global citizens on social media.

With this proximity, one would imagine that we are becoming acquainted with and appreciative of our differences. But it appears that the closer we get, the more we become conscious of persistent global inequities.

It is accurate to say that the major social innovation of our generation is the discovery of the internet. Because of this innovation, the volume of global wealth has increased. The 2013 Credit Suisse Global Wealth report shows that global wealth has increased to a new height, standing at USD 241 trillion, a 4.6% increase from the previous year, representing 68% increment since 2003. And there is great hope that global wealth will increase by 40% to USD 334 trillion by 2018. The CSGW measures and analyses trends in wealth across nations, from the very bottom of the “wealth pyramid” to ultra high net worth individuals.

Despite the increase in global wealth, global inequalities have also expanded. According to World Bank, 95% of the world’s population is surviving on less than US$10 a day. The poorest 40% of the world’s population account for 5% of global income. The richest 20% account for three-quarters of the world’s income. UNICEF estimates that 22,000 children die daily due to poverty. There are over 40 million people living with HIV in the world today and 80% - we are told - live in Sub-Sahara Africa.

These trends reveal that the wealth being created is accumulating in the hands of few individuals, moreover within a specific geographic locations – Europe, Australia, Japan and North America.

With increasing global wealth, there is also increasing global inequality and inequities. Ironically, the countries where much wealth is being accumulated are also countries which lacks in almost every ingredient for the wealth that they accumulate. They do not have sufficient mineral wealth; they suffer from harsh periodic weather conditions and endure some of the worst natural calamities such as hurricanes and so forth.

The poorest areas in the world are also the richest in resources; Gold, Oil, Diamond, Cobalt, Coltan, Uranium, Timber, Grass, Rain forests, fertile soil, great weather, steady supply of solar energy, fresh water bodies, rivers, and exceptional spread of coastal lines, among others.

Over the years, I have thought so hard about the gloom that befell Black Africa since civilization era. The racist global world order has set low expectation for black people. In 2011, the American Republican Party students held a bake sale at University of California, Berkeley. They baked cakes for sale and coloured them according to racial composition of America. For pricing, the White cakes were $2, followed by Asian cakes for $1.5, the Latinos for $1 and the blacks cakes were priced lowest, at $0.75.

Although the cake sale organizers claimed that they were showcasing realities of racism and inequities in American society, they made their point.

The wealth of the world has been distributed in a similar unequal manner. It is reflected in resources and funding for global health. Usually diseases considered to be for white people including its medical research attract large funding. When it comes to funding for diseases and conditions considered affecting predominantly Black communities, the story changes –  always series of debates followed by long unexplained delays until a crisis level is obtained. A clear example is the politics behind securing sufficient funding for HIV/AIDS research and treatment of Malaria, Tuberculosis and other tropical diseases.

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Disband NAADS to revitalize Rural Economies

RURAL ECONOMIES

In his State of the Nation address, President Museveni reiterated his frustration with the National Agricultural Advisory services (NAADS). This is not the first time that the President has expressed his disappointment with NAADS. The President expressed his frustration with NAADS during the NRM anniversary where he threatened to disband the entire group. And I agree!

NAADS has not only frustrated the President, but the entire Nation. But that is not unusual. Every government agency created to mediate and to deliver services to the country, has failed. This is partly because most of them are created with a mindset that they are a political strategy, not an engine to remove barriers.

Politics, rather than needs, do drive these agencies and the President should pay much attention to this approach. Every government agency is susceptible to mismanagement and corruption. The moment they are set up, their problems begin with the political interference in its administration. Then tribalism and sectarianism creeps in. Trust that in any organization where most of it’s officers are employed for political convenience, it will not deliver. Worse still, when the favor is forecasted on one ethnic base, corruption and the employment of rudimentary traditional ways of handling affairs will be customized. NAADS, like all other government agencies suffers from this disease.

The solution to NAADS is to disband it so as to revitalize Farmers’ Cooperatives. By disbanding NAADS, we shall have done away with this wasteful “middle-man” such that the NAADS resources can be delivered directly to Farmers’ Cooperatives based on specified needs of farmers. It is easier to identify and isolate poorly managed Cooperatives and deal with it than with NAADS.

Further, the National Agricultural Research Organization should be reoriented to meet the direct needs of the farmers. Much of the NAADS money should be used to provide agricultural extension services and direct trainings to the farmers while distribution responsibilities shall be accorded to Cooperatives. Much of the money can be used effectively to improve storage, extend rural electrification and for importation of farm implements for modernization of farming.

The priority of the country right now should be revitalization of rural economies. There are unlocked potentials in rural communities which require some little support in infrastructure and agricultural services. Already in the Countryside the VSLAs are doing very well with very limited external support.

In Pajule, for instance, the average cost to hire a tractor to plough one acre of a garden is between 60,000 - 80,000/= depending on demand, it could be higher. If the farmer has 3-5 acres, the overall cost of using a tractor becomes counter productive in the long run. This is because government tractors which were promised during the 2011 Presidential elections are not accessible to majority of farmers. In fact, I never saw any of those tractors being used anywhere in Pader district during my extensive exploration of the district.

