Offline: Africa does not need a Prince Charming

Abstract

By the end of this century, one in three people on our planet will be living in sub-Saharan Africa (today, the proportion is one in eight). Yet this profound shift in population power carries with it little agreement on what should be done to secure the future health and wellbeing of African peoples. Economists are divided. Olusegun Obasanjo (President of Nigeria, 1999–2007), together with several Africa experts, published his prescription for the continent this month (Making Africa Work: a Handbook, Hurst). Their analysis is rooted in a deeply negative diagnosis. Africa continues to suffer from patronage-ridden political systems, violence, poverty, poor governance, failed states, social chaos, and aid dependency. The only way out is through fundamental change, strengthening the private sector, and learning from other countries. By striking contrast, Morten Jerven (Africa: Why Economists Got It Wrong, Zed, 2015) argues that African nations have not been the persistent failures so many (including Obasanjo) suggest. Jerven sees the period from postcolonial independence (the early 1960s) to the oil-price shocks of the 1970s as one of impressive economic growth that surpassed the rest of the world. The slowdowns or reversals of the 1980s were not due to bad policies enacted by incompetent governments. On the contrary, they can be largely attributed to externally imposed crises, such as one-size-fits-all structural adjustment programmes. It was these neocolonial inflictions that caused poor governance, incentivised corruption, and triggered aid dependency. The pessimism that infects so much allegedly informed opinion about Africa today is mistaken. With such wildly opposite conclusions, is it any wonder that politicians and policy makers might be confused about what they should do to realise the hopes of Africa's citizens? Kenya is an example of a country caught between these two conflicting visions. Pessimists could point to the re-run of a bitterly contested presidential election on Oct 17, which is raising extreme political tensions; a 3-month-old nurses' strike; and economic growth forecasts that are now being revised downwards. Optimists, meanwhile, might point to the construction of a KSh500 million health complex in Kilifi, with state-of-the-art cancer treatment and intensive care facilities; an internationally admired ban on plastic bags; and a growing reputation for devising home-grown solutions to the country's challenges—the African Population and Health Research Centre (APHRC) in Nairobi, led by Alex Ezeh, was rated the premiere African thinktank for domestic health policy in 2016. The APHRC has made a huge contribution to policy capacity-building in Kenya, with 370 completed PhD degrees over the 19 years of Ezeh's leadership. At the launch of The Lancet's Commission on the Future of Health in sub-Saharan Africa at the APHRC in Nairobi this month, Siddharth Chatterjee, UN Resident Coordinator in Kenya, argued that the country could lead the way towards Africa's goal of universal health coverage. The major conclusion of our Commission backed Jerven's more positive analysis of Africa's opportunities. Closing the health gap for Africa within a generation is achievable. Nelson Sewankambo put it this way—“evidence-based optimism, with caution”. Dr Tedros, WHO's Director-General, endorsed the Commission's findings and recommendations. “This report is central to the future of health in Africa”, he wrote. None of us present in Nairobi were complacent about the challenges ahead. Africa is not a single entity, and health predicaments will require historically and culturally contextualised solutions. A report by itself will not change anything. Advocacy, investments in higher education, and regional cooperation will be essential. And evidence must be applied with appropriate accountability to ensure that promises and commitments are fulfilled. Ezeh vacates his position as Executive Director of APHRC on Oct 1, 2017. In another sign that Africa is embracing a very different future, he is to be succeeded by Catherine Kyobutungi. We will be working with Catherine and the Commission to deliver on their recommendations. At the first meeting of the Commission in 2013, lead author Irene Agyepong noted that some see Africa consisting of “sleeping beasts under the influence of a wicked fairy hoping for a Prince Charming”. As she intimated, Africa is not bewitched by an evil spirit. It does not need a Prince Charming. In Ezeh's words, it's time Africans believed more in themselves and the work they do.