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Quality of Life Issues for Developing Africa


At Just 1 World, we explore the quality of life issues for developing Africa. Read on to find out analyses and our proposals for what is needed. Use the buttons below to navigate the discussion points in this topic.

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Food and hunger

The dictionary defines food as 'what one takes into the body to maintain life and growth'. It goes without saying then that everyone has to eat to live.


According to the United Nations World Food Programme (WFP) there is enough food in the world today for every man, woman, and child to lead healthy and productive lives. Even though the world's population has grown 6-fold in the past 200 hundred years, food production has grown even faster thanks mainly to modern machinery, hybrid seeds and better fertilisers.


And with the advent of precision farming, which ensures that each plant gets just the right amount of water and fertiliser for maximum yield using drones, satellites, robots and large-scale data collection, this looks set to continue. Precision farming also has the potential to reduce fertiliser use whilst allowing farmers to adapt to the effects of climate change according to Mark Rosegrant, a director of the International Food Policy Research Institute (IFPRI).

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In the last 20 years farm production has increased by 260% with 2% fewer inputs. This means that there is now 17% more food available per person than there was 30 years ago. Today, it is estimated that 12% (1.6bn hectares) of the Earth's land surface is under crop production and 33% (2.5bn) of people) worldwide depend on farming to support themselves.


However, according to the UN Food and Agriculture Organisation (FAO), one third of all food produced in the world - approximately 1.3bn tonnes per annum - goes to waste due to a combination of factors -  poor harvesting, unsuitable storage and transportation problems.


In the rich countries of the North, where individually we spend on average £9 (US$10.30) per day on food, the supply and variety has never been better. Visit any supermarket and you will find shelves stacked with affordable produce from all over the world. And coronavirus notwithstanding, going out for a meal too, in our towns and cities, affords us a choice of restaurants which serves dishes and drinks from every continent. As a result, on average, most people in the North exceed the FAO recommended daily minimum intake of 1,800 kilocalories a day by some distance.

Yet, on the other side of the globe, in the South, life could not be more different. Here most people are subsistence farmers often eking out a perilous existence using methods of farming that have barely changed through the centuries. Bad harvests are a continual hazard in this part of the world where some 54 nations (37 in sub-Saharan Africa) are low-income countries that do not produce enough food to feed their people. And the problem for these countries is that although there may be plentiful supplies of food in the world for everyone, politics, conflict, greed and indifference, all too often, stand in the way of getting surplus food to where it is often desperately needed.

The most self-sufficient country in the world in food production is Argentina which produces 273% of its own food. The country least able to feed itself is Zimbabwe which produces just 54% of its requirements as a result of the forced take-overs of farms owned by whites (skilled workers) some 25 years ago. Incredibly in 1980, just before independence, Zimbabwe was the bread-basket of southern Africa exporting surpluses to neighbouring nations.


According to the Global Hunger Index compiled by IFPRI 871m* people (1 in 9 in the world) go to bed hungry every night - including 1 in 4 living in sub-Saharan Africa. Here 19 countries are suffering from levels of hunger that are either 'alarming' or 'extremely alarming' with the worst affected countries being Central African Republic, Chad, Liberia, Sierra Leone, Sudan, Madagascar, Niger, Zambia and Zimbabwe: North Nigeria is also a problem. At the same time, Burundi, DRC, Comoros, Eritrea, South Sudan and Somalia were among 13 countries excluded from the index due to lack of data. (*2020 is the fifth year in a row that world hunger has risen.)


There is more food for thought though for nutritionists reckon that the same amount of people again suffer from a hidden hunger - a lack of sufficient micronutrients which are vitamins and minerals that support physical and mental health. Conflict is another major driver of hunger. The UN estimates that 100m people in the world suffer in this way.


Taken together, across the world today, 21,000 people die daily from malnutrition and hunger-related diseases - many of them children under 5. That means that the lack of food/malnutrition kills more children in the world today than any infectious diseases, war or natural disasters yet it remains a 'silent emergency' arousing little public concern until the next emergency is thrust onto our TV screens.


In contrast, in the North, a combination of over-abundance, changed eating habits, low incomes and less-active lifestyles has led to a situation where a large proportion of the population is overweight or obese**. For example, today in the US, according to the World Health Organisation (WHO), it is estimated that 70% of the population is overweight including 30% who are obese which includes 9% who are severely obese. For the UK*** the figures are 64% and 28% whilst 3 in 20 children are considered obese when they start primary school rising to 1 in 5 when they leave. All of which creates a significant public health challenge. In 2019-20 there were an estimated 900,000 hospital admissions in England where obesity was a factor, an increase of 5% on the previous year. (In 1960 only 2.5% of Britons were obese, 6% in 1980 and 15% in 1993) The UK is the most obese nation in Western Europe. In comparison, in Japan, the obesity rate is just 4% where the diet is rich in rice, vegetables and fish.


More than half the world's population today lives in cities and this urbanisation has caused a rapid shift in diet and lifestyle, with more processed foods and less physical activity. At the same time, according to UNICEF, not a single country in the world has made progress in decreasing levels of overweight and obesity in the past 20 years.


(Annually, British adults drink 9.7 litres of pure alcohol per annum which equals 108 bottles of wine or 340 pints of beer/lager. That is almost a litre more than the OECD average of 8.9 litres and higher than consumption in Italy, US and Australia. But not as much as France and Germany. Lithuania is the heaviest drinking nation with 12.3 litres whilst Indonesians drink the least.)


The Department of Health estimates that 80% of weight gain in the UK is caused by overeating/over indulging in the wrong type of foods and by low levels of physical activity. In the UK this 'extravagant' lifestyle in turn leads to an estimated 33,000 premature deaths annually at a cost to the National Health Service (NHS) of £9bn (US$10.3bn). And this 'epidemic' also has the knock-on effect of 22m days being lost every year in the work place through sickness leading to a loss of output totalling £2.5bn (US$2.9bn). According to World Health Organisation (WHO), unless something changes fundamentally, by 2030, 70% of the UK population will be overweight or obese. (In total, according to the World Obesity Federation, in 2023 2.7bn people aged 5 and over are overweight including 1.1bn who are obese, triple the figures for 1975.) At the same time, in the UK, rates of childhood obesity are more than twice as high in the pooorest areas where there are five times more fast food restaurants than the most affluent areas.

The changes needed, say experts, are for the government to restrain the food industry by taxing fizzy drinks/fast food, removing vending machines from schools and taking junk food out of hospitals and government offices. And you and me need to cut down on portions! (However, all of this is a really tough challenge for in a recent study conducted across 22 countries it was found that for every advertisement for healthy foods there were four promoting unhealthy foods!)


At the same time we should try leaving our cars at home more and walk or cycle to our intended destination. The average car journey is only 8 miles with 25% of these journeys less than a mile. And for those already using public buses why not start by walking to the next bus stop and then, in a week, the next one after that! (Taxes on red meat could also be considered for that would reduce consumption, improve diets, reduce greenhouse gases from livestock and lead to the freeing up of more land for crops.)


Being overweight, it seems, is now becoming more prevalent in the developing world too. According to the Overseas Development Institute the number of obese and overweight adults in the South has almost quadrupled in the last 30 years to around 900m which added to those in the North means that one quarter of the world's population is now overweight.


However, it is the often acute food shortages in the South that should be given priority.


To start with surplus food supplies from the North urgently need to made available to countries where there are desperate shortages. Politics should not be played with hunger and starving people need immediate help. But this should not be seen as a permanent solution as shipping food will not improve the prospects of the world's hopelessly poor, three quarters of whom live in rural areas.


At the same time governments in developing countries need to allocate more than the current 6% of their national budgets to agriculture. In 2003, in the Maputo Declaration, African leaders committed to allocating 10% of their national budgets to agriculture. However, fifteen years on just 7 countries - Burkina Faso, Ethiopia, Guinea, Malawi, Mali, Niger, and Senegal - have reached or exceeded the 10% target whilst 9 countries - Angola, Eritrea, Ethiopia, Burkina Faso, Congo Republic, Gambia, Guinea-Bissau, Nigeria, Senegal and Tanzania - have reached growth in agriculture of more than 6% p.a. And so still today in Africa, bizarrely, even with an average of 6% of national budgets allocated to agriculture more money is wasted on defence on a continent where almost 75% of the population is engaged in subsistence farming.


