In 10 years Ghana may not require any aid at all
Ghana is one of Africa’s great successes – a stable
and thriving country that is testament to the impact of aid:
John Mulholland
Early last Sunday morning on a plane ride from the Ghanaian capital,
Accra, to the northern town of Tamale, Jeffrey Sachs – director of the
Earth Institute research group, economist at Columbia University and
international development expert – is explaining what happens when you
move from the south of the country towards the north.
“If you look at Ghana and all of west Africa, it's wet in the south,
and as you go further north you get into desert. All of west Africa is
graded by climate. It's cocoa plantations and tree crops and palm oil up
the coast, but as you move north you move into the savannah, and as you
go further you get to the desert.
“In general, the farther you go north, the drier you go, and in
general as you move from south to north you also go from more Christian
to more Muslim communities. And as you move from wetter to drier, you go
from sedentary agricultural to more pastoral. And whenever in economics
you go from the coast to the interior you almost always go into a poor
economic gradient.
Fatahiya Yakubu, a Ghanaian nurse |
“Everything about this trip from Accra to Tamale is moving towards
more poverty in Ghana and more Muslim, more distance from markets, less
productive agriculture, lower population densities, and more
marginalised politically.”
This brief assessment offers a unique insight into why aid is
becoming not just an ethical but a political issue. And why Ghana, one
of the most stable and economically successful countries in Africa,
recognises how imperative it is to address poverty and infrastructural
failings in its northern territories.
If they were in any doubt, they just need to look to near-neighbour
Nigeria, where escalating sectarian violence is spreading between the
largely Christian south and the Muslim north. The situation maps
precisely what Sachs has outlined: Nigeria's northern regions are
climatically stressed, economically disadvantaged (Nigeria's oil
reserves are in the south), agriculturally challenged and politically
marginalised. The lessons from Nigeria are all too clear – and
increasingly brutal and bloody.
By any measure Ghana is a success story. The first African country to
gain independence in 1957 following 83 years of colonial rule by the
British, it is now a stable democracy whose last five elections have
been deemed free and fair. It has made huge progress in reducing
poverty, having already met the millennium development goals on poverty
and hunger, and boasts a growth rate that places it among the
best-performing economies in the world.
And yet these impressive statistics seem to count for very little
when we arrive, after a two-and-a-half-hour journey north of Tamale, at
the small village of Kpasenkpe and visit the clinic.
It is a clinic, in a sense. There is a building, and a nurse. There
are vaccinations for children's immunisation programmes. But there is
precious little else in this bare, three-room brick building. A few
yards in the dusty distance are some small houses; in better days, these
served as nurses’ quarters.
Fatahiya Yakubu, 24, is one of the two nurses at the clinic serving
30,000 people in this and neighbouring villages. Only it doesn't serve
them. Not really. It has nothing to offer beyond vaccinations and wound
dressings.
Yakubu is stoic as she surveys the barren clinic. She tells a story
of a man who arrived on a day when it was short-staffed and there was no
one to put a tourniquet on his wound. The nearest hospital is an hour
and a quarter's drive away in Walewale, but there are no cars here and
the single ambulance that serves the area has to cater for over 100,000
people. The patient died before he could reach hospital.
Yakubu is trained to nurse, but the scope for nursing is limited. “If
this place got help, things would go very well and our dreams would be
met,” she says.
Bono, lead singer of U2 and a veteran aid activist, is also on the
trip representing ONE, the advocacy group he helped set up, which, with
various partners, is campaigning for transparency in Africa's booming
commodities industry.
It is also fighting for countries such as the UK to double “smart”,
or evidence-based, aid for the Global Fund, founded by former UN
secretary general Kofi Annan to fight HIV/Aids, tuberculosis and
malaria. He is listening to Yakubu's story; when she has finished he
remarks, partly to himself, and partly to her: “It's a ghost clinic –
it's a memory of a clinic.”
Prior to the visit to Kpasenkpe, where he teamed up with Sachs – a
key architect in creating the Global Fund – Bono hosted a group of
senior Republicans from the US Senate in Accra. After visiting Ghana he
spent the rest of the week travelling to neighbouring countries.
Bono can be a lightning rod for criticism, though few of his critics
probably know much about the time he spends in Africa, or his lobbying
in the world's capitals as he pesters foreign leaders for foreign aid.
His critics are voluble, but it is difficult to argue with the
improvement in the lives of African people who escape the scourges of
HIV, TB and malaria as a direct result of the programmes that he and his
aid partners support.
