(November 2000) Sub-Saharan Africans stand to benefit from the fulfillment of several goals for improving the welfare of the world's poorest people set by the international community for the next 15 years, but internal conflict, HIV/AIDS, and cuts in donor contributions are just some of the barriers to success.
The Millennium Summit, held at the United Nations in September, is the most recent international forum to set an agenda for reducing poverty, including that of the 300 million people south of the Sahara who, according to the World Bank, live on barely 65 cents a day. The Summit drafted a wish list long enough to keep health and development workers busy for a long time. It would be easy to dismiss its conclusions as naively optimistic.
Goals Include Reducing Maternal and Child Mortality
The pledges are not new. The issues related to maternal and child mortality, in particular, reinforce goals set by major UN conferences of the 1990s, including the International Conference on Population and Development (ICPD) in 1994 and the Fourth World Conference on Women in 1995. By 2015, the 150 world leaders at the Summit promised:
- To reduce maternal mortality by three-quarters and under-5 child mortality by two-thirds.
- To halt and to have begun to reverse the spread of HIV/AIDS, malaria, and other major diseases.
- To halve the proportion (22 percent) of the world's people living on less than a dollar a day, as well to halve the proportion of those who lack access to safe drinking water (20 percent).
The world leaders also want to have "achieved a significant improvement in the lives of at least 100 million slum dwellers" by 2020. In addition, the overwhelmingly male heads of government and state also pledged to "promote gender equality and the empowerment of women."
The question remains, how much of all this is realizable in sub-Saharan Africa?
Health Services for Women and Children are a Priority
Health services for women and children in this region are already severely lacking. Estimates from the World Health Organization show that the maternal mortality ratio (the obstetric risk associated with each pregnancy) averages around 940 maternal deaths per 100,000 live births, compared with an average of around 27 maternal deaths for every 100,000 live births in developed nations. For every 1,000 live births in sub-Saharan Africa, 94 children die before their first birthdays, a number that is 10 times greater than that for Europe, according to PRB's 2000 World Population Data Sheet.
War and Conflict Eat Up Resources
War and conflict continue to spark doubts about Africa's security. Violent conflicts that afflict the region, such as those in Burundi, Rwanda, Sudan, Congo, Angola, Sierra Leone, Ethiopia, Eritrea, and the Democratic Republic of the Congo, are diverting scarce resources away from social services and reversing gains in social development. Conflicts such as these also destroy the physical infrastructure that enables delivery of key social services.
HIV/AIDS Further Impoverishes Communities
The spread of HIV/AIDS in sub-Saharan Africa is another impediment to achievement of the goals. The disease is destroying families and further impoverishing communities. The Joint United Nations Programme on HIV/AIDS (UNAIDS) describes the epidemic as a crisis that is having a profound impact on infant, child, and maternal mortality, life expectancy, and economic growth. There are now 16 sub-Saharan African countries in which more than one-tenth of the adult population ages 15 to 49 is infected with HIV. In Botswana, roughly 36 percent of adults are infected with the virus, while close to 20 percent are infected in South Africa.
Donor Support Declining
Donor cutbacks in aid present another obstacle to the achievement of the Millennium Summit's goals. As a percentage of gross national product (GNP), development assistance from more developed countries has fallen from 0.3 percent to 0.2 percent since the late 1980s, according to the United Nations' Human Development Report 2000. The UN has set 0.7 percent of GNP as a target for these countries. Major donors, including the United States, Germany, and Japan, are the major laggards.
Population Programs Have Been Cut
Shortfalls in contributions have already forced cuts in population and development initiatives in African countries. The United Nations Population Fund (UNFPA), promoted as the lead UN agency on population and ICPD work, has been forced to cut or suspend post-Cairo programs. In Africa, UNFPA has cut its support for programs by 40 percent since 1998. In cash, that means a reduction in programming from US$77 million in 1998, to US$58.6 million last year, and to US$46.8 million this year.
These cutbacks have serious consequences at the country level. In Tanzania, for example, the government has had to postpone its census for four years from August 1998 to August 2002. A program in Côte d'Ivoire to promote awareness of reproductive health and combat the spread of HIV/AIDS in and by the military has been suspended. Other countries such as Ethiopia, Eritrea, Angola, Nigeria, and Ghana have been forced to cut ambitious reproductive health programs.
Some of these programs are aimed at expanding the number of facilities offering reproductive health services, particularly in rural areas, and at widening the range of services that they provide, especially to adolescents. Others are designed to involve men in reproductive health and reduce traditional practices seen as harmful to women, such as female genital cutting. The programs also attempt to integrate reproductive health services into all government planning and training in the health sector.
New Debt Relief Package to Free up Some Resources
For poor countries mired in debt, a newly funded relief package drawn up by the international community should make some extra resources available for social spending. Approval by the U.S. Congress at the end of October of the United States' portion of the enhanced Heavily Indebted Poor Countries (HIPC) initiative means that the plan, adopted by the World Bank and the International Monetary Fund (IMF), is now fully funded for two years. The plan should benefit 41 of the world's poorest countries, 33 of them in Africa.
As of October 2000, 11 countries, including nine from Africa (Benin, Burkina Faso, Cameroon, Mali, Mauritania, Mozambique, Senegal, Tanzania, and Uganda) qualified for the debt relief. The Bank and the IMF hope to have another nine countries on board by the end of 2000. In exchange for relief, the beneficiaries are to increase allocations from their internal budgets for basic health services for the poor, immunization of children, as well as improvements in the quality of education and other social services. Total debt service relief committed to the 11 countries exceeds US$16 billion.
Realizing the Goals Requires Action on Several Fronts
World leaders agree that reducing the risks of such events as wars, economic crises, disease, and natural disasters is key to improving lives in poor communities. The World Bank notes that in sub-Saharan Africa, where poverty and high population growth help undercut key measures of social progress (life expectancy, education, and access to resources to improve living standards), it is essential that countries achieve economic growth and more equitable income distribution. According to the Bank's World Development Report 2000/2001: Attacking Poverty, this will require decisive action in four main areas:
- Conflict resolution and improved governance
- greater equity and investment in Africa's people
- increased competitiveness and diversified economies
- greater support from the international community
On the question of fulfilling the goals of the Millennium Summit, UN development agencies hope that the high level at which the pledges were made — the level of prime ministers and presidents — will translate into greater success, compared with commitments made at other world forums. UN Secretary General Kofi Annan is to report annually on progress in achieving the targets of the Millennium Declaration.
Ian Williams is a freelance journalist based in New York. Yvette Collymore is senior editor, Population Reference Bureau.