Can African states eliminate malaria?

Southern Africa has an ambitious plan to eliminate malaria by 2030. According to the FT:

Under the Elimination8 plan, the idea is to end malaria by 2020 in four so-called frontline states where transmission levels are already low — below 10 per 1,000. These are Botswana, Namibia, South Africa and Swaziland. Four higher-transmission, “second line” countries — Angola, Mozambique, Zambia and Zimbabwe, where transmission rates can climb as high as 400 per thousand — have until 2030 to get the job done.

Kenya presents a less sanguine but still somewhat positive story. The country reported 8.3 million cases of malaria in 2018, a decline of 12% from 2012. And out of these cases, 16,000 fatalities were reported. Contrast this with China which in 2017 reported a grand total of 2,672 malaria cases, all of which were due to infections while abroad. China’s population is 1.4 billion. Kenya’s population is 49 million. 40 years ago China reported more than 24 million malaria cases annually.

So how did China do it?

Screen Shot 2018-04-24 at 9.08.41 PM.pngThrough a combination of vector control, human behavioral change (including use of treated bed nets), and treatment. All three approaches are important. For instance, while the malaria mortality rate of 0.09% in Kenya is not super high (thanks to treatment), it still means that each year millions of work hours are lost due to illness. It is also a significant drain on the healthcare system. In addition, while treated bed nets have been shown to save lots of lives, we should still work towards complete elimination of the disease.

And that will require an aggressive form of vector control, something that is glaringly missing from most malaria programs on the Continent.

Interestingly, the international community used to take vector control seriously, which resulted in some significant results (see map):

 In 1955, the UN committed to ending the scourge of malaria. It was optimistic because it thought there were effective tools. The pesticide DDT had been found to kill the mosquitoes that were spreading the disease in US army camps in the Pacific during the second world war. Widespread use of DDT and the drug chloroquine drove malaria out of many countries in the Americas, Europe and parts of Asia.

But it all fell apart. There was no real attempt to tackle malaria in sub-Saharan Africa because it was thought to be too difficult. Elsewhere, elimination fell foul of the problem that has bedevilled all malaria control efforts: resistance of the malaria parasite to drugs and of the mosquitoes to pesticides. Then in 1962, Rachel Carson’s blockbuster Silent Spring was published, alerting the world to the environmental devastation wreaked by DDT. The UN’s malaria eradication plan was officially scrapped in 1969.

The over-correction arising from Carson’s paradigm-shifting findings meant that much of the world was willing to sit on their hands as more than 400,000 people died each year of malaria. The WHO only dabbles in vector control through treated bed nets. Sadly, resistance to its choice of insecticides stood at 81% in 2016.

That translates to over 200 million people infected each year, over 400,000 of whom die.

Even Bill Gates agrees that complete eradication of malaria is the most sustainable solution:

“Eradication is the only sustainable solution to malaria,” Bill Gates said on the release of the report his foundation produced with the UN last September. “The alternative would be endless investment in the development of new drugs and insecticides just to stay one step ahead of resistance. The world can’t afford that approach.”

Is anyone out there investing in research on environmentally-safe insecticides?

 

 

Africa does not need your used shoes

This is from a yoga studio in Cambridge, MA:

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H/T 

More broadly, it is worth remembering that aid in kind is almost always a waste of everyone’s time and money. Send cash instead. In the specific case of shoes, TOMS did a study that found zero impact of their shoe donation program:

According to the Economist (in 2016):

The first of two studies found that TOMS was not wrecking local markets. On average, for every 20 pairs of shoes donated, people bought just one fewer pair locally—a statistically insignificant effect. The second study also found that the children liked the shoes. Some boys complained they were for “pregnant women” and some mothers griped that they didn’t have laces. But more than 90% of the children wore them.

Unfortunately, the academics failed to find much other good news. They found handing out the free shoes had no effect on overall shoelessness, shoe ownership (older shoes were presumably thrown away), general health, foot health or self-esteem. “We thought we might find at least something,” laments Bruce Wydick, one of the academics. “They were a welcome gift to the children…but they were not transformative.”

