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Health:
The Africcan example (VI)
Universities have space for only a tiny fraction of secondary school
graduates and competition to secure admittance is intense. Those who are
admitted are not guaranteed a good education, however. University libraries
are often poorly stocked and, most critically, lack up-to-date scientific
journals. Computers are few and Internet access rare. Most campuses were
built in the 1950s and 1960s and have deteriorated, the more so because of
limited funds for maintenance. The quality of higher education is also
affected by frequent student protests over issues ranging from poor living
conditions to politics. On many occasions governments have responded with
force and closed campuses for considerable periods of time. While faculties
are usually of high quality, with many members having been trained in Europe
and North America, the conditions severely constrain what they can do. As a
result, many look outside Africa for employment, which contributes
significantly to Africa’s brain drain.
Health
A combination of new diseases and reemerging old ones is putting the lives
of millions of Africans in serious jeopardy. At the top of the list is
HIV/AIDS, which is devastating much of sub-Saharan Africa. National health
services are under serious stress as more and more funds and personnel have
to be devoted to treating and caring for AIDS victims. This has drawn
attention and resources away from other health problems, such as malaria and
other infectious diseases. While various environmental and social issues can
be identified as the cause of these afflictions, the real culprit is
poverty. Until poverty is controlled, Africa’s health situation will remain
precarious, and doubly so for the most vulnerable: children.
HIV/AIDS
To date, more than 70 percent of the victims of HIV/AIDS worldwide have been
Africans. The world’s first case on record is traceable to a plasma sample
from a man who died in 1959 in the Belgian Congo (present-day DRC), but
clinical identification of the disease was not possible until the early
1980s. By then it had already reached epidemic proportions, with Uganda and
Rwanda as the epicenter of occurrence. In subsequent years, the epicenter
moved progressively southward, and now Botswana and South Africa are seeing
the highest rates of infection. As yet, HIV/AIDS has progressed more slowly
in West Africa, with the exception of Côte d’Ivoire, which has been hit
hard. Rates are increasing, however, especially in Nigeria. West Africa also
has cases of HIV-2, an apparently less virulent strain of HIV that seems to
result in lower death rates. Few cases of HIV infection have as yet been
reported in North Africa.
Two modes of transmission account for virtually all cases of infection in
Africa. The most significant has been heterosexual intercourse. Spread of
the virus has been facilitated by a tradition of men having multiple sexual
partners. The increased mobility of the African population has also helped
the spread of HIV. The earliest lines of transmission were along roads
carrying heavy truck traffic, with the infection points being rest stops
where prostitutes served truckers. Both populations soon became infected and
began spreading the disease to others.
As it has progressed, infection rates have grown more rapidly among females,
especially younger ones. Several factors are responsible for this trend.
First and foremost, condom use is limited, either because its protective
value is unknown or because it is disliked. In addition, teenage African
girls often start their sex lives with older men—whether married to them or
not—who are more likely to be infected than boys their age. At the same
time, as knowledge of AIDS has spread, men have sought to have sex with even
younger girls in the belief that they will not already be infected. And, in
many large cities such as Nairobi and Cape Town, cases of rape are on the
rise.
The increase of HIV among women brings about the second major mode of
transmission, which is mother-to-child. More and more babies are entering
the world infected, and many healthy newborns are infected through their
mothers’ milk. Transmission through homosexual sex and intravenous drug use
are uncommon in Africa.
In general, African governments have been slow to respond to the HIV/AIDS
epidemic, or even to admit that a problem exists. Two significant exceptions
are Uganda and Zambia, where efforts to halt the spread of HIV/AIDS date to
the mid-1980s. The Ugandan program has been especially effective, and the
disease there is receding. Zambia has also begun to see infection rates fall
among its most vulnerable population, pregnant teenagers.
The impacts of the HIV/AIDS epidemic are many and far-reaching. Countries
where rates are very high, such as Botswana, will soon notice a “missing”
adult population, leaving the country numerically dominated by the elderly
and young. Numbers of orphans are on the rise, an unusual situation in
Africa, where extended families and communities traditionally provide
childcare. The missing adult population has already begun to affect economic
productivity across the board, whether on farms or in factories. The
teaching profession has been especially hard hit. AIDS is now by far the
leading cause of death among teachers in the Côte d’Ivoire, and Zambia has
found it cannot replace the number of teachers who have died or fallen ill.
