Having had the foresight to make meeting the MDGs of “Water and Sanitation” the theme of the 2008 mid year AU Summit, and even earlier establishing the African Ministerial Conference on Water, member states did not visibly deliver on any significant outcomes that African citizens - of the 33 countries where less than 50% of citizens have access to improved sanitation - or the 35 where not up to 80% of citizens have access to improved water sources - can embrace with hope for a better future.

As stated at pre summit briefings by AU Commissioner for Rural Economy and Agriculture Rhoda Peace Tumusiime “Africa is endowed with abundant water resources with over 60 Transboundary River Basins, 17 major rivers and 16 large lakes but these resources are highly underutilized as only 3.8% is developed for water supply, irrigation and hydropower generation, 6% of the cultivated land is irrigated and only about 3% of our hydro potential is developed.”

Based on this glaring underutilisation of water resources, and despite the summits unavoidable attention to events in Zimbabwe, there should have been: pre-summit packs indicating the best performing and least performing countries for the summit themes; tracking of performance trends over the last few years; identification of what gaps need to be bridged continentally - and a summit theme communiqué from the Assembly of Heads of State outlining regional cooperation on transborder water resources, industrial waste and sanitation, also stating financial resources necessary for this; what member states have now committed to do and by when; especially to maximise use of water resources in a sustainable way.

This would not be mere symbolism or an empty naming and shaming game. Access to safe water and [domestic and industrial] sanitation is a prerequisite for good health and sustainable development. Their absence promotes squalor and disease, and disease knows no borders. In its publication on the "Water for Life Decade, 2005-2015", the UN cited "Lack of safe water and adequate sanitation” as “the world's single largest cause of illness," emphasizing that both can facilitate or "spread such diseases as diarrhea, cholera, dysentery, typhoid, hepatitis, polio, trachoma… malaria and filariasis.” There are also clear linkages between sustainable management of water resources, environment issues and food production. And with reference to the joint theme of sanitation - between domestic and industrial waste management, environmental protection and public health.

It is also little appreciated that the struggle for water, land and other resources is an underlying cause of conflicts including the genocide in Darfur, or that similar conflicts could break out in the future due to lack foresight on sustainable management of water and other resources within or across countries. But more on this later.

For the record [1], the top ten African countries providing best access to improved drinking water are: Mauritius 100%; Egypt 98%; Botswana 96%; Tunisia 94%; Namibia and South Africa jointly at 93%; Djibouti 92%; Gabon and Seychelles jointly at 87%; Gambia 86%; Algeria and Comoros jointly at 85%; and Morocco 83%.

And the bottom ten being: Gabon and Kenya jointly at 57%; Tanzania 55%; Sierra Leone at 53%; Angola 51%; Chad 48%; Madagascar and Nigeria jointly at 47%; DRC 46%; Equatorial Guinea 43%; Ethiopia, Mozambique, and Niger jointly 42; and Somalia 29%.

For Sanitation, the top 10 are: Seychelles 100%; Libya 97%; Algeria 94%; Mauritius 94%; Tunisia 85%; Morocco 72%; Djibouti 67%; Egypt 60%; Malawi 60% and South Africa 59%.

And the bottom 10: Benin and Nigeria jointly at 30%; Cote D’Ivore 24%; Senegal 28%; Rwanda and Somalia jointly 23%; Congo 20%; Guinea 19%; Burkina Faso 13%; Madagascar and Togo jointly at 12%; Ethiopia and Sierra Leone jointly at 11%; Ghana 10%; Chad 9%; Niger 7%; and Eritrea 5%. [These overall figures do not reflect disparities between urban and rural areas].

It is crucial that we note these. Not just because they were not widely provided as summit official information, but also because both African governments and civil society need a global picture to make the linkages between issues, and to note how much work needs to be done on summit themes and related issues - which claim millions of African lives annually.

Unless AU member states provide the recently renewed leadership of the AU Commission with crucial resources and capacity to ensure it can play its catalytic role for wide spread continental awareness and development – and governments provide clear summit outcomes and the resources for implementing them – then AU member states risk reducing the Commission to a conference organising unit instead of being the engine for African development on a rights based basis.

