By Eleanor Day [Edited by Ella Falk and Tayyiba Nasir]
The Sub-Saharan African nation can be characterised by two things from the ‘western gaze’. A country in stifling poverty and one wracked with disease, which further pushes the nations into poverty, both as a result of foreign debt. This essay will argue that it is impossible to distinguish which of the two were a greater threat to the survival of post-colonial Africa because they were intrinsically linked. The implications of foreign debt have stirred the priorities of many post-colonial governments away from social welfare and towards debt repayment. In a part of the world already vulnerable to disease as a result of warm moist temperatures that fostered diseases such as cholera, and a lack of sexual education fostering the deadly spread of HIV and AIDS, the cut backs in healthcare and funding made it inevitable that many post-colonial African countries were left in a cycle of deprivation, unable to pass through the stages of development. Therefore, disease threatened the survival of post-colonial Africa as a result of the implications caused by foreign debt.
As African historian Jean Francois Bayart developed in his theory called ‘extraversion’, the resources and subsequent economies of the nations have been shaped outward since the beginning of European involvement in the African continent.[1] In this he means that the resources of the African countries were stripped to follow the economic desires of other nations, from the Trans-Atlantic Slave Trade to the use of cash crops today. Post-colonial nations’ economies were not shaped to trade inwardly to benefit their own suppliers, but rather only traded externally resulting in high imports and reliance on other nations for goods as they were not trading with themselves. More significantly, this resulted in debt. In 1985, Zimbabwe’s national debt amounted to 32.2% of Gross National Product (GNP).[2] The country alone, with the AIDS epidemic affecting the nation at the same time, was encapsulated by a problem created by western influence. This was further damaged by a lack of interest in social welfare by most African leaders, as they themselves were following the pattern of their past colonial rulers. The rich were getting richer and the poor were getting poorer. Even in resource rich nations such as Uganda; when the country was making a profit, the government was keeping the benefits for themselves and little ‘trickle down’ occurred. In Uganda in the 1990s, only twenty cents for every US dollar of government spending reached primary schools as they had promised to do so.[3] These states can be described as ‘Gatekeeper States’ as argued by historian Frederick Cooper.[4] Cooper is referring to the corrupt nature of those in power. If you held office in a post-colonial nation, you had access to untapped resources and control of who can access said resources. Without a diplomatic or transparent budget, the benefits of these resources were not felt by the majority of the population. Gerald Helleiner argues that it was not just the corrupt African leaders that were to blame, but rather the motivations of multi-national corporations such as the World Bank and International Monetary Fund (IMF) which must also be taken into consideration. Helleiner argues that the influence of these two corporations had become excessive in Africa and continued donor obsessions had little to do any more with the prospect of debt repayment and only limited reference to helping in long term development.[5] At a hearing before the United States Senate Committee on Foreign Relations in May 2004, experts argued that the World Bank participated in the corruption of roughly one hundred billion dollars of its loan funds intended for development.[6] The methods of aid and debt alleviation were not working, further creating a cycle of increasing reliance on international funding and preventing development, arguably posing a threat to the survival of post-colonial African nations as they were unable to survive without this funding. The beginning of the new stage of foreign intervention occurred in the 1980s following the economic issues that occurred in the 1970s. The idea was to create an economic program, streamlining the spending in post-colonial African countries to put them onto a path of development and debt repayment. It was not all it seemed to be at first. In 1988 a Structural Adjustment Program (SAP) was implemented to reduce the consumption of goods and services to get African nations on to the path of repayment. This resulted in a drastic reduction of trade and exchange controls designed to protect the local economy from foreign competition and high interest rates to fight inflation, promote savings and most significantly, goods were sold in dollars in order to start paying back debts that had accumulated over the years. This program was implemented across the continent and between 1985 and 1990 some thirty-eight sub-Saharan African countries rolled out over two hundred and fifty-seven adjustment programmes.[7] It quickly became obvious that this program was not what it seemed to be and as historian Onimode argues, SAPs have hindered African development by linking local economies more firmly within the capitalist system, thus inhibiting local industrialisation and perpetuating traditional trade patterns.