Leaving scandals and shuffles behind him in darkest Ottawa, Prime Minister Jean Chrétien is occupied with better things at the G8 Summit this month as he tries to seal an action plan for the New Partnership for Africa's Development (NEPAD), conceived by African leaders last year in Abuja, Nigeria. It is a sorry fact that the world's aid to sub-Saharan Africa declined in the last decade — Canadian aid fell by 40%1 — despite the worsening humanitarian crisis wrought by infectious disease, political upheaval and war. The 818 million people in Africa have the lowest average life expectancy in the world (54 years, to Canada's 79) and the highest infant mortality rate (88 per 1000 live births, to Canada's 5.5).2 Every year, 90% of the 300 to 500 million clinical cases of malaria worldwide occur in sub-Saharan Africa, along with 1.5 million cases of tuberculosis. HIV is now the leading cause of death in sub-Saharan Africa, where 28 million people are infected.2
Although disease is often an effect of impoverishment, the economic consequences of disease are also “pernicious.”3 Reduced productivity and income, loss of human capital, accentuated social inequities, curtailed opportunities for youth and other societal debilitations reduce “state capacity” not only for health and prosperity, but also with respect to good governance and political order. The lower a state's capacity to begin with, the weaker its ability to withstand stresses such as environmental degradation, conflict and emerging infectious disease. Many African countries are in this perilous condition.
The NEPAD strategy is to develop in “partnership” with developed nations — and the World Bank — a capacity for recovery and growth rather than to persist with the “aid first” approach that never provides much more than temporary relief. Goals selected for fast-tracking are disease control, development of information technology, debt reduction and market access. If these sound “global,” the stated intention is for change to be directed by elected governments, by Africans and for Africans. In NEPAD's vocabulary, democracy and development are cognates.4 For that matter, only democracies with open markets need apply.5
Canada's pledge of $500 million for a trust fund for Africa, premised on the anticipation of budget surpluses over the next 3 years, is a laudable but smallish step toward closing Africa's estimated “resource gap” of $64 billion. We wish the Prime Minister well as he tries to ensure that NEPAD is played as the main theme at Kananaskis. But there are some discordant notes. Will the political and economic prerequisites for aid entrenched in NEPAD's top-down approach ultimately serve those in Africa who are most disadvantaged by political instability and economic ruin? If only democratic governments qualify for a helping hand, and if privatization and the liberalization of trade are unquestioned values under NEPAD, where will this leave embryonic democracies and local economies struggling at the grass roots, in women's groups and local workers' collectives and human rights associations?1 Not even the best intentions are simple. — CMAJ
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