Malaria
Often called the “silent killer” due to the lack of attention it receives,
malaria is spread by the bite of the female Anopheles mosquito. Worldwide,
the disease afflicts between 300 million and 500 million people annually,
and 90 percent of the cases occur in tropical Africa. In terms of mortality,
children under age five are the most vulnerable group, with some 700,000
dying in Africa each year. This death toll exceeds that from AIDS. Adults
are less likely to die from malaria, but still suffer from the sickness.
Infection often peaks during the rainy season, and higher rates of bedridden
workers affect the agricultural productivity of families, communities, and
nations. Experts estimate that the annual costs of malaria treatment and
lost productivity due to malaria total between $2 billion and $3 billion for
the continent as a whole.
The World Health Organization (WHO) began malaria control programs in 1948,
spraying mosquito-breeding sites with insecticides and administering
antimalarial drugs. For a time, it appeared that the disease might be
eliminated, or at least brought under control. But since the late 1970s
malaria has resurged. Mosquitoes have developed resistances to insecticides,
as have the malaria parasites to traditional chloroquine-based antimalarial
drugs. Urban malaria is spreading, largely as a result of the growth of
squalid shantytowns that provide numerous pools of standing water where
mosquitoes can breed. Civil conflict and natural disasters such as floods
are other contributors to malaria’s spread. The seriousness of the problem
led the WHO and other international groups to launch Operation Roll Back
Malaria in 1998. This operation aims to intensify monitoring, prevention,
and treatment efforts, with the ultimate objective being the development of
an antimalarial vaccine.
Other Afflictions
Tuberculosis is another age-old disease that has become more widespread
since the early 1980s, largely because it is a common opportunistic
infection in AIDS cases. Drug-resistant varieties of tuberculosis are making
treatment more difficult for all sufferers.
Cholera, once uncommon on the continent, is now endemic in Africa. Outbreaks
are associated with contaminated water supplies, and contamination has
become ever more common in both rural and urban areas.
Malnutrition is another widespread health problem among infants and young
children. Many babies are born underweight, often because their mothers
suffer from malnutrition. Studies have shown that many African children
experience a slowdown in growth following weaning, when their diet suddenly
shifts from high-protein, high-energy mothers’ milk to predominantly starchy
foods. Malnourished children often develop protein-energy malnutrition
conditions such as marasmus (essentially infantile starvation) and
kwashiorkor, characterized by body swelling. Both conditions can be fatal,
the latter often in association with infectious and parasitic diseases such
as measles and malaria, as well as diarrhea.
Economy
Since prehistoric times, the majority of Africans have been farmers and
herders who raised crops and livestock for subsistence. In precolonial
times, a few African states developed long-distance trade networks based on
the exchange of raw materials and some specialized local goods. Starting in
the 15th century, European colonization of Africa brought overseas demand
for certain agricultural and mineral products. The colonizers built new
transportation networks and introduced technological innovations and new
crops. At the same time, they exported millions of able-bodied Africans as
slaves, exploited African labor within the continent, and undermined local
industries, crafts, trade networks, and governments. By the mid-20th
century, European colonies in Africa had established one-way trade systems
in which Africa’s wealth of raw materials were exported to enrich foreign
coffers, with little regard for development within Africa.
As decolonization began in the late 1950s, the African economy was divided
into two distinct sectors. Most of the population took part in the
traditional rural sector, which featured subsistence production of food and
simple manufactured products. The remainder was involved in a relatively
modern sector, based in cities and mining and plantation centers. There,
Africans worked for wages, producing mineral or agricultural raw materials
for export to industrialized countries. Although people in most rural
communities earned some money from seasonal work in the cities and modern
industrial centers, the two sectors were largely separate.
In subsequent decades, African governments pursued various economic
development initiatives in an attempt to improve the living standards of
their people. In many countries, these efforts led to the growth of
manufacturing of consumer goods and other products. Services—in education,
health care, civil services, and other areas—also grew in economic
importance.
Development efforts led to a greater degree of interaction and movement of
people and money between the modern and subsistence sectors of the African
economy. Yet, by the early 21st century, the sectors were still far from
integrated. Most of the population still pursued traditional subsistence
activities, which continued to provide sustenance for the majority of
Africans. At the same time, despite increasing levels of industrialization
in many countries, Africa’s raw materials continued to be produced primarily
for export.
Traditional Subsistence Sector
Despite economic development efforts, the traditional subsistence sector is
a constant in the African economy. In general, the majority of African
people farm, herd livestock, fish, make handcrafted products, and trade
their goods much as they have for hundreds of years.
