The HIV/AIDS pandemic and the governance challenge in Africa

Addis Ababa, 16 November 2005 - The HIV/AIDS pandemic poses one of the greatest challenges to the African continent, affecting all aspects of socio-economic life and requiring bold moves to combat its effects.

As the workforce becomes more and more debilitated by the epidemic, African states must cope with declining institutional capacity coupled with budgetary increases in the health and prevention sectors. This in turn diverts essential resources from society's other basic needs.

The decline in economic growth and productivity is directly attributable to the erosion of the labour force at its most productive age. For example, in Ethiopia, on average, non-AIDS-affected households spend 33.6 hours per week on agriculture, while AIDS-afflicted households spend only 11.6 to 16.4 hours. In Zambia, families without a chronically ill head of household increased planting by 22 percent in 2002-03 (compared to the previous year), while those with a chronically ill head of household planted 13 percent less. (ECA 2004).

Essential health personnel are particularly affected by the pandemic. Over a quarter of the medical staff in the hardest-hit countries are infected with the virus (UNAIDS 2001). In Mozambique, 20 percent of student nurses died from AIDS in 2000 (World Bank 2003). In Lusaka, Zambia, HIV prevalence reached 39 percent among midwives and 44 percent among nurses (Whiteside and Barnett 2002).

Efficiency and flexibility are needed in a state dealing with the HIV/AIDS pandemic. The average prevalence rate in sub-Saharan Africa is 7.4 percent, which means that 25.4 million people are currently living with the virus. (UNAIDS, 2004). Even though trends vary from country to country, it is quite clear that it affects the most productive and reproductive members of society, between 15 and 45 years of age. And it is six times higher for women than for men.

In Kenya, for example, 50 employees of the Kenya Revenue Authority died in 1998, 43 of them from AIDS-related diseases (Barnett and Whiteside 2002). In Malawi, health problems among public sector workers increased six-fold during the period 1990-2000, with HIV/AIDS suspected to be a key cause (UNDP 2002).

The ability of governments to raise tax revenues has also been undermined by the effects of the epidemic on household and corporate income. A study undertaken in South Africa by ING Barings estimated that government revenue was 0.7 percent lower in 2000 due to AIDS, and that it would be 4.1 percent lower in 2011 (Quattek 2000).

According to the forthcoming African Governance Report, published by ECA, the following are major challenges posed by the pandemic on African governments: weakening institutional capacity, diversion of scarce resources, decline in economic growth, deepening social crisis, and rising threat to national security due to high infection rates among military personnel.

African states must take strong action and bold political initiatives to tackle these issues. There have been some good practices. Uganda has long been regarded as a success story, managing to reduce initial levels of infection from almost 13 percent in the mid-90s to 4 percent by the end of 2003. This was mainly due to an aggressive multi-sectoral approach involving all the top ministries. It was heavily based on information dissemination and effective coordination through the establishment of the Uganda Aids Commission in 1991. (UNAIDS 2004)

However, focusing only on internal structural strategies is not enough. The linkages between governance and HIV/AIDS also mean that market requirements should be balanced against government management of policies and service delivery. Market forces are one of the reasons behind the brain drain in Africa, which also limits state capacity. And problems related to providing low cost treatment drugs are rooted in the global market economy. This necessitates stronger communication and partnership between the health and financial sectors at national level, as well as with international partners and global financial institutions.

Good governance based on strong institutional development is vital in the fight against HIV/AIDS. Without strong state capacity, African governments will be unable to win a struggle that is already tragically depleting their most valuable resources. Crucially, the need to address good governance in light of the HIV/AIDS pandemic is urgent and mandatory, if African states are to achieve the targets set by the Millennium Development Goals.