2. AFRICA AT RISK OF WAR, CONFLICT AND FURTHER INSTABILITY OVER ‘WATER SECURITY’:

The apparent lack of AU Summit outcomes or targets on transborder agreements and financial commitments for improved and sustainable utilisation of water resources throws into sharp relief the fact that Africa still has no collective continental response to environmental sustainability issues that can rapidly undermine stability and development. These include the impact of climate change: on water, environmental resources and on health; or the more immediate food crisis that also impacts on social stability, and on health through malnutrition.

As can be seen by recent food riots in several countries, famine in others, and conflict in Darfur that has resulted in genocide - the management and sustainable use of water, land and other environmental resources is both a human security, and peace and security issue.

An examination of the demographics of the impact of climate change on water resources, indicates that It is easy to see a hundred ‘Darfur’s’ exploding across Africa in the next 4 to 5 decades - if there is no continental forward planning to ensure water security for all.

As climate and environmental change impact on rivers, it is also very possible that within our generation - cross border conflicts or civil wars could erupt over the damming of rivers for electricity - between up stream and down stream countries – over control of water resources.

AU member states must note, and act on the fact that - the biggest social and economic development lesson of all history is that allowing, or creating a situation that reduces any society or community to a state of conflict over any kind of resources brings out the worst forms of bestiality in human kind – by creating a pack mentality based on the lowest common denominator whether language, ethnicity, religion, race or criminal interests - and which hyenas would be ashamed off. The shameful events in Sierra Leone and Darfur are arguably in the same reprehensible category of human behaviour, though different in scale, organisation and motivation from the genocides in Nazi Germany, Cambodia, the Balkans or Rwanda that had a more ‘refined’ and codified basis.

African governments must therefore be proactive in identifying and preventing the emergence of conflicts based on poor utilisation or unsustainable use of resources – rather than wait for the conflicts to emerge and then start the agonising search for “Hybrid forces” to contain murderous activities of the successors of the “Janjaweed”.

The MDGs and especially those of access to water, food and health should therefore not be seen as an end in themselves, but as a means to ensuring the march of Africa towards rediscovering and building societies based on the best traditions of human civilisation.

The above also underline three crucial policy issues. Firstly, the lack of proper integration of MDGs into African national development plans. Secondly, the need for more proactive measures including: establishing special directorates for development and sustainable management of water and environmental resources on a cross border basis; the same for food security; and for public health. Thirdly, the urgency for AU member states to immediately implement the Abuja pledge to allocate 15% of national domestic resources to health as a first step towards treatment, prevention and care to reduce disease prevalence worsened by poor provision of water and [domestic and industrial] sanitation. Implementing the Abuja 15% commitment will also ensure financing of the newly adopted Implementation Plan of the Africa Health Strategy presented to the AU summit for approval, and also the health based MDGs [which have been undermined by water and sanitation issues].

There must be clear realisation that for every single percentage of national populations not provided with improved and sustainable access to water [and sanitation], this represents tens of thousands - and depending on country population even millions - exposed to increased risk of death either through disease, or if reduced to conflict over water and land resources - through displacement and genocide as in Darfur.

3. G8, GLOBAL AND AFRICAN DEVELOPMENT, AND THE REAL THREATS TO GLOBAL SECURITY:

Having not set clear African targets and commitments at the AU summit on the water and sanitation MDGs, 7 key African leaders were invited to the G8 summit process in acknowledgement of “G8 concern over Africa’s plight”. Not surprisingly Zimbabwe is also dominating G8 outcomes on African issues.

This must not distract from the fact that even before the Japan G8 summit commenced, there were already reports most notably in the Financial Times that the G8 will not deliver on development promises made at previous summits especially in Germany and the UK. This is not to say that the G8 has not made contributions to global development. However the contributions fall far short of what is needed, and of what is possible for G8 countries to deliver.

“Underlying all of the ambitious sectoral commitments made in 2005 was the commitment to mobilise an additional $25 billion in development assistance for Africa by 2010 and to spend this money effectively. Due to some clarifications, the total committed… is now an increase in official development assistance (ODA) from $15.8 billion in 2004 to $37.6 billion in 2010 – an increase of an additional $21.8 billion. Three years since the commitments were made, only $3 billion of the increase has been delivered… – leaving $18.8 billion still to be delivered [2]."