Even with this huge presence on the land, food security continues to remain elusive with many farmers barely able to produce enough food for their own families never mind having any left over to sell. Yet Africa's farmers, who are mainly women working on tiny plots, could grow approximately three times more food if they had more government support in gaining access to essential inputs: fertilisers, pesticides, irrigation and access to local agricultural expertise. And this would not only be a good investment in farming it would also help reduce Africa's annual food import bill of US$35bn on the continent with the largest amount of rain-fed uncultivated land. Moreover, as 65% of agricultural land in Africa is degraded, being allowed access to genetically modified (GM) seeds would also make an enormous difference to food production whilst cutting down on toxic pesticide sprays. Currently, however, due to the machinations of the European Union, green campaign groups and many churches, the advent of GM crops is all too often resisted by those in authority in Africa.


Farmers also suffer from not owning their own land which makes it impossible for them to put up security in order to borrow money to help bring about improvements. As such, one of the first tasks for governments and state authorities in the South should be to try to work to vest every farmer in the title to his/her own land. In this way the home/farm could be used as security to borrow money for better seeds, fertilisers, tools and machinery which would lead to a big increase in crop production. However, native customs, where all tribal land is vested in the chief, can make this a challenge in many parts of Africa.


Farmers could also be encouraged to amalgamate their small plots into co-operatives. (Currently 80% of farms in sub-Saharan Africa are smallholder-family concerns performing at about 40% of their potential) Co-operatives would allow machinery to be bought making life easier for those working the land. In turn this should boost production leaving larger profits to be shared according to the size of land contributed and the hours of work put in. Having certificates of ownership in a co-operative would also allow other farmers to join in and allow those wanting out the means to do so. Coming together like this would also help those families where the bread winner is no longer there or incapable of work. It would also allow children to get back to school instead of having to work in the fields in order to help their families maintain food production. (According to experts growth in agriculture is up to 11 times more effective at reducing poverty than increases in any other sector. Also 60% of the world's unused agricultural land lies in Africa.)


The main cause of food shortages in poor countries is usually blamed by governments on drought but all too often this can be used as an excuse. Nobody disputes that hunger is aggravated by bad weather but according to a blog from IFPRI in July 2017 'ending famines and chronic hunger requires good governance.' For example, in many parts of Africa water is readily available in countries lacking in food but too many governments either through neglect, alternative priorities, incompetence or lack of finance are not using the water resources available.


Take Ethiopia, for example. Until recently, water from the Ethiopian Highlands, and the huge expanse of Lake Tana, was hardly tapped at all by a government more concerned about arguing over a worthless town in a useless piece of desert on its border with Eritrea. This was apparently considered more important than encouraging farmers to move to more fertile parts of the country where irrigation channels, bore-holes and wells could be constructed to provide water for all their needs. Thankfully this is all about to change with the completion of the construction of the Grand Ethiopian Renaissance Dam, an impressive hydropower project, which will be the continent's largest. Similar potential lies in the Congo River if the will is there!


Transport is also a problem. A recent World Bank study found that high transport costs in Africa were driven just as much by poor regulations as by bad roads. (Only 16% of roads in Africa are paved.) Current regulations impose substantial barriers to entry thus allowing existing transport companies to maintain a monopoly and charge high prices.


Joined-up government is essential for moving food supplies within a country. And here again Ethiopia suffered from government inertia in the past. A combination of poor communication, inefficiency and corruption across the country meant that even in good years surplus food lay rotting in one part of the country whilst people starved in another. But even when the message did get through there were few roads in Ethiopia and most of them were potholed big time. So moving grain around the country could be perilous and costly as can be seen from the experience of one enterprising grain merchant who tried to take a truck load of grain from the south to the hungry north of the country.


The journey of 900k (560 miles) meant 17 days on the road to reach his destination. In that time he was stopped 10 times by local officials whom he had to bribe in order to be allowed to move on. And at the end of his ordeal he found that the roads had been so rough that many of his grain sacks had burst open. However, his problems didn't end there. Selling in Ethiopia was also made hazardous by the fact that there was no legal system to enforce contracts and very few traders had bank accounts. As a result vendors could only sell for cash and buyers had to inspect and weigh every bag of grain to ensure that they hadn't been cheated. So as he couldn't find a trustworthy trader prepared to pay in cash he finished up literally giving what was left of his load away. Needless to say that grain merchant is unlikely to undertake such a journey again.


At one time more than 20 million Ethiopians were still facing chronic food shortages but this is changing. In 2010 large-scale public and private investments in agricultural research and the promotion of fertilizer use led to substantial gains in cereal production and the availability of food. At the same time infrastructure investments such as improving and expanding road networks are helping to effectively move crops from farms to markets. Together these investments have helped smallholder farm households to achieve higher yields and production, raising their incomes and access to food. Additional programmes including terrace building to reduce soil erosion and education on nutrition have also helped stave off hunger. (Ethiopia is the birthplace of Arabica coffee which tends to be grown in the cool, humid highlands. With temperatures steadily rising in Ethiopia this is now damaging the crop forcing new plantations to be created on higher ground where the climate is cooler and wetter. Ethiopia is the 5th largest coffee producer in the world employing 15 million farmers and makes up a quarter of the country's export earnings.)


However, often exacerbating the food situation in Africa are foreign governments and large international corporations, mainly from India, the Orient and the Gulf, seeking prime agricultural land to grow food for their own people back home. And African governments, it seems, are more than ready to oblige. At the forefront here again is Ethiopia where it is estimated that the government has leased or sold 10 million acres of prime farmland to foreign investors since 2008. In order to achieve this the government has forcefully removed tens of thousands of people, with no compensation, onto marginal land where they are left to fend for themselves. And there they continue to eke out a living whilst fruit and vegetables worth an estimated US$250m per year are exported. So the government may have upped food production in Ethiopia but at the expense of many farming families.


Other countries which have already leased/sold land to foreign entities include Sudan with 4 million hectares, DRC 2.8m, Mozambique 2.7m, Mali 2.0m, Zambia 2.0m, Cameroon 2.0m, Liberia 1.6m, Benin 1.2m, Sierra Leone 1.1m with many of the deals going through at rock-bottom prices. And in the cases of Benin and Sierra Leone Oxfam calculates these figures represent 34% and 32% respectively of total agricultural land in these countries.


African governments should have laid down certain conditions before ceding land to foreign entities:-
1. all of the people whose land was requisitioned should have been compensated and given alternative land.
2. 90% of those employed on each project should be locals.
3. 50% of the food produced should remain in the country.


It could be argued, however, that the selling of land to foreigners helped to dispose of one government in Africa. In March, 2009, in Madagascar, Andre Rajoelina overthrew the government of Marc Ravalomanana after he promised to lease half the fertile land in the country to Daewoo, the South Korean conglomerate.


All of this means that food aid will continue to be important if mass starvation is to be prevented, not just in Africa, but around the world. In 2021 WFP undertook the largest operation in its history targeting 140m people as it responded to conflict - still the biggest driver of hunger - climate crises, the economic consequences of Covid 19, and rising costs. In 2020 the WFP was awarded the Nobel Peace Prize in recognition of the work of the WFP staff who lay their lives on the line every day to bring food and assistance to those in need.

Some UK food facts:-


According to Wrap, the waste-reduction charity, families in the UK are throwing away £810 worth of food a year on average. This means that a quarter of a tonne of food a year, the equivalent of 500 meals, ends up in the food-recycling bin. Half the waste results from food not being eaten before its use-by date and the rest is from cooking or serving too much. Food waste in households rose from 6 million tonnes in 2012 to 9.5 million tonnes in 2021.


Perhaps the main reason for this is our misinterpreting of supermarket labelling. Display until is only for supermarket information; best before means what it says that the food is best consumed by the date indicated but can still be used after that; use by is the date that should be heeded and the food recycled or thrown away after this expiry date as it could harbour harmful bacteria. However, life can be prolonged even here if the food is frozen before the 'use by' date. Also we can tell here by looking at fruit and vegetables whether or not they are still fit to cook or eat.


