IHP news #310 (March 6, 2015)

International Women’s Day

By on March 6, 2015

Dear Colleagues,

This week’s short reflection comes from Charles Birungi  (EV 2013), and is titled ‘The Africa Rising paradox’.



“Is Africa really “rising”? Going by an avalanche of media stories in recent years, YES. This “Africa Rising” narrative has been, in a large measure, perpetuated by cover stories in The Economist and Time Magazine, to mention just a few of the most prominent ones. The narrative goes that as a result of increased foreign direct investment and high growth rates in Africa, the continent is on track to become the next global economic powerhouse. Wonderful. For global health, however, this begs the question: where are the dividends from this “rising”? The question was relevant even before Ebola hit West-Africa.

At the risk of oversimplifying, a rise in GDP is expected to translate into a corresponding rise in African governments’ public financing of health services from the ensuing revenues. However, it is an open secret that domestic health financing is not rising as fast as the GDP rises in many African countries. For example, in spite of impressive economic growth rates in Tanzania, government accounts for only 12% of total health expenditure in 2013/14. Isn’t this a paradox? And Tanzania is not alone. Many other examples can be cited where domestic health financing has remained dismally low despite the “Africa rising” rhetoric. In some instances, a “replacement effect” has been observed whereby some Sub-Saharan Africa countries don’t prioritize investments in health relative to their ability to finance health care, (still) looking to donors instead – some African governments focus instead on building economic infrastructure. Fair enough, you could say, keeping in mind this week’s article by Angus Deaton et al in Health Affairs – they found among others that sub-Saharan Africans don’t consider health care the most pressing issue for their governments.

But to come back on the question whether Africa is rising or not, I believe, just like Rick Rowden, that analysts have focussed on very unhelpful metrics to gauge Africa’s development. As already mentioned elsewhere (see for example the book “How Rich countries got rich… and why poor countries stay poor”), “development” has for centuries been considered as a synonym for “industrialization”. It is only then that you can truly be seen as “rising”. On that account, only some African countries are doing ok, even with the current impressive economic growth figures (and not necessarily the most democratic ones, if I may add). Dani Rodrik is one of the many scholars wondering whether  Sub-Saharan African economic performance will be sustainable ( and that was before he even started talking about the perils of “premature de-industrialization”).  Others, like Justin Yifu Lin, are more optimistic, even bullish. But at the very least, there is still some doubt on Africa as “the next economic powerhouse”. Enter the huge demographic pressure, the increasing security issues, Africa’s looming climate crisis, and many other challenges, and Africa still looks set for tense decades.

Going back to African health care, as the end of the Ebola epidemic seems in sight, analysts have pointed to weak health systems as the main contributor to the large impact the epidemic has had on the affected countries. Weak health systems, in turn, are a result of low investments. Earlier this week, a new Save the Children report gave some more detail on how common weak health systems actually are. But the Ebola crisis has also “revealed  the consequences of deep-seated, unequal global social and economic relations that international development entrenches, as practised in recent decades” (see an IDS series last week). Not sure the latter message was emphasised  that much, this week at the ‘From Emergency to Recovery’ conference on Ebola in Brussels. For an epidemic with global consequences, global solidarity and shared responsibility are key.  But this goes much further than just donor assistance (even if donor help goes beyond  the current Ebola response to assistance with the long-term recovery of these countries). For a start: perhaps it’s time to listen to developing countries asking for bilateral investment treaties to drop their ISDS clauses, and in general renegotiation of investment treaties, in order to secure more policy space.  And that’s just one example of post-2015 priorities.

Perhaps then, the Africa rising “paradox” will no longer be a paradox.”


In this week’s Featured article, my colleague Pierre Massat (ITM)  reflects on Silicon Valley entrepreneurs and their mindset. He starts with the Uber model and ends up with Amazon tribes. A provocative stance, perhaps, and you’ll certainly not agree with everything said, but that’s not the point of IHP, is it? Do have a look!



Enjoy your reading.

The editorial team

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