“In order to be on a straight-line trajectory to delivering the full commitment by 2010, the ‘G7’ would have needed to increase assistance by $5.88 billion between 2006 and 2007 – but with only $837 million in additional assistance in 2007, they have fallen $5.04 billion short of that target [3].”

However in addition to not being met, these G8 commitments do not match the global need. Various estimates from leading global health based institutions alone indicate that funds needed to fight major disease and non-disease conditions globally are: for TB US$56.1 billion over the ten years leading up to 2015 [4]; “To meet the goal of global universal access by 2010, available financial resources for HIV must more than quadruple by 2010 compared to 2007 – up to US$ 42.2 billion…and continue to rise to US$ 54.0 billion by 2015 [5]; For Maternal and Child Health “an additional $US10.2 billion is needed yearly to ensure universal coverage of maternal, newborn and child health interventions to achieve MDGs 4 and 5" [6] by 2015; and for Malaria “a total of US$ 38 billion (optimistic scenario) to US$ 45 billion (pessimistic scenario) will be required from 2006 to 2015 [7]."

In annual terms and in everyday language: The estimated funding gap for TB is [over 10 years US$30.8 billion or] $3.8bn a year [8]. For HIV “there was a gap of US$8.1 billion between resources available from all sources and resources needed in 2007, as estimated by UNAIDS [9]”; Maternal and Child Health US$10billion annually; and for Malaria US$4.5billion annually. Or added up, a gap of an additional US$26.4 billion annually on health MDGs.

For Africa alone, the estimated cost of meeting all the MDGs is USD$72 billion per annum [10].

If this sounds like a lot of money for global development annually or over the 10 years leading to 2015, consider that by contrast the world’s most powerful nation alone - spends US$2billion a week on war according to the Congressional Research Service (CRS), the public policy arm of the US Congress. Or US$12billion a month according to Joseph Stiglitz Columbia University Professor, and former World Bank Chief Economist who won the Nobel Prize for Economics in 2001.

According to Stiglitz and Linda J. Bilmes co-authors of the "The Three Trillion Dollar War: The True Cost of the Iraq Conflict" - and writing in the Washington Post on March 9 this year, “the United States is a rich and strong country, but even rich and strong countries squander trillions of dollars at their peril. Think what a difference $3 trillion could make for so many of the United States' -- or the world's -- problems. We could have had a Marshall Plan to help desperately poor countries, winning the hearts and maybe the minds of Muslim nations now gripped by anti-Americanism. In a world with millions of illiterate children, we could have achieved literacy for all -- for less than the price of a month's combat in Iraq. We worry about China’s growing influence in Africa, but the upfront cost of a month of fighting in Iraq would pay for more than doubling our annual current aid spending on Africa.”

And this snapshot does not take into consideration the possible but not yet forthcoming resources from other G8 countries. In other words the argument of Stilgtz, Blimes and other leading development economists is that the money for global development is there, and for all the money spent on war since the turn of the millennium, global security has not improved and is now probably worse.

On the other hand, more countries in the developing world especially are on the brink of conflict based on water and other life resources. Food riots have started breaking out in some countries, and the global spread of HIV alone from just a few cases first recognised in the US in 1981 to an estimated 32 million people globally demonstrates what can happen if the fight against a communicable disease is under funded. Countries like Lesotho and Swaziland with populations under 2 million are tipping closer daily to half their populations becoming HIV positive – with little or no treatment – and the growing shadow of TB looming behind. Alongside countries like Somalia and DRC locked into a vicious cycle of conflict and poverty, the possibility of more unviable or failed states produced by a combination of human security, and peace and security factors grow by the day. Just how many peacekeeping forces, or ‘wars’ in the name of peace can the world afford, when we can prevent the peace from breaking down, by ensuring sustainable global development for a fraction of the sum.

The message is clear and we must make no mistake about it, failure to ensure collective and rapid global progress towards the MDGs and in particular the water, food and health MDGs is arguably the greater threat to global security.

