Have NGOs replaced the State in African Health Care Provisioning?

At the time of independence, many African countries aspired to provide western-style welfare state social provisions by providing free medical care and free university education and other social services to their citizens.
The prevailing political currents of socialist ideology around the globe in the 1960s occasioned by the cold war brought to birth the idea of ‘African socialism’ which in its crudest forms emphasized the sense of ‘African community’ and therefore the concept that ‘everybody’s welfare was everybody’s business’. In East Africa, Ugandan Prime Minister Milton Obote unveiled the ‘common man’s charter’ a socialist manifesto for newly independent Uganda. In Tanzania, President Julius Nyerere gave credence to ‘ujaama’ villages or communal villages that provided an all embracing community.
Social services were freely provided and medical services at government hospitals were free as were other social provisions.
However in the early 1980s the idea of an ‘African’ welfare state came under serious threat as being unsustainable owing to failing economies under hardship due to falling international prices of the cash crops on which many African countries depended coupled with chronic political turmoil and ethnic tensions ubiquitous in post independence Africa.
African countries, and Uganda in particular, sought budget deficit financing from the World Bank and the International Monetary Fund (IMF).
The Breton Woods institutions prescribed the hugely unpopular Structural Adjustment programmes (SAPs) that called for radically reduced social spending in the social sectors of health and education by the introduction of ‘user fees’ and ‘cost sharing’ in social service provision as well as the full-scale marketization of social provisioning.
The introduction of market liberalization reforms, including privatization of the social sector, has turned citizens into client-consumers rather than social provision beneficiaries with millions falling through the cracks.
The prolonged diminished fiscal ability of the Ugandan state to provide social welfare has seen an increasing importance of non -governmental agency providers of health care. In sectors such as HIV/AIDS health care and treatment in Uganda, non governmental and civil societal organizations dominate. Hence the failure of the state and the market in Uganda has seen the emergence of new service providers and the expansion of space for alternate players. The central question would therefore be that has the ‘pluralism’ of social welfare providers in Uganda called into question the need for a paradigm shift to a tri-model of state, market and civil society?

Deng Xiaoping And The Cultural Revolution: A Daughter Recalls The Critical Years: A Book Review.

Deng Xiaoping and the Cultural Revolution is an autobiographical book about the trials and tribulations of Chinese leader, Deng Xiaoping during the ten-year disastrously tragic ‘cultural revolution’ in Mao Tse Tung’s 1970’s China. Deng Rong, Deng’s daughter, provides an exceptionally intimate first-hand account of China’s ‘reign of terror’ under Chairman Mao Tse Tung. In many ways it comes off as a therapeutic book Deng Xiaoping himself would have ordered to recount his pain and humiliation but also to defend and protect his place in the communist party and China’s history as a whole.
On a human interest level, it is simply the story of an extra ordinary man who weathered political storm after storm. He was twice ‘over thrown’ and stripped of all his elite positions and status in the Chinese government under Mao’s orders and evicted out of his official residences. After being ‘overthrown’ he worked for many years as an ordinary fitter in a tractor factory hundreds of miles away from the capital Beijing and the second time he lived under virtual house arrest after his second ‘overthrow’. Each time he fell, he got back on his feet much like the proverbial cat with ‘nine lives’. Deng Xiaoping had an incredibly indomitable spirit and even in his darkest day waited patiently for the tide to turn.
Reading this book reminded me of Nelson Mandela’s Long Walk to Freedom another tale of an extraordinary life and a man who defied adversity and rose to the highest office of his land, just like Deng Xiaoping in China.
Deng Xiaoping was the paramount leader of China after Mao Tse Tung’s death in 1976 , having previously served as Vice Premier of China. With his experience in China’s war of liberation and steady rise in the China’s communist party, he was widely viewed as the successor to Chinese Premier Zhou Enlai, who died of cancer in 1976, leaving a gaping leadership gap at the highest level. Some even viewed him as a possible successor to Mao Tse Tung himself who in his 80’s was ailing and nearing his end as China’s paramount leader.
But there was one problem. Deng Xiaoping, who for a time lived in France in a ‘work-study’ arrangement, was not ideologically aligned to Mao’s extreme Marxist line of ‘class struggle’ and ‘dialectic materialism’. Although a member of China’s communist party of long standing, a hero of the China’s war of independence and an experienced administrator, many of the extremists in his party viewed him as a closet capitalist or to use their own term ‘a capitalist in-roader’.
In all fairness, Deng Xiaoping‘s ideological leanings were not strictly Marxist and asking what he was doing in a communist party is a decent question. He seemed more concerned with the pragmatic questions of state such as reviving the Chinese economy after the dysfunction occasioned by the cultural revolution, alleviating poverty in the country side, revitalizing industrial production, modernizing China etc. He once said he didn’t care whether a cat was black or white as long as it caught mice.Mao in fact had anointed the younger Lin Biao as his successor who in his estimation was closest to him in ideology and would preserve his beloved cultural revolution.
Mao installed Hua Guafeng as his successor whom Deng out manouvered after Mao's death and started China on its socialist market economy. In many respects, Deng Xiaopeng is the father of modern China. The China that is set to overtake Japan this year as the world's second largest economy.