[8] By 1999, the World Bank and IMF decided that a new approach was needed to combat the issues of Heavily Indebted Poor Countries (HIPC). The members of the G7 countries therefore proposed an alternative. The enhanced HIPC Initiative proposed to grant larger reductions to the total accumulated debt and quick reductions in debt service payments, however they were not broad enough or carried out at a fast-enough pace for them to be deemed effective.[9] The biggest issue was that the priorities of those in power, both those giving the financial help and those receiving it, did not have the best interests of those in need at heart. As shown through the statistics of corruption and the fact that goods were traded in dollars, it weakened local currencies and further increased the need for imports. Neither fostered the foundations of strong independent post-colonial nations as they were so heavily burdened by debt. A study from the UN has revealed that HIPC continue to annually pay $13.5 billion in service payments.[10] This statistic illustrates how affordable debt cancellation would be: one dollar from each G7 citizen per year could cover the cost of cancelling the debts owed by HIPC countries to the World Bank and IMF.[11] There was no desire to do so and this was simply putting human life at risk as the effects of debt repayment policies were most profoundly found on the cuts towards social and healthcare. Zimbabwe has been a location of much debate on whether the implementation of SAP has caused more harm than good and regarding the threat of disease, it can be argued that it furthered the destruction posed by disease. The SAP were very harsh with investment and economic growth remained stagnant while living conditions of vulnerable groups grew significantly worse. Such economic disparities display the rich getting richer and the poor suffering. In 1979, it was calculated that four per cent of the population were earning sixty per cent of the nation income.[12] To relieve this, between 1983 and 1990 Zimbabwe started implementing an IMF inspired stabilisation program, however in the process 20,840 positions were lost to the private sector from January 1991 to November 1992.[13] In an attempt to alleviate these drastic cutbacks the government introduced free medical care to all those whose monthly incomes were less than one hundred and fifty Zimbabwean dollars a month and those outside formal employment.[14] Fewer people benefitted than expected because this number was static and did not reflect the change in wage levels during the 1980s as a result of inflation. Wage distribution patterns for the period between 1982 and 1992 reveal that in 1982 around forty-six per cent of formal sector employees qualified for free healthcare, however, by 1992 it was revealed that less than two per cent were eligible.[15] The people of Zimbabwe were left with no affordable private healthcare and public healthcare received so many cuts that it was no longer suitable for service. These statistics prove that the only motivation for the Zimbabwean government was to appeal to money lending countries and did not reflect or change any programmes designed to help the masses. By mid-1992 eight hundred health workers had been retrenched and four hundred nursing posts abolished. In the period of a mass AIDS epidemic, the government hindered recovery rather than helping, all to cut debt repayments.[16] Therefore, it must be argued that debt repayments were intrinsic to the devastating effects disease played on the survival of post-colonial Africa. There were many similarities between the governments of post-colonial Africa and the colonisers, as shown already in the lack of trickle down. Lack of care towards the masses increased the chances of disease spreading, and with the government focusing on strengthening the economy and ignoring healthcare, it was no surprise that epidemics occurred in these areas. In Dakar, the capital of Senegal, the causes of cholera in the area can be traced all the way back to the infrastructure put in place by the French when the country was under colonial rule. Between 1905 and 1960, the core urban area received modern sanitation from the colonial government as it was the home of French citizens whilst stationed out in Senegal.[17] After independence, urban growth in the urban city accelerated and infrastructure failed to keep up. When floods arrived in 1985, which partly caused the upcoming cholera outbreak, only thirty-six per cent of the district buildings were connected to the sewer network. The outbreak of 1985 was the first of many more to come and resulted in 2,988 cases and three hundred deaths.[18] The failures of the sanitation system were not identified, therefore, when cholera returned in 1995 it resulted in another 3,222 cases and 137 deaths .[19] In this instance, only forty-nine per cent of homes were connected to the sewer system and eighteen per cent of the city’s population did not have ready access to working latrines.