The global situation could arguably be worse if not for the under acknowledged role played by non G8 countries like Denmark, Ireland, Netherlands, Norway, Sweden and others in supporting global development efforts.

4. WE WELCOME GLOBAL SOLIDARITY BUT AFRICAN LEADERS MUST DEMONSTRATE LEADERSHIP:

Without doubt historical injustices, interventions in and exploitation of Africa - especially 500 years of industrial scale slavery and colonialism have had a devastating impact on African development. People that underestimate the impact of this, only need imagine for instance, the chaos in Darfur magnified across much of the continent – not lasting a few years – but hundreds – not facilitated by one government in denial – but promoted by several imperial powers openly grabbing and sharing human and natural resources – and it can be better appreciated why the first manned flight to Mars will not take off from the jungles of DRC or the plains of Somalia.

The challenge for the present generation of Africans born within the last 50 years of African independence is to overcome the obstacles placed before us by injustices over which we had no control.

The more developed countries and especially those where the basis of their initial industrialisation lies in the exploitation of others, owe humanity a debt to ensure the human race can now go forward as one – through collective global development.

But while global development campaigners demonstrate their solidarity and step up efforts to ensure more developed nations contribute their fair share to fighting underdevelopment and poverty which arguably represent greater threats to global security than other alleged causes – African’s also have a fundamental obligation to engage our governments to ensure that they fulfil their obligations to citizens - from whom they derive their legitimacy.

We must therefore as a people impress on our governments that unsatisfactory continental planning and management of water, environmental and food resources is not unacceptable, and that this must change if sustainable African development is to become a reality. The impact of these on health, and absence of the right to healthcare for tens of millions sharply highlights the imminent death of a people in a way that nothing else does.

And while without a shadow of doubt – the absence of the right to health signifies the imminence of death and thereby establishes health as the ultimate human right - because it can also guarantee a healthy, long and productive life for individuals - the right to health is in turn the most fundamental development issue for humanity because every society perishes or flourishes on the health of its people.

This is why it should be of utmost concern to African leaders that with every passing year, not only are an increasing number of African countries becoming permanent features at the bottom of the UN Human Development Index, life expectancy is now so low – and dropping so fast - that for practical purposes there might as well be no government in some countries.

In the 2007 UN HDI, only Seychelles, Libya and Mauritius out of 53 AU member states qualified as High Human Development Nations at numbers 50, 56, and 65 respectively. After these three, only Tunisia comes in under the 100 mark at 91. African countries dominate the bottom 77, and the last 30 are all African except Timor and Yemen [11]. The situation in Liberia and Somalia, alongside countries like Afghanistan are such that at the time of compilation of the report, there was apparently no basis for computation in these countries.

To quote from the report, “the HDI – human development index – is a summary composite index that measures a country's average achievements in three basic aspects of human development: health, knowledge, and a decent standard of living. Health is measured by life expectancy at birth; knowledge is measured by a combination of the adult literacy rate and the combined primary, secondary, and tertiary gross enrolment ratio; and standard of living by GDP per capita (PPP US$).”

The introduction to the report therefore emphasises an often understated truth that “People are the real wealth of nations”, and therefore that “Human Development is a development paradigm that is about much more than the rise or fall of national incomes. It is about creating an environment in which people can develop their full potential and lead productive, creative lives in accord with their needs and interests.” For Africa, this means that economic growth without investment in social development is negative growth - because all it ends up doing is widening the abyss between an elite and the mass of citizens.

Nothing – and nothing - reflects the lack of that enabling environment to fulfil potential more than the issue of [healthy] life expectancy. And unless favourable conditions for fulfilling potential are created very quickly, Africa’s development aspirations will suffer even bigger blows from more brain drain when from 2009 the European “blue card” scheme is expected to kick in. EU “Commission officials say the E.U. has… a dearth of skilled workers in sectors like engineering, information technology, pharmaceuticals, health care and teaching” and is “targeting bright young migrants who could fill job categories where Europe could face chronic shortages [12]." The scheme “calls for admission of an additional 20 million Asian, African and Latin American workers in the next two decades [13]; And it should be no surprise where the majority of these will come from. Already hundreds of thousands of Africans forced to migrate to the more developed world are playing key roles - in every field from medicine to space exploration, genetics, diverse technological areas, sports, the arts, business, management and leadership - and in low paid jobs for which many are overqualified.