The New Global World Order: The Emergence of China and the Decline of U.S.Power

Is United States’ global power, influence and leadership on the decline? Voices from Strategic think tanks around the world and from within the United States itself suggest that there is an emerging consensus that US leadership of the west and its global hegemony in general is severely under threat and slipping steadily.
British academic, Martin Jacques has authored a new book with a telling title 'When China Rules the World: The End of the Western World and the Birth of a New Global Order' he estimates that over the next half-century, China will emerge as the world’s leading s power and that there is a shift of power from the west to the East.
In another thoughtful piece, Japanese analyst Hitoshi Tanaka, author of The Crisis of Global Governance and the Rise of East Asia argues that US leadership of the world has slipped for two reasons. The disastrous foreign policy of former US president George W Bush ,including the costly invasion of Iraq, without United Nations Security Council approval and a continuing costly war in Afghanistan in military and economic terms. Nobel Prize economist Joseph Stiglitz puts the cost of the US debacle in Iraq at $ 3 trillion.
The failure by the US to exercise global environmental leadership on the Kyoto protocol has irked many of the US’s own allies including Japan and the United Kingdom.
One would add that the current global financial crisis and the declining US economy have not helped matters either and exposed the vulnerability of US economy which has reportedly shrank - a major cornerstone of US geopolitical capability and prestige. The US has borrowed excessively from China to finance President Obama’s stimulus measures to shore up the US economy.
TIME magazine reports that the US owes China $ 763.5 billion in US Treasury department debt.
Signaling an emerging new world order, China has publicly called for a replacement of the United States dollar as the world’s reserve currency owing to perceptions of a long-term weakening US economy. China has threatened to introduce a new global reserve currency called’ the renminbi’ to replace the US dollar. China’s increasing importance is exemplified in its influence in the current global financial crisis., it is viewed as the ’primary driver of global economic growth’. Indeed recently reported economic growth in China was interpreted as a more optimistic outlook for the rest of the world economy.
According to Newsweek China is slated to surpass Japan this year as the second largest economy in the world with India not far behind.
The rise of China, analysts suggest, has altered the world order and will see the declining influence of the Group of 8 countries (G8) of US, UK, Canada, France Germany, Italy, Japan and Russia and in their place the G2, China and US. President Obama has said that Washington and Beijing will shape the 21st Century.
‘At the time of its formation in 1976,the G7 members accounted for 64% of global GDP, that number has now fallen to 56%. Meanwhile the economies of the so called G5 nations-Brazil, China ,India Mexico and South Africa have expanded and now account for approximately 12.7 % of global GDP. A figure that will continue to rise in the coming years’ writes Hitoshi Tanaka.

