Kelechi Alagwu via Atlas

The other day, I read a LinkedIn post by UNDP’s Chief Economist for Asia on Africa’s slow development. It’s something I’ve known for a while, really depressing stuff, but the post made it much more dire.

So the post starts with this:

“Extreme poverty will soon be almost extinct in Asia. And that means it will start rising again at the global level….Continued progress in Asia over the next few years will soon make extreme poverty an almost exclusively Sub-Saharan African predicament. The pattern of global poverty will become the pattern of SSA poverty.”

So basically, in the coming years, those living in extreme poverty, that is, on less than $3 a day, will be found exclusively in Africa.

Philip Schellekens gives three reasons for this prediction:

• The poverty gap in Africa is much wider than in Asia, 17% vs 0.5%

• Economic growth is much slower in Africa than in Asia. In fact, the rapid decline in extreme poverty was due to massive economic growth in Asia. China and India, to be precise

• Above all, Africa is experiencing a population boom, the highest there is, at 2.4% a year compared to 0.9% in South Asia and 0.2% in the rest of Asia. Meaning that more and more people are born into countries with lagging economic growth, thereby increasing the number of people living in extreme poverty.

In the comments, someone said: “Yes, Africa will be the next big challenge.”

Are we really the runt of the pack?

Think of any productivity indices: Electricity. Agriculture. Manufacturing. Formal employment. Education. GDP. We are lagging on all of them. What’s more frustrating is that a handful of African economies are not just lagging in economic growth, they are shrinking!1

Of course, insecurity plays a huge role in our current state, but overall, our growth has mostly been impeded by weak structural and social infrastructures and institutions. But I will leave these for the political economists and experts.

Moving on.

There is a danger to seeing Africa as “the next big challenge.”

This statement reduces us to one massive problem to solve. Or conquer. Like climbing Mt. Everest. Perhaps this explains why Western development economists have a huge (morbid even, dare I say it??) fascination with us.

I mean, it’s like that time I was in second year med school, and we were standing in front of a cadaver for the first time. A real body, OMG! Then we were hacking away and got to the armpit and saw the brachial plexus: those yellow cords we saw in our atlas were right in front of us (grey and broken and reeking of formaldehyde, though, but you get the point).

It was a validating experience. What we were learning was real. So perhaps Africa, with her many idiosyncrasies and problems, validates all the learning learnt during an Econs major?

Dear God, I hope not.

Neec via Atlas

“I mean, we’re flesh and blood. Real, three-dimensional people.”

The latest Commonwealth Short Story Prize Winners were announced last week! Was really (really) rooting for Ola W. Halim to win the regional prize for Africa, but hey, any win is a win for the continent. Congrats to South Africa’s Lisa-Anne Julien!

Lisa’s story is very light and humorous, kind of reminds me of Frank McCourt’s Tis, and just about any self-deprecating, deeply observant first-person narrative, but don’t be deceived. The story is a satire.

In summary, a black maid works for a caring, lovely, condescending, and ignorant mistress (whom I suspect is white). Her mistress can’t understand why her maid still lives with her physically abusive husband, so she gives advice and encouragement and just about does anything she can to get her maid to leave the marriage.

Meanwhile, the mistress is suffering from a form of emotional abuse from her philandering husband. But unlike the mistress, the maid doesn’t give advice but does all she can to shield her mistress from the full weight of her husband’s unfaithfulness.

Classic. Does it sound familiar yet?

There is this bit in the story that hit the bullseye, you can’t miss it. In it, the maid is talking with other maids about marriage, their bosses, class, and then here goes:

Damn.

Do you see it yet?

I read this and thought of the many developmental projects we have gone through as a continent. And all the weird (if you really think about it) RCTs we have endured. Case in point, see these:

• An RCT in Ethiopia to observe whether watching videos of successful people will make research participants more aspirational.

• An RCT in Malawi to observe whether giving teenage girls cash will reduce the risk of HIV and Herpes from unprotected sex.

• An RCT in Kenya to observe whether a four-hour visualization class will make mothers provide chlorinated water to their kids.

Sometimes I feel like we are just fascinating objects to be tweaked and observed, like “hey, if you press this lever, you get this. If you press the other lever, you get that!”

And we wonder why a lot of RCT results aren’t easily reproducible in other settings.

I would like to think the researchers above had good intentions.

But, we are first and foremost people: complex, imperfect, puzzling, alive, and human. And a lot of these interventions would be unnecessary if we didn’t have most people living on less than $3/day. Sigh.

Am I anti-RCT? I doubt that. I’m an applied researcher! I pore through RCTs and meta-analyses, looking for statistical evidence! It’s just that sometimes I wish there were a better way to find, vet, and use evidence. I don’t know how to explain this feeling, though. This blog post captures my love-hate relationship with RCTs in the social sciences.

