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HIV/AIDS and Governance in Africa

HIV/AIDS and Governance in Africa

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Published by The Wilson Center
Nana K. Poku explores the connections between HIV/AIDS and governance in sub-Saharan Africa.
Nana K. Poku explores the connections between HIV/AIDS and governance in sub-Saharan Africa.

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Categories:Types, Research
Published by: The Wilson Center on Sep 05, 2012
Copyright:Attribution Non-commercial


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Population, Health, Environment, and Conflict
HIV/AIDS and Governance in Africa
ythe end of the 20th century, two-thirds of the countries in sub-Saharan Africa had embarked on comprehen-sive democratic transitions. As the 21st century begins, howwill these transitions continueamidst HIV prevalence as high as 20, 30, andeven 40 percent of the active population insome countries? Imagine states largely emptiedof people between the ages of 15 and 49 years,the remaining population composed largely of children, older citizens, and the very sick. Statesystems would exist, but would be unable tofulfill their coreresponsibilities and functions.These “hollowstatescould not provide sus-tained leadership across society or adequately interact with citizens through democratic insti-tutions—and would thus be at risk for greaterpolitical instability. Although the proximate cause of Africa’s AIDS crisis is HIV,the underlying societalcauses aremuch broader and more familiar. Across the continent, poverty structures notonly the contours of the pandemic but also theoutcomes for individuals. Until poverty isreduced we will make little progress towardeither reducing transmission of the virus orenhancing capacity to cope with its socio-eco-nomic consequences. It follows that sustainedhuman development is an essential precondi-tion for any effectiveresponse to the pandemicin Africa. Herein lies Africa’spredicament: Hocan weachievethe sustainable developmentessential for an effectiveresponse to the epi-demic when the epidemic destroys the very capacities essential for the response—namely,bykilling the most economically productivemembers of the continent?
AIDS and the African State
The disease exploits and exacerbates existing social and economic disparities and constraints insociety. The ability of nations to improve the well-being of their citizens, build strong and sta-ble societies, and expand opportunities for all isthreatened by this epidemic. Women, children,and men who live in poverty and difficult circum-stances are finding their conditions even moredifficult, further increasing their chances of con-tracting the virus. The growing risk of HIV infec-tion is especially evident among young womenand girls, who comprise two-thirds of all young people with HIV/AIDS in sub-Saharan Africa (World Health Organization–Africa Region,2005). Girls and young women are twice as likely to be infected with HIV than young men, and insome parts of the continent, they are six timesmore likely; in parts of eastern and southern Africa, more than one-third of teenage girls areinfected with HIV (UNAIDS, 2004).Declines in life expectancy reveal the epi-demic’s immediate impact. Average lifeexpectancy is now 49.9 years in sub-Saharan Africa; in the absence of AIDS, it would havebeen about 62 years (UN Department of Economic and Social Affairs [UNDESA],2005). In Botswana, life expectancy hasdropped to 34, a level not seen since before1950. In less than 10 years, many countries in
Nana K. Poku
is the John FergusonProfessor of African Studies at BradfordUniversity, United Kingdom. He was thedirector of research for the Commission onHIV/AIDS and Governance in Africa. (Photo:©DavidHawxhurst, Woodrow WilsonCenter)
the region will see life expectancies fall to near30 years—the same as at the end of the 19thcentury (UNDESA, 2005). Without adequate financial and strategicsupport for human capacity planning, calls forgreater political leadership amount to mererhetoric. In the absence of a functional civilservice of well-trained, highly skilled, andknowledgeable people, such political promisescannot be kept. A fundamental organizationalprinciple of the state—the cadre of civil ser-vants who assure its effective functioning—isthrown into question by incapacity due to theprolonged illnesses and early deaths of govern-ment employees.Take Zambia: According to the UnitedNations Commission on HIV/AIDS andGovernance in Africa (CHGA), mortality fig-ures in the education sector from 2001 to 2004,projected to 2011, indicate that 13,000 teach-ers will need to be trained, instead of the 5,093needed without AIDS. A similar study of localgovernments reveals that Zambia could lose 32percent of its workforce to HIV/AIDS over thenext 20 years and government agencies willneed to replace an additional 1.7 percent of thestaff each year over the same period to maintaincurrent staffing levels (CHGA, 2004).It is not, however, only the absolute levels of mortality that should concern policymakers,serious though they are. They should be partic-ularly concerned about the broader implica-tions of high and rising levels of morbidity andmortality for institutional knowledge formationand retention—that is, how to sustain anorganization and ensure that it operates effi-ciently under conditions of persistent loss of human resource capacity. The impact of HIV/AIDS on the educated and professionalcadres reduces their ability to pass on theiraccumulated knowledge and expertise to suc-ceeding generations. As a result, younger andless experienced workers find it harder toacquire the specialized skills, expertise, and pro-fessionalism needed for their jobs. In the longerterm, fewer experienced officials will be avail-able to train younger personnel in key formalskills, or pass on more informal standard oper-ating procedures or norms such as ministerialaccountability, bureaucratic neutrality, officialethics, and institutional transparency, with neg-ative consequences for the quality of both pub-lic and private services.