In regard to US and China, Daniel Drezner talks of the former and later respectively as ‘a declining hegemon with the willingness but not the capability to act as the global leader, combined with a rising power with the capability but not the willingness to act as a global leader’.
I would add that the rise of Arab states such as United Arab Emirates and Qatar with their burgeoning financial muscle from oil wealth have added another dimension to the global balance of power scene. Arab financiers have bought a handful of English Premiership football clubs such as Manchester City and Portsmouth. It was reported that an Arab consortium bought a stake in Germany’s Mercedes Benz group. In Uganda, telecom giants Zain and Warid are testimony to the growing financial influence of the orient in world business.

So, is US power really on the decline? The death of giants is often prematurely called.
Mark Twain was prematurely announced dead and remarked thus 'The reports of my death are greatly exaggerated’.

Why Capitalism Truimphs in Asia and Fails in Africa

President Obama speaking in Ghana on his recently concluded Africa trip re -echoed a question that has puzzled economists and other social scientists. Why has South Korea which had about the same Gross Domestic Product (GDP) as Uganda at independence in 1962 gone on to become a global industrial power house while Uganda wallows at the bottom list of the league of nations ?
In fact Kenya’s GDP was even higher than that of South Korea at independence in 1963 but South Korea’s GDP today stands at--- compared to Kenya’s,,,,
In 1959 Singapore ‘s per capita income was $ 400 compared to today’s $ 22,000.
At the time of African independence many of the countries in Anglophone Africa were regarded as better prospects than the South Korea, Taiwan and Singapore of the 1960s.
Sixty years on, the African countries have not only become poorer than they were in the 1960s’ but trail their East Asian counter parts on just about any major development indicator ever formulated.
Lee Kuan Yew, Singapore’s first Prime minister, writing in his memoirs From Third World to First recounts how, over three decades, Singapore was built virtually from scratch in the 1960s, with no army, parliament and other basics of a state to speak of.
In contrast, at the time, Uganda was a functional state with most of the apparatus of statecraft.
Lee Kuan Yew through astute leadership and indomitable will went on to build a state that today boasts a per capital income that rivals several members of the current European Union. This he did through encouraging entrepreneurship and economic freedom
In Malaysia, Prime Minister Mahathir Mohamad between 1988 and 1997 transformed Malaysia into a manufacturing, financial and telecommunications hub. Malaysia started producing cheap appliances for western markets and providing home to the plants of major Japanese giants such as Sony and Panasonic owing to relatively cheap Malaysian labour.
China as recently as 1972 was a struggling state reeling from the disastrous ‘cultural revolution’ of Chairman Mao Tse Tung who pursued a radically communist agenda imprisoning and purging his party of any real or imagined ‘capitalists’ that bred untold poverty and dysfunction in a sleeping giant. Subsequent Chinese leader, Deng Xiaoping, strategically realizing that communism would not transform China made a u- turn and started China on the road to export-led industrialization dubbing it’ capitalism with communist characteristics’.
China, among other strategies, adopted a policy of population control and invested heavily in education especially in maths and science. It’s no wonder that Chinese and Indian students dominate natural science doctoral programmes in the United States.
Crucially, Asia ‘s example suggests that the state can be a major player and driver of growth and in Singapore, Taiwan and China, the state took the centre stage in driving national growth. It may not be widely known that the Chinese firms constructing stadiums and high rises from Luanda to Kinshasa are actually Chinese state-owned companies.
Tragically, in the place of the transformative leaders Asia has had, in Africa we have had ‘big men’. Although Asia’s success stories also suggest that a ‘benevolent’ dictatorship especially geared towards economic transformation is not entirely unwelcome considering that Lee Kuan Yew of Singapore, Deng Xiaoping of China, Mahathir Mohamad of Malaysia ,Suharto of Indonesia were not the most illustrious students of democracy but provided the leadership that turned the tide in their respective countries. Apologists for President Paul Kagame of Rwanda tend to take this posture.
It has also been suggested that Asian cultural values such as Confucianism, honour and a hard work ethic are conducive for productivity and spur economic growth. David Landes’ in his insightful ’The Wealth and Poverty of Nations’ Underscores the relationship between culture and economic advancement
While Europeans love their holidays and shut down on Sundays, Asians have no such proclivities.
The Chinese have won many civil works contracts in Uganda and the rest of Africa partly because of cost economics. Chinese engineers are said to be cheaper than their Ugandan counterparts, for instance, and they deliver that building when they say they will.
Next time we shall see how Africa took a wrong turn and why Asia continued on the path to the Promised Land.