Moha Amin via Atlas

Japa: Yoruba word; to migrate (escape, more like) from Nigeria’s many headaches.

I recently read Daniel Yu’s “Exporters Without Borders: Why You Should Start a Company Instead of Working in Aid.”

It’s a contrast to In Development’s inaugural piece on unconditional cash transfers (I find it brilliant that the magazine lets two opposite approaches to global development sit that close to each other), and Daniel does a great job addressing the usual objections to why value export is Africa’s surest bet to rapid development…But I am digressing.

After reading his article, I started looking for more information about his projects on the continent. Then I landed on Africa Jobs Fund, a Ren Phil-backed initiative to improve the continent’s welfare by export manufacturing and international labor mobility. The project’s thesis argues that these interventions are the most cost-effective in improving the welfare of Africans at less than $10 per year of doubled income, which translates to $25 per DALY; four times more cost-effective than GiveWell’s top performing charities and 50 times better than most livelihood interventions.

I was wondering if their model included losses due to skilled labour movement from the continent, and was thinking of a commentary on this when In Development published Charles Kenny’s Where’s My Ministry of Emigration?

In it, he described the benefits of emigration to origin countries: remittances, economic growth, and a brain gain effect where workforce vacuums encourage a ramping up of domestic supply.

But what about losses, though? Particularly, from health workers migrating? Who, by Oliver’s argument, are very valuable to destination countries.

For my master’s dissertation, I did a systematic review of the costs of health worker migration from the continent. My review showed that most of the literature focused on direct costs: capital losses from subsidized medical\nursing education and the associated ROI over the worker’s career. Only one paper modelled indirect costs: U5 and maternal deaths. And even that is just one way to think of indirect costs.

Charles took time to explain safeguards against these losses: bilateral trade agreements with destination countries, the need for source countries to ramp up training via expanding private (not public) education, and the provision of loans, etc.

I’m doubtful if this has worked in Africa. At the moment, the UK only has bilateral agreements with just two countries (Kenya and South Africa), and for good reason, 37 African countries are on the WHO’s health workforce safeguarding list.

Now, about the benefits of emigration to source countries: We can argue that emigration ramps up more training of health workers, as in the Philippines. But they are currently experiencing a shortage of nurses, and in 2022 removed an 11-year moratorium on the creation of new nursing schools. Furthermore, because the Philippines ramped up nursing training specifically for emigration and not to boost domestic supply, it created a trend where nurses worked mainly for the required work experience to emigrate.

This trend had a negative spillover during the COVID pandemic when the country placed a 6-month ban on health worker emigration. Experienced nurses refused to work, bidding their time when the travel ban was called off. Major contributors to this clocking-out trend were the poor pay and poorer working conditions in most of the country’s public hospitals.

Now the bit about remittances. Yes, remittances have a huge role to play in Africa. They have outpaced ODA flows to the continent in the last two decades and will continue to do so well into the future. However, these remittances are not cohesive enough to reach/impact the most vulnerable. Take Nigeria, for instance. The FP, along with the Ford Foundation, released a report on the state of Nigeria’s diasporan philanthropy. I gleaned two things: one, remittances for infrastructure are heavily skewed towards private housing and real estate rather than health, education, and other social infrastructure. Two, philanthropy is geographically skewed towards the South-Western region (which has one of the highest HDI in the country). The North-East, with the lowest HDI, receives the least flow of diasporan philanthropy. This report added credence to a newsletter where I argued that remittances from Africa’s diasporan health workforce do not reach the people most vulnerable to their emigration.

Am I anti immigration? Of course not. Everyone has the right to migrate to improve their welfare. Heck, I am a non-practising doctor living in England! But has my emigration contributed to my country’s welfare? Nope. To be brutal, I think I am part of the wave of health professionals who japa abroad for better pay, better living, and better working conditions.

But I believe that emigration can be a useful tool for improving the continent’s welfare. Hey, we have a young and energetic population! But we must be clear-eyed about the costs, benefits, and tradeoffs involved.

Oreoluwa Adeyemi via Atlas

I’m always sparring with my sister Emilie on LinkedIn, on issues about decolonization, but today, I concede. Her piece on the negative spillovers of market shaping on national health systems takes the words out of my mouth.

As a backstory, the NYT recently published an alarming story on Zambia’s rising rates of HIV infection and AIDS mortality. It’s so bad that rates of admitted patients with advanced disease increased from 2 cases a month to 28 cases in February. Since the USAID cuts last year, the country’s HIV program has been bare-bones, providing just the barest to more than a million people in need. Paediatric testing times are delayed, antenatal testing is gutted, CHWs are redundant, etc. So you can imagine the scale of HIV incidence and mortality. I reckon it’s way higher than the cases currently presenting at clinics.