More worrying, whereas 66% of the children who were not given the shoes agreed that “others should provide for the needs of my family”, among those who were given the shoes the proportion rose to 79%. “It’s easier to stomach aid-dependency when it comes with tangible impacts,” says Mr Wydick.

Swaziland is now called eSwatini

This is from the AFP:

The king of Swaziland, one of the world’s few absolute monarchs, announced on Thursday that his country had changed its name to eSwatini to mark 50 years since independence from British rule.

Meaning “place of the Swazi”, eSwatini is the Swazi language name for the tiny nation landlocked between South Africa and Mozambique.

… The name Swaziland angers some citizens as it is a mix of Swazi and English.

According to the World Bank, per capita income in eSwatini has been in decline since peaking at just over $4,000 in 2014. One reason for this name change might be King Mswati’s search for legitimacy via other means.

At the same time, I suspect that we will see a lot more changes like this across the Continent over the next several years (even during good economic times). It is the case that more and more African states are finally finding their footing domestically. And as that happens, the African middle class will demand for changes in place names to reflect local cultural tastes and interpretations of history. For example, Lake Victoria will some day become Nam Lolwe, or Nyanza (the Sukuma name for the lake). It was not that long ago that Kenya’s Lake Turkana was named Lake Rudolph (after a crown prince of Austria-Hungary).

It is worth noting that since the end of Apartheid South Africa has gone through an extensive process of changes in place names (for obvious reasons).

Finally, here are the meanings of African country names:

placenames

The Political Legacy of Kenneth Matiba

In 1988 President Daniel arap Moi overplayed his hand, and set in motion the beginning of the end of KANU’s dominance in Kenyan politics. Ever since the attempted coup of August 1982, Moi had increasingly concentrated power in KANU and in his own hands. First he made Kenya a de jure single party state under KANU and called the 1983 snap election to rid Parliament of critical voices. He then went about strengthening the KANU national office to serve as an enforcer of strict party discipline within and outside of Parliament. KANU became baba na mama, and Kenya a nascent Party State (albeit nothing near what CCM in Tanzania or UNIP in Zambia had accomplished). By the mid-1980s Moi had abandoned all pretenses to the supremacy of parliament, and in 1986 declared KANU to be supreme over bunge. In the same year he removed security of tenure for the Attorney General and Auditor General; and in 1988 leaned on Parliament to remove security of tenure for judges.

1988 was also the year of the infamous Mlolongo elections. Ahead of the KANU primaries, Moi (through KANU) abolished the secret ballot and decreed that voters should queue behind their preferred candidates. This was an attempt to intimidate voters into selecting pro-Moi legislators. But in a sign of KANU’s weakness at the grassroots level, District Commissioners still had to rig out popular candidates whose lines were visibly the longest. The backlash against the Mlolongo election caused irreparable damage to the elite consensus that had (very tenuously) underpinned single party rule in Kenya since the death of President Jomo Kenyatta in 1978.

Screen Shot 2018-04-15 at 3.39.42 PM.pngAmong those targeted by Moi in 1988 was Kenneth Matiba, a wealthy former Civil Servant, executive at East African Breweries, and M.P. for Mbiri (later renamed Kiharu) Constituency in Murang’a District since 1979. In order to defend his seat, Matiba went as far as hiring a helicopter and cameramen to take pictures and video evidence of the length of this queues, just in case the District Commissioner declared his opponent the winner. Matiba saved his seat, against his perennial opponent Julius Gikonyo Kiano, but would be out of government and then parliament in less than a year.

In September 1988 KANU held its branch elections. Matiba was vying for the position of Chairman of the Murang’a branch against Joseph Kamotho, MP for Kangema. Following brazen rigging, in which Matiba lost his own home area, the District Commissioner declared Kamotho the winner. Matiba disputed the result, forcing Moi to order a repeat of the poll. But Matiba and his supporters boycotted the repeat election, citing a lack of faith in the local Provincial Administration officials who doubled as KANU election officials.

Then on December 9, 1988 Matiba did the unthinkable: He resigned from the Cabinet as Minister of Transport and Communications. This was the first time since 1966 that a Kenyan Cabinet Minister had resigned. It was also a direct insult targeted at Moi, who was scheduled to receive international guests the next day to celebrate his first decade in power (“Moi Day” was created on the same day).

