It is, says Gabriel Demombynes, of the World Bank’s Nairobi office, “a tremendous success story that has only barely been recognised”. Michael Clemens of the Centre for Global Development calls it simply “the biggest, best story in development”. It is the huge decline in child mortality now gathering pace across Africa.
According to Demombynes and Karina Trommlerova, also of the World Bank, 16 of the 20 African countries which have made detailed surveys of living conditions since 2005, reported falls in their child-mortality rates (this rate is the number of deaths of children under five per 1,000 live births). Twelve had falls of over 4.4 percent a year, which is the rate of decline needed to meet the millennium development goal (MDG) of cutting by two-thirds the child-mortality rate between 1990-2015. Three countries — Senegal, Rwanda and Kenya — have seen falls of more than 8 percent a year, almost twice the MDG rate and enough to halve child mortality in about a decade. These three now have the same level of child mortality as India, one of the most successful economies in the world during the past decade.
According to Demombynes, a combination of broad economic growth and specific public health policies, notably the increase in the use of insecticide-treated bednets (ITNs) which discourage malaria transmitting anopheles mosquitoes has made a big difference.
Ethiopia, Ghana, Rwanda and Uganda have been among Africa’s star economic performers recently, with annual GDP growth averaging over 6.5 percent in 2005-10. At the other end of the scale, Zimbabwe saw its GDP fall and mortality rise. This seems intuitively right. An increase in national income should reduce mortality not just because it is usually associated with lower poverty and better nutrition but also because growth can be a proxy for other good things: more sensible economic policies; more democratic, accountable governments; and a greater commitment to improving people’s living standards.
Kenya is a test case. It has cut the rate of infant mortality (deaths of infants under one year) by more than any other country. It has had healthy economic growth (4.8 percent a year in 2005-10) and a functioning democracy, albeit after horrendous post-election violence in 2008. But Demombynes noticed something else: it increased the use of treated bednets from 8 percent of all households in 2003 to 60 percent in 2008. Using figures on the geographical variation of malaria, he calculates that half the overall drop in Kenya’s infant mortality can be explained by the huge rise in the use of ITNs in areas where malaria is endemic.
The broad moral of the story is different: aid does not seem to have been the decisive factor in cutting child mortality. No single thing was. But better policies, better government, new technology and other benefits are starting to bear fruit. “This will be startling news for anyone who still thinks Africa is mired in unending poverty and death,” says Clemens.
(Excerpted and adapted from The Economist)