[20] Therefore, it was not just the limitations of those working in healthcare which caused disease but also the failure of governments to improve the infrastructure and living conditions of its residents to mitigate disease. Between 2002 and 2006 Angola experienced a boom in industry, subsequently the government called for eighteen mass evictions in highly populated areas of the country, displacing over 20,000 people and destroying three-thousand slum dwelling communities.[21] The Angolan government did not intend to rehouse these people and subsequently people were living in even worse conditions than before. Three quarters of the capital city’s four million inhabitants were living in shacks that received no sanitation and very few children had access to education. It was no surprise that with these conditions a mass cholera outbreak began in February 2006 and continued until Spring 2007. As of 2006, Angola spent only 2.6% of the country’s GDP on healthcare, therefore, no resources were in place to combat the epidemic and the Medicines sans Frontiers (MSF), started pouring resources into Angola instead. [22] This case was not unique, and a very similar event occurred in Zimbabwe too. In 2009 piped water in several locations across the country was switched off for more than two years and demoralized workers lacked the financial incentive to carry out repairs. To fund a plan to pay health workers and supply water treatment centres, the Zimbabwean government appealed for fifty-one million dollars in emergency funds. As of Spring of 2009, only forty-three per cent of the goal had been met and agencies feared that donors were less willing to pay for long-term investment in water, sanitation and hygiene because of this.[23] Especially as it was later revealed that President Robert Mugabe had already received a combined aid package of three hundred million dollars from international donors with nothing to show of it.[24] This feeling of distrust towards the corrupt leaders of post-colonial African states, specifically Mugabe, damaged the access towards treatment of disease. Antiretroviral was developed to prevent the spread of HIV and AIDS, however, donors such as the World Bank threatened to channel funds ‘to a government whose probity is distrusted’.[25] By the end of 2006, an estimated forty million people worldwide were living with an HIV infection and globally AIDS was the fourth leading cause of infection. Data from 2005 shows that the rate of new HIV infections greatly exceeded the expansion of HIV treatment, making it clear the desperate need for this treatment, however some of those most in need were not getting it because of the ‘gate keeper’ states they are held hostage in.[26] What made HIV and AIDS such a dangerous infection for those living in post-colonial Africa, was the fact that it brought a very slow death and therefore an expensive one. This had many wider implications that damaged the survival of a country in the long term. It was calculated that a wife caring for her husband would spend forty-five to sixty per cent less time caring for her family and providing an income, therefore she would need to give out tasks to her children, keeping them out of school. In some cases, the women of the family turned to prostitution further exposing them to the dangers of disease. HIV was often the disease that characterised poverty in Africa. By 2005, more than thirteen million Africans had died of AIDS with over two million dying each year, which calculates to four deaths each minute. AIDS are such an all-encompassing disease because the patient does not die from AIDS itself but from another infection as the immune system is weakened by the HIV virus. In already resource stricken hospitals, HIV placed a very heavy burden as found in a 2007 report from Swaziland; over half of all hospital beds were taken up by HIV and AIDS related illnesses, rendering non- HIV and AIDS patients limited access as a result.[27] The family unit was destroyed by the disease. In 2001, it was estimated that only six percent of those killed by HIV made a will, meaning that women often lost claim to their marital home if their husband was killed, and children were barred from inheritance. Children felt the burden heavily. In 2004, Sub-Saharan Africa had an estimated twelve million AIDs orphans and children often became head of the household as a result. Children turned to work and poorer households turned to cash crops like cotton and coffee instead, damaging their nutrition. Reports of starvation in Western Uganda were found and between 1980 and 1999 average calorie intake in Zambia fell by fifteen percent. Children were weak and worked, dropped out of school which it meant it was harder to find a higher skilled job in later life. All signs pointed towards greater reliance on western help. It was a never-ending cycle because of a reliance on foreign aid, debt occurred, and to reduce debt western economic debt alleviation systems were created, which reduced funding towards healthcare. When diseases occurred, they thrived due to poor conditions, which were then ignored by the government resulting in a lack of healthcare support because the funding was not there. Families without a breadwinner returned to cash crops, which did not fill their bellies but rather the pockets of those who placed them in debt in the first place and