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Structural adjustment - effects in Zambia
29 Oct 1999
"Africa's Hidden Killers"
"The problem with taking a blood sample for your malaria test is that the cockroaches may eat it in the night," announced the nurse. "Ants are an even worse problem. The place is infested with them." Siavonga hospital, on the shores of Lake Karibe in southern Zambia, is suffering. "We have to put patients with TB in the same room as women who are giving birth," says one of the four Cuban doctors who battle to run the place. They also have to charge fees for their healthcare, and patients have to provide their own medicines, syringes and clean needles. What if they can't afford to pay? The doctor shrugs. "What do you think? They die."
People are dying. Quietly, but in huge numbers, all over Zambia, lives are being wasted. Wasted not because of some accident of nature, but as a direct result of economic policies imposed by faceless Western planners. For over twenty years now the World Bank and the International Monetary Fund have been forcing Structural Adjustment Programmes on the bankrupt countries of Africa. Trapped between a near-religious belief in economic neo-liberalism and the US-driven interests of big business, these two institutions are blind to the havoc they are causing. Almost every country on the continent has succumbed to their prescription. And across Africa, the vultures are circling.
The World Bank claims that Zambia's reformed healthcare system is a model for the rest of Africa. "It's true that there are no queues," says Dickson Jere, a freelance journalist formerly with the Zambia Post. "But that's because people are simply dying at home."
They're called BIDs - 'brought in dead's. At Casualty in Lusaka's University Teaching Hospital (UTH), they are an increasingly common phenomenon, especially among children. "If you want to see the impact of Structural Adjustment on Zambia," Emily Sikazwe, director of the anti-poverty group Women for Change, told me: "Go to UTH".
I went to UTH. It is Lusaka's biggest hospital, where those who can't afford private healthcare end up. In a packed ward near the main entrance a man writhed in bed. "I'm dying," he moaned, while his wife stood helplessly by his side. Emaciated figures shivered under sparse bedclothes. Families crowded around beds, many of them on the floor, bringing food to the sick to supplement the meagre hospital rations of beans and maize meal. In another ward a preacher harangued a dying woman, whose family stood round with heads bowed. As he waved his bible, she struggled to move her lips to acknowledge him.
Enter the children's ward and the smell hits you like a wall. A musty, medicinal odour - the smell of sickness, and of death. Rows of children lie on small beds, slowly passing away from preventable diseases like TB, malaria and pneumonia. On the other side of the building is a cleaner, neater ward, where half the beds stand empty. This is the fee-paying section, where families who can pay a 100,000 Kwacha ($40) deposit can buy a slightly better chance of life. In World Bank language, this is 'user-responsive healthcare'.
Don't just go to UTH. Go also to Misisi, or to any of the twenty or so shanty 'compounds' that ring Lusaka. In Misisi, barely a kilometre away from Lusaka's town centre, Masauso Phiri stands outside the windowless concrete shed that is his house. Next door an old man nearly died of starvation - luckily he was saved by the return of his son from the Copperbelt. That's not unusual. People are dying of starvation in Misisi. But they do so quietly, wasting away in their houses, too ashamed to venture out. Things were not always like this.
Mr. Phiri, like many of his neighbours, has heard of structural adjustment. It was because of SAP that he lost his job as a security guard. It was because of SAP that he lost a child - a three-year-old boy, who died of pneumonia in 1996. "I know it is meant to put the economy on the right track, but to me it seems to make us suffer," he says. "We can't eat policies." He looks at the ground. "I don't have any hope. I don't have any money, so I can't think of any future. My future is doomed."
Only one in five people in Misisi are employed. The unemployed are part of an army of jobless, created when economists from the World Bank and IMF decided that Zambia's public sector was 'bloated' and that companies would benefit from the tonic of privatisation and an 'opening' of markets to international competition. The Zambian government boasts that it has the speediest privatisation programme in Africa. But half the companies sold out of the state sector are now bankrupt. Over 60,000 people have lost their jobs as a direct result of the economic liberalisation programme introduced after 1991. With many mouths dependent on one breadwinner, this has thrown an estimated 420,000 into destitution.
In their desperation, people turn on each other - and crime is soaring in the compounds around Lusaka. I attended the funeral of one old woman, shot in her house by 'bandits' as she tried to prevent them entering. In the darkness outside her house, male friends and relatives sit around the fire in quiet contemplation. They will spend the night there, in the cold, just sitting, talking and remembering. Inside the house women wail. The robbers took nothing. The old woman had nothing to take.