For Yakubu, help is, luckily, at hand, since Sachs has travelled here
to formally announce that the next “Millennium Village” will be in
Kpasenkpe. The Millennium Villages project is led by the Earth
Institute, the development organisation Millennium Promise and UN
agencies. It takes a radical approach to aid, targeting five principal
causes of extreme poverty and addressing all of them in an integrated
way: health, education, agriculture, rural infrastructure and economic
development. The aim is to create one joined-up aid programme instead of
having different aid agencies tackling these issues separately.
The most radical aspect of the Millennium Village concept is twofold:
firstly, it involves local government and implementation by the
communities themselves; and secondly, it is designed to create
sustainable communities that will outgrow the need for aid. A village
will be subject to rigorous evaluations in order to demonstrate
sustainability and scalability, and that aid developed with an exit
strategy can actually work.
In an external review of the Millennium Villages project, the
Overseas Development Institute recorded crop yield increases of between
85% and 350% and reductions of up to 50% in the incidence of malaria.
It is this evidence-based approach that gives Sachs the confidence to
stand in front of what seems like the entire village gathered in the
elders’ meeting area to greet the delegation of politicians and
development experts. Sachs is unequivocal as he takes the microphone and
proclaims, in almost messianic fashion: “You are going to see an
improvement in the lives of your people. I promise you, one year from
now, your health facility will be functioning and known throughout the
region.”
He then lists the improvements to come for farmers, students,
mothers, girls in education; it is akin to a stump speech and is greeted
with cheers by the locals. “We have five years to make programmes that
work for farming, health care, schools, for increasing incomes and
improving the lives of your communities. We have a lot of work to do
together.”
The Kpasenkpe clinic must wait for the aid to arrive but the omens
are promising, because the next day we visit Tema hospital in Accra,
which has been receiving aid from the Global Fund. The contrast with
Kpasenkpe couldn't be more stark. And the contrast between the brave but
beleaguered Yakubu and Tema staff doctor Patricia Asamoah could not be
more marked. Asamoah is positively beaming as she shows us around. This
is a happy hospital; a functioning hospital. But it wasn't always like
this.
The impact of the Global Fund is everywhere. We visit the
anti-retroviral unit, where patients with HIV/Aids are being treated. It
is ordered and functioning much as any hospital would. But Asamoah
remembers a different time: “Before we got help from the Global Fund,
these kind of patients in the ARV unit were all wheelchair-bound. Now
they can walk in themselves.”
Access to drugs explains the difference. “Our clinics were empty
because we didn't have drugs, and instead the hospitals were full. They
were more like hospices than hospitals – we didn't have anything to
treat patients with.”
The same story is repeated all over the hospital: babies being
diagnosed with HIV early enough to save their lives; men and women being
restored to health after contracting TB; radiant mothers and babies at
the antenatal clinic; smiles from the staff and heartfelt gratitude from
the patients.
At one point, unprompted, one of the recovering TB patients points to
Asamoah and says: “She's my mother – she looked after me, it's all down
to her.”
This is how it should be, but it's not necessarily how it always will
be if the west reneges on its commitment to the next tranche of money
for the Global Fund.
Jamie Drummond, the executive director of ONE, says: “ONE helped get
the first financing for the Global Fund 10 years ago and it's had a
wonderful multimillion-life-saving first decade – but needs a big boost
for the next 10 years to not just halt but turn back the tide of Aids,
TB and malaria.
A survey just found the Global Fund the second most transparent aid
mechanism in the world. That's why One is pushing for the UK to double
its funding this year.”
The UK government has been steadfast in maintaining its commitment to
international aid, drawing high praise from Bono and Sachs (see right),
despite a growing clamour for it to cut back on foreign donations.
But the battle for aid will only get more difficult, which is why
smart aid programmes like the Millennium Villages project and the Global
Fund are all the more important in convincing politicians that
investment in Africa makes ethical and economic sense, as a whole new
continent of consumers come on stream in a newly dynamic Africa.
And there are the political motivations for tackling poverty too. As
Bono remarks: “When extreme poverty, extreme climate and extreme
ideology come together, it's a difficult thing to undo.”
Increasingly, senior military figures in the US are looking at how
aid can be a politically stabilising force – or, as Bono says, “instead
of putting out the fires, it is a lot cheaper to stop them in the first
place”. The fruits of extreme poverty, climate and ideology are being
reaped in the horn of Africa, with devastating results.
And then there is a more simple, human response to extreme poverty.
As Bono concludes: “It's impossible, I believe, to keep up the scam that
brutal, ugly, dumb poverty is something we can live with. That's a scam.
You can't live with it if you see it. We bring over tough US military
guys and US senators to Africa. When they see it up close – you can't
live with it. The only way you can live with it is to lie to yourself
and pretend it's not what people say it is.”
- Guardian |