could have prevented the extremities of the disease in the first place. It is impossible to separate the effects of foreign debt and disease on the survival of post-colonial Africa because as a result of debt reducing programmes, the government was focused solely on selling goods to an external market and ignoring the needs of their own people. Paired with corrupt and authoritarian governments who prevented any ‘trickle down’ that occurred, this further increased the issue, as foreign aid was less likely to give help when disaster occurred. Due to cuts in healthcare and appalling conditions the government allowed people to live in, disease spread fast, which changed the demographic of Sub-Saharan Africa, further placing a greater burden on the younger generation as they inherited the economic issues of their predecessors, caught in the never ending cycle of foreign debt. Notes
[1] J. F Bayart, ‘African in the world: A History of Extraversion’, African Affairs, 99/395 (2000), pp. 217-267. [2] Dan Tevera, ‘The Medicine That Might Kill the Patient: Structural Adjustment and Urban Poverty in Zimbabwe’, in David Simon (ed.), Structurally Adjusted Africa, Poverty, Debt and Basic Needs (London: Pluto Press, 1995), p. 80. [3] Dambisa Moyo, Dead Aid: Why Aid is Not Working and How There is Another Way for Africa (London: Penguin Publishers, 2010), p. 53. [4] Frederick Cooper, African Since 1940: The Past of the Present, (Cambridge: University Printing House, 2019) p. 7. [5] Gerald K. Helleiner, ‘The IMF, the World Bank and Africa’s Adjustment and External Debt Problems: An Unofficial View’, World Development, 21/12 (1992), pp. 20055-20058. [6] Moyo, Dead Aid, p. 52. [7] Fantu Cheru, ‘Debt, adjustment and the Politics of Effective Response to HIV/AIDS in Africa’, Third World Quarterly, 23/2 (2002), pp. 299-312. [8] B. Onimode, The IMF, the World Bank and the African Debt (London: Zed Books, 1989). [9] Cheru, ‘Debt’, pp. 299-312. [10] Cheru, ‘Debt’, pp. 299-312. [11] Cheru, ‘Debt’, pp. 299-312. [12] Tevera, ‘The Medicine that Might Kill the Patient’, p. 80. [13] Tevera, ‘The Medicine that Might Kill the Patient’, p. 83. [14] Tevera, ‘The Medicine that Might Kill the Patient’, p. 83. [15] Tevera, ‘The Medicine that Might Kill the Patient’, p. 84. [16] Tevera, ‘The Medicine that Might Kill the Patient’, p. 83. [17] Myron J. Echenberg, Africa in the Time of Cholera: A History of Pandemics from 1815 to the Present (Cambridge: Cambridge University Press, 2011), p. 141. [18] Echenberg, Africa in the Time of Cholera, p. 141. [19] Echenberg, Africa in the Time of Cholera, p. 141. [20] Echenberg, Africa in the Time of Cholera, p. 141. [21] Echenberg, Africa in the Time of Cholera, p. 161. [22] Echenberg, Africa in the Time of Cholera, p. 161. [23] K. Chambers, ‘Zimbabwe’s Battle Against Cholera, The Lancet, 373/9668 (2009), p. 994. [24] Moyo, Dead Aid, p. 147 [25] John Iliffe, The African AIDS Epidemic: A History (Athens: Ohio University Press), p.153. [26] Donald Bundy; Anthi Patrikios; Changu Mannathoko; Andy Tembon; Stella Manda; Bachir Sarr; Lesley Drake. ‘Accelerating the Education Sector Response to HIV: Five Years of Experience from Sub-Saharan Africa. Education and HIV/AIDS’, World Bank <https://openknowledge.worldbank.org/handle/10986/2412 License: CC BY 3.0 IGO> [Accessed 19 December 2019]. [27] Swaziland Government, Ministry of Economic Planning and Development, ‘Second Report on the Achievement of the Millennium Development Goals’ (2007), pp. 40-45. Bibliography
Bayart, J.F., ‘African in the World: A History of Extraversion’. African Affairs. 99/395, 2000
Bundy, Donald; Patrikios, Anthi; Mannathoko, Changu; Tembon, Andy; Manda, Stella; Sarr, Bachir; Drake, Lesley. ‘Accelerating the Education Sector Response to HIV: Five Years of Experience from Sub-Saharan Africa. Education and HIV/AIDS’. World Bank. <https://openknowledge.worldbank.org/handle/10986/2412 License: CC BY 3.0 IGO> [Accessed 19 December 2019]
Chambers, K. ‘Zimbabwe’s Battle Against Cholera’. The Lancet. 373/9668, 2009
Cheru, Fantu. ‘Debt, Adjustment and the Politics of Effective Response to HIV/AIDS in Africa’. Third World Quarterly. 23/2, 2002
Cooper, Frederick. African Since 1940: The Past of the Present. Cambridge: University Printing House, 2019
Echenberg, Myron J. Africa in the Time of Cholera: A History of Pandemics from 1815 to the Present. Cambridge: Cambridge University Press, 2011
Helleiner, K Gerald. ‘The IMF, the World Bank and Africa’s Adjustment and External Debt Problems: An Unofficial View’. World Development. 21/12, 1992
Iliffe, John. The African AIDS Epidemic: A History. Athens, Ohio University Press
Swaziland Government. Ministry of Economic Planning and Development. ‘Second Report on the Achievement of the Millennium Development Goals’, 2007
Moyo, Dambisa. Dead Aid: Why Aid is not working and How There is Another Way for Africa. London: Penguin, 2010
Onimode, B. The IMF, The World Bank and The African Debt. London: Zed Books, 1989
Tevera, Dan. ‘The Medicine That Might Kill the Patient: Structural Adjustment and Urban Poverty in Zimbabwe’, in David Simon (ed.). Structurally Adjusted Africa, Poverty, Debt and Basic Needs. London: Pluto Press, 1995
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