Britain's biggest supermarkets have signed up to the Courtauld Commitment 2025 in a campaign that aims to tackle the estimated two million tonnes of food wasted every year in the UK. As such Tesco, Sainsbury's, Morrisons and others will try to double the amount of surplus food they redistribute in a new drive to give to charities which help the poor. Tesco has even made the aim that no food that is safe to eat will be wasted inside Tesco UK supermarkets.


REfUSE, a branch of the Real Food Project in Chester-le-Street in Durham in the north-east of England uses perfectly good food that has been wrongly labelled 'worthless' due to over-ordering, strict cosmetic standards, damaged packaging, incorrect labelling, best-before dates, cancelled orders etc. Then, through the help of volunteers, they have opened up a cafe on the basis of Pay As You Feel. Anyone, including the homeless/refugees, coming in for food/drink can pay in cash or help wash up, play music or blog about the cafe to pay for their meals. The food is donated by local shops, supermarkets, restaurants, wholesalers and from allotments. The Real Food Project adhere to all the Environmental Health regulations and have a 5* Food Hygiene rating. Any profit made goes back into expanding the business. Surely a practical solution by very dedicated people to a shameful problem that could be adopted across the country and beyond. see www.refusedurham.org.uk


In a study by the University of Aberdeen more than 18 million acres of land in foreign countries is now used to grow crops either consumed directly by Britons or fed to British animals that produce meat and milk. This is exactly double the amount of land used in the UK for growing crops and shows Britain is much more reliant on imported food than government official figures show. This comes after a warning form the UK National Farmers Union which accuses successive governments of displaying 'dangerous complacency' over the country's ability to feed itself.


(**A healthy weight range is based on a measurement known as the Body Mass Index (BMI). To calculate your BMI you divide your weight in kilograms by your height in metres squared. The ideal weight is a reading between 20 and 25 but you are underweight if it is below 20. Between 25 and 30 people are considered overweight and above 30 you are classified as obese.)


(***It is estimated that more than 8 million people in the UK live in households that struggle to put enough food on the table, according to estimates by the Food Foundation. And with growing numbers of people using Trussell Trust food banks hunger in the UK is perhaps more widespread than it might appear.)

Water

Look at a map of the world and the first thing that strikes you is the amount of blue. Sea water represents 70% of the surface of the globe so perhaps where we all live should be called Planet Water and not Planet Earth! However, as Coleridge's Ancient Mariner out on the high seas remarked, it is a case of 'water, water, everywhere, nor any drop to drink'. Saline water in seas and oceans forms 97.4% of the water on our planet leaving only 2.6% in the form of fresh water.


The greater part of sea water is in the Pacific Ocean which is bigger than all the land masses put together. In total the Pacific holds just over half (51.6%) of all the ocean water followed by the Atlantic Ocean with 23.6% and the Indian Ocean with 21.2% leaving just 3.6% to be accounted for by all the other seas. The average depth of the oceans is 3.86 kms (2.4 miles).


Although only 2.6% of the water on the globe is fresh water it may be a surprise to learn that 68% of this is actually frozen in the Antarctic and Greenland ice caps. Nearly 90% of the planet's ice is in Antarctica with most of the rest in the Arctic. At the South Pole, the ice is over 3km thick and the area contains 6 million cubic miles of ice which, if melted, would raise the oceans by an estimated height of 60 metres. In contrast the ice at the North Pole is only 4.5 metres thick.


Incredible though it may seem, the small amount of 0.8% of water which is available to us in the form of accessible fresh water is enough to fulfil the needs of everyone in the world. Over a year, it is estimated that 14,000 cubic kilometres are available to us in rivers, lakes and underground reserves of which only half is used. (However, many experts believe that parts of the world are running out of water as wetlands vanish, deserts spread, rivers and lakes dry up and underground aquifers fail to get replenished.)

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Of the freshwater we use, agriculture accounts for 68%, industry 17%, domestic use 10% while 5% is lost through broken pipes or evaporation.


Demand for water continues to grow and today in the rich countries of the North we use 6 times more than we used in 1950. We use it in the home, often without thinking, to shower, flush the toilet, clean, wash clothes, drink and cook. Outside we use it in our gardens and to wash our cars. Water is needed to grow our food, generate power, build houses and in manufacturing where, incredibly, it takes 148,000 litres to produce just 1 car!


Like the air we breathe water is indispensable and we cannot live without it. But unlike the air we breathe, water carries a cost - albeit small. For although water has been described as a 'gift from God' someone has to put the pipes in the ground, ensure it is safe to drink whilst ensuring there is a constant supply.


The average cost of tap water in the UK is 0.1p per litre. Flushing the toilet needs 6 litres of water and sets us back 0.6p; having a shower takes 7 minutes and uses 35 litres costing 3.5p. A washing machine cycle uses 50 litres and a bath uses 80 litres. In total, in the UK, on average, each of us uses 142 litres of water per day at a 'staggering' cost of just 14.2p. For us, then, whatever way you look at it, water is undoubtedly a bargain without equal!

Unfortunately, though, today there are an estimated 771m people, most of whom live in the developing world, who do not have access to clean water and where 31% of schools don't have clean water either. (In 2018, in sub-Saharan Africa, only 68% of people had access to improved sources of water, up from 38% in 1990) However, at the same time, the UN High-Level Panel on Water estimates that at least 2bn people globally still use a source of water that is fecally contaminated. (More than 2m people living in the US today, mainly in Texas and Alabama, are without safe running water due to funding issues.)


But in the developing world even collecting water can require incredible fortitude.

There, girls, some barely into their teens, rise early every morning and set off walking, sometimes long distances, to collect water for use by their families. In temperatures of 40ºC, they will queue up to collect water from a pool which is often muddied by the time they get to the front. And when they get home, because they were not able to carry enough, they often have to return to collect more. They do this every day until perhaps younger sisters take over. In these rural areas, it is estimated that 25% of household time is taken up finding and carrying water. And it is collected from literally anywhere: sometimes in the dry season the water is brought back from a pool where cattle and wild animals have been drinking. There is often no alternative.


As a result, people in the South only use an average of 10 litres per day but by drinking unclean water, many regularly suffer severe bouts of diarrhoea which can leave them weak and unable to work. (According to WaterAid report "State of the World's Water 2016" the oil-rich countries of Angola and Equatorial Guinea have scandalously the lowest percentage of households able to access clean water in the world.)


<<<UN World Water Day 22 March>>>


Closely related to clean water is the need for proper sanitation. And the two requirements together are paramount for any society to advance.



<<<UN World Toilet Day 19 November>>>


Thanks to our Victorian ancestors piped water and sanitation have been available throughout the UK for more than 100 years. And it was their joint introduction that helped pave the way for the huge increase in life expectancy from 50 years in 1880 to 65 years in 1920. Their major contribution towards improved health was further underlined in a poll conducted by the British Medical Journal which set out to find the greatest medical advance in the last 150 years. To the surprise of many in the medical profession the separation of clean water from sewage was voted into No 1 position ahead of the discovery of anaesthesia, antibiotics, vaccines, D.N.A. and the contraceptive pill. So civil engineers can lay claim to have been responsible for the greatest medical advance in probably the whole of history!

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Sadly, however, today in the world 1.7bn people don't have a decent toilet off their own*. At the same time the human waste from another 2.1bn people in towns and cities is not safely treated and ends up dangerously polluting rivers, lakes and seas. The situation, though, is worst in sub-Saharan Africa where 63% of the people lack proper sanitation and costs the region US$56bn (£46.6bn) a year in lost productivity. Without a toilet you must go outside to defecate or urinate and have to do so in conditions which lack safety, privacy and dignity. This is bad enough for men but much worse for women and dangerous for young girls. Hygiene here also becomes a problem for failure to wash hands regularly fuels diseases. However, almost 2.3bn people lack soap for hand washing at home. Hand-washing with soap at critical times can reduce the incidence of diarrhoea by 50%. (315,000 children under five die every year from diarrhoea caused by unclean water and poor sanitation. Diarrhoea kills more children under five every year than AIDS, malaria and measles combined. And at any one time half of hospital beds in developing countries are filled with people suffering from diarrhoea. The World Bank estimates that the cost of poor sanitation is in excess of US$260bn annually.)