Basic survival issues played a key role in such migration, but so did many of the past dictatorships encapsulated by the likes of the Mobutu regime that were propped up by cold war politics, and inflicted repression and exodus of intellectuals and potential leaders on such a scale that aspirations of the African generation that reached its prime in the 30 years following Ghana led African independence in 1957 were almost totally destroyed. Nigerian Wordsmith and Nobel Prize Laureate Wole Soyinka famously described these as “the wasted generation”.

Unless African leaders start demonstrating giant steps of visible progress on basic governance, human rights and development issues, the question for the emerging generation of African’s may be - not how well can you live in Africa, but for how long? Millions of Africans are not even getting an opportunity to be a “wasted generation”; they are being wasted at birth, dying under the age of 5 at the rate of an estimated 4.8 million a year.

In the top ten countries on the 2007 UN HDI list, (Iceland, Norway, Australia, Canada, Ireland, Sweden, Switzerland, Japan, Netherlands and France) life expectancy is between 78 and 82 years (with maternal mortality almost at zero), and for the bottom 10 countries (DRC, Ethiopia, Chad, CAR, Mozambique, Mali, Niger, Guinea Bissau, Burkina Faso and Sierra Leone, life expectancy based on HDI calculations are between 41 and 55 years. These are also amongst the countries with the worst indicators for Maternal Mortality. In the period between the computation of the 2007 HDI and today, life expectancy has further dropped in these and other countries such that in at least 12 African countries various sources indicate that life expectancy is now between 36 and 39 years.

In development terms, African countries with low and still plummeting life expectancy are loosing the benefit of the equivalent of between 25 years and 40 years per person - of knowledge, experience and capacity. Multiply this lost knowledge and capacity by these countries shares of the over 8 million lives lost annually to preventable, treatable or manageable (PTM) health conditions and the magnitude of Africa’s loss becomes clearer. Easily, some countries have lost 25million years worth of combined social knowledge and intellect. Evidently, the next generation of nano computers, or the genetic regeneration of human organs and limbs will not emerge from the refugee camps of Darfur.

[With due apologies and acknowledgment of their immense contributions – we do not need ‘a task force of Harvard trained Economists’ to tell us that] long-term social and economic development of Africa is impossible with life expectancy sinking to an average of 40 years, child mortality of 4.8 million per annum and Maternal Death [which is almost 100% preventable] of almost 300,000 per annum. By contrast, the most developed nations in the world are also those with the greatest percentage of their populations over 65 years and almost zero Child and Maternal Mortality.

But this does not just happen. For instance, the 10 countries with the best life expectancy have between 198 and 362 doctors per 100,000, while the bottom 10 have between 2 and 11 doctors per 100,000. By comparison a medium income country like Cuba with the one of the best global ratios at 591 per 100,000 has life expectancy of 77 years [14]. So when African governments are called upon to train and retain more health workers and professionals by providing them with a better facilities and improved working conditions – its not simply an argument for the personal aggrandisement of doctors, pharmacists, nurses, mid wives and technicians – its an argument for the survival of whole nations. 8 million lost lives a year to PTM health issues is the numerical equivalent of Lesotho, Liberia, Swaziland and Equatorial Guinea evaporating in one year. Multiplied by 5,10 or 20 years it’s the equivalent of any African country dying out including Nigeria which at an estimated 144 million is the Africa’s most populous nation and the worlds 8th most populous. The question is often asked, of just how many African leaders can entrust their own personal health to the current state of their health systems.

A state only needs go over the tipping point of unviablity for its collapse to become inevitable. That point is determined by multiple factors including but not limited to its overall population and its density, size of its economy, ratio of skilled workers and professionals to population, literacy levels, life expectancy, birth rate, child and maternal mortality, governance and stability, sustainable use and management of water, food, environment and other resources - and crucially if its health systems can withstand a major hit by even just one or a combination of efficient infectious diseases.

