Africa Needs 'Greater Sense Of Urgency' to Manage HIV/Aids Epidemic

18 April 2004
interview

Washington, DC — K.Y. Amoako, the executive secretary of the United Nations Economic Commission for Africa (ECA), which is based in Addis Ababa, is a prominent African voice for reform and development. He has headed the organisation, the regional arm of the United Nations in Africa, holding the rank of Under-Secretary-General of the United Nations, since 1995. Previously, Amoako worked for two decades as a World Bank official.

Amoako is currently chairing the Commission for HIV/AIDS and Governance in Africa (CHGA), which was established last year by UN Secretary General Kofi Annan to examine the worsening epidemic and recommend specific ways to respond to the impact it is having on governments' ability to function.

Among the commission's stated aims are assessing "the complex and long-term implications of the HIV/AIDS epidemic on government capacity and economic development in Africa," raising awareness within Africa and abroad on the "scale, gravity and nature" of the threat, and mobilizing the political will to promote "the necessary policy and programme measures" to deal with the human resource capacity impact and the scaling up of treatment required to effectively combat the disease.

During a recent visit to Washington, he talked with AllAfrica about the work of the commission and other issues. Excerpts.

Does the work of the new commission involve more of a country-specific approach than a continental approach?

We're not talking about a common approach to building capacity across the continent. The idea is to take a snapshot. We use a common methodology, and what we are trying to do is to understand the good, the bad and the ugly in each country. On the capacity issue, I strongly believe that if you look, for example, at the whole question of public sector management and institutions. It's about strengthening capacity, it's about a regulatory framework, it's about the whole range of issues. And countries are at different stages. And what we hope to do, ultimately, and this is the first study we're doing - maybe five years from now we can go back and do the same thing in many of these countries to see how things have evolved.

How are the Commission on HIV/AIDS and Governance and the Economic Commission for Africa institutionally involved in tackling the issue of HIV/AIDS?

Since 2000, I think we've seen some progress, but on the other hand the pandemic is getting worse and worse on the continent. What we are trying to do now is say "OK, let's better understand the impact that AIDS is having on our societies." And by understanding better the impact that it is having on our societies, we can redouble our efforts a lot more to tackle it with more vigor. Because it is really having an impact on growth rates, on orphans, on the whole landscape of the continent.

We have countries where life expectancy, as you know, is dropping very, very sharply. So it is at a core of our survival. And that is what this commission is trying to do: to better understand the impact of HIV and have government come up with the strategies to deal with the institutional and structural impact of HIV/AIDS. That is what we are trying to do with this commission.

Do you think decision-makers have an appropriate sense of urgency in their approaches to combating HIV?

The sense of urgency is perhaps not there. And that's precisely why this commission is important. We hear a lot of numbers on the impact and on the growth rates, but there's never been any systematic attempt to trace it across the continent, country by country, and then really to say, this is the magnitude of the impact. So I think the more we can do that, it will sort of bring a greater sense of urgency. And I think that may be one contribution that this commission's work can do. Even if you take on the fact that we have the anti-retrovirals now available and the drug prices have decreased, 20 million people are infected today. It is estimated that 5 million need the ARVs as quickly as possible. But the health systems and the infrastructure for delivery, for upscale treatment, are still very weak. So the question is how do we tackle this? So these are some of the issues that the commission will be looking into.

Most African countries have chosen not to participate in the peer review mechanism. What does this say about the future of good governance and regional integration in Africa?

Democracy does work in Africa! People have to have a choice - that's what democracy is all about. But with Nepad, I've heard it several times: "Out of 54 countries, only sixteen!" It's better sixteen than zero! You have to start from somewhere. And if those sixteen show, I'm confident more will come. Right now, frankly, we spend a lot of time on the peer review mechanisms. The peer review process is getting approved [and] it is going to take [time] to do one peer review, you know? So for these sixteen countries, it is going to take two years if you want to do it thoroughly. I think that's a good start. If you can do sixteen countries thoroughly in two years, by that time others will line up, and then we move there. I think that's good news.

Do regional approaches create new problems as countries undergoing conflict or economic recession drag their neighbors down, as, for example with Zimbabwe?

There are 54 countries in Africa. There's a diversity of countries. That's the point. That's precisely the point. We cannot treat all of us the same. And there are some good things happening. We need to encourage those. We need to learn from each other.

Zimbabwe is one country. What is happening in Zimbabwe is very, very difficult for the Zimbabwean people. But also, for every Zimbabwe, you have a Ghana, you have a Kenya. We have a Senegal. So I think we need to see it from that context and not paint everyone with the same brush.

You have mentioned the importance of regional integration. Can you point us to areas where there's been progress?

Yes. The last two years, my job has been to study in depth the whole governance issue and we've also been looking at regional integration in Africa. And we have a report coming out, called "Accelerating Regional Integration in Africa," that looks at the whole regional integration: looks at Ecowas, looks at Comesa, looks at the impact of regional integration on telecommunications, on trade, and all that. And there is some good news. My own sense is that on regional integration there is a lot more that we need to do. We haven't made as much progress towards regional integration as we all are obliged to do for the founding fathers, right?

In areas like development in West Africa and in Southern Africa, we've seen tremendous progress in telecommunications. And we are beginning to see a lot of progress, I think, on the whole conflict side, with the recent developments in the DRC, Burundi, and in Liberia with Ecomog. The fact that the regional institutions are taking on these challenges is important.

The rebirth of the African Union that we are witnessing now, the Peace and SAecurity Council that's going to be set up, the Pan African Parliament - these institutions [demonstrate successful integration]. So I see a new commitment toward the integration, and Nepad also provides an opportunity for moving towards that. We need to do more towards the economic side and in trade. Only ten percent of African trade is within Africa. Connectivity has to be improved. So it's a mixed picture.

