AIDS Leaves Africa’s
Economic Future in Doubt
By: Peter Wehrwein
“The worst of the
AIDS epidemic may be yet to come, say U.N. economists”
As the HIV epidemic deepens in
Africa, it is leaving an economically devastated continent in its
wake.
More than one-quarter of working-age adults are infected with HIV in
some communities in sub-Saharan Africa, a statistic that brings
profound economic repercussions for families and communities.
Families that must care for a member who is ill with AIDS often
deplete monetary resources that would otherwise be used to cover
necessities and to invest in children’s futures.
And when AIDS claims the lives of people in their most productive
years, grieving orphans and elderly must contend with the sudden
loss of financial support, communities must bear the burden of
caring for those left behind, and countries must draw on a
diminishing pool of trained and talented workers.
Anita Alban, an economist for the United Nations Joint Program on
HIV/AIDS (UNAIDS), cites a study of urbanites in Cote d’Ivoire that
showed families with a member sick from AIDS cut spending on their
children’s education in half and reduced food consumption by about
40 percent as they struggled to cover health expenditures that
soared to four times their usual level.
According to studies in Cote d’Ivoire’s largest city, Abidjan,
Uganda’s Rakai district, and Tanzania’s Ziwa Magharibi region,
families cope with these losses largely with cash and in-kind
transfers from other families, a support infrastructure that
reflects the interdependence of African society.
According to Alban, relatives take in many of the orphan children,
so the cost of their care is largely unregistered on government
balance sheets. But urbanization and migration of labor are eating
away at extended family structures that have quietly shouldered
childcare.
Orphans suffer disadvantages even when relatives care for them.
Studies have shown that orphans do not eat as well as other children
and are not given the same opportunities to go to school. As a
remedy, some countries have moved to provide special welfare
services for orphans.
Families in Zimbabwe who take in an orphaned child, for example, are
compensated for school fees and school uniforms, according to Alban.
But she questions whether Zimbabwe, with an adult infection rate of
26 percent and an estimated 600,000 orphans next year, will be able
to afford this kind of special support.
Economic yardsticks inadequate
One of the paradoxes of the HIV epidemic in sub-Saharan Africa is
that for most of this decade it has not made a dent on standard
macroeconomic yardsticks such as gross domestic product (GDP), a
measure of the total value of goods and services produced by an
economy over a period of time.
Mead Over, who with Martha Ainsworth was the principal author of the
World Bank’s 1997 book, “Confronting AIDS,” argues that declines in
population growth caused by AIDS would tend to offset any declines
in economic growth caused by the epidemic.
This is due in part to the labor situation in Africa: In the cold
logic of supply and demand, the labor surplus in most African
economies means that workers removed from the workforce by AIDS can
be replaced without a loss of productivity.
Yet many experts, including Ainsworth, believe that standard
economic statistics such as GDP per capita are the wrong way to
measure the economic impact of AIDS in Africa. She said the impact
of the epidemic needs to be seen in the larger context of human
welfare.
“Countries have lost 10 to 20 years of life expectancy due to a
single disease -- an enormous setback in individual welfare,
reversing years of investments in human capital,” Ainsworth says.
“GDP per capita or GDP growth do not capture this dimension of
welfare loss, especially the lost welfare to those who die.”
Moreover, as the epidemic has worsened, so have estimations of its
effect on African economies, even without taking into account the
broader human welfare issues.
The impact is obvious
David Bloom, a professor of economics and demography at the Harvard
School of Public Health, had been one of the economists chronicling
the epidemic’s relatively mild impact on macroeconomic indicators.
Now, however, he warns, “The whole economy [in Africa] could
unravel.”
Besides, says Daniel Tarantola, a senior policy adviser to World
Health Organization Director-General Gro Harlem Brundtland, the
scope of the epidemic is now so large now that numbers are no longer
necessary to make the argument for the epidemic’s economic
consequences.
“For those who live and work in Africa,” Tarantola says, “the impact
on individual, family, and community economies is obvious. Sickness,
death, and the loss of productive capacity in communities where as
many as one-third of the women in their reproductive years are HIV
infected hardly needs to be supported by data.”
Already the epidemic’s burden on the health care system is
increasingly obvious, although efforts to quantify the impact have
lagged. Alan Whiteside, head of the Health Economics and HIV/AIDS
Research Division of the University of Natal in South Africa,
reports that up to 50 percent of the beds in South Africa’s large
provincial hospitals are occupied by people with AIDS.
“What is about to come is 10 times worse,” said Bloom, who visited
South African late last year. “You are going to see a tidal wave of
AIDS cases in South Africa, and the health care system is going to
be hit hard.”
A cumulative effect
Because it is difficult to measure the macroeconomic impact of an
epidemic directly, economists have generally depended on economic
models, which are built on a set of assumptions. Naturally,
different assumptions yield different numbers.
In “Confronting AIDS,” the World Bank factored in labor supply
issues and the amount to which health care would be financed out of
savings to come up with a “rough estimate” of a 0.5 percent
reduction in per capita GDP growth.
One-half of 1 percent may not seem like much. Indeed, for countries
with high growth rates such as Botswana and Uganda, that kind of
reduction “will not be crippling,” says Mead Over. But he notes that
a lower growth rate has a cumulative effect.
“A country whose growth rate is 2 percent a year in the absence of
AIDS will increase its GNP [gross national product] per capita by 81
percent in one generation, which is about 30 years,” Over says. “Now
suppose that AIDS reduces growth to just 1.5 percent per year. The
same country will increase its GNP per capita by only 56 percent in
the same period.”
Yet Over echoes the belief that figures such as these are mere
signposts on a larger landscape of human suffering and tragedy.
“They fail to measure the grief of the survivors and totally
disregard the loss of the dead and dying.”
ACTIONS: >>
email this
article to a friend >>
react to this
article >> more articles
Note:
Please email your
opinion to op-ed@majalla.org; Op-Ed articles are not
peer-reviewed.
New Op-Ed articles
are published monthly, and as special edition when warranted
|