The King of Pop is Gone too Soon.

I first learnt about Michael Jackson when I was about ten. It was the Uganda of the early 1980’s and it was Obote II’s Uganda. Michael Jackson was my first major interaction with American pop culture. As I recall, it was the Thriller album days. The VCR was making an entrance in some select Ugandan living rooms. Those were the days of break dance and it was cool to do some break dance with the kids back at school.
I remember watching the full-length ‘Thriller’ music video and Rambo’s ‘First Blood’ at Namilyango Junior School when I was in form four of boarding school. . I recall the Ethiopian famine of 1985 and the anthem that ‘We are the world’ became at the time.
Michael Jackson was a very fascinating and unique act, even more so for a young Ugandan boy who didn’t have much alternative pop acts to compare him with. Of course I now know that MJ was ‘it’ and there will never be another MJ. In the words of the Motown founder who first signed the Jackson 5 ‘Michael Jackson was the greatest entertainer that ever lived’.
I had a soft spot for MJ and he didn’t lose me as a fan even when it become clear that his private life was a totally different script from the Michael Jackson we saw on the screen belting out, Thriller, Bad, Earth song, Heal the world, you name it.
He was very much a part of my childhood and initiated me into American pop and that fascination with everything American. As I child, I longed to visit the land of MJ and that dream came to pass in 2001 at Dallas, Fort Worth.
When he was announced dead, I couldn’t help but feel that a part of my childhood had gone with him. As children we sang his hits, imitated his signature dance strokes. Wore his trademark white socks, hat and fantasized about his red jacket.
His Thriller, Off the Wall and Bad albums stand out for me and when I think of MJ, I remember his ground-breaking music videos especially the ‘BAD’ video which is forever burned in my brain. Who's bad?!
As a school kid I remember using oil paint to label my cap with the letters ‘BAD’.
Yes, there will never be another Michael Jackson. Even Usher and Justin Timberlake would agree.

Dambisa Moyo's 'Dead Aid': A Book Review

Dambisa Moyo’s new book Dead Aid has sent ripples across the globe, particularly for those in the billion- dollar aid industry for whom this provocative book ought to make required reading. Dambisa argues that development aid to Africa ‘is no longer part of the potential solution but, its part of the problem-in fact aid is the problem’.
Dambisa Moyo is a London-based Zambian economist with degrees from Harvard and Oxford Universities with stints at the World Bank and Goldman Sachs.
Dambisa shows that over a 60 year period , US$ 1 trillion in development aid has been sunk into African countries with nothing to show for it in the recipient countries. Dead Aid maintains that aid money goes down the drain of corruption and props up despotic African regimes which are more concerned about appeasing paying donors rather than the disenfranchised populations they lead. Dambisa argues that development aid leads to market distortions, perpetuates an aid dependency syndrome in Africa and that enterprise, innovation and entrepreneurship suffer as a result when all African leaders have to do is’ wait to bank cheques’. Dambisa’s argument that aid is counter- productive is hardly original and William Easterly in earlier, more illustrious endeavors, White Man’s Burden and The Elusive Quest for Growth and Paul Collier’s The Bottom Billion make even more compelling cases.
Even World Bank staffers have penned books around the subject such as Phyllis Pomerantz’s Aid Effectiveness in Africa but Dambisa takes it a notch higher
’ The notion that aid can alleviate systemic poverty, and has done so is a myth. Millions in Africa are poorer today because of aid; misery and poverty have not ended but increased. Aid has been, and continues to be, an unmitigated political, economic, and humanitarian disaster’
Even African heads of states such as Presidents Yoweri Museveni of Uganda, Abdoulaye Wade of Senegal and Paul Kagame of Rwanda are publicly making the case that trade not aid is a better hope for lifting millions out of poverty and deprivation in Africa and the rest of developing world. Although trade is the new buzz word among African leaders clearly foreign aid is still needed and its critics will be the first to acknowledge this much. The point being made is that aid should be more effectively targeted and it should not be seen as the panacea for bringing countries out of chronic poverty.
Dambisa’s call for the end of foreign aid altogether, which she calls for in the next five years, sounds at best hugely radical. In the place of western aid, she calls for African countries to cultivate fiscal discipline by raising finance through international bonds or international commercial lenders which in the current climate of the global credit crunch is an proposal dead- on-arrival .
Foreign aid may not have worked in Africa but to dismiss it outright would be to belittle the value of the Marshall Plan or US aid to Europe after the Second World War which transformed Europe or the case of American support to South Korea which is an emerging global economic power house. Clearly the debate ought not to be whether aid can be helpful but rather how it can be made much more effective and much more smartly targeted than it has in the past.
Indeed more innovative approaches to giving aid are gaining currency at a micro level and western entrepreneurs interested in improving Africa’s lot are thinking up some creative approaches. Aid is no longer purely humanitarian but has a tinge of business interest. For example computer companies which want to make contributions to development causes increase sales through declaring that US$ 5 will go to African charity from every lap top sale rather than make outright donations.
A Uganda entrepreneur in Denmark through his initiative byc4.com creates a forum for European humanitarian capitalists to lend money to deserving Ugandan businesses with friendly interest loans.
The days of conditions-free money seem to be in the fog of the season’s end.In summing, Dead Aid ‘s diagnosis on aid merits attention, the prescriptions offered, less so. African poverty is a multi-faceted animal with structural, cultural, institutional, attitudinal and even historical

