While the Millennium Development Goals program has made some major gains in its targets in many African countries, that progress could be reversed if concrete steps are not taken to eradicate poverty, argues Waiswa Nkwanga.

Earlier this year Bill Gates made a very strong case for development aid. He argued that because of development aid “the world is better than it has ever been.” A few months later, in July 2014 to be precise, the United Nations released the Millennium Development Goals (MDGs) report, which seemingly affirmed Gates’ assertion that aid has indeed made the world a better place.  The report shows that Africa has made big gains in areas such as providing access to primary education, reducing infant and child mortality, fighting malaria, HIV/Aids and tuberculosis, as well as increasing access to potable drinking water.

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This is all good news. But when one looks deeper into the report a completely different picture emerges. While there have been major gains, the MDGs have not been as successful as its advocates would have you believe. In fact, since the introduction of the MDGs more than a decade ago, some of the targeted areas have done even worse.

The MDGs are eight goals that, among other things, seek to combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women. It also seeks to foster sustainable development in poor countries. All these are set to be accomplished by 2015. While each of the eight MDGs is important in its own right, none is more crucial than poverty eradication. In general, the poor in every society tend to have shorter lifespans than do rich people for obvious reasons. Many can barely afford two meals a day. They have no access to good healthcare and often rely on under-qualified practitioners for medical care. Needless to say, poverty is a vicious cycle that begets more poverty. Important as poverty eradication is, what does the UN MDG report have to say about poverty in Africa?

According to the report, poverty is on the rise in Africa, fourteen years after the introduction of the MDGs.  The report shows that the number of Africans living in extreme poverty (less than $1.25 per person/day) rose from 290 million in 1990 to 414 million in 2010. That’s nearly half of the continent’s estimated population of a billion people. What’s more, the study indicates that fewer children in Africa have access to food: “The number of undernourished children increased from an estimated 27 million in 1990 to 32 million in 2012,” resulting in 58 million children suffering from stunted growth, an increase in 14 million since 1990.

These statistics are very unsettling. Rising poverty could reverse all the gains made in different areas of the MDG measures. For instance, one aspect where international aid has been incredibly successful is in the fight against HIV/Aids. In 2013, 6.7 million people with HIV received antiretroviral treatment worldwide under the President’s Emergency Plan for Aids Relief (Pepfar). More than that, the program provided anti-retroviral medications to prevent mother-to-child transmission (PMTCT) of the virus. Of the 780,000 women who tested positive for HIV, 95 percent of the babies were born HIV-free. Incredible. But ARVs by themselves have not been enough to prevent survivors from succumbing to the scourge of extreme poverty.

Consider, for instance, the case of Rachel Namulondo, a seventeen-year-old Ugandan girl who contracted HIV from an aunt she was nursing when she was just eight-years-old.  Namulondo was one of the lucky few people with HIV to benefit from the Pepfar funds and universal primary education. Yet neither ARVs nor free education could save her life in the face of abject poverty. Because of poverty Namulondo used to walk twelve kilometres to the nearest clinic to pick her ARVs. Frequently, she did this on an empty stomach, and, as a result, her health deteriorated faster than it should have.  In 2012, in an effort to raise money to save the child’s life, the local community invited Namulondo to speak at a meeting during which she said, “I have lost hope. Much as I get the drugs, I should have a balanced diet, which my grandfather cannot afford.” Those were her last words to the community. She died a few days later.

This is just one story. But the reality is all too common in many poor communities in Africa. This puts into perspective why the report’s findings that poverty is on the rise are deeply troubling. Simply put, poverty kills.

The way forward?
The role of international aid in development efforts is highly controversial. As a result, discussions of the topic have often ended in fruitless attacks and counter-attacks between advocates and critics. There are strong arguments to be made on both sides of the debate, and while it is true that aid has in some cases become part of the problem, the fact remains that hundreds of millions of people desperately rely on aid to survive. So it is understandable why advocates of international aid present it mainly as a success. Indeed, if is more efficiently allocated, and governments in poor countries are more transparent and supportive of international efforts, aid can be more effective than it has been.