AIDS and Economic Development
The problem is particularly acute for people inrural areas. HIV/AIDS is significantly reshap-ing the indigenous transfer of knowledge of local agro-ecology, farming practices, and farmmanagement. These changes in rural knowl-edge structures are, in turn, restructuring rurallivelihoods at several levels. At the householdlevel in some countries, chronically ill heads of households reduced the area of land they culti-vated by as much as half, resulting in decreasedcrop production and lower food availability (Drimie, 2002). In rural Zimbabwe, maize out-put by households that experienced a death dueto HIV/AIDS declined by nearly half, more insome households (Kwaramba, 1997).Lowered production due to the loss of house-hold labor often continues for at least one yearafter a death occurs. Some households, especially those already short of household labor, may neverreturn to previous production levels, and familiesseverely impacted by the loss of income may beforced to disperse to survive. At the community level, the epidemic is shifting the composition of agricultural output from commercial cropstoward food for consumption, with adverseeffects on incomes and employment. While thismay ensure household food supplies in the shortterm, it has long-term effects on the growth of outputs, incomes, and foreign exchange earnings,and therefore on development. Ahighly publicized World Bank study argues that after allowing for intergenerationallosses of human capital (and knowledge), theprojected macroeconomic effects of HIV/AIDS will be severe (Bell, Devarajan, & Gersbach,2003). These intergenerational effects havealready been widely noted, especially on agri-culture (McPherson, 2002). The impact is fur-ther aggravated by existing weaknesses in statecapacity, such as a lack of civil service reforms,
The net effect of HIV/AIDS on theAfrican state maybe institutionalfragility, thuscompromising itsoverall capacityto deal effectivelywith nationalemergencies,while increasingpolitical instability.
“brain drain(staff leaving for the private sectoror other countries), and financial constraintsrequested by international agencies such as theInternational Monetary Fund. In the mostaffected countries, the epidemic has already decreased institutional robustness and vitality,reshaped governmental structures, and restruc-tured state-society relations.Malcolm McPherson (2003) rightly arguesthat HIV/AIDS strips time out of the decisionhorizons of those who are infected or affected.Individuals who are HIV-positive (or think they are) concentrate on the present and immediatefuture. Many activities that used to be attractive when life expectancies were “normal” lose theirappeal, and even their relevance. Consequently,HIV/AIDS changes economic behavior, oftendramatically. The act of saving, for example,requires individuals to forego consumption. With time at a premium, the incentive to savediminishes. Investment, which involves thecommitment of current resources in the expec-tation of some future benefit, becomes lessattractive. At the macro level, these trends areself-reinforcing. The decline in savings reducesthe resources available for investment. Asinvestment falls, the rate of economic growthcan decline, reducing savings. As a result, we can expect national revenues todiminish in comparative terms and the produc-tivity and profitability of businesses to fall. Asproduction and service delivery is disrupted,income is also likely to fall. These are no longerprojections; evidence suggests that families andbusinesses are shifting spending from productiveactivities to medical care and related services,reducing both savings and government revenues(CHGA, 2005). Atthe same time, the costs asso-
Figure 1: The Impacts of HIV/AIDS on Political Systems and Processes
Adapted from Poku (2006).
Participation inelectionsReshapeddemographic patternofelectoratesSupport bases forpolitical partiesweakeneddifferentiallyPoliticalrepresentationincreased attritionamong electedofficialsPopular politicalopinionincreasedpercentage of theelectorate arepersonally affecteddirectly or indirectlyby HIV/AIDSPublicadministration andservice deliveryreduced size of public sector workforceloss of institutionalknowledge,specialized skills andmanagerial skillsdeteriorating workmorale
Impacts on corepillars of democracyEffects ondemocratic processesRisks to politicalstability
Electoraladministration andmanagementloss of competenceand humanresourcesdepleted ruralelectoralmanagementsystemsskewed electoralrepresentationunder-representationofspecific socialgroups, such asyouth, women andethnic groupsincreased number of by-electionsincreased number of power-shifts in localrepresentation toparliamentsreduced capacity toimplementdemocratic decisionsvicious circle of decline in servicedeliverylowered capacity toachieve the MDGmore people arelikely to prioritizeHIV/AIDS over otherpolitical issuespolitization of HIV/ AIDS throughincreased civilsociety activityreduced efficacy of electoral processesgreater politicalalienation amonggroups that areunder-represented ingovernmentincreased illegitimacyofcentralgovernment incertain regionscontinuity of government isdisrupteddevelopment of regional policybecomes disjointedhollowed-outstructures of stateincreased corruptionreduced statelegitimacyincreased discontentwith political leaderswho do not commit topolicies of socialprotection,prevention andtreatment of HIV/ AIDSdistortion of publicexpenditureframeworksdecreasedtransparency inelectionsincreasedopportunities forelectoral fraudreduced confidenceinthe electoralsystem

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