Wangari Mathaai's Unbowed:A Pedestrian Book Review

I am reading a May 2009 copy of TIME magazine and Liberian President,Sirleaf Johnson, in her 'Ten Questions' TIME interview mentions Kenyan activist,Wangari Maathai as one of her role models. And she is in good company.The first elected female president in Africa also mentions Julius Nyerere(former Tanzanian president)and Nelson Mandela among her other role models.
When Wangari Maathai was awared the Nobel Peace Prize in 2004, many were taken by suprise. Many know Wangari as an environmental activist, the founder of the Green Belt Movement in Kenya which as has chapter around the globe.
Reading a copy of Unbowed, Wangari Maathai 's memoir convinces any doubter that she deserved the Nobel prize.
Wangari Mathaai was one of former Kenyan president- Arap Moi's solitary opponents. And this is a shocker given that we know Wangari mostly as a green- crusader.
In a country where there was only one official political party-KANU, Wangari and colleagues provided the only opposition that Kenya knew. Its a miracle that she survived death which many of her peers were not so lucky to survive. Her methods like those of Martin Luther King and Mahtama Gandhi were decidely non-violent.
The book though is a remarkable testimony to the birth of an environmental advocacy group operating in a tyranical state in Africa. It took enormous personal sacrifice and sheer guts to beat the odds in keeping the green belt movement's candle burning in Moi's Kenya. The police, the judiciary and even the academia in Kenya all at different times proved to be road blocks in the way of Wangari Mathaai. In fear of the Moi government, they frustrated the efforts of Wangari and her environmental cause as appeasement to the Moi regime which understood Wangari as a threat to the regime in Kenya even when all she did was just to get women to plant trees! Of course it was alot more complicated than that. Wangari was treated as an opponent for many reasons, including, her external support from the west and her clout among women in Kenya and also because of partriachial perceptions that as an 'african woman' she had claimed more than her fair share of public affairs and belonged to the domestic realm.
The books begins off beautifully with a nostalgic tale of life in rural kenya during British colonial rule through Wangari's teenage eyes and takes us on a journey to colonial Nakuru,Nairobi and then the United States back to Nairobi and then to Germany and then back to Nairobi again-the story of her incredibly remarkable life. Wangari' s tale is seemingly larger-than-life. Her stuborn, fearless and selfless will amidst trials and tribulations seems beyond mere mortals.
Unbowed is also a story of one woman's effort to save the environment in Kenya and an african woman's treatise on the perils of environmental mismanagement and in the words of Mahtama Gandhi, being the change that she wanted in her world.