“Big conversation” in Ethiopia
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On a sunny Sunday last month I was sitting at the side of a field in the Ethiopian Highlands with Hilary Benn MP, talking with some of the world’s poorest people.
In his private capacity as a Labour Member of Parliament, and as part of the Labour Party’s “big conversation”, Hilary had agreed to spend a day with Save the Children at the start of his official visit to Ethiopia as Secretary of State for International Development. Too poor to be sick A short flight from Addis Ababa to Makane Salam in Debresina district revealed the vastness and inaccessibility of the rural areas - and the huge scale of the task of providing basic services to the people. We landed on a gravel airstrip perched on a hilltop, to be met by Save the Children’s local staff team and officials from the provincial and district administrations. Our first port of call was the local health centre, a short distance away, where we talked with staff, patients and officials about the problems they face.
Ethiopia is one of the world’s poorest countries: 80 per cent of its people survive on less than $1 a day, and average life expectancy is 44. The health centre serves over 180,000 people but has no doctor – there are only 2,000 doctors in a country of 65 million people. The nearest doctor is 80 km away; there is a bus, but it only goes 1-3 times a week and costs $6 – far more than poor people can afford. So for many people – like the young woman we saw struggling with complications in pregnancy – the most realistic option is to go home and hope. No wonder Save the Children’s report into the health system in Ethiopia was called Too Poor to Be Sick. Basic health care The health centre does have medicines, but they usually run out quickly because the government does not have enough money to pay for them. In fact, 20 per cent of Ethiopian government expenditure goes to provide health and education services, but this only provides a meagre $1.50 per head on health per year. The World Health Organisation estimates a minimum of $30-40 per head per year is required to provide even a basic level of health care. In the UK 12 per cent of government expenditure on health secures over $1,000 per head per year.
There is a lot that Save the Children can do in a situation like this. Working with the local health department we have helped construct new health posts, improved facilities and equipment at the main health centre, and provided technical and managerial training for staff. We have also been tracking poor families over time to understand why they cannot access health care. This has led to a new pilot programme to improve the general supply of drugs and to ensure that costs are waived for the poorest and most vulnerable. However, the problem is clearly bigger than Save the Children can solve on its own, which is why it was important to take Hilary Benn to see it. The simple inescapable fact is that there is not enough money available for basic services for poor people in poor countries. Official aid to sub-Saharan Africa has fallen from $30 to $20 per head per year in the last decade. Although the UK government has reversed this trend in its own spending, it and others have a long way to go before adequate levels are reached. In 1970 the UK signed up to the United Nations target of spending 0.7 per cent of its wealth on overseas aid. It has yet to keep this promise. Globally the picture is even worse. The world’s 22 richest donors committed on average just 0.22 per cent of their income to overseas aid in 2002 – less than a third of their promise. Dignity and capacity The visit also illustrated the importance of strengthening local government and community capacity so that the extra resources can be well used. Government cannot solve all the problems on its own. Civil society must be part of the solution. At the health centre we met a group of young people who have been working on raising awareness of HIV/AIDS in their community, mainly through music and drama workshops in schools. HIV/AIDS is a further dark threat hanging over Ethiopia: 2.6 million people including 250,000 children are infected. Lack of resources and infrastructure again plays a major part, as do ignorance and prejudice, particularly among adults. Among the myths the young people have to dispel in their work is that you cannot become infected after dark, or if you do not pay for sex. Equally our field-side conversations in a neighbouring village showed the importance of understanding the coping mechanisms of communities under stress and of supporting their own efforts to improve their lives. Although living in desperate poverty, they retained every ounce of dignity and were clearly fully capable of helping themselves if supported in the right way. We spoke about what it means to be “chronically food insecure”, i.e. in need of food assistance every year. Seven per cent of this district’s population falls into this category, although in years of bad rainfall and poor harvest this can rise dramatically. In 2003, 42 per cent of the population needed food assistance, which Save the Children provided in collaboration with the Ethiopian government.
We are currently piloting cash payments to supplement government food assistance, both to provide immediate relief and in the longer term to encourage economic activity and help to grow markets. This truly did feel like a “big conversation”. Twenty-four hours earlier Hilary Benn had been in his Leeds constituency, holding his regular weekly MP surgery. Here he may have been talking to a different set of constituents, but the issues we were debating were just as germane to his manifesto. We live in a world that spends $1,000 billion a year on arms, $300 billion a year on agricultural subsidies and only $50 billion a year on aid to bring hope to poor people like those we met in Debresina. In the UK alone we spend £5.54 billion a year on sweets: over £2 billion more than the budget of Hilary Benn’s department for the entire world. That is arguably the biggest single conversation any UK political party should be having with itself today. Mike Aaronson is Director General of Save the Children UK. --- OneWorld Guest Editorials represent the viewpoint of the authors and not necessarily that of the OneWorld Network. Read and comment on previous Guest Editorials. If you would like to write or suggest a future OneWorld Guest Editorial, please contact miles.litvinoff@oneworld.net or josie.kirby@oneworld.net. |
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