among Africa’s 600 million people. HIV is increasing child mortality
(more than 1 million children are infected) and affects adolescents and
women disproportionately, with half of new infections occurring among
those 15–24 and six women infected for every five men in a number of
the hardest-hit countries. HIV thus hits people in their prime produc-
tive years, profoundly disrupting the economic and social bases of fam-
ilies and dramatically reducing national income.
As noted, there are more than 8 million orphans in Africa as a result of
HIV/AIDS, 1 million in Uganda alone. Dependency ratios are shooting
up and economic insecurity is increasing. At the national and even the
continental level, the illness and impending death of up to one in four
adults in some countries will have an enormous impact on national pro-
ductivity, earnings, and savings (World Bank 1999b). This impact will be
strongest in Southern Africa, where HIV is most widespread and where
much of Africa’s GDP is located. The combination of HIV infection and
malaria infection is especially insidious, weakening in a mutually destruc-
tive action the immune systems of both the pregnant mother and the fetus.
Though perhaps the most dramatic element undermining family
structures and threatening income security, HIV/AIDS is not the only
one. War and civil conflict became more common in the 1990s, and 28
percent of the world’s 12 million refugees are now in Africa (UNHCR
1998). Increasing numbers of refugees and migrants, coupled with high
urbanization, will exacerbate the spread of HIV/AIDS. As the new cen-
tury opens, there is hope that the main recent conflicts are being resolved.
But much peace is fragile, and the consequences for Africa’s families are
profound. Furthermore, many conflicts remain.
War and conflict come on top of other external shocks for many peo-
ple, such as more than 30 years of drought in the Sahel. Indeed, 60 per-
cent of Africa is vulnerable to drought, and 30 percent is extremely
vulnerable. In addition, much of the poor’s consumption is seasonal
(chapter 3), and macroeconomic shocks have a greater impact on the
poor than on others. Moreover, in Africa as elsewhere, urbanization,
while generally promoting development through the concentration of
populations, weakens traditional family structures. And in Africa par-
ticularly, employment growth appears to have stagnated along with
economies more generally. Coupled with massive poverty, family struc-
tures and income security are severely threatened by the increased vul-
nerability brought by HIV/AIDS, conflict, drought, and urbanization
(World Bank 1999a).
CAN AFRICA C LAIM TH E 21
Family structures and
income security are
severely threatened by
vulnerability brought by
drought, and urbanization
Why the Human Development Crisis?
FRICAISTO CLAIM THE
20th century pattern of rapid population growth, stagnating primary
enrollments, declining health, poor nutrition, and growing income
insecurity, all affecting children and women disproportionately as a result
of poverty and deteriorating family structures. Reversing the pattern
means understanding its causes. This section explores some possible
Do Africans Value Investments in Human Development?
It is sometimes suggested that African households do not invest in
human development, especially education, because the private returns to
that investment are not high enough to justify it. The evidence on pri-
vate returns to education in Africa is mixed and somewhat dated. But it
appears that market wage returns are usually high, as elsewhere in the
world, especially for postprimary education.
There is considerable controversy about the absolute size of the returns
to education in Africa. Psacharopoulos (1994), for instance, aggregates
the private returns to primary education at 41 percent, to secondary edu-
cation at 27 percent, and to higher education at 28 percent. Mingat and
Suchaut (forthcoming) put them at 30, 21, and 28 percent. Others think
that these estimates overestimate the returns to schooling. And indeed,
issues of omitted variable bias and selection complicate the interpretation
of wage-education gradients in Africa (as elsewhere).
Even studies that control for bias, however, find substantial private
returns to education in Africa, on the order of an 8–10 percent increase
in wages per year of schooling (van der Gaag and Vijverberg 1987). These
data are largely static. Unresearched in modern Africa is the key question
of whether returns to skills are rising because of increasing demand or
declining because of increasing supply (Knight and Sabot 1990).
Whatever the precise numbers, the private returns to schooling are sig-
nificant in Africa—suggesting that households should want to invest.
This quantitative evidence is strongly supported by anecdotal evi-
dence. In many countries the buildings erected through voluntary effort
for primary and secondary education, for local training centers, and for
health clinics attest to the willingness of households and communities
to invest in the future of their children. Outlays on school fees, uni-
INVES TING IN PE OPLE
communities are willing
to invest in the future of
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forms, and the like account for a substantial claim on households’ cash
income (Fine and others 1999). Given the poor and declining quality
of education offered to many poor households, their continued will-
ingness to forgo a considerable share of current consumption provides
unambiguous evidence of a strong desire to invest in their children’s
future. In Mauritania and other countries, parents fund private tutor-
ing (often by the same teachers) to supplement low-quality public
schooling. Offered timely, comprehensible, and appropriate advice,
African mothers will take appropriate measures to provide for their chil-
dren’s nutrition and development. Entire communities have often
banded together to support a gifted child’s secondary and university
Strauss (2000) has summarized the evidence on household and com-
munity factors affecting investment in human development in Africa.
