Last November, the then incoming United States (US) President Donald Trump’s transition team fired a slew of pointed, unsettling questions to outgoing president Barack Obama’s Africa policy people.
Predictably, the US liberal media and Africa policy wonks reacted with intemperate righteous indignation. The gist of the questions was whether America was getting value for money from its aid to Africa. This is a question that the incoming administration is entitled to ask. Here, I take on three that I consider the big ones.
Is Pepfar (President’s Emergency Plan for Aids Relief) becoming a massive, international entitlement programme?
About a decade ago, my family’s housekeeper fell ill. I took her to a public hospital. The queues were long, and her condition was worsening quickly, so I rushed her to a nearby private hospital. It turned out that she had a life threatening infection that required hospitalisation for several days. The bill was hefty – about six months of her pay. A few months later she decided to leave to go back to her rural home to fend for her property. She was a widow, and her in-laws wanted to dispossess her. Seeing as she would not have any source of income there and her terminal dues did not amount to much, I gave her an additional gratuity equivalent to six months’ pay to help with a new start in the village.
It’s been many years, but every few months, the lady sends me a text message requesting help with one thing or another. Sometimes I ignore them, and sometimes I oblige, except for Christmas when I always oblige.
In economics we call my situation the Samaritan’s dilemma. The term, which alludes to the biblical parable of the good Samaritan, was coined by 1986 economics Nobel laureate James Buchanan. The dilemma itself is the following. My former housekeeper texts me for help with a sick child. It could be true or untrue, but my cost of verifying the claim exceeds the amount of money she’s asking for. If its untrue, I will be rewarding dishonesty. If I decline and it is true, a child I could have saved for very little could die.
The Pepfar was launched as a response to a global health emergency. At the time, the scale of the emergency was ominous – it looked like another black death was in the offing. The threat and fear was not just about contracting HIV and Aids, but also the attendant rise in global disease burden on account of opportunistic infections, and tuberculosis. Some scenarios suggested a health apocalypse on the scale of the black death.
When Pepfar was launched in 2003, the cost of HIV and Aids treatment was prohibitive. For poor people in Africa, being HIV-positive was a death sentence. It was estimated that less than 50,000 Africans were on treatment. The pandemic is under control, but the numbers are still frightening. There are 38 million people who have HIV, 26 million of them in Africa, 20 million in eastern and southern Africa. HIV and Aids related complications are still the leading cause of deaths in Africa, killing about 1.1 million people a year.
The answer to Trump’s question is in two parts. First, whether countries can afford to finance HIV and Aids treatment. Second, whether they can be relied upon to do so.
Cost data that is reliable and up-to-date is extremely difficult to come by, which is surprising if not suspicious given the scale of the HIV and Aids establishment, including a specialised UN agency. Some dated academic studies indicate that costs in this region are between US$500-1,000 (Sh51,758-103,517) per patient per year. One study conducted in Kenya came up with costs in the order of US$250 (Sh25,879).
Latest data from the National Aids Control Council shows that there are 1.5 million Kenyans who have HIV and Aids of whom 900,000 are on treatment which translates to 66 per cent coverage.
This figure translates to US$225 million (Sh23.3 billion) for those under treatment and US$375 million (Sh38.8 billion) for full coverage. The council’s 2015-2016 report puts national resource needs at Sh31.5 billion.
Can we afford this? The answer is an unequivocal yes. We are talking figures in the order of three per cent of our tax revenues.
The only question then is, would we? And herein lies Mr Trump’s dilemma. If we do, well and good. If we don’t, thousands, perhaps millions of people that could have been saved for very little will surely die. There is no way of knowing beforehand.
Is Pepfar a massive international entitlement programme? Yes.
With so much corruption in Africa, how much of our funding is stolen? Why should we spend these funds on Africa when we are suffering here in the US?
In recent weeks, we have learnt that the Kenyan government is in the process of buying military hardware worth US$418 million (Sh43.3 billion). The pièce de résistance is a consignment of 12 souped up crop dusters.
We first heard of the deal when it was reported as cleared. Next came a motion by a congressman from North Carolina asking the US Congress to stop the sale. His gripe is that the company that Kenya was buying the planes from does not manufacture them, while there was a firm in his state that manufactures the planes and can sell them to Kenya for something like half the price.
