Wednesday, November 9, 2011
There has been a lot of media coverage of countries such as Tanzania (Uganda, Ghana and others) calling David Cameron's bluff on his insistance that British foreign aid should be cut to countries that have laws prohibiting homosexuality. They have told him to butt out of their business. However, if Tanzanians are so concerned about powerful interests interfering with their sovereignty, they would be better off standing up to the far more opressive and damaging strictures of the World Bank.
At around the same time as the HIV/AIDS epidemic was spreading through Tanzania, mainly unnoticed, the World Bank was busy sabotaging the country's post-independence gains in the areas of health, education, infrastructure and social services. This was the bank's policy of 'structural adjustment', which meant that desperate countries, without the ability to repay massive loans, were given massive loans on condition that they cut their public services, regardless of the rapidly growing need for them to be further expanded.
One of the consequences of this was a steady decline in the numbers of people employed in vital areas of public service, such as health. A report into human resource (HR) levels in Tanzanian health services finds that "Between 1994/95 and 2001/02, the active supply of health workers fell from 67,000 [...] to 49,900 health workers [...], an inevitable consequence of the employment freeze imposed by the Government between 1993-1999 in order to balance its budget and receive credits from the World Bank."
The report was a result of research carried out by Sikika in 2010, who have also researched and reported on dangerously low levels of medical equipment and supplies in Tanzanian hospitals. They find that on average, facilities in the area surveyed have less than half of the skilled health personnel they require; they request fewer personnel than they require every year; they receive fewer than they request; many of those deployed, more than three quarters in rural areas, do not take up their position; and attrition rates are high in some professions.
Aside from underfunding of the health sector, the authors suggest that personnel shortages may be partly related to shortages of other resources, such as medical supplies, equipment and pharmaceuticals, which would render many professionals superfluous. This effect could work in both directions, with non-human resources remaining low as long as there are too few personnel available to utilize them.
Funding is undoubtedly a serious issue and Tanzania still only spends 10-12% of its national budget on health, instead of the 15% recommended by the Abuja Declaration. But after more than two decades of neglect, and a budget that continues to be decimated by repayments to the world's biggest loan sharks, the country's health services are unlikely to catch up in the foreseeable future.
The authors make some perceptive recommendations but, without radical reform of unelected bureaucracies, such as the World Bank, IMF, UN agencies, WHO, WTO, and bureaucracies who have no democratic mandate in Tanzania, such as Western governments, the health sector will remain as stunted, malnourished, diseased and incapacitated as many Tanzanian people.
At the mercy of external commercial and political interests, efforts to reduce the spread of HIV/AIDS and to treat and care for those already infected will always be limited. At the same time, the HIV industry's obsession with sex will allow HIV transmission through non-sexual routes, such as through unsafe healthcare and cosmetic procedures, to continue unabated and uninvestigated.
Of course, severe shortages of personnel and supplies don't necessarily mean that hospital acquired HIV infection rates increase. Relatively low rates of HIV transmission in countries like Tanzania (also Kenya and Uganda) may reflect the low capacity of its health services to treat most people. We don't know that for sure; but that's because we have, as yet, no way of estimating the relative contribution of non-sexually transmitted HIV to the worst HIV epidemics.