According to WaterAid the hardest places to find a loo in Africa are in Ethiopia and South Sudan where 93% and 91% respectively of the people who live there have no access to a proper toilet.


Relief may now be at hand, however! A team of US scientists have now developed a self-cleaning lavatory which could save 100 billion litres of water a year. They have developed a coating that is able to repel even the most clingy of stools and using nanotechnology ensures that everything flushes down smoothly. Human waste can then be processed chemically at household level. Under this revolutionary method the amount of water used in toilets would be reduced by an estimated 90%.

In 2000 all the nations of the world signed up to the UN Millennium Development Goals (MDG) of halving world poverty levels of 1990 by 2015. Included in these targets were the aims to halve the proportion of people without safe water and adequate sanitation which are arguably the toughest challenges of all. Between 1990 and 2010 2bn people gained access to improved drinking water sources, such as piped supplies and protected wells, which means that the UN MDG target of halving the proportion of people without clean water was reached well before 2015. However, the world was nowhere near reaching the UN MDG target of 75% for sanitation as only 65% of the world currently has improved sanitation.


At the same time though the story was quite different for sub-Saharan Africa. A study by the London School of Hygiene & Tropical Medicine found that only a handful of countries there met the target for clean water whilst not one country achieved the MDG goal in sanitation. These conclusions suggest this part of the world will not reach the 2015 MDG target for water until 2040 and for sanitation it will take another 2 centuries! And this was only halving the 1990 figures. At this rate universal access to clean water in sub-Saharan Africa will take until late into the 21st century and for sanitation until the 24th century. And by then it is not impossible that humans may well be living on other planets - having first found water there of course!


Safe local water sources and sanitation then have to be prioritised for together they bring FOUR additional benefits to people's lives - better health, children will spend more time at school, more food can be grown which means that families have greater resources. So whatever way you look at it clean water and proper sanitation are an investment without equal. (In all, it is estimated that for every US$1 invested in water and sanitation yields a return of US$5.)


To replace the Millennium Development Goals, in 2015, the United Nations re-set the goals for both water and sanitation. In a 2030 Agenda for Sustainable Development comprising 17 goals and 169 targets were included:-


a) to achieve universal and equitable access to safe and affordable drinking water for all.
b) to achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations.


Great aspirations but they are totally unrealistic. And you wonder what planet those who drew them up were living on!


However, all developing countries need to get serious about this and should at least try to improve water supplies and sanitation and rich countries should aim to help those that are serious.

Governments in poor countries should start by implementing some or all of the following cost-effective measures:-

  • suggest people collect rain water from roofs.
  • mending the mass of leaking pipes found in many towns and cities. This could save a phenomenal amount of water. (Even in the UK, according to the Consumer Council for Water, 3bn litres (660 million gallons) of water - equivalent to 1,180 Olympic swimming pools - are lost every day in England and Wales through leakages.)
  • water purifying tablets can make water safer to drink. So too can solar water disinfection where water is put in throwaway plastic bottles which are then placed on a black surface in full sunlight thus killing, in time, the micro-organisms in the polluted water.
  • invest in the latest toilets that are now coming onto the market that are cheap to run without the need for sewer or water connections. These offer a low-cost approach to treating faecal sludge that result in usable products such as energy or fertilisers.
  • encourage the washing of hands before food is prepared or eaten and keeping surfaces clean. (Soap is amazingly found in most homes in the developing world and is used for washing but all too often it is overlooked when it comes to what needs to be done after going to the toilet.)
  • suggest taking precautions against infections and the proper disposal of human waste. And further, with flies getting everywhere, all food should be stored safely and all fruit/vegetables washed before being eaten.
  • outlaw the dumping of chemical and toxic wastes in rivers and the sea.

All of the above measures will help ameliorate the water situation in each country and that is important. However, as 96% of water in Africa* is undeveloped, it is going to be a colossal task to get clean water flowing across the continent. But a start must be made and ALL means should be used in meeting this challenge - even to the extent of inviting international water companies to participate. (*Half of all fresh water in Africa is to be found in the Congo basin)


Bringing in private companies, which account for just 8% of world water services, may be anathema to many governments and international NGO's like Oxfam but if the choice is between safe water on the one side and dirty or no water on the other, there really can be no debate.


International water companies, however, will only commit themselves to sinking wells, building reservoirs and installing/maintaining pumps and pipes and constructing desalinisation plants if they can charge for the water. That means the price paid by consumers should be just over the cost of the supply in order to give water companies the incentive to invest in new water schemes. Charging consumers would also encourage water conservation. However, the poor should not lose out here because they have little or no money: everyone should be allowed 25 litres of clean water every day for human survival.

When the African National Congress (ANC) came to power in 1994 14m South Africans did not have clean water. Today 9m of those have been connected up and the aim is for the rest to be on tap by the end of 2025. And what a difference it is making to people’s lives there. Girls can now go to school instead of fetching water, women can spend more time caring for their families and subsistence farmers are able to grow more food. Moreover, the risk of life threatening diseases spread by unsafe water is being dramatically reduced leaving people to enjoy longer and healthier lives. However, scandalously the ANC government in South Africa has been so plagued by corrupt officials that half of all running water is being lost through broken pipes. Nelson Mandela must be turning in his grave!


Sourcing and securing clean water for poor people then is a win/win/win/win situation like no other. Yet, incredibly only a small percentage of rich country ODA funding for specific projects goes for investment in water in the developing world.


This present allocation of Western ODA for water then needs to increase. But, at the same time, the way this assistance is given should also change. What developing countries need most of all is expertise and rich countries should increasingly consider sending (as ODA) water engineers, planners, surveyors, hydrologists etc - the people who can make water flow literally anywhere - to source and secure safe water supplies and to extend proper sanitation. And whilst on the job locals could be trained by these experts.


For countries in the European Union this would best be achieved through working together to pool resources. Once this was agreed the next step would be, unfortunately, to involve the bureaucratic African Union which should provide, in time, the overarching framework for directing water resources development. Working through the African Union should also take care of any political considerations. And, in time, through this comprehensive and co-ordinated approach millions more Africans could soon see clean water and better sanitation delivered to their cities, towns and villages. And with continuing commitment from OECD countries water development projects would continue across the continent until most of the population are at least within 1 mile of a safe water source.


Rainfall is projected to decline in Africa in the coming years due to global warming according to some experts. And for many people who currently rely on rain no precipitation means no crops and no food. But in many respects this is just a logistical problem. For example, in the Ethiopian Highlands - the 'water tank' of Africa - there is enough water fall annually to feed 12 great rivers and in the midst of that area stands Lake Tana whose waters, until recently, were barely touched.


There is then a huge potential in many parts of Africa to literally make the desert bloom, as has been the case in Israel for 40 years. But somehow, all too often, the political vision is lacking. That is why the EU through the African Union should grab the moment and start to draw up plans about how best to develop huge virgin water sources. This will be a formidable undertaking but working in collaboration much could be achieved so that many more Africans can access the life-changing priceless asset of clean water.


[The Grand Renaissance Dam, which is currently nearing completion on the Blue Nile in Ethiopia, will be Africa's largest hydroelectric power plant when finished. It was set to open in December 2020 but has been delayed as Egypt fears the project will affect the flow of the Nile from which the country relies on for 90% of its water. President Abdel Fattah al-Sisi of Egypt sees this as so important to his people that he doesn't rule out using military force. The US$4bn (£3.3bn) dam is expected to generate 6,000 megawatts of electricity which would potentially mean that all Ethiopians would gain access to electricity with any surplus being exported to neighbouring countries.]


[When it comes to rainfall it may surprise many to learn that the southeast of England has a surprisingly dry climate with an average annual rainfall of about 500-600mm, less than South Sudan or Perth in Western Australia. London is particularly dry with a lower average yearly rainfall than Sydney, Barcelona, Istanbul or Miami.]

How you and I can help

1 . Drinking tap water costs us a negligible amount. But most of us think nothing of buying bottled water in a shop at 75p for 0.5 litre which is 1500 times the cost of tap water. At the same time, we are even prepared to pay £1.50 in a restaurant for the same bottled water which is an incredible 3000 times the cost of tap water. And can we tell the difference? Probably not. So here is an easy way to save money and help those without access to clean water.