Africa has so far been relatively lucky in terms of escaping regular blows from Tsunamis, hurricanes and earthquakes. But this will not always be the case. Already many countries are suffering the impact of indifference of Tsunami and earthquake proportions. Just think what could happen when the impacts of climate change deliver the real blows – to nations apparently unprepared to deal with even day to day issues.

So, while we hold leaders and governments of more developed nations accountable for commitments to global human security and development - we must also ensure that African leaders and governments meet their primary responsibility of ensuring the good health of their people and overall African development – by meeting their own obligations and commitments.

At the last AU summit, the MDG Africa Steering Group – composed of Secretary-General of the United Nations, President of African Development Bank Group, Chairperson of African Union Commission, President of European Commission, Managing Director of International Monetary Fund, President of Islamic Development Bank Group, Secretary-General of Organisation for Economic Co-operation and Development, and President of the World Bank Group – launched a landmark report outlining success, and challenges to meeting the MDGs in Africa.

Despite the heavy weight billing of H.E. Jakaya Kikwete, Chairperson of the African Union, Ms. Asha-Rose Migiro, United Nations Deputy Secretary-General, H.E. Mr. Jean Ping, Chairperson of the African Union Commission, Mr. Maxwell Mkwezalamba, African Union Commissioner for Economic Affairs and Mr. Jeffrey Sachs, Special Advisor to the UN Secretary-General BAN Ki-moon - the launch sank almost without a trace under the weight of the media frenzy surrounding Zimbabwe. That report [launched unwisely at the end of the summit] needs to be resurrected from its apparent early grave and examined in detail by African governments and institutions.

We must not forget however that the MDGs are not an end in themselves, but rather a vital measurement of human progress in key areas necessary for us to earn the phrase “human civilisation”. There will be debates about which political, and economic systems and policies will best facilitate them. But there is no debate that leadership and political will are required to ensure that the progress made is not lost.

Nothing will demonstrate leadership better, than an official progress report of African development commitments at AU summit level in 2009 which identifies on a thematic basis and at national, sub regional and continental levels, achievements so far on each of the MDGs - Poverty & Hunger; Education; Gender Equality; Child & Maternal Health; HIV & AIDS, TB and Malaria; Environmental Sustainability; and Global partnerships - including the gaps to be met, resources needed at country level, and most importantly how much of these resources will be provided by African governments themselves, when and by whom. This is the only way we can measure African progress, the implementation of African commitments to development, and the creation of a real basis for a better African future.

*Sankore is Coordinator of the Africa Public Health 15% Now Campaign, which engages African governments, global and African and institutions on implementation of the AU Africa Health Strategy, Health MDGs and fulfilling the AU Abuja pledge to allocate 15% of domestic national resources to health. He is also on the editorial advisory board of Pambazuka.

*The campaign can be contacted at contactus[at]africapublichealth[dot]org, and contactus[at]africa15percentcampaign[dot]org . Reactions and comments on the write up should also be copied to editor[at]pambazuka[dot]org.

*Please send comments to [email protected] or comment online at http://www.pambazuka.org/

Notes:

1. World Health Organisation, 2008 World Health Statistics Report. [There are disparities between provision of water and sanitation in urban and rural areas not reflected in the combined figures. See full report for break down]

2. Data Report, July 2008

3. Ibid

4. Stop TB Global Plan 2006 to 2015

5. UNAIDS 2007 Report, Financial Resources Required to Achieve Universal Access to HIV Prevention, Treatment, Care and Support

6. PMNCH Global Call to G8 leaders and other donors to champion maternal, newborn and child health, April 2008.

7. Bulletin of the World Health Organization 2007; 85:623–630.

8. Stop TB Global Plan 2006 to 2015

9. UNAIDS and Kaiser Foundation July 2008 Report

10. Report by the MDG Africa Steering Group, June 2008

11. United Nations Human Development Index 2007/2008

12. Time Magazine, October 24,2007

13. International Herald Tribune, October 23, 2007

14. United Nations Human Development Index 2007/2008