Nonetheless, there is no doubt that the current aid model is not a viable approach to the long-term economic development of poor countries. Indeed, beyond eradicating extreme poverty and want, the current aid model has no mechanism for fostering long-term economic development, which is the key to sustained poverty eradication. Advocates rightly argue that providing primary education and medicine to people, and supporting basic agriculture will translate into economic development and poverty reduction.

But these things by themselves are not enough to, say, bring about structural transformation and job creation at the scale currently needed in Africa, a continent with the youngest youth populations, according to The African Economic Outlook. (And according to the 2013 estimates by the Population Reference Bureau, about 297 million people in Africa are between the ages of 10 and 24. This age group is projected to nearly double to about 561 million by 2050.) It will take aggressive government policies that extend well beyond crisis management, charity, and support for basic agriculture—the central focus of the current aid model—to create economic opportunities for the bulging youth population.

Having been born and lived in abject poverty in Africa myself, I know first hand what young Africans desperately need and want. They need job opportunities. Period. They want to be productive members of and contribute to their societies like all of us do. So how do job opportunities come about?

Traditionally, governments have dealt with these issues by investing heavily in public infrastructure—roads, schools, or hospitals. But more importantly, in order to promote sustainable economic development, structural transformation and jobs and wealth creation, governments have traditionally built industries. This has been more effective at eliminating poverty, enabling many people  – often the poor and unemployed – to enter the workforce.

It is therefore surprising that Bill Gates, the biggest proponent of international development aid, seems hostile to this view. “I’ve heard this myth stated about lots of places, but most often about Africa. A quick Web search will turn up dozens of headlines and book titles such as How Rich Countries Got Rich and Why Poor Countries Stay Poor. Thankfully these books are not bestsellers, because the basic premise is false.”

True, the book in question is overly critical and dismissive of the potential of aid to improve lives in poor countries, which is probably why Gates seems to take issue with it. However, to assert that the premise of the book is false seems like an overreaction if not a misinterpretation of the book’s basic premise. The basic argument that Erik S. Reinert, the book’s author, puts forward is that in order to develop and create wealth, poor countries would have to follow the same model as advanced industrial nations did to get rich. In other words, industrialisation is the key to economic growth. Few economists would disagree with that premise.

The difference between Gates and Reinert’s approach to poverty reduction and development is a fundamental one, however. As Ugandan journalist, Andrew Mwenda, explained in his TED talk, there is a fundamental difference between poverty reduction, the focus of aid, and wealth creation, the central theme of Reinert’s book. Without industry, aid has failed to support activities that could help poor countries to not only create wealth and jobs for their people so that they can contribute to the development of their own societies—but also to become fully competitive in international markets.

A similar gap exists in healthcare, where recent international success in the fight against diseases hasn’t necessarily resulted in strong healthcare systems necessary to sustain it over the long-term. According to reports by the World Bank, there are 2 physicians and 11 nurses/midwifes per 10,000 persons respectively in sub-Saharan Africa. The recent Ebola crisis in West Africa, where countries lack even the most basic health care capabilities to control and contain the disease’s spread is a good example. And as Leila Chirayath Janah of Samasource recently opined about her experience with pregnant women in Uganda, the problem seems more dire than we think.

Bill Gates is a great man with good intentions, and he is absolutely right that the world is a better place today than it was fifty years ago. As he rightly points out, compared with fifty years ago, people in poor countries live healthier and longer lives today. Moreover, more children than ever before have access to primary education.  But what aid advocates fail to consider is the fact that poor countries could have been better off and more self-reliant had they industrialised instead of being perpetually reliant on aid. Aid does a good job saving lives at least in the short-term. In the long-term, however, we can only hope that poverty will not negate what has been achieved.

Waiswa Nkwanga is a LSE alumnus.