He has also written to our ambassador in Washington advising him that the planes were overpriced to the tune of US$200 million (Sh20.7 billion). His latest salvo is a request for an investigation into the deal on the grounds that he has received “credible allegations of faulty contraction practices, fraud and unfair treatment surrounding the sale”.
Military procurement is known to be one of the most corrupt businesses on earth. This gives us a sense of the order of magnitude. The congressman alleges that each the plane is overpriced to the tune of US$16.7 million (Sh1.7 billion). An article in The Economist magazine puts the price tag of the plane at US$5 million (Sh517.6 million), meaning they are inflated fourfold.
How much of US funding is stolen? In this particular deal, it’s in the order of 75 per cent. But the most important insight is not how much is stolen but by who and from who. Let’s start with the latter question. This is not a grant. It’s a loan. The money is to be stolen from us, not from Americans. The reason why the congressman from North Carolina is fighting the deal is because he wants the jobs to go to his state. Who are the thieves? Well, we do not know how the loot is to be shared, but 50-50 seems to be a good working assumption.
@realDonaldTrump, you are damn right on this one. Please keep your money – you need it more than we do.
We have been fighting al-Shabaab for a decade, why haven’t we won?
Although the cost of the wars in Iraq and Afghanistan is disputed, experts seem to converge on US$4 - 6 trillion (Sh414.4 - Sh621 trillion). The Congressional Budget Office puts the direct operational costs at US$1.6 trillion (Sh165.6 trillion). These are crazy figures.
At the start of the wars, Afghanistan and Iraq had a combined population of 45 million (65 million today). Working with the lower figure, the costs work out to US$90,000 (Sh9.3 million) per citizen. Even the direct cost still works out to US$36,000 (Sh3.7 million) per person. The higher figure is in the order of the per capita income of Qatar, the highest in the world, and 1.6 times that of the US. It is 150 times Afghanistan’s current per capita income and 18 times that of Iraq. The lower figure is in the order of the per capita income of Italy, 60 times that of Afghanistan, and seven times that of Iraq.
A 2014 US government report put the cost of rebuilding Afghanistan at US$100 billion (Sh10.4 trillion), a cost said to have been heavily inflated by corruption. It’s a crazy figure, corruption notwithstanding. For the equivalent of the cost of the Marshal Plan in real terms, has only managed to raise Afghani’s average incomes to US$600 (Sh62,110). How much would it have cost to “buy” every Afghan and Iraqi man, woman and child, including al-Qaeda and the Taliban instead, ten thousand dollars, twenty thousand?
Figures on the cost of war in Somalia are harder to come by.
The European Union is reportedly financing salaries of members of the the African Union Mission in Somalia only to the tune of US$200 million (Sh20.7 billion) a year. Al-Shabaab are said to have 10,000 fighters. Amisom’s wage bill alone works out to US$20,000 (Sh2.1 million) per al-Shabaab fighter, US$1,600 (Sh165,627) a month. I’ve read that most of local al-Shabaab fighters are from marginalised communities. They are victims of state failure not hard core terrorists. It is doubtful that they live on more than US$100 (Sh10,351) a month. I would hazard a guess that the annual budget of fighting al-Shabaab is sufficient to put every potential al-Shabaab recruit in the Somali security services at a decent wage and career prospects. I bet they would take it.
I’m no historian, but I cannot find a war where an invading military has defeated an insurgency. Vietnam. The mighty Soviet army left Afghanistan tail between legs after a 10-year bloody campaign that devastated Afghanistan and bankrupted the USSR. Two years later, the Soviet empire disintegrated. The Taliban remains undefeated, while in Iraq, the US won the war and lost the peace. It remains to be seen whether thr US empire will survive the forays.
And we are about to throw Sh42 billion we can ill afford into an un-winnable war. What if we were to wage peace instead. How much do schools and health facilities cost to build in Somalia? Let us say Sh5 million. How many schools, health facilities, boreholes, markets and micro-finance dukas and such would it take to win the peace, five hundred? A thousand? Well at Sh5 million, Sh42 billion would buy you 8,400 projects. I’ll wager you a herd of camels that’s enough ammunition to carpet bomb Somalia into total submission.
Aid and wars are massive entitlements programmed for the rich.