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 American philanthropist and Microsoft cofounder Bill Gates.
Gates 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,” he said.
He argued 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.
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.
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.
Gates said lessons could also be learned from Ghana – “another African country that could serve as a model for development in both health and agriculture”. “It has been among the continent’s best examples on vaccination.”
In 2012, with assistance from the vaccine initiative, GAVI Alliance, Ghana simultaneously rolled out pneumococcal and rotavirus vaccines – according to Gates this was the first time any African country had introduced two vaccines at the same time.
Moreover, he said African countries such as Zambia are demonstrating that encouraging declines in malaria are possible where governments take determined action.
“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.”
*The author is Mail & Guardian Health Editor