Back in the flush days of 2005, a confident, wealthy G8 promised sub-Saharan Africa $25 billion more per year to help the region achieve the Millennium Development Goals (MDGs) by the target date of 2015, then 10 years hence. Now with five years remaining, the euros, dollars and yen are not pouring in, and those promises are at serious risk of being betrayed. The economic crisis that, unimaginable in 2005, managed to sink huge Western companies and force others into government receivership, has kept the entire sub-Saharan region waiting for the support for which many countries had so thoughtfully prepared.
As Africans wait to see the promises fulfilled, in urban areas across the region, already degraded housing conditions and overburdened social service systems continue to deteriorate. Africa’s cities are overwhelmed – a result of ceaseless in-migration resulting from failed harvests, the effects of climate change, lack of economic opportunity and ethnic conflict. Given the tremendous population pressures on space and public services, and without the sustained, predictable overseas financing to build and train for fully functioning health care systems, schools, and viable road, water, waste disposal and energy systems, urban dwellers now suffer increasingly from congestion, pollution, waterborne and infectious diseases and the same dearth of livelihood opportunities they fled in the countryside.
In the Millennium Cities Initiative’s MDG-related research, we are finding out just how painful the donors’ financing delays can be. While the rich world asks the poor to be patient until it can afford to help, mothers across the continent continue to die needlessly in childbirth as they wait, hemorrhaging, for the lone operating room at the tertiary care facility, because there is neither an ob-gyn, skilled birth attendant or safe blood supply available that would have made possible a cesarean delivery at the frontline facility in their own communities. Girls still drop out before and during junior high school simply for the lack of access to private latrines and feminine pads, thereby losing out on future educational, skill-building and earning opportunities, and all but ensuring an earlier marriage and higher fertility. And with the poor physical infrastructure, crippling traffic, unreliable energy and Internet access, even the best-intentioned foreign investors are hesitating – limiting job creation, transformational income generation and hope. The young men and women in the Millennium Cities, their own aspirations buoyed countless times by too many unmet promises, now seem increasingly demoralized by the dearth of opportunities awaiting them. Their frustration goads them increasingly into Africa’s even more severely challenged mega-cities, where their continued failure to thrive can understandably result in bitterness or despair.
Many development organizations will zero in on a single sector, where they might enjoy some tangible “quick-wins.” Although targeted single-sector work is crucial, we’ve learned in the course of MCI’s first five years that the aim of our collective efforts must be to pursue comprehensive, fully integrated development that can build upon the synergistic relationships among the MDGs. A non-profit or bilateral agency might focus on education, for instance, by training teachers, or furnishing texts, classrooms, computers and safe latrines; but if the city’s informal settlements suffer from open sewage and poor drainage, leading to rainy season flooding and the outbreak of cholera or other waterborne diseases, then too many children will be too sick to get to school, and these well-intended investments will not reap their desired results. Although no one group can be expected to cover all areas in which sub-Saharan cities have significant deficits, the essential complementarity of MDG-related programs needs to be fully exploited, to ensure their broadest possible impact.
The traditional donor community may or may not come through for Africa. Even with a well-disposed administration in Washington, it has proven difficult to get U.S. foreign assistance above even half of one percent of GDP, and to have it focused not just on the admittedly important categories of emergency relief or global health, or lavished on America’s current security partners, but on truly comprehensive, multi-sectoral development in the world’s poorest quarters. The real question, then, for smaller organizations — research institutions such as the Earth Institute, and NGOs such as many of MCI’s wonderful partners – is how to leverage our own efforts to maximal effect.
MCI’s answer has been to engage, together with capable local and international actors, in building small-scale, low-cost, fully functional systems in MDG-related areas where we have discovered critical gaps, and to demonstrate that the models can work and are capable of being replicated. We have done this in the area of newborn survival, where in 2007 MCI arranged for an Israeli-led course in neonatal emergency care in Kumasi, Ghana, that revealed a dangerously overcrowded neonatal intensive care unit (ICU) at the teaching hospital there. After extensive consultations with local and national public health officials, this discovery led to the design, construction of and training for two neonatal triage clinics, built by the Israeli government to their neonatologists’ specifications and attached to existing public hospitals run by the Kumasi Metropolitan Health Directorate. These clinics, which have already reduced the ICU’s crowding more than 30 percent, still were unable to serve many mothers and infants for the reasons mentioned earlier: no safe blood, too few skilled medical practitioners. So MCI has worked not only to find financing, but to partner with organizations who can help fill some of these gaps. The International Society for Ultrasound in Obstetrics and Gynecology and Siemens have contributed new ultrasound machines and an ongoing training program to Kumasi. Together with the American Academy of Pediatrics (AAP), Johnson & Johnson and the NGO AmeriCares, MCI has also launched a program in both Kumasi and Accra, Ghana’s capital, to train pediatricians, nurses, midwives and community health workers in the AAP’s new neonatal resuscitation protocols and to train new mothers on newborn health tips, danger signs and when to seek professional help. MCI will join the Child Unit of the Ghana Health Service (GHS) to monitor the effects of these trainings on infant survival in both Millennium Cities. If the results are as positive as hoped, MCI and AAP will work with the GHS and Ghana’s Ministry of Health, where newborn survival has long been a top priority, on a nationwide roll-out of the program.
The United Nations General Assembly has dedicated this year’s annual meeting to a Summit on the MDGs in order to galvanize the entire world into ratcheting up its pace. Today’s report card, from the vantage point of sub-Saharan cities, is not flattering. Drought, coastal erosion and flooding, and the growing endemic and anthropogenic disease burden are not waiting for the developed world before ravaging entire communities, usually of the most vulnerable.
Each week more than a million people are born in or move into cities, leading to a doubling within 30 years of the urban population, according to UN-HABITAT. In sub-Saharan Africa, 70 percent of these urban dwellers live in slums, with limited access to essential human services. It is imperative that we who can take smart, rapid actions to deliver on the Millennium Development Goals. Governments aside, a sacred trust is at stake, among human beings from rich countries and poor ones – all of whom, after all, are only interested in the survival and preservation of our planet in ways that can ensure the health and wellbeing of our children, and their children, and theirs.