The move made Matiba a marked man. He was promptly expelled from KANU which resulted in the loss of his parliamentary seat. But these moves only served to strengthen Matiba’s cause for freer electoral politics in Kenya. In the words of Gibson Kamau Kuria:

Matiba was a kind of reluctant reformer… he did not have issues with the system until the excesses of mlolongo in 1988. Up until then, he was part of the authoritarian government. The important thing about him, however, is that he had a sense of decency. He got converted to the cause of pluralism. Kenya had reached a stage where it was contravening Article 21 of the Universal Declaration of Human Rights, which states that “everyone has a right to take part in the government of his country, directly or through freely chosen representatives.” Mlolongo was a negation of all that.

Screen Shot 2018-04-15 at 7.57.23 PM.pngMatiba then joined forces with intellectuals, church leaders, and politicians who were calling for a return to multiparty politics. For his efforts he was detained on July 4 1990 as he and other opposition leaders prepared for the first Saba Saba (July 7th) rally at Kamukunji grounds in Nairobi. While in detention he was tortured, suffered a stroke on May 26th 1991, and was only allowed treatment a week later. He spent the next 11 months receiving treatment in London before his triumphant return to Nairobi on May 2, 1992 (see image). Matiba never fully recovered from the stroke, and in 2017 was awarded $9.5m in damages after a successful suit against the Kenyan state.

Moi would later acquiesce to both domestic and international pressure and allow for constitutional amendments to reintroduce multiparty politics in December 1991.

Was the end of  KANU’s single party rule inevitable even without Matiba’s efforts?

Perhaps. Besides Matiba, there were several other leading lights in Kenya’s opposition movement capable of bringing down the proverbial Mugumo tree — men and women like Oginga Odinga, Bishops Alexander Muge and Henry Okullu, Paul Muite, Gitobu Imanyara, Martin Shikuku, Gibson Kamau Kuria, James Orengo, Kijana Wamalwa, Kiraitu Murungi, Raila Odinga, Charity Ngilu, Martha Karua, and Wangari Maathai, among others. As single party regimes fell all over the Continent between 1990 and 1994 like dominos, so would have KANU’s single party dominance.

However, Matiba’s important legacy is that he was the first prominent insider to publicly ditch KANU and Moi. Because of his actions Moi went from appearing to be completely in charge in 1988 to fighting for his political life in 1992.

Scholars of democratization processes have long emphasized the importance of intra-elite splits in autocratic regimes as catalysts of transition. Seen in this light, Matiba’s resignation from Cabinet was important in that it forced Moi to react in ways that only accelerated further defections from his government and KANU. In quick succession he lost his Vice President Josephat Karanja, former Vice President Mwai Kibaki, KANU Chairman Peter Oloo Aringo, and Minister Njoroge Mungai. These defections, inspired in part by the considerable wealth and economic independence of those involved, were as clear a sign as any of open elite rebellion against Moi’s rule, and forced him into accepting term limits and multiparty electoral politics. Moi would later survive the 1992 (with 36.4% of the vote) and 1997 (40.6%) elections amid opposition division, but was forced to step down in 2002 in observance of term limits.

As Kenya mourns Kenneth Stanley Njindo Matiba (1932-2018), his legacy will endure forever as the ultimate insider who nonetheless took significant risks against Moi’s autocracy. His personal sacrifices created space for many of the freedoms that Kenyans enjoy today.

Lala salama Bwana “Let the People Decide!”, a true hero of Kenya’s Second Liberation.

 

 

 

What exactly is China up to in Africa?

Leading Afro-Chinese relations scholar Deborah Brautigam has a great piece over at the Washington Post:

On Chinese imported labor in Africa:

Surveys of employment on Chinese projects in Africa repeatedly find that three-quarters or more of the workers are, in fact, local. This makes business sense. In China, textile workers now earn about $500 a month — far more than workers in most African countries. Chinese investors flocking to set up factories in low-cost countries like Ethiopia are not thinking about importing Chinese workers. Like U.S. and European factory owners who moved their factories to China in past decades, Chinese firms are now outsourcing their own manufacturing to cheaper countries.