"SAPs cause poverty," says Women for Change's Emily Sikazwe. "And poverty has a woman's face." Women shoulder the main burden of providing for families, and girl children are the first to be withdrawn from school when a father loses his job. Women like Esnart Banda, a widow with five children, who makes about 2000 Kwacha (60 US cents) a day selling vegetables in a market near Misisi. Most days she can only afford one meal for her children, even though the youngest is suffering from TB. Her kids join 40% of Zambia's child population in suffering from chronic under-nutrition.
It's worth pausing here to look at the figures. In 1980, under the former 'socialist' government of Kenneth Kaunda, the infant mortality rate was 97 deaths per 1000 births. It's now 202 per 1000. That means one in five children in Zambia die before reaching the age of five. The average life expectancy has fallen from 54 in the mid 1980s to 45 now. With the AIDS epidemic, this can only get worse. Over the same period the primary school enrollment rate has plummeted from 96% to 77%. Half a million children are now out of school, out of a total national population of only nine million.
These last figures are not accidental. They are a direct result of cuts in public spending and the introduction of school fees. For example, whereas in 1991 the Zambian government spent about $60 per primary school pupil, it now spends just $15. Cuts in public spending - the slimming down of a 'bloated' public sector - are a central plank of structural adjustment, as promoted by the World Bank and the IMF. In one of SAP's greatest ironies, the World Bank is now recasting itself as a 'Knowledge Bank' - at the same time as it condemns millions of children across Africa to a lifetime of ignorance and illiteracy.
"What if the IMF was to pack its bags and leave Zambia? Do they imagine the situation would get worse for us?" asks Emily Sikazwe. "What would they say if we took them to the World Court in The Hague and accused them of genocide?" How does she sum up the impact of structural adjustment on Zambia? "Devastating."
Half a world away in Washington, the architects of this human disaster dine in comfort and seclusion, spending more on one meal than Masauso Phiri's wife makes in a year of selling buns in their shanty town. Although 90% of Bank staff work at its Washington headquarters, the ten percent unlucky enough to be posted in the Third World receive ample compensation for their misfortune. This includes free furnished, air-conditioned housing with all utilities paid, an annual $5000 'assignment allowance' and education grants (averaging $8,570) for all children below college age. Salaries are tax-free, and averaged $86,000 in 1995, rising to a grand total of $144,000 on average when benefits are taken into account. No 'structural adjustment' then for this privileged coterie of bankers and policy analysts. Meanwhile in Africa, a hidden genocide lays waste to the continent.
"It's not right for a bank to run the whole world," says Fred M'membe, editor of Zambia's independent daily newspaper The Post. "They do not represent anybody other than the countries which control them. What this means in practice is that the United States runs our countries." He continues: "Look at any African country today, and you'll find that the figures are swinging down. Education standards are going down, health standards going down, and infrastructure literally breaking up."
In the midst of this chaos, what remains of Africa's wealth is being plundered. And this, argue many, is the real impetus behind structural adjustment. "They say if you perform well, there'll be a flow of foreign direct investment," says M'membe. 'Investment' like Shoprite, the South African supermarket chain that is colonising Zambia on the back of a massive government tax rebate. Shoprite has laid waste to the economies of entire towns, undercutting local traders and putting stores run for generations by one family out of business.
To make matters worse, Shoprite buys nothing locally. Tax-free produce - even maize and potatoes - is trucked in from Zimbabwe and South Africa. Meanwhile, Zambian maize rots in the fields, because the farmers who grow it cannot find a market. Under the previous government an agricultural marketing board was responsible for collecting and distributing produce from the whole country. Under structural adjustment, the private sector is left to do its worst. But with the poor state of the country's roads, private traders find it cheaper to import subsidised maize from the United States. Some farmers are so desperate that they give their produce away to Lusaka-based dealers, who promise to return with the earnings. Of course, they never do.
The majority of privatised Zambian businesses have been sold off into foreign ownership. In the case of Zambia Breweries - producers of the country's famous Mosi (Victoria Falls) lager - South African Breweries is now in charge. Many more home-grown companies have simply gone bankrupt or are struggling to survive at all. Zambia Consolidated Copper Mines - which acts as a mini-government in the country's Copperbelt region - is still on the market. Western multinationals were sniffing around, but ZCCM runs at a loss. If the company collapses, it be a personal disaster for a large proportion of Zambia's population.
"Africa can only develop with the participation of its own people," says Emily Sikazwe. People-centred development. It's a strategy to which the UN, NGOs and even the World Bank have signed up to. Organising together into a Campaign Against Poverty, Zambian NGOs are issuing a challenge to the World Bank and the IMF to allow Africans to participate in deciding how their countries are run.
If the neo-liberal economists of the World Bank are interested in heeding this call, they will have to leave their plush offices in Washington. They'll have to have to go to Lusaka, to Nairobi and to Harare. They'll have to go to Misisi, to UTH, and they'll have to listen to what people there say.
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