Farming is by far the most important subsistence activity, and it dominates
rural production in the tropical forest and tropical savanna zones of West,
Central, and southern Africa. Traditional agriculture is basic and at best
yields enough food and income for the household to survive. The average
rural household has no access to scientifically improved seeds, farm
machinery, or sophisticated methods of farm management. On most African
farms, the soil must be worked with hand tools or small, animal-drawn plows.
Use of artificial fertilizers is almost nonexistent. Insects and vermin are
constant threats, sometimes eating away more than half of the crops. Farmers
raise crops primarily to supply food for the family. However, there may be
small surpluses, and these are sold to purchase other foods and essential
goods.
Cottage industry employs close to one-third of the rural labor force, not
counting the many farmers who also engage in this activity on the side. It
is largely responsible for the local supply of clothing, footwear, farm
implements, and construction materials, as well as for processed foods. This
sector also produces crafts, cloth, jewelry, and decorative artifacts to
sell to tourists in urban areas and at tourist attractions.
Small-scale commerce, taking place in small, often periodic, markets, is
vital to people’s sustenance in Africa’s rural areas. At these markets,
rural Africans sell crop surpluses and cottage industry products to traders
who, in return, sell them goods such as spices, condiments, kerosene (for
domestic lighting), soap, matches, batteries, clothing, and spare parts for
bicycles and carts. The small-scale traders then sell the crops and
manufactured products to larger-scale traders. These small-scale traders
have played a crucial role in bringing the subsistence sector into the
larger economy by buying farm products and making consumer goods available
to the rural producer.
Migratory herding, based on extensive and frequent movement of livestock,
declined in importance over most of Africa in the second half of the 20th
century. The area required for migratory herding has been greatly reduced as
pasturelands have been taken over for agriculture—particularly modern
plantations—and wildlife reserves. Fishing is a minor subsistence activity
in most of Africa because of a general scarcity of good fishing grounds and
because most of the continent’s rural population lives in the interior.
Development of the Modern Sector
The modern sector of the African economy was developed largely by Europeans
during the colonial period and geared toward the export of raw materials.
Industrialization was minimal. After independence, many African governments
pursued industrialization programs with varying success. Today, African
nations face the challenge of expanding their economies to fulfill the needs
of their people while maintaining their profitable export-oriented
activities.
Colonial Economy
The colonial economy was centered around isolated agricultural and mining
centers in which foreign-financed and foreign-managed firms employed local
labor to produce raw materials for export to Europe, North America, and
Japan. Colonial administrations started most of the important large-scale
farming and mining activities: for example, cotton growing in the irrigated
Al Jazirah (Gezira) region of Sudan, rubber growing on plantations in
Liberia, coffee growing in Côte d’Ivoire, Ethiopia, and Kenya, and copper
mining in Zambia.
For a variety of reasons, colonial economies did not focus on developing
industry to produce finished goods for local consumption. First, markets for
finished goods in Africa were small. Second, mineral and agricultural raw
materials, for the most part, were not processed in Africa, or were only
minimally processed to ease shipment to ports. Third, since African
industrialization was largely initiated by European firms, it was not in the
firms’ interest to create competition for their own products in Europe.
Fourth, in the case of some countries, both the colonial and later African
governments kept the exchange rates of their currencies too high, making
imported consumer goods more affordable.
South Africa and Zimbabwe were two distinct exceptions to this general lack
of industrialization. South Africa had been administered by settlers of
European descent since the early 20th century. The size and technical skill
level of the settler population—combined with relative autonomy from
colonial powers—supported greater economic development, making it possible
for industrialization to succeed. In the case of the colony of Rhodesia
(what is now Zimbabwe), the white minority regime faced world sanctions for
its illegal takeover of the government in 1965, and was forced to embark on
homegrown industrial development to meet its own domestic needs. At
independence in 1980, Zimbabwe had one of the most developed economies on
the continent, second only to South Africa.
Colonial export-oriented industries did make some positive marks on the
African economic landscape. They introduced important innovations in
transportation, banking, marketing, trade, and many commercial services.
They also led to improvements in government administration, agricultural
practices, health care, and education. However, these innovations were not
intended to modernize Africa as a whole. Instead, they were primarily
concentrated in and around a small number of principal ports and trade
centers, which usually also served as colonial capitals. This unbalanced
system gave rise to tremendous disparities between developed urban centers
and the rural sector.
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SATURDAY, NOVEMBER 4 2006