On Chinese loans to African states:

… In Africa, we found that China had lent at least $95.5 billion between 2000 and 2015. That’s a lot of debt. Yet by and large, the Chinese loans in our database were performing a useful service: financing Africa’s serious infrastructure gap. On a continent where over 600 million Africans have no access to electricity, 40 percent of the Chinese loans paid for power generation and transmission. Another 30 percent went to modernizing Africa’s crumbling transport infrastructure.

On alleged Chinese land grabs:

… the total amount of land actually acquired by Chinese firms was only about 240,000 hectares: 4 percent of the reported amount.

I like to remind my students of the qualitative difference of the “Chinese model” of resource exploitation in Africa.

Previously, Exxon, Elf and other Western resource sector firms would pay African leaders in cash, most of which wound up in Swiss banks, property in southern France, and various tax havens outside the Continent. This was, if you will, the “Western model” of resource exploitation in Africa.

afrobarometerEnter the Chinese. Their model is to pay for resources both in cash and in kind. African leaders still get cash that they can stash abroad. But they also get roads, railways, stadia, hospitals, water works, among other infrastructure investments. And more recently Chinese firms have begun to invest in actual factories — most notably in Ethiopia. It is no wonder that a majority of Africans have a favorable view of China (see image).

Some of these projects produced sub-standard structures (in the recent past the quality has gone up). And the level of indebtedness of African states as a result should concern every sane person. But this arrangement is orders of magnitude better than useless capacity building workshops and janus-faced democracy promotion on the back of rapacious pillaging with little public investments to show for it.

Finally, the inability of African states to negotiate reasonable deals with Beijing is on African political and economic elites. The Chinese have every right to rationally push for the best deals they can get. And if they are smart, they will also work to avoid future defaults by not overstepping their bounds.

To paraphrase a Mozambican diplomat at a recent event here on campus, Africans are too smart to allow themselves to be recolonized by the Chinese.

Kenya trade fact of the day

This is from the prospectus issued by the Kenyan Treasury ahead of its $2b eurobond issue in late February.

Africa is the largest market for Kenya’s exports, accounting for 40.7 per cent. of total exports in 2016, and 37.7 per cent. in the nine months ended 30 September 2017. The Common Market for Eastern and Southern Africa (“COMESA”) remained the dominant destination of exports, accounting for approximately 72.5 per cent. of the total exports to Africa and 30 per cent. of total exports in 2016.

The European Union continues to be Kenya’s second largest export market, accounting for 21.0 per cent. of total exports in 2016 and 21.6 per cent. in the nine months ended 30 September 2017. Exports to the European Union declined by 3.7 per cent. in 2016, with exports from the United Kingdom and Germany, two of the top three destinations of Kenya’s exports within the European Union, declining by 7.6 per cent. and 5.2 per cent., respectively, in the same period. In addition, a large portion of foreign tourists visiting Kenya are from Italy, Germany, the United States and the United Kingdom, which accounted for a combined 38.2 per cent. of departing tourists in 2016.

A decline in demand for exports to Kenya’s major trading partners, such as the European Union or COMESA countries, or a decline in tourism receipts, could have a material adverse impact on Kenya’s balance of payments and economy.

Over the last five years intra-Africa trade as a share of total trade in the region has risen from less than 12% to about 18%. With the implementation of the African Continental Free Trade Area this figure will jump to over 25%, and will likely grow faster over the next four decades as the African population explodes to over 2 billion people.

Read the while thing here.

Memes on State-Led Industrialization

The graph on the right is popular among pop development economists. But it doesn’t tell us what most people think it does.

In addition to experiencing a different form of colonialism than Ghana or India did, receiving lots of Western aid for geopolitical reasons, and having access to markets in Japan and the US, South Korea also had a much longer history of ethnically and socially unified statehood than either Ghana or India before colonization.