NAADS has also been associated with too much politicking and favouritism. Rural farmers believe that NAADS provides their services to known NRM supporters who are already doing well. Those who are established are given more while those who are struggling are neglected. I believe that government agencies should not be partisan because every Ugandan pays taxes, and at least every Ugandan is party to foreign debts that Uganda accumulates to fund its agencies.

The real deal for the wasted NAADS money will be found when wise investments are made in revitalizing Farmers’ Cooperatives. There proof that revitalization of rural economies is being fundamentally driven by Farmers’ organizations. The government can support this by delivering to the Farmers the tools and facilities they need for their production and ensuring that farmers contribute in shaping the produce markets.

Unfortunately, NAADS is too wasteful and will not deliver as a middle-man between government and rural farmers. There is need for revitalization of Farmers’ Cooperatives and investing in them directly.

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Indictment of Millennium Village Projects

 Millennium Village Projects

The debate raging on between Microsoft guru, Bills Gates and the world celebrated microeconomist, Jeffrey D. Sachs of the Earth Institute at Columbia University touches on the core of Global Health. (Refer to Uganda’s The Independent magazine: Why Jeffrey Sachs matter by Bill Gates and; Why Bill Gates gets it wrong by Jeffrey Sachs – May 31, 2014). These debates provide an indictment for the millennium village projects – a brain child of Jeffrey Sachs in his quest to end poverty in Africa. In reality, this debate is an indictment of all foreign interventions that have been conceived from western capitals or institutions and imposed on Africa.

Here, Bill Gates reiterates the critiques of the Millennium Village Project contained in a book by Vanity Fair writer, Nina Munk titled The Idealists: Jeffrey Sachs and the Quest to End Poverty (Published by Random House Inc, NY). The book reads very easily as a narrative in a novel but not as one of those methodological and glossy text books.

The debate between these two philanthropists is much welcome in the world where transparency and imperialist agenda appears transposed. No doubts, both men have used their influence and resources very generously to better the causes of humanity and to liberate Africa from its sorry conditions of persistent hunger, ill-health and poverty. Having dished out over US$28.6 billion in grants payout so far, Bill Gates is perhaps, the most committed person in the world, in this struggle against dehumanizing conditions in Africa and elsewhere – and that is where his leadership in Global Health matters.

Given the much negative evaluation that the MVP is attracting, one needs to fully understand the problems with such programs. While they are ethically sound, well intentioned, meticulously executed and located in places where they are most needed, they fail to deliver on their ultimate aims and objectives and instead exacerbate those same problems they are intended to resolve or rectify!

The MVPs were designed to improve living conditions in villages and to bridge the gap in social services where governments in those countries have failed. MVP went about into populations building health centers, schools, libraries, teaching modern farming methods, providing health education, distributing mosquito nets, drugs, providing immunization services, and extending communication systems in countries such as Malawi, to end isolation, in Dertu (Northern Kenya) where Ms Munk found it to be of no essence, they constructed markets - and did more.

Furthermore, the MVPs are a welcome intervention for theory testing, but it ends at that. The lessons that Jeffrey Sachs and his colleagues should have learned about Africa and such impositions are numerous. The WB/IMF imposed the much dreaded structural adjustment programs which, instead of uplifting African nations from debts, it achieved the exact opposite effect. Thereafter, every program, whether by the EU, US or China imposed on Africa have continued to defy sustainability and collapsed the moment the dollar support is ended.

As scholars and global health leaders, the main areas of concerns before any investment is implemented should be about locals’ buy-in and sustainability. Often, these philanthropists do not pay much attention to any of the crucial factors such as cultural fit of their programs and the fact that human societies are not homogenous, that so each program requires customizing. Failure to include diversity in these theories, from a non western calibration is also the beginning of their failures.

Interestingly, for an economist like Dr. Sachs, he fails to understand the complex nature of poverty, its various tenets and manifestations. In general, he makes it appear that the nature of African poverty has eluded many in the Western capitals.

This explains why Western-prescribed solutions appear to address universal poverty as experienced in the West – deprivation. An influential analysis of rural poverty in Africa was well articulated by Patrick J. Muzaale in the Journal of Social Development in Africa in 1982. In his seminal work: Rural Poverty, Social Development and their Implications for Fieldwork Practices, Muzaale explicates different typologies of poverty and those that are specific to rural Africa. The MVP experience is perhaps the major lesson that Bill Gates and Jeffrey Sachs can use to teach the western world about the complex nature of poverty in Africa.

Lastly, I commend the efforts of Nina Munk. Had she not been diverted with the obsession to critique the MVP too early, she could have done the most relevant work for the success of MVPs. Her initial intentions to capture the voices of the underprivileged recipients of the MVP whose inputs were excluded and yet were crucial. Without these voices, the MVP project will remain experimental and will collapse the moment the MVP dollars dry out like all other projects before it.

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