Instead of buying bottled water, before going to bed at night, put a bottle of tap water in the fridge and take it to work/school the next day. At the same time if you are eating out in a restaurant ask for tap water which should come free of charge. Tell your friends to do the same and with the savings help deliver new life to people in the developing world through sending the money saved to WaterAid (see below).

2 . Collected rainfall in water butts or water tanks  can be used to flush our lavatories. In so doing we would not only be saving money (if on a meter) but we would also be using perfectly good wastewater that currently just flows away through the drainage system. Money saved here could also go to benefit WaterAid.


WATERAID is a major UK charity dedicated to the provision of safe domestic water, sanitation and hygiene to people living in the world's poorest countries. It is supported by the general public and UK water companies. In 2021/22 WaterAid helped 1,531,000 people gain access to safe water and over 1,552,000 people achieve access to sanitation. The charity was also instrumental delivering good hygiene to 8,296,000 people. In total since 1981 WaterAid has provided new safe supplies of water to 28,500,000 people,  provided improved sanitation to 29,700,000 people and reached 20,000,000 with good hygiene. Most components used in securing clean water, installing toilets and securing good hygiene are locally sourced and after completion all projects are left in the capable hands of locals who have been trained in their upkeep. Just a single donation of £15 (US18) to WaterAid enables one person to access a lasting supply of safe water. Every £1 donated which is invested in safe water and toilets returns an average of £5 in increased productivity. see www.wateraid.org.uk

Health

It can be argued that to have good health is far more important than being rich, being acclaimed as a sport or film superstar, enjoying family life or having an interesting, exciting and well-paid job. Health determines what you can achieve in life, where you can go, your state of mind and your ability to make your own decisions. Good health is vital if people are to make the most of their lives. Across the globe, particularly. in the developing world,  not all people are so lucky but the aim of every government should be to provide medical services free of charge, paid for out of general taxation, to everyone from the cradle to the crematorium.

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The health of people in North America and Europe advanced immeasurably around 120 years ago with piped water coming on tap, improved sanitation, and better nutritional levels.Complementing these advances were the increase in the number of doctors/nurses being trained, more advanced operations being performed and new discoveries in medicines, all of which helped push life expectancies even higher.  Then the gradual introduction of health insurance and/or free national health services ensured that health care was available to everyone throughout life 24/7. And today in the rich countries of the developed world, it seems, scientists continue to conquer new frontiers in medicine allowing surgeons to perform more intricate operations and doctors to prescribe new and better drugs for patients. The caring nurses look after patients until they are ready to go home or move in with family/friends or into a residential care centre. Today, in rich countries, 10% of the workforce can be found in health and social care.


In stark contrast, in countries in the developing world, with less money available and few trained doctors and nurses, most governments struggle to provide even basic healthcare. Poor as these countries are, increased pressure falls on their health services due to the effects of people drinking unsafe water and lack of proper hygiene. Danger to health also lurks here through poor sanitation and the open sewers that dog the streets in all too many slums. It is estimated that 60% of hospital beds in Africa are occupied by patients with water-borne diseases such as dysentery, diarrhoea, cholera, and typhoid.

Health in the global south

It is in the South then where the fiercest battles against disease are waged daily. But here, the fight for better health is often undermined when doctors and nurses, once trained, opt to leave their homeland to seek better opportunities with higher pay overseas e.g in 2022 more than 1,200 Ghanaian nurses joined the UK's nursing register even though the UK National Health Service states that active recruitment in Ghana is not allowed. This aggravates an already dreadful health situation found in many developing countries where sometimes only 1 in 3 people have access to hospitals and medical centres. And even for these 'lucky ones', drugs, if there are any, are too expensive. As a result, modern advances in medicines and treatments are beyond their reach leaving the door open for diseases of epidemic proportions like HIV/AIDS and malaria, and, more recently in West Africa, Ebola to run rampant. Locally this often means the decimation of entire populations leaving children orphaned, industries depleted of skilled workers and average life expectancy spiralling downwards.


Just one story exemplifies the frailty of life in poor nations.


In a small town in Zambia, a mother brought her two children to the doctor - one was three years old, the other thirteen. Both were very sick. The doctor prescribed medicine for each of them. She thanked him and left. When he saw her again, some time later, he asked her how the children were, and she told him that the younger one had died. She explained that, as she did not have enough money to pay for treatment for both children, with much pain, she decided to pay for the older child’s medicine. He got better quickly but the family had to watch, heartbroken, as the younger child died.


In the North a similar situation would provoke utter outrage leading to a government enquiry.... but in the South it is just an everyday occurrence.

One look at the comparable figures on health from countries in the North and South underlines this yawning gap in the provision of healthcare.

USA UK Japan Bangladesh Haiti Niger
Average no patients per doctor 384 357 400 1847 5000 27599
No of patients to 1 hospital bed 314 266 79 2886 1234 6689
Infant mortality-per 1000 live births 5.8 3.9 1.8 27 40 42
Child mortality- per 1000 6.1 4.6 2.6 41 70 80
Life expectancy 79 81 84 72 63 60
Access clean water % 100 100 100 34 58 56
% av daily intake calories FAO rec min req 143 135 118 95 92 91
Amount spent on health US$ per cap 10,000 3885 4519 32 54 26
Total health exp/GNI% 16.9 9.8 10.7 3.5 5.0 3.7

The '2018 Mo Ibrahim Forum Report: Public service in Africa' calculated that only three African countries; Libya, Mauritius and Tunisia, have at least one doctor per 1,000 people. And it is with such poor health infrastructure that countries in the South also have to confront pollution, the largest environmental threat to human health, responsible for 8.3m premature deaths, or 15% of all deaths globally. (Pollution kills three times as many people a year as Malaria, TB and HIV/AIDS combined.)


Exacerbated by climate change, according to Global Alliance on Health and Pollution (GAHP), the world faces serious risks from pollution. The top ten nations with the most pollution deaths include both the world's largest and wealthiest countries, and some of its poorer ones. However, deaths from pollution in relation to population size sees Chad, with 287 deaths per 100,000 people, top the world list. In second place is Central African Republic (251) followed by North Korea (202), Niger (192) and Madagascar (183). This outcome may come as a surprise to many people but the reason poor countries suffer so fundamentally from pollution is because of poor sanitation and contaminated indoor air.

Then there are the world's other major killer diseases:

MALARIA is a life threatening parasitic disease transmitted by mosquitos which is endemic in more than 100 countries. It is the world's oldest disease and today half the world's population is still at risk from malaria. In 2022 it was estimated that there were 229m cases worldwide resulting in 600,000 deaths, nearly all in young African children. However, the good news is that mortality rates for malaria have dropped by 60% globally since 2000 although in the last six years there seems to have been a levelling off. One of the reasons for this is that the mosquito and the malaria parasite are developing resistance to the interventions used to fight them.


94% of the malaria cases occur in Africa mostly among young children resulting in malaria being responsible for 1 in 3 hospital admissions there. A child in Africa has, on average, between 1.5 and 5.5 episodes of malarial fever every year. In Africa malaria kills a child every 2 minutes and is the leading cause of under-5 mortality there. Countries with the most cases of malaria in sub-Saharan Africa are Burkina Faso, Cameroon, DRC, Ghana, Mali, Mozambique, Niger, Nigeria, Tanzania and Uganda. (Contrastingly, in May 2019, Algeria was declared malaria-free by WHO and joins Lesotho, Mauritius and Seychelles in a small list of African countries where malaria has been conquered.)


Vector control is the main way to prevent and reduce malaria transmission. Two forms of vector control are effective in a wide range of circumstances: insecticide-treated mosquito nets (ITNs) and indoor residual spraying. Over the last 15 years, there has been a major increase in coverage of ITNs in sub-Saharan Africa. By 2020, half of the population had access to an ITN, compared to less than 2% in 2000. In 2020 120 million people globally were protected by indoor residual spraying, including 50 million in Africa. About 6% of the population at risk of malaria in Africa live in households protected by indoor residual spraying.


