The Foresight Africa, African Growth Initiative invited scholars and experts to delve into six overarching themes that highlight areas in which African countries and their citizens are taking the lead to achieve inclusive growth. In a world where China and other emerging economies are ascendant, where cooperation on global governance is under challenge, and where free trade faces headwinds, Africa is argued to need its own institutions to play a more assertive role in advancing the continent’s agenda. The report emphasizes that Africa’s future lies in its own hands and that it already has the power to reach its goals. The authors describe, and argue for, new and innovative instruments to better mobilize and leverage resources for development financing. They authors explore and offer recommendations on policy interventions to broaden the benefits of future economic growth. Further chapters explore technological innovations and their potential to transform the continent. The final chapter explores a shifting global landscape of diplomacy – what will the impact of reduced engagement from the United States be? How do development, defence, and diplomacy best fit into foreign policies toward the continent?
Health equity in economic and trade policies
This paper examined sulphur dioxide (SO2) emission trends, emission regulations and residents’ perceived health risks from exposures to such emissions at Selous Metallurgical Complex platinum group metal smelting facility in Zimbabwe. SO2 data from roof monitoring sites at the smelter furnace were aggregated into annual, quarterly and monthly emission trends from 2008 to 2015. The regulatory regime’s ability to protect human health from SO2 pollution in communities located around the smelter was examined. Questionnaire responses to perceived health risks from SO2 exposure from 40 purposively sampled residents were assessed. Between 2008 and 2015, annual SO2emissions increased from 7951 to 2500 tonnes. Emissions exceeded the recommended standard limit of 50 mg/Nm3, presenting considerable adverse health risks to local residents. Concerns relating to inefficient environmental impact assessment licensing system, poor monitoring and auditing by the environmental management agency, as well as non-deterring SO2emission exceedance penalties were identified as major drivers of emission increase. Thirty-two of the forty respondents perceived exposure to SO2 emissions as adverse and the cause of their illnesses, with coughing, nasal congestion and shortness of breath the most frequently self-reported symptoms. A set of legally-binding SO2 emission standards supported by stringent environmental impact assessment licensing arrangements for smelting industries are suggested for development and enforcement to reduce the SO2 emission problem. Community participation in SO2 emissions monitoring was also proposed as a core part of sustainable environmental management in communities located around smelters.
A recent World Bank report, The Changing Wealth of Nations 2018, offers evidence of how much poorer Africa is becoming thanks to rampant minerals, oil and gas extraction. Yet the author notes that World Bank policies and practices remain oriented to enforcing foreign loan repayments and transnational corporate profit repatriation. Central to its “natural capital accounting,” the Bank uses an “Adjusted Net Savings” (ANS) measure for changes in economic, ecological and educational wealth. The Bank asks, “How does sub-Saharan Africa compare to other regions? Not favourably.” The ANS decline for sub-Saharan Africa was worst from 2001-09 and 2013-15. The author observes that there are two ways to address transnational corporate (TNC) capture of African wealth: bottom-up through direct action blocking extraction, or top-down through reforms. He critiques the latter, such as in the African Union’s 2009 Alternative Mining Vision (AMV) position that foreign resource investors with capital, skills and expertise are critical to development, which ignores these evident trends on the continent.
This report presents the movement of all the main financial resources into and out of Africa, mainly using 2012 figures. It found that $134 billion entered the continent in 2017, mainly in the form of loans, foreign investment and aid. However, some $192 billion was taken out, mainly in profits made by foreign companies, tax dodging and the costs of adapting to climate change. Africa was found to suffer a net deficit of $58 billion a year. This is reported to have has led to reductions in government holdings of international reserves and lower (but still significant) multinational company profits taken out of the continent. They report that there are now more loans to African governments, another in inflow, although this comes at the cost of future debt payments and possibly debt crises.
This report was prompted by tailings dams disasters and rising global concerns about the safety, management and impacts of storing and managing large volumes of mine tailings. The report laments that although the number of dam failures has declined over many years, the number of serious failures has increased, despite advances in the engineering knowledge that can prevent them. The report makes two recommendations that can help the industry to eliminate tailing dam failures. Firstly, it calls for a “safety-first” approach to tailings storage that should be reflected in both management actions and on-the-ground operations. The report also recommends establishing a UN Environment stakeholder forum to facilitate international strengthening of tailings dam regulation. These approaches could include establishing a database of mine sites, identifying best practice and developing technical solutions to the main causes of failure. The assessment also discusses how mining firms can adopt cleaner processes, new technologies and re-use materials in order to reduce waste.