Household investment is largely determined by the education of the par-
ents, by household income, and by income responses (at least for health
care). There is almost no evidence on the response of households to school
choice in Africa, but evidence from elsewhere indicates that there will
likely be an income response. The implication of all this is that public,
rather than private, health and education services are becoming more tar-
geted at low-income populations.
At the community level there is considerable evidence that health and
school facilities are more likely to be used when they are close to the com-
munity. The impact of distance on use seems to be greater than that of
user fees, though there is not as much evidence on user fees in Africa
(Strauss and Thomas 1988).
While households demand investments in education and health, and
invest their own funds in these areas, a disturbing recent development is
the inability of the poorest of the poor to cope with increased vulnera-
bility. Traditionally, the poor have had diverse mechanisms for protect-
ing themselves against vulnerability—joining labor-sharing clubs in
Togo, taking children out of school to work in the household in
Swaziland, selling cattle in Zimbabwe. But these traditional mechanisms
have become less effective at managing household risks as the risks, and
household vulnerability, have increased. In Burkina Faso, for example,
cattle sales by households during the most extreme drought period
finance only 20–30 percent of the village-level income shortfall.
In addition, Africa’s traditional system of social protection—the
extended family—is under extreme stress because of conflict, HIV/AIDS,
CAN AFRICA C LAIM TH E 21
households have fewer
mechanisms for coping
drought, and migration, and can no longer provide the economic and
social protection to households that it once did. This, in turn, is begin-
ning to affect households’ abilities to enroll their children in school, as in
Côte d’Ivoire, Kenya, and Zambia. This increased vulnerability is not just
a rural phenomenon: the primary enrollment rate in Nairobi (Kenya), for
instance, has dropped to 61 percent from 103 percent in 1980. The
increased attraction of education programs that include meals attests to
this increased vulnerability.
Are Resources Used Efficiently?
Because of its young population, Africa’s human development invest-
ment needs are great. Yet its resources are limited, even with external aid.
Thus it might seem that Africa simply does not have enough resources to
invest in its people.
But the reality is more complicated. In 1993 public investment in edu-
cation averaged 3.8 percent of GDP in Africa compared with 2.7 percent
in Asia and 2.8 percent in Latin America (table 4.2). In general, private
spending adds another 50 percent to public spending. Health spending
in Africa averages 5.6 percent of GDP, the same as the global average for
low- and middle-income countries and significantly more than the
3.5–4.1 percent for Asia (table 4.3). Public spending accounts for about
half of Africa’s health spending.
Of course, these spending data refer to the continent as a whole. One
of the most remarkable features of human development investments in
Africa is their differentiation across countries. Public spending on edu-
cation in francophone West African countries amounts to 5.5 percent of
GDP; that in anglophone East African countries is 2.3 percent of GDP.
Median per capita public spending on health is about $6 a year in
INVES TING IN PE OPLE
Table 4.2 Public Spending on Education in Africa, Asia, and Latin America,
1975 and 1993 (percentage of GDP)
All countries with GDP below $2,000
Source:Mingat and Suchaut forthcoming.
Relative to GDP, Africa
spends as much—or
more—on education and
health as other regions
CAN AFRICA C LAIM TH E 21
African countries have developed national “education for all” programs.
And most have subscribed to the International Development Goals for
2015, which include targets for education and health along with those
for poverty reduction, gender equality, and environmental sustainability
(chapter 1; OECD 1996).
The problem is not necessarily a lack of political commitment but
rather the wide range of actions needed and the intensely political nature
of the reforms required to create effective service delivery systems. In
recent years most governments have been preoccupied with improving
macroeconomic policy (chapter 1). Political commitment is now needed
not just to boosting human development in general but to improving
nutrition, to implementing major health and education reforms, to con-
fronting HIV/AIDS, to protecting the vulnerable, and so on. It is diffi-
cult for governments, however committed, to move simultaneously on
many fronts, each of which is vastly more complicated than macroeco-
This difficulty is compounded by the political nature of the reforms.
They involve overcoming massive vested interests, which requires stead-
fast political will and is not always feasible—especially given the new
democratic climate and frequent elections in many countries and the polit-
ical weakness of rural populations. Teachers tend to be heavily unionized,
university students often represent a powerful political force though a tiny
numerical minority, hospitals have more influence than clinics, and so on.
Taken together, public education and health labor forces usually represent
the bulk of the nonmilitary public service in African countries.
Despite these complex issues of political economy, many countries
have made a major start. Burkina Faso, Guinea, and Senegal, for exam-
ple, are making teacher salaries more flexible, partly by permitting the
recruitment of community-based teachers who are off the civil service pay
scales. More progress can be expected, linked to the growth of civil soci-
ety throughout Africa and to the power of information. As Africans bet-
ter understand what is at stake, they will increasingly demand better
services through standard political channels and through civil society
At the same time, reform is always a lot easier when economies are
growing and transition costs can be more easily absorbed through
increased resources. Not only must vested interests be overcome, but
human development programs must simultaneously focus on the needs
of the poorest, through basic health and education, and on the need to
It is difficult—but not
governments to move
forward on the many
fronts needed to create
effective service delivery
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