A combination of bednets and insecticide spraying should help to keep reducing dramatically the number of malaria cases as long as funding can be guaranteed. Malaria makes people feverish and unable to work and many of those who survive an attack can suffer from brain damage. In economic terms it is estimated that malaria costs Africa $12bn (£10.4bn) or 1.3% GNI annually in lost productivity. This tragic disease has been responsible for more deaths throughout history than any other but now it may at last start to be brought under control.


But countries would also score by building improved housing and draining swamps.


A malaria vaccine with potential life-changing consequences has recently been developed by scientists at the University of Oxford. The group will roll out the vaccine in 2024 after trials show up to 80% protection. The vaccine, called RTS,S,  is cheap and a deal has already been struck with the Serum Institute of India to manufacture more than 100m doses per annum.

TUBERCULOSIS (TB) is a contagious disease and like the common cold it spreads through the air. It is a disease of poverty affecting mostly young adults in their most productive years. The vast majority of deaths are in the developing world where only 1 in 4 sufferers from the disease has access to effective medical treatment. The latest figures from WHO show that the number of people falling ill with TB in 2019 was estimated at 10 million with 1.3 million dying from the disease including 250,000 with HIV. This is down from a peak of 1.8 million in 2003. It is estimated by WHO that effective diagnosis and treatment of TB saved an estimated 62million lives between 2000 and 2019. Left untreated each TB sufferer will infect on average 10 -15 people each year. TB drugs have been around for more than 3 decades and cost as little as $10 (£8.30) for a 6 - 8 month course of treatment. However, even at this price, many sufferers in the developing world cannot afford drugs and without treatment 70% of them will die. Ending the TB epidemic by 2030 is among the health targets of UN Sustainable Development Goals agreed in 2015.


HIV/AIDS - Since being discovered in 1981, it is estimated AIDS has infected 75.7m people killing 32.7m and in sub-Saharan Africa it has become a pandemic comparable to the Black Death in Europe in the 14th century. The United Nations Aids Agency has recently revised down the number of people suffering from AIDS around the world from a previously estimated 39.5m to 37.7m. The number of new infections is also down to an estimated 1.5m in 2020 from 3.2m in 1997. Of this latest total of 37.7m sufferers, 26.3m of them live in sub-Saharan Africa where an estimated 660,000 people died from the disease in 2020 out of a world wide total of 690,000. However, in sub-Saharan Africa, the number of AIDS-related deaths in 2020 was 55% lower than in 2005.


There AIDS still results in more deaths than any other infectious disease and is depriving some of the poorest countries of their most economically productive workforce. For example, at its height, in countries like Botswana, Zambia and Zimbabwe there were large numbers of teachers with AIDS who were dying faster than they could be replaced. South Africa still has the largest number of people (7.7m) living with AIDS whilst Eswatini has the highest rate of HIV infection in the world with 27.3% of the population infected, just ahead of Lesotho with 25%. However, thanks to organisations like the Global Fund, about 68% of all those needing treatment are now receiving it. And according to the World Health Organisation (WHO) the world is poised to end the AIDS epidemic by 2030 - provided it can accelerate the pace of progress achieved globally over the past 12 years. But here it will depend not only in maintaining current annual funding of US$22bn (£18.3bn) but increasing this figure to US$30bn (£25bn). A way to go then but already much has been achieved - and in 2015 the Millennium Development Goal that called for the halting and reversing the spread of HIV on a global basis was met.

Almost everywhere you look in sub-Saharan Africa AIDS has wreaked a terrible toll resulting in 1 in 10 children being orphaned and left to be looked after by grandparents - if they were still alive. Otherwise the eldest child has had to become the breadwinner sacrificing his/her own future to bring up brothers and sisters many of whom will themselves have AIDS. And as orphans these children will undoubtedly have a high risk of malnutrition, suffer from the stress of seeing their parents die and probably never see a school classroom.


Most countries in sub-Saharan Africa have been slow to address the problem of AIDS mainly because of the lack of finance, government commitment and a fragmented health service. But a notable exception to this rule has been Uganda whose government was quick to move into action and as a result the infection rate there has now fallen from 30% in 1990 to just 6%.


When it came to tackling prevention the Ugandan government used a combination a massive advertising through the media trying to alert youngsters of the dangers of unprotected sex and by the use of posters. The ABC approach - Abstain, Be faithful and use a Condom - was the favoured method. At the same time health services in poor countries are also starting to screen blood before transfusion so that patients do not become infected in that way.


In 2002, the UN launched the Global Fund to Fight AIDS, TB and Malaria. Supported by OECD countries and international charities including the Bill and Melinda Gates Foundation, the Global Fund has become one of the most powerful tools in the fight against AIDS, TB and malaria. As at 30 December, 2021 the Fund has financed more than 1,050 programmes in 150 countries saving an estimated 50 million lives and turned the tide against these terrible diseases: new HIV infections have been cut by 20%, malaria deaths in Africa are down by one third and TB deaths worldwide have fallen by more than 40%. In raw figures, in 2021, the Global Fund is providing HIV treatment for more than 23.3 million people, up from 5.3 million in 2013; 5.3 million people are being treated for TB and the Fund distributed 133 million bednets to prevent malaria. (Studies have found that if a person living with HIV is receiving anti retroviral therapy the risk of transmitting the virus to their sexual partner is reduced by up to 96%.) The battle against these diseases then is slowly starting to be won thanks mainly to the Global Fund and the huge reduction in the cost of AIDS drugs where annual treatment costs are down from US$20,000 15 years ago to as little as US$200 today.


Governments in developed countries should also use this opportune moment to go further in helping poor countries in the South combat disease. Africa, for example, shoulders 24% of the global disease burden but only accounts for 1% of the global financial resources for healthcare according to WHO. At present only 10% of global health research addresses 90% of global disease problems as there is little incentive for pharmaceutical companies to fund development into finding a cure for diseases found mainly in the third world as people there would not be able to afford the drugs. Governments in rich countries, then, should offer to fund research into not just AIDS but all tropical diseases like malaria, dengue fever, ebola etc. on the basis of richly rewarding success - and paying nothing for failure. This should fuel massive research and when success comes it would dramatically change the health landscape in the developing world. Now that would not only be globalisation at its best, it would be one of the best investments ever made on the globe. [On average, the time taken to develop a new drug from scratch takes 14 years and costs an estimated US$1.2bn (£1bn)].


In a recent 'Lancet' investigation in Africa it was found that:-


- 23,000 doctors and nurses leave Africa every year. Only 50 of the 600 doctors trained in Zambia in the last few years are still in that country and there are more Ethiopian doctors in the US than there are in Ethiopia. (It has to be admitted here though that many African doctors practising in rich nations use up their holiday entitlement every year by magnanimously returning and working for nothing in their homeland.)


- out of every 4 nurses who complete their training in Malawi: 1 migrates, 1 takes a better paid job in another sector, 1 dies of AIDS and only 1 remains in nursing in the country.


These are ludicrous health statistics on medical personnel from the world's most blighted continent and represent an appalling loss of talent to those impoverished countries.


Rich countries, then, should not only stop encouraging doctors and nurses trained in Africa from coming to work over here they should move to reverse the process altogether by offering to train doctors and nurses from the developing world on the understanding they return to their own countries. Then even more progress can be made towards the ideal of one day decent medical services being made available to everyone in every country in Africa. However, it has to be borne in mind that collectively the world is short of 2,000,000 doctors according to WHO.


A report 'corruption in healthcare' produced by Transparency International in March 2019 found that 'corruption has a devastating impact on health systems and is responsible for the deaths of around 140,000 children every year holding back the fight against some of the world's deadliest diseases. While WHO estimates that an extra US$370bn per year would be enough to give everyone on the planet access to healthcare, experts warn that over US$500bn in health resources are lost annually to corruption.' The report documents how 'widespread bribe-taking, theft of medical supplies, absenteeism and other abuses prevent patients from getting the care they need, fuel antimicrobial resistance, and contribute to the spread of HIV/AIDS.'