But Zambia’s failing system is not only due to the loss of USAID funding. It’s partly due to the collapsed parallel systems USAID knowingly or unwittingly created. Before the cuts, USAID ran its own parallel operations, logistics, staff, and supply chain for twenty years, without integrating them into the country’s Ministry of Health.

As described in the NYT:

“Thousands of critical health care workers were still employees of aid groups, and not the Ministry of Health, so they lost their jobs. Ministry employees had no idea how to use the drug- and test-ordering system. In Ndola, they had to plead with the fired data clerks to come back and teach the remaining clinicians the passwords and how to look up patient records. The purchase of medications, operation of the supply chain, payment of staff: Zambia had continued to let the United States pay for and manage almost all of it.”

Emilie echoes this (without sarcasm), in a short LinkedIn post (which drew my attention to the NYT piece):

“So yes that 20 Eur internet subscription that donors are asked to pay or want to pay, can disrupt an entire system 10000 fold.”

Then, in her newsletter, she takes it up a notch to discuss how market shaping fuels dependency.

First off, market shaping has done a lot in improving access to drugs in LMICs. High prices, market fragmentation, and low volume are some of the niggly problems that make drug access in these areas difficult. With market shaping, drugs become affordable, marketers can scale their products, and make a profit. In return, countries have access to important technologies for infectious diseases like malaria, syphilis, and HIV.

But this is not without a tradeoff. Emilie argues that market shaping creates a form of market distortion through parallel systems that are independent of national systems. This is a concern because at the moment, suppliers negotiate directly with intermediaries (donors/providers with catalytic capital), leaving intervention countries to function as implementers. Furthermore, suppliers do not engage with each country but as aggregated pools of buyers. In this case, drug prices are lower only if countries pool together for demand.

You can argue that these features make market shaping possible in the first place, and you are right.

But what happens when intermediaries (who are concentrated in the Global North) leave? Do countries have the power to negotiate access directly with suppliers?

In her newsletter, Emile gives some suggestions on what donors/recipient countries could do. She also mentions organizations making conscious efforts to uncouple from the inherent power dynamic in market shaping.

I’ll close this commentary with an image of what these efforts should look like.

Credit: Emilie Sabine Koum Besson

Adeniyi Taofeek by Atlas

The other day, I was reading a LinkedIn post by Yannick, my brother on the other side of the continent, on the state of South Africa’s electrification. So South Africa is “Africa’s solar giant” with the fastest-growing solar market. But this boom lives within a paradox where SA’s electrical bills have tripled in over 10 years, leaving South Africans in a sticky middle, where, although they use solar, they still depend on the national coal grid, whose pay/operations are becoming increasingly inefficient, partly due to SA’s switch to solar. Wahala

The reason? Well, this is where Yannick and I differ. He says South Africa’s skyrocketing electrical bills are because the country’s electrification is based on coal: “a 19th-century energy logic”. The solution? He suggests that South Africa ramp up solar projects.

The hitch here is that they don’t have enough money to do it, though. In fact, a lot of countries on the continent do not have enough money to ramp up solar. And the capital to fund them comes with all sorts of terms and conditions that make financing expensive. For example, I read this recent piece on The Conversation on the state of clean energy financing on the continent. In summary, loans are expected to be paid back faster and with higher interest rates.

My question: if solar is expensive, why aren’t we cranking up coal? Yannick conceded two things: one, coal is cheap; two, coal plants in South Africa are failing because the country was neither mining enough coal nor expanding the grid to match a rapidly growing population.

And this too is not a unique problem in South Africa. Africa in the 21st century has not used up as much coal as the UK in the 19th century. No, really, coal production in the UK in 1913 was 292 million tonnes. The entire production of coal in Africa in 2023 was 234 million tonnes!

I was thinking of all these when I read Yannick’s post, so I asked him, “Why aren’t we cranking up coal exploration and mining since it’s obvious we can’t keep up with solar?” Of which he said: Coal is polluting. Fair enough.

This is the logic of most impact investors right now; in fact, more than 19% of all AUMs are fed into clean energy projects. Westerners are doing all they can to atone for all the coal they used up, and we?

Well, how do I put this? It’s like that time your big bro returned from uni wearing Toms and listening to Olamide. Six months ago, you both were heading out to school, but now here he is, all cool and aloof, and did he even get taller and buff? Turns out he did get buff. And here he is in the yard, effortlessly lifting weights made with rods and concrete blocks.

You adore him, and you want to be him, naturally. You want the things he has. Hell, you want to inhabit his body. So you try to lift that concrete rod. But the thing is, you are 10, and your muscles are puny and squished by baby fat. Awwn, wee lamb. Obere nwa

But will you concede yet?

Bright Simons published a policy brief earlier this year on what Africa should classify as critical minerals, and if you feel TL;DR: Critical minerals for developed countries may be green minerals like lithium, chromium, and nickel. For us, critical minerals are minerals critical to our rapid industrialization: iron, coal, potash, phosphate, copper, etc.