Here is a summary of the mechanisms involved from Bockstette, Chanda and Putterman (2002):

A longer history of statehood might prove favorable to economic development under the circumstances of recent decades for several reasons. There may be learning by doing in the ways of public administration, in which case long-standing states, with larger pools of experienced personnel, may do what they do better than newly formed states. The operation of a state may support the development of attitudes consistent with bureaucratic discipline and hierarchical control, making for greater state (and perhaps more broadly, organizational) effectiveness. An experienced state like China seems to have been capable of fostering basic industrialization and the upgrading of its human capital stock even under institutions of government planning and state property in the 1960s and 1970s, whereas an inexperienced state like Mozambique sowed economic disaster when attempting to pursue similar policies a few years later. Such differences may carry over to a market setting — contrast, for instance, the late 20th century economic development of Japan and South Korea, modern countries with ancient national histories, with that of the Philippines, a nation that lacked a state before its 16th century colonization by Spain.

State-building under ISIS

The New York Times has an interesting piece on everyday instances of stateness under ISIS. From the article, it appears that in addition to its macabre coercive powers, Al-Baghdadi’s caliphate managed to develop significant levels of infrastructural power and  bureaucratic capacity. Below are some examples.

On the provision of public goods and services and regulation of social life:

ISIS built a state of administrative efficiency that collected taxes and picked up the garbage. It ran a marriage office that oversaw medical examinations to ensure that couples could have children. It issued birth certificates — printed on Islamic State stationery — to babies born under the caliphate’s black flag. It even ran its own D.M.V.

On differentiation from the Iraqi government:

The documents and interviews with dozens of people who lived under their rule show that the group at times offered better services and proved itself more capable than the government it had replaced.

On being able to graft itself atop preexisting administrative structures:

Screen Shot 2018-04-05 at 8.11.12 AM.pngThey also suggest that the militants learned from mistakes the United States made in 2003 after it invaded Iraq, including the decision to purge members of Saddam Hussein’s ruling party from their positions and bar them from future employment. That decree succeeded in erasing the Baathist state, but also gutted the country’s civil institutions, creating the power vacuum that groups like ISIS rushed to fill.

A little more than a decade later, after seizing huge tracts of Iraq and Syria, the militants tried a different tactic. They built their state on the back of the one that existed before, absorbing the administrative know-how of its hundreds of government cadres. An examination of how the group governed reveals a pattern of collaboration between the militants and the civilians under their yoke.

On extractive capacity and revenue source diversification:

One of the keys to their success was their diversified revenue stream. The group drew its income from so many strands of the economy that airstrikes alone were not enough to cripple it.

Ledgers, receipt books and monthly budgets describe how the militants monetized every inch of territory they conquered, taxing every bushel of wheat, every liter of sheep’s milk and every watermelon sold at markets they controlled. From agriculture alone, they reaped hundreds of millions of dollars. Contrary to popular perception, the group was self-financed, not dependent on external donors.

….. It was daily commerce and agriculture — not petroleum — that powered the economy of the caliphate.

Read the whole thing here.

GRAÇA MACHEL’S LETTER TO WINNIE MADIKIZELA-MANDELA

This is from Eye Witness News:

As I struggle to accept your transition, I take solace in the fact that you have risen to become one of the brightest stars in the sky where you will remain ever present and radiantly shining. You will continue to serve as a guide to your loving family, your grateful nation, our beloved Africa, and indeed, the world.

winnieThe extraordinary life you led is an example of resilient fortitude and inextinguishable passion that is a source of inspiration to us all of how to courageously confront challenges with unwavering strength and determination.

Thank you for your brilliant wisdom, your fierce defiance and your stylish beauty.

Fortunately, stars shine brightest during the darkest of hours. I know you will continue to illuminate our sky, even through the storms and clouds. Your legacy will be an uplifting beacon from which we can continue to draw guidance and strength during difficult times.

You loved our people unconditionally and sacrificed so much for our freedom. It is my prayer that as befitting tributes are paid to you both at home and abroad, all of us will internalise the values you helped to mould and birth into existence.

As a nation, I hope we will stand tall and proud, and as uncompromising as you were in the defence and protection of our rights. As one of our brightest stars, continue to be the lioness that protects your children and your grandchildren. Warm their hearts so that while your transition may shake them, it does not break their spirit.

Your legacy is everlasting. Take a well-deserved rest in peace, my BIG sister.

Love and Respect Always,

Your little sister, Graça.

May your spirit live on in all of us, Winnie Mandela. A great human being. A precious gift to humanity. You belong in the pantheon of the greatest sons and daughters of the Continent who ever lived.