Then there is EBOLA* which was discovered in 1976 when there were 2 deadly outbreaks of the disease. One was in a village near Ebola in the Democratic Republic of Congo (DRC) and hence its name. Ebola is a virus that initially causes sudden fever, intense weakness, muscle pain and a sore throat. It then progresses to vomiting, diarrhoea and both internal and external bleeding. People are infected when they have direct contact through broken skin, or the mouth and nose, with the blood, vomit, faeces or bodily fluids of someone with the disease. Patients tend to die from dehydration and multiple organ failure.


*Ebola seems to have originated from bats.


The average fatality rate from Ebola is 50% but has reached 90% in previous outbreaks. The worst ever outbreak occurred in west Africa killing more than 11,000 people between 2014-16.


The DRC is also fighting a measles epidemic that has currently killed more than 6,000 people whilst tackling Covid-19 which has infected more than 11,000 people killing 275.


Also in DRC dozens of mothers, some as young as 13, are being held hostage in hospitals against their wishes because they have not paid their bills after unexpectedly having caesarean deliveries which can cost up to £400 more than a regular birth. Some have been held for months. This is reprehensible and an absolute scandal locking people up who are healthy and putting them at risk of getting Covid-19.


(Amazingly, according to WHO, life expectancy in Africa has risen from 40 years in 1960, 50 years in 1990 to 60 years in 2016 due to more child vaccinations, malaria control and better HIV treatment.)


[UK - In a report published in January 2016 it was disclosed that there are more than 4 million diabetics in Britain and that 2 out of 3 adults weigh too much. The UK spends £6bn per annum on the medical costs of obesity and a further £10bn on dealing with diabetes. UK ministers are currently considering taxing sugary drinks as an effective way to discourage unhealthy diets. At the same time more emphasis needs to be put on balanced diets and healthy eating. But the British government should also consider going further by encouraging people to exercise more by offering free membership to sports facilities once a week. Also incentives to drive less: it is ludicrous, for example, that the average car journey in the UK is only 8 miles with 25% of these being of less than 1 mile. (It has to be admitted though that genetics play a part here for some people can eat almost anything and not put on weight whilst others, no matter how hard they try, just cannot get into shape.)]


[UK - bed-blocking in hospitals. It is regrettable that elderly patients who have finished their treatment cannot be discharged because they are unable to look after themselves at home. No parent would ever leave a child in hospital and no children should ever leave a parent in hospital either. Most parents spend 24/7 endless hours, particularly in the first few years, looking after and entertaining each and every child and, in return, children surely have an obligation to their parents to do the same when they get old and infirm and cannot look after themselves. In the words of a Basque proverb 'what one owes to one's parents is never repaid.'

There is no doubt that old people would survive and thrive much better in the family home environment. And, after all, that is how family life has spun out all through history.]

Education

Although they might not believe it at the time, the best present that any boy or girl could ever wish for is EDUCATION.


For most children there will be no better gift in their entire lives than having the chance to go to school to learn to read and write and to count and calculate. These are the essential elements in laying the foundations for acquiring the skills and knowledge which should provide every child with a passport to a lifetime of possibilities. At the same time education provides the opportunity of being able to be of service to others. All in all, in our modern world, the continuing success of any country and its people depends on the ability and training of its youngsters.


In advanced countries education is often taken for granted and is usually provided free by the state up to the age of 18 and sometimes beyond. However, in most parts of the developing world children are seldom so lucky. According to an UN Educational, Scientific and Cultural Organisation (UNESCO) report at least 74 countries have an acute teacher shortage adding that some 2.7 million teachers would have to be recruited, mostly in sub-Saharan Africa, in order to achieve universal primary education. Of this total 1.4 million are needed to replace teachers leaving the workplace, while the remaining 1.3 million are needed to expand access to primary education and underwrite quality by ensuring that there are not more than 40 students for every teacher.


Nevertheless, across the developing world primary school enrolment is rising slowly and currently stands at 91%. However, in sub-Saharan Africa, primary school enrolment is lower at 77% (1990 53%). According to The Economist 95% of children in the Democratic Republic of Congo cannot read a simple sentence at the age of 10, in Ethiopia it is 90% and even in South Africa it is 78%. However, the worst country to be a child is in South Sudan, where civil war continues to smoulder and tribalism prevents a government being formed. Fewer than 40% of children attend school and where, since internal strife broke out, more than 800 schools have been demolished and more than 40,000 children have had to abandon their classrooms. Next comes oil-rich Equatorial Guinea with 45% of kids in school followed by Niger with 53%, Burkino Faso with 58%, and Sudan with 59%. In Nigeria, in recent years, numbers in primary education have fallen meaning that one in five of the world's out-of-school children are Nigerian. In Zimbabwe, free education ended in 1990 and parents had to then pay school fees. And with drought, opaque government, a wrecked economy and staggering unemployment school numbers are again on the decline. On the other hand, there are a few bright spots, with Botswana, Cape Verde, Mauritius, Uganda, Rwanda, and Sao Tome/Principe confirmed as having 100% of kids in primary education at the end of 2020. Meanwhile in Tanzania 94% and in Ethiopia 87% of primary age children are now at school. (From January 2016 all charges for primary schooling were lifted in Tanzania when it became compulsory for all kids to attend school.)


Although figures are rising for primary school attendance in sub-Saharan it doesn't necessarily imply progress everywhere. Although the UN calculates that 81% of boys and 77% of girls are in primary school it is reckoned that only 46% of boys and 36% of girls go on to complete primary school. In South Sudan only 10% of pupils finish primary school education and even in Uganda only 30%. Figures are higher though for Rwanda with 74%, Tanzania with 81% and Kenya with 84%.

Education in sub-Saharan Africa

At the same time, more than half the teachers in the following countries are untrained: - Angola, Benin, Equatorial Guinea, Guinea-Bissau, Madagascar, Niger, Senegal, and South Sudan. In sub-Saharan Africa in 2018, only 64% of primary and 50% of secondary school teachers were trained compared to 71% and 79% respectively in 2005. The decline is due to the rising demand for education. If these figures are shocking then so is the fact that according to UNESCO, 40% of all young people there are unable to read a single sentence.

This in a continent that is crying out for talent and expertise to help their countries progress. But even when the talent is there sadly 1 in 9 African graduates leaves to find work in the developed world which is disastrous for trying to move the continent forward. (In Guyana, in South America, it is estimated that 95% of successful graduates emigrate to either US or Canada - an horrendous waste of talent the country can ill-afford.)


Overall UNESCO has calculated that in 2020, 63m children (1990 105m) of primary school age were out of school world-wide and almost half of those (34.6m) were in sub-Saharan Africa where Nigeria, because of its size, boasts the greatest number of kids out of school in the world with 11m. In this sub-continent more than half the kids are not in school in South Sudan, Liberia, Eritrea, oil-rich Equatorial Guinea and increasingly in the Sahel where armed fighters continue their struggle against authority. At the same time UNESCO estimates that worldwide 264m children are not learning to read, write or count, whether they are in school or not, because their education is of such poor quality. This means that the world wastes US$129bn on poor education that fails to give children even the basic skills they need.

In sub-Saharan Africa the main reasons for children being out of school are :-


a) there may not be a school within walking distance,

b) there may not be enough teachers to teach all of the children,

c) parents may be unable to afford to pay school fees or to meet the cost of food, scholastic materials and uniforms. The UN estimates that these costs can consume, on average, 25% of poor families' household budgets.

d) the family may be so poor that they need their children to help on their plot of land.

e) and in a kind of selection process it may be that only one or two children will attend school from a family or perhaps just the boys. And this latter problem has consequences for future family life as World Bank research has demonstrated that education increases the likelihood of women choosing to have smaller, healthier families and deciding to send their own children to school.


Another problem is class sizes. We in the rich world may baulk at the idea of more than 30 pupils in a class but in many parts of sub-Saharan Africa the pupil/teacher ratio is absurd at more than double that figure :- in Central African Republic it is 80:1, in Malawi 69:1, in Chad 62:1, in Mozambique 55:1, in Guinea-Bissau 52:1 and in South Sudan 50:1. Imagine having to control a class of 80 kids! Conversely in Mauritius there are 22 children per primary school teacher.

