As the world's poorest countries, particularly in Sub Saharan Africa, fall behind their developed counterparts, their citizens are faced with seemingly insurmountable obstacles. Extreme poverty, fatal illnesses, and deplorable conditions make the prospect of becoming a global player extremely daunting. You can actually take a look at how far some countries have fallen - in terms of setbacks in wealth and health - by checking out www.gapminder.org. There you'll see that while many have managed to build health and wealth during the last generation, Africa's nations have fallen even farther behind. The statistics should give the Obama administration pause, and provide a springboard for a radical reworking of our foreign aid approach (if Paul Farmer is confirmed to direct foreign assistance, this will happen.
Although difficult, creating wealth and prosperity in these impoverished nations is not impossible. It cannot be done through traditional aid or microfinance alone; it is clear that heath care must be an integral part of any strategy for success.
Here's why: by definition, a sustainable economy enables countries to survive independently. Loans and donated resources from the U.S. and other nations can, at best, jump start economic progress if properly managed (unfortunately, these may also foster corruption and inefficiency). However, in order to create a truly viable economy, countries must pay attention to factors that are often overlooked, such as the health of their workforce.
Diseases such as AIDS, tuberculosis, malaria, and neglected tropical diseases continue to make that difficult to achieve for much of the African continent. Together, these diseases result in millions of lost work days (and millions of lives lost).
Malaria alone costs upwards of $12 billion in losses annually, eating up an estimated 40% of health expenditure. Without a cure, productivity will continue to decline significantly. Couple the impacts of that disease with others, and the inaccessibility of maternal health care and family planning, and the sustainability of the continent's economies hangs in the balance.
While we must focus on improving adult workers' health, we must also strive to ensure that children are taken care of as well. In Rwanda, where over 57% of the population is under the age of 20, poor health disproportionately affects the young. An estimated 23% of children are underweight, 45% suffer from moderate malnutrition and 19% are severely malnourished. More than one in 10 children dies before reaching the age of five. Without healthy children, African countries suffer both macroeconomically and microeconomically. When household-level health is a day-to-day tragedy for millions of families, its impacts at the community and national level weigh heavily on development.
Despite major challenges, the health situation in Rwanda is ripe for change. Almost 15 years after the genocide, the country is stable, national unity has been restored, rates of violence and crime are low, and infrastructure has been rebuilt. Earlier investment in Rwanda's health care system has already borne fruit. The Access Project, which began working in Rwanda several years ago, today provides management support to 79 health facilities that serve over two million people. When I started the project there, it was with a team of expatriates. Today, it's completely Rwandan-led. Since the start of Access's work, the nation has seen a major uptick in its health, thanks to Government of Rwanda plans and support from partners. In just the past two years, for example, family planning utilization has increased from roughly 10% of the population to nearly 27% -- that's one of the greatest leaps in the history of maternal health.
That's a start, but much more needs to be done. New business initiatives, agricultural and craft cooperatives, public/private partnerships, and relationships between Rwandan and foreign investors all point the way to creating a new prosperity and an African middle-class. Prosperity and investment are tough to come by in nations that have malaria and AIDS epidemics. By controlling those, donor organizations and governments can go a long way in establishing an agenda for cultivating business. The data doesn't lie: sickness and poverty have grown together during the last few decades; we now have a chance to turn the tables and foster health and wealth. The playing field is now wide open for the Obama Administration to take the lead.