How to Eliminate Malaria

Sri Lanka is the latest country to be declared malaria free by the WHO.

How did they do it?

According to the New York Times:

In 2000, outside the rebel-controlled areas in the northeast, malaria cases began dropping as the government, with donor help, deployed a mix of indoor spraying, bed nets, rapid diagnostic kits and medicines that combined artemisinin, an effective treatment, with other drugs.

The government also screened blood samples drawn — for any reason — in public clinics and hospitals for malaria infection, and officials established a nationwide electronic case-reporting system.malariaeradication

In war-torn areas, the disease retreated more slowly, although the Tigers often cooperated with malaria-control teams because their villages and fighters also suffered.

Nonetheless, in a population of 20 million, it took years to get rid of the last few hundred annual cases. Most were soldiers and itinerant laborers, often from India, who worked in remote slash-and-burn farming areas and in logging and gem-mining camps.

Someone tell African policymakers that bed nets and behavior change are not enough.

Every other region of the world appears to be willing and able to combine vector (mosquito) control with other strategies of containing malaria with success (and enthusiastic donor support). But for some reason mosquito control is still lagging in Africa, even in otherwise strong and stable states. In some instances this has been due to environmental concerns while in others it has been due to the misplaced priorities of public health officials, donors, development agencies, and academic researchers.

The result:

About 3.2 billion people – nearly half of the world’s population – are at risk of malaria. In 2015, there were roughly 214 million malaria cases and an estimated 438 000 malaria deaths. Increased prevention and control measures have led to a 60% reduction in malaria mortality rates globally since 2000. Sub-Saharan Africa continues to carry a disproportionately high share of the global malaria burden. In 2015, the region was home to 89% of malaria cases and 91% of malaria deaths. 

214 million malaria cases amount to lots and lots of lost productivity. Also, losing one Miami every year in deaths is simply unacceptable.

More on this here. 

will the latest land grab help africa?

Update: You can find individual country reports from the Oakland Institute, a California based think tank, here.

I am on record as having reservations about the latest scramble for Africa African governments leasing vital arable land to foreign companies and governments (esp. in the face of high levels of food insecurity in the region).

Like many, my first reaction was to protest against these land deals. Like most natural-resource concessions on the Continent, they appeared to favor only the foreigners and a tiny clique of well placed individuals in African governments – at the expense of the many.

But I am beginning to have second thoughts. This latest land grab on the continent maybe the catalyst of an African green revolution. Most African governments gave up on non cash-crop agriculture in the 1970s. Some, like Nigeria, abandoned agriculture wholesale and quickly became net exporters of agricultural goods. Bad policy (see Bates) and non-agricultural resources (mostly oil and metals) were to blame.

While my general skepticism remains, here are potential upsides:

  1. Commercialization of non cash-crop agriculture: The vast majority of agricultural production in Africa takes place in smallholder farms that are hard to finance or insure (tea, coffee, and other cash crops get all the money). Their small sizes also limit the economic feasibility of improvements such as mechanization, irrigation, etc. The advent of commercial production of food crops in the region will have market effects, for sure. Agricultural SM&Es and even Big Agriculture will bring much needed capital to this vital sector of the economy.
  2. Land consolidation: This is already happening (and is the main source of my skepticism regarding the benefits of these deals). With consolidation comes economics of scale, R&D, mechanization, etc. I hope that African governments will ensure that this latter day enclosure movement takes place in a humane manner. It is in their own interest since most of these governments’ political bases reside in the countryside and live on subsistence agriculture. Consolidation might also spur further growth by creating demand for more goods (people earn wages and their are no longer producing their own food). Remember that specialization determines the extent of the market (Adam Smith).
  3. Technological diffusion: With commercialization will come irrigation, mechanization, use of fertilization, R&D, etc that will most certainly diffuse to the local agricultural sector. Rain-fed agriculture when you have the Nile, the Niger, the Voltas, the Congo, the Zambezi, Tana, Athi, etc, is so pre-Mesopotamia.
  4. Political reforms: In my view, one of the key impediments to political reforms in Africa has been the persistence of what Hyden called the “uncaptured peasantry.” A landed peasantry that can live off the land allows politicians to play with the macro-economy like there is no tomorrow. If the people get off the land, the general performance of the national economy will have a bigger impact on their lives. Suddenly, reaction to stratospheric inflation rates and other failures in the macroeconomy will not be confined only to urban centres. This will, in part, serve to end Africa’s tyranny of the countryside – a situation in which ethnic chiefs elected from the countryside ignore the underrepresented urban dwellers – and spur real democratic accountability.

Discussion of the downside of these deals is already out there. It also helps to look at the potential upside (at least in the long-run). I remain convinced that the real pro-poor growth in Africa will come from SM&Es and big business, whether in agriculture or other sectors.