But even if you are one of the luckier ones in Africa and have a school to go to other challenges can present themselves:-


a) the classroom may well be under a tree as the local community cannot afford to build a school. Inevitably then, when it rains, lessons stop and on really wet days pupils do not even turn up.

b) in many schools there are no desks leaving kids to sit on bricks trying to read outdated and worn out textbooks. And as there is no electricity, the internet is no substitute.

c) double shifts are sometimes needed to accommodate all the pupils putting tremendous pressure on teachers.

d) teachers are in short supply and often training is inadequate. In some sub-Saharan African countries - Angola, Benin, Equatorial Guinea, Guinea-Bissau, Senegal and South Sudan - fewer than 50% of primary school teachers are trained to national standards. Education also suffers by too many teachers being paid months in arrears forcing them to go 'part time' as they seek alternative ways of paying their bills. It is not uncommon in some areas, for one teacher to be left in charge of an entire school whilst all the other teachers do second jobs!

e) HIV/AIDS has caused huge damage to the education system in many countries with teachers falling ill. In fact in many poor countries like Malawi and Zambia, AIDS was killing teachers faster than they could be replaced. Many children, too, are missing school because they have to look after parents or other relatives who are dying.


So far we have only dealt with primary schools but as children get older their chances of going on to secondary school are even smaller. All in all, in sub-Saharan Africa, more children of secondary school age attend primary school than secondary school and only 20% of children of secondary school age gain secondary education. As for university education that is for those families with money or those lucky enough to obtain a bursary. Only 3% of African children go on to attend university.

This lack of educational opportunity is reflected in the fact that in the developing world today, according to UNESCO, there are 775m adults who are illiterate, 2/3rds of them women. Today, in sub-Saharan Africa, more than half the adult population of the following 9 countries can neither read nor write. In Niger the literacy rate is 19%, in Burkina Faso 29%, in Mali 31%, in Chad 34%, in Ethiopia 39%, in Guinea 41%, in Benin and Sierra Leone 42% and in Senegal 49%.


If poor countries are going to start to advance education has to be at the very heart of development but too many governments are failing to seriously invest in their children's education. Currently, it seems, according to UNESCO, in 31 countries in sub-Saharan Africa more than 50% of the money spent on education is wasted because of poor schooling. In Nigeria, for example, according to Kevin Watkins, Executive Director of the Overseas Development Institute, 'the quality of education is woeful. Half of the children who get through 6 years of primary schooling emerge unable to read a simple sentence or add 2 digit numbers. There's a good reason for these outcomes. Most of Nigeria's teachers are unable to pass primary school exit tests. And in October 2017, the state governor of Kaduna sacked 21,780 teachers, 2/3rds of the total, because they had failed to to score 75% or more in an examination paper for their 6 year old pupils. Add to this a chronic shortage of text books and you get a recipe for schooling without learning.' And this is 2022!


At the World Education Forum held in Dakar in Senegal in 2000, 180 countries made a commitment to the effect that no country seriously committed to primary education for every child should be thwarted by lack of funds. This strong commitment made by some of the world's richest governments should have been a tremendous incentive for countries to act. The same theme of Universal Primary Education (UPE) was further boosted by the United Nations at the Millennium Summit in 2000 by its inclusion as one of several UN Millennium Development Goals to be reached by the end of 2015. Moreover, this was further underlined again in the UN Sustainable Development Goals for 2030 with Goal 4 aiming to 'ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.' And limited progress is being made here for developing countries now spend, on average, 3.8% of their budgets on education compared to 2.9% in 1999. Despite recent successes, though, with 30m children still out of primary school a recent report by Social Watch, a think tank, on present trends, it will take sub-Saharan Africa until almost the end of this century to achieve universal primary education (UPE).


So for UPE to succeed in all areas of the developing world it is going to need money and commitment from both rich and poor countries. And in financial terms alone it is now estimated that US$16bn (£13.3bn), a significant increase over previous estimates, will need to be found annually for investment in schools, books, materials and teachers. So two questions 1) where will this money come from and 2) will all parents send their children to school anyway?


1) Rich countries could start to make education for all a reality by supporting governments in the developing world which show real resolve in attempts to get children into schools. These wealthy nations could do this by increasing their ODA budgets or by targeting existing grants to poor countries for educational purposes. Rich countries could also play a further important role in offering to train teachers in various secondary school subjects and by offering free places at their universities for the brightest and best of school-leavers from the developing world on condition, that on graduation, they put their talents to good use back in their own countries.


2) In a study carried out by the World Food Programme in West Africa it was found that introducing school meals* more than doubled school enrolment whilst at the same time led to a 40% improvement in academic results. This is perhaps not surprising as many children in Africa eat less than the bare minimum. If going to school means that children get at least one good meal every day it can only help their development whilst at the same time leaving more food available for the rest of the family. And at an annual cost of US$18 (£15) for each pupil this looks like a bargain.


*Mary's Meals, a charity based in Dalmally in Scotland, serves more than a million meals a day to school children worldwide including to over 25% of primary-school children in Malawi. see www.marysmeals.org.uk


A free lunch is one thing but another necessity is the need to abolish school fees. The Kibaki government in Kenya did just this when it was elected in December 2002 and immediately put an additional 1.9m children in the classroom. And when Tanzania abolished primary school fees enrolment shot up from 59% to 82% in 2 years. Similarly, as a result of the interest savings when the country's debt was cancelled through the HIPC Initiative in 1998 (see DEBT RELIEF), the Ugandan government was able to channel hundreds of millions of dollars mainly into health, water and free primary education. As a result there are supposedly now an extra 3.5m children in primary school in Uganda although 27% of children are still reckoned to be out of school at any one time.**


Today, success in the global economy is even more closely linked to the skill of the workforce than ever before so it is essential that children everywhere are given the foundations of an education that will allow them to grasp these opportunities. And we cannot afford to fail them! For no education means children not just being unable to use their minds to full advantage - with so much time on their hands it often leads youngsters into crime, drugs, violence and prostitution which ultimately lead to prison and escalating social problems.

In the Programme for International Student Assessment (PISA) report by OECD for 2020, based on test scores in maths, science and reading, attained by 15 year olds in 70 countries across the globe, Singapore came out top. In second place was Hong Kong followed by Japan and Macau. Top European country, in 5th place, was Estonia followed by Canada, Taiwan and Finland and South Korea. In 10th place was China followed by Ireland and Slovenia. Germany and The Netherlands occupy 13th place. The UK came in 23rd and the US 31st. Occupying the bottom 5 positions were Dominican Republic, Kosovo, Algeria, Macedonia and Tunisia. Shockingly, even in the UK, it was found that 1 in 5 youngsters leave school without a basic level of education.


**As with so many things in sub-Saharan Africa too often things are not what they seem. In a 2012 report, independently commissioned by the Ugandan government, it was found that there was gross mismanagement in many aspects of education:-


a) shoddy construction work, incomplete/abandoned buildings, collapsed pit latrines.
b) scams which had created ghost teachers leading to double salary payments and false arrears claims.
c) in the 415 schools visited the Commission found a total of 72,350 ghost students in primary school which nationally translated into 22% of students; for secondary schools the figure represented 12%.
d) wastage of money through 5,000,000 children repeating a class instead of the policy of automatic promotion being implemented.
e) 50% of head teachers and 25% of teachers were absent from school along with 21% of the children at any one time.
f) unverified, unreliable and often inaccurate data was reported to the education ministry by head teachers.
g) there was a high failure rate of pupils in Primary 7 with too many pupils leaving the school system without scoring any grade.
h) the Commission established that the procurement process is riddled with illegal contracting and flouting of procurement laws and standard procedures leading to actual and/or potential loss of colossal amounts of money.


Still a very long way to go then and much still to learn!


(The 2020 QS World University Rankings shows Oxford University as the globe's No1 teaching institution coming out on top in 8 out of 48 subjects assessed including anthropology and pharmacology. 13 of the 48 disciplines are topped by a UK university although none by Cambridge. However, Cambridge featured in the top ten in 38 subjects, more than any other university. The US remains dominant in tertiary education coming out on top in 30 subjects. Harvard was ranked the best in 11 disciplines including economics, law and medicine whilst the Massachusetts Institutue of Technology came first in 12 subjects including chemistry, physics and maths.)

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