Does the progress have to be regional or sub-regional before you can make much progress at the AU-Nepad level, or do you see both happening simultaneously?

There's a blueprint, a framework that's been made out. With the African Economic Community, protocols are supposed to be established so that there's a whole framework put in place where you build from the ground at the sub-regional level, and ultimately at a regional level, with a coordination mechanism at the center. And ultimately, that leads to an African Economic Community with a common currency and all that. So, it's all there, on paper.

But the point is - there is this new momentum, this sort of new energy towards a revitalization. I think that leadership is very important and that's where I'm beginning to see excitement, and that's why I think our process is going to be very helpful, because we have a systematical look at what has worked and what has not worked. I hope with that process and the leadership of the African Union, we can make some progress in this area. It's critical.

In terms of what has worked and what has not worked, have you come up with some conclusions, some broad conclusions in general that apply across the board?

Yes. For instance, we strongly believe that we need to rationalize the institutions we have for regional integration. There are too many of them, too many regional integration organizations in Africa. Sometimes their objectives are conflicting or sometimes they are the same. Various countries could belong to two or three. So rationalization of the institutions is going to be very, very important.

We are also beginning to find that many of them have over-ambitious targets or objectives. They don't have the resources to do them. And member states sometimes don't even pay their contributions on time. So again, the institutional strengthening through rationalization, in particular, is going to be key. That's one big conclusion that we have come to in this report.

Also, we have come to the conclusion that the whole progress towards what we call free trade areas within Africa, through customs unions and all that, have been very slow. There has been some progress, but it has been slow because countries sometimes [put] protocols in and don't actually implement or ratify them. This is something that we feel we need to do to drive the the regional integration agenda. Also, even on the whole issue of trade, it's not just about tariff barriers. [There are] a lot of non-tariff barriers. [We don't have] free movement of people and goods across one border to the other. We need to rationalize it. So these are some of the broad conclusions that we've come to.

Do regional approaches create new problems as countries undergoing conflict or economic recession drag their neighbors down, as, for example with Zimbabwe?

There are 54 countries in Africa. There's a diversity of countries. That's the point. That's precisely the point. We cannot treat all of us the same. And there are some good things happening. We need to encourage those. We need to learn from each other.

Zimbabwe is one country. What is happening in Zimbabwe is very, very difficult for the Zimbabwean people. But also, for every Zimbabwe, you have a Ghana, you have a Kenya. We have a Senegal. So I think we need to see it from that context and not paint everyone with the same brush.

How does poor inter-African transportation affect trade?

That's one part of [what I meant ] when I said non-tariff barriers! For example, it's estimated that if you want to drive from one part of West Africa to another, the barriers that you have to cross for 100 km are sometimes eight times. So transport costs are extremely heavy.

Within Southern Africa and Eastern Africa, the connectivity is much better. Central Africa is very, very difficult. West Africa is also very difficult, although it has improved. Liberalization is important. Forming joint ventures for airlines, pooling resources, these are the things that we need to do in the airline sector. Costs are very high - air transport costs are extremely high in Africa. That's for sure.

There's been some fairly dramatic increases in U.S. money proposed for Africa. The Millennium Challenge Account also raises the old issue of how involved should donors be in the governance of recipient countries?

The good news is that we are seeing the largest increase in official government assistance for Africa for many years. I also think there are some real issues. We have realized that conditionality just doesn't work. That evidence is very clear - unless the ownership, unless the implementation capacity is there. So the Millennium Challenge Account basically will have to confront that. And I'd like to see more countries in Africa potentially qualify for it.

We also say that aid is just one part of the larger agenda for development in Africa. We need to also see the larger issues of trade, we need the issues of debt, and all these things. We have to see it in a more holistic sense. The MCA is very important, but it's not a sufficient condition for the kinds of things that we need to do in Africa.

I know there are some criteria that have been set up and on the basis of those criteria, a certain number of countries, both African and non-African have been told "you can qualify." Even how decisions are going to be made among those countries, I don't know. So the decisions on the allocations have to be made. The question is if other countries are not on the list today, can they ever qualify if the institutions improve? So that's another issue that will clearly have to be decided.

Increasingly the donor community is beginning to agree that we need to pool resources - that different donor programs operating in an uncoordinated fashion lead to problems on the ground: multiplicity, huge transaction costs and the like. One question is: how does the MCA work with the other donors?

Some have said that the Bush administration's new Millennium Challenge Accounts signals a move away from regional approaches towards country-specific programs. Do you believe country-level approaches should be emphasized?

Yes, but it is the individual countries that collectively make a continent, right? There are certain things that only countries can do at the national level. But on the continental approach, we strongly believe in Africans and pan-Africanism. We believe in regional integration and we also strongly believe that the regional approach can help us move forward.

So national programs and policies are critical to meeting the Millennium Goals. But if we all collectively move in the same direction, then you can have a situation where the whole is greater than the sum of the parts. I think we will be making better progress. And that's why Nepad becomes critically important, because it gives you a framework around which all African countries can commune.

Lately the U.S. has been campaigning for other countries to forgive Iraq's debt. Do you believe the pressure to forgive Iraqi debt could have the effect of forcing the issue of African debt?

It sets a good precedent. So maybe they will have to follow. It's all about self-interest and political interest. Period.

Another item that is key to U.S.-Africa relations is the agricultural sector. Do you see any movement on agricultural subsidies that would help Africa?

I think there is increasing momentum to go back to the table on the post-Cancun issues, to really look at all that. On the subsidy issues, I think agriculture is very important to Africa. All the issues on the Doha Round [of trade talks] are really of tremendous importance to Africa.

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