This study aimed to identify how research organisations and partnerships could contribute to capacity strengthening for health technology assessment and priority-setting in Africa. A rapid scan was conducted of international formal and grey literature and lessons extracted from the deliberations of two international and regional workshops relating to capacity-building for health technology assessment. ‘Capacity’ was defined in broad terms, including a conducive political environment, strong public institutional capacity to drive priority-setting, effective networking between experts, strong research organisations and skilled researchers. Effective priority-setting requires more than high quality economic research. Researchers have to engage with an array of stakeholders, network closely other research organisations, build partnerships with different levels of government and train the future generation of researchers and policy-makers. In low- and middle-income countries where there are seldom government units or agencies dedicated to health technology assessment, they also have to support the development of an effective priority-setting process that is sensitive to societal and government needs and priorities. Research organisations were found to have an important role to play in contributing to the development of health technology assessment and priority-setting capacity. In Africa, where there are resource and capacity challenges, effective partnerships between local and international researchers, and with key government stakeholders, can leverage existing skills and knowledge to generate a critical mass of individuals and institutions. It is proposed that these would help to meet the priority-setting needs of African countries.
This paper analyses the implications of a tiered pricing and voluntary licensing strategy for access to Direct Acting Antivirals (DAAs) for treating Hepatitis C Virus (HCV). Seven countries in Africa were examined (Egypt, Ethiopia, Nigeria, Democratic Republic of Congo, Cameroon, Rwanda and South Africa) to assess their financial capacity to provide DAAs for treating HCV under present voluntary licensing and tiered-pricing arrangements. The cost of 12-weeks of generic DAA varied from $684 per patient treated in Egypt to $750 per patient treated in other countries. The current prices of DAAs are much higher than the median annual income per capita and the annual health budget of most of these countries. If governments alone were to bear the costs of universal treatment coverage, then the required additional health expenditure from present rates would range from a 4% increase in South Africa to a staggering 403% in Cameroon. The current arrangements for increasing access to DAAs, to eliminate HCV would require increases in expenditure that are too burdensome for governments, individuals and families. The authors argue that countries need to implement the flexibilities in the Doha Declaration on Trade Related Intellectual Property Rights agreement, including compulsory licensing and patent opposition to address this, and this requires political commitment, financial will, global solidarity and civil society activism.
In principle, trade and investment agreements are meant to boost economic growth. However, the removal of trade barriers and the provision of investment incentives to attract foreign direct investments may facilitate increased trade in and/or more efficient production of commodities considered harmful to health such as tobacco. The authors analyze existing evidence on trade and investment liberalization and its relationship to tobacco trade in Sub-Saharan African countries. Comparisons are made between tobacco trading patterns and foreign direct investments made by tobacco companies. The authors estimate and compare changes in the Konjunkturforschungsstelle (KOF) Economic Globalization measure, relative price measure and cigarette prices. Preferential regional trade agreements appear to have encouraged the consolidation of cigarette production, which has shaped trading patterns of tobacco leaf. Since 2002, British American Tobacco has invested in tobacco manufacturing facilities in Nigeria, Kenya and South Africa strategically located to serve different regions in Africa. Following this, British America Tobacco closed factories in Ghana, Rwanda, Uganda, Mauritius and Angola. At the same time, Malawi and Tanzania exported a large percentage of tobacco leaf to European countries. After 2010, there was an increase in tobacco exports from Malawi and Zambia to China, which may be a result of preferential trade agreements the EU and China have with these countries. Economic liberalization has been accompanied by greater cigarette affordability for the countries included in the analysis. Only excise taxes and income are reported by the authors to have an effect on cigarette prices within the region. The results suggest that the changing economic structures of international trade and investment are likely heightening the efficiency and effectiveness of the tobacco industry. As tobacco control advocates consider supply-side tobacco control interventions, the authors suggest that they consider carefully the effects of these economic agreements and whether there are ways to mitigate them.
On 19 September, the World Health Organization released a new report that reaffirms the world is running out of antibiotics to fight key and deadly infections due to the fast pace of resistance by bacteria and the lack of new antibiotics to replace or supplement the existing antibiotics. Most new drugs in the pipeline are only modifications of existing classes of antibiotics and are short term solutions, says the WHO. And there are very few potential treatment options for antibiotic resistant infections causing the greatest health threats including resistant TB. This article by TWN explore the issue and the level of (under)investment in new treatments. It argues further for improved infection prevention and control and for fostering appropriate use of existing and future antibiotics.
The report Honest Accounts 2017: how the world profits from Africa’s wealth explores how Africa’s wealth is effectively “stolen” from the continent and “calculates the movement of financial resources into and out of Africa and some key costs imposed on Africa by the rest of the world”. Nick Dearden, director of Global Justice Now, writes that although there is money coming into the continent in the form of remittances, there is a larger amount leaving the continent in the form of taxes, “repatriate[d]” profits and illegal trade. A 2014 estimate suggests that rich Africans were holding a massive $500-billion in tax havens. Africa’s people are effectively robbed of wealth by an economy that enables a tiny minority of Africans to get rich by allowing wealth to flow out of Africa. With few exceptions, countries with abundant mineral wealth experience poorer democracy, weaker economic growth, and worse development. The author raises that to prevent tax dodging, governments must stop prevaricating on action to address tax havens.