Balancing books at the cost of lives

Tajudeen Abdul-Raheem looks at the the Africa Public Health Development Trust (APHDT) campaign to hold African governments to their commitment of allocating 15% of their annual budgets to health.

There are many people who used to be firebrand revolutionaries who have retreated into NGOs and are adapting guerrilla strategies to their advocacy, ambushing governments and others who hold power over what we eat, what we drink, our leisure and pleasures, be they corporate shirks, religious establishments or other powers that may be.

Many are moving away from inertia-inducing cynicism to active engagement and strategic infiltration of global, regional and sub-regional multilateral meetings, and influencing their agenda both from within and without. A downside of this, of course, is the constant danger of being incorporated, of popular ideas being hijacked and subverted, or of becoming too respectable and ineffectual.

There was resistance among many of Africa's leaders about opening up their summits and other regional multilateral meetings. Many of them were bent on keeping the business of government the exclusive preserve of 'sovereignty and territorial integrity' of largely unelected and mostly unelectable dictators. However, due to the persistence and perseverance of pro-democracy forces and continuing democratic gains, the spaces that opened up at national levels gained complementary spaces at sub-regional and continental levels. In some cases rights, conventions, charters and other politico-legal instruments agreed at the continental level have become a catalyst for reform at national levels. The engagement by human rights and other pro-democracy groups with the African Commission for Human and People's Rights (ACHPR) is one good example.

A major consequence of entering the corridors of power is that many of us are ceasing to be active revolutionaries and becoming expert RESOLUTIONARIES, adept at tracking these events, plodding through voluminous and sometimes unreadable documents.

But this no longer true among a growing brigade of African Resolutionaries. They read these documents and use them as entry points to engage with our governments, policy makers, multilateral agencies and developments partners at various levels. One group that is likely to be more influential in the long run is the Africa Public Health Development Trust (APHDT), a coalition of health advocacy groups across Africa being coordinated by the indefatigable Rotimi Sankore, a veteran in Africa's social movement. As we gain more legitimate space for civil and political rights, socio-economic and cultural rights, rights to development will become more central to our social movements, superseding the 'sexy by default' traditional human rights groups and the protest by per diem that some of them have become.

Some of the contradictory dynamics in engaging with governments are evident in APHDT's campaign to get African governments to meet their commitment to allocate 15% of their annual budgets to health. The APHDT and its allies are campaigning that they honour their commitment. However, at the recent AU/ECA joint meeting of African finance, planning and economic development ministers between 31 March and 2 April this commitment was going to be quietly dropped, but for the presence of the APDHT and its allies, including the UNMC.

The agenda was packed, but both APDHT and the UNMC shadowed the meeting to guarantee finance for Africa's capacity to meet the MDGs, and in particular to ensure that the public health commitments in relation to the four health-related goals, as well as the Abuja 15% commitment, remain.

Of the four points suggested by the CSOs that were persuasive to the experts, only the following two, in modified language, made it to the ministers' final resolutions:

1.That towards actualising the implementation of the AU Africa Health Strategy and associated health plans, including those on HIV, TB, malaria and reproductive health, African countries must urgently meet the AU Abuja pledge to allocate at least 15% of national budgets to health, combined with a consistent upward review of percentage expenditure on health and per capita expenditure on health, to ensure that the necessary levels of expenditure to increase life expectancy by 2010 and to meet the health-based MDGs by 2015 are achieved.

2.That African ministers of finance, planning and economic development organize a joint conference by 2008 or early 2009 to agree on the specifics for sustainable health financing to implement the Africa health frameworks and meet the health-based MDGs.

The recommendations that ministers adopted under paragraph 153 of the draft report, which also informed resolution 7 bullet 5 of the same report, were silent on the 15%.

There was discontent among the finance ministers regarding the feasibility of achieving the 15% target when there are so many competing priorities in the budget. Fiscal conservatism is the norm for finance ministers in these ideologically driven days of neo-liberalism. However, ministers have no right to refuse to implement their political bosses' decisions. They can only do so if their political bosses have forgotten their own commitments and the citizens are not aware of them. Citizens have a duty to remind them and also demand that these commitments are met.

It is most scandalous that according to the APDHT ‘…Africa currently loses over 8 million people a year mainly to TB, HIV, malaria, maternal mortality… This tragic loss, which is the equivalent of whole countries dying out and greater than losses from all modern conflicts combined, is a result of weak or collapsed public health systems.’

It goes without saying therefore that ‘…the long-term sustainable financing of public health as a whole should be recognised as a top social and economic development priority for the ECA and AU Member States.’ And indeed anyone seriously interested in Africa's development.

If you are outraged that millions of our peoples die annually in most cases from preventable diseases you have a duty to challenge your minister of finance to stop robbing the sick and causing more unnecessary deaths by balancing books against lives. The recommendations will be going forward to the next summit in Cairo. Be sure that your president recommits himself or herself to the Abuja pledge and not renege on them as the ministers are suggesting.

Our heads of state, ministers of finance, health, education and international partners express commitment to meeting the MDGs, yet they are unwilling to put their money where their mouth is. It must be that their hearts are not in it.

African governments are quick to partner with anybody, and cry their hearts out when it comes to aid, trade and debt, but are reluctant to be accountable to their own citizens about their own budgeting and spending commitments. Africa cannot insist (rightly) that the richer countries meet their commitment to increase aid to 0.7 % of their GDPs and then renege on specific commitments to their own peoples.

The 2001 Abuja 15% pledge is not just a number that can be conveniently erased from documents or dropped quietly. It is not just another statistic. It is a betrayal of the dead and the living. It is a choice between life and death.

*Tajudeen Abdul-Raheem writes this column as a Pan Africanist.

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