When donors sponsor war

But these days, there seems to be more money for donors interested in regime change, than there is money for real issues that affect people such as poverty alleviation, improved living standards and education which can made a serious and strategic difference in combating disease. Contrary to widespread belief, total donor support for disease control in Africa has been meagre in recent years, and poor countries lack the financial means to address their public health crises. The result is that, despite existing technology, each year millions of people are dying in Africa and other hard hit regions with consequent economic, political and social turmoil.
One summary measure of health, the number of children that die before the age of 5 for every 1 000 births, remains staggeringly high at 172 deaths in sub-Saharan Africa compared with just 6 in the high-income countries.
Global donor support of US$10-20 billion per year, much less than 0,1 percent of the combined US$25 trillion gross national product (GNP) of the rich nations, would save millions of lives each year and would enable Africa to escape from a downward spiral of disease and economic collapse. But the latest developments in Libya, Cote D’Ivoire, Sudan, Uganda, Somalia and other African countries, have shown that many developed countries like United States of America, France, Britain and Canada would rather sponsor wars that disease control in Africa.
They would rather destroy that existing little infrastructure in a war in these developing countries- the only centres of service delivery – with bombs and guns to effect regime change but do not put similar efforts in improving health service delivery.
The economics of public health in the poorest countries are stark. Sub-Saharan Africa has an average annual income of US$500 per capita, and if one excludes South Africa with its US$3 000 per capita, the average falls to just a little over US$300 per capita.
Governments of poor countries, even when not strapped for cash by debt crises, are rarely able to master 4 percent of national income for public health, and the average is around 1,8 percent for sub-Saharan Africa (excluding South Africa). But even 4 percent of the GNP would leave a country with a US$300 per capita annual income with just $12 per person in health spending.
That allowance would have to address the multiple and interlocking crises of HIV/Aids, malaria and tuberculosis (TB). There are also acute respiratory infections, diarrheal diseases and various vaccine-preventable diseases in under-immunised populations, which claim several million lives per year.
South Asia is in a similar bind, with very low public health spending per person in an impoverished region, though the disease ecology is somewhat more benign than in sub-Saharan Africa.
The donor community has talked about support for disease control for decades, but action has been much less than promise. Specific programmes have been well advertised and highly successful – most famously smallpox eradication and more recently the dramatic reduction in polio incidence and the successful battle against onchocerciasis (African river blindness).
However, the larger truth is that healthcare has been shockingly under-funded. According to the data of the Organisation of Economic Co-operation and Development, the scorekeeper of official development assistance, the global donor community gave all of sub-Saharan Africa just US$836 million in aid for health during 1999, or roughly $1.30 per African, added on to the meagre sums that African governments themselves can muster.
Donor support for HIV/Aids control programmes for sub-Saharan Africa averaged a paltry US$70 million per year between 1996 and 1998, even as the pandemic surged. Since then the figures have been dwindling and by 2011, the figure became largely insignificant, to the extend that its is now a mockery to talk about donor funding on disease control when compared to what is spend at war.
Total official development assistance was in the order of US$3 per HIV-infected individual in Africa.
The results are plain to see. In virtually every sphere of public health in Africa there has been regress rather than progress. Immunisation rates declined in many parts of the continent during the 1990s.
Malaria has been resurgent, reaching into urban areas such as Dar-es-Salaam and Accra which were essentially free of malaria in earlier generations. Harare seem to be get worried about malaria too.
Most dramatic of all, HIV/Aids has swept through the continent, especially in southern and eastern Africa, leaving behind a cumulative 17 million dead and 12 million orphans, with an estimated 25 million people now HIV-infected, 3,8 million new cases in 2000, and an estimated 2,4 million deaths during the year.
The inequities of global health have been dramatised as never before by the lack of access of HIV-infected Africans to life-extending highly active antiretroviral therapy (HAART).

l Dr Munthanga Mutigari is a medical practitioner in Kenya. DayAfrica.com