Government

The World Bank and HIV/AIDS Governance in Sub-Saharan Africa: Perpetrators or Defenders against the Epidemic?

Since the early 1980s, the HIV/AIDS epidemic has devastated the social, economic, and political landscape of sub-Saharan Africa, and has continued to impose a significant challenge against the region’s development. Indeed, the widespread proliferation of the disease has led to the immense regression of many sub-Saharan African countries. According to UNAIDS in 2013, there were an estimated 24.7 million people living with HIV in sub-Saharan Africa – nearly 71% of the global total, with 1.1 million people dying from AIDS-related illnesses.

In the fight against HIV/AIDs, organisations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and the World Health Organisation (WHO) have often been regarded as the international forerunners in HIV/AIDS governance in sub-Saharan Africa. However,  the role and impact of the World Bank on HIV/AIDS in the region has largely been ignored within public health and public policy literature. In fact, the World Bank have been pivotal to the proficiency of the sub-Saharan African response to HIV/AIDS at all levels of governance, playing a decisive role in both exacerbating, and reducing the effects of the disease throughout the region.

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The role of the World Bank on HIV/AIDS governance originates from the organisation’s recovery programme for sub-Saharan African economies during the 1980s and 1990s, principally through Structural Adjustment Programmes (SAP). However, the World Bank’s market-oriented lending policy in sub-Saharan Africa was crucial in weakening the functionality of sub-Saharan African governments prior to the outbreak of the epidemic. The strict conditionalities that formed part of SAPs in order to encourage political and economic reform had extensive destabilising effects on sub-Saharan African societies, particularly on the delivery of basic services such healthcare, education and welfare. In implementing austerity measures under SAPs, social spending in sub-Saharan Africa per capita declined to 76 per cent of the level spent in 1981 by the 2000s, impoverishing several countries throughout the region, and was exceptionally damaging for the poorest individuals. This is despite the fact that there is little conclusive evidence that SAPs had a positive impact on economic growth in sub-Saharan Africa.

The depleted basic services helped to reduce the governmental response to HIV/AIDS, and shaped the conditions for the proliferation of the disease. Inflated food prices lessened employment and trade opportunities, particularly in rural areas – increasing the threat of the disease by encouraging rural migration to urban areas. Moreover, the introduction of user fees in health and educational services decreased the accessibility of treatment and HIV/AIDS awareness. In fact, basic services themselves – such as health centres, became sources of HIV infection. Cuts to civil services also restricted the capacity of several governments, deteriorating the administrative ability of sub-Saharan Africa countries in addressing the disease.

The World Bank’s response to HIV/AIDS in sub-Saharan African countries during the adjustment period was also limited. World Bank funding for HIV/AIDS projects began in 1986, however the organisation’s support remained limited over the next decade. Prior to 2000, the World Bank funded a number of generic projects with HIV/AIDS components throughout Africa, none of which exceeded US$10 million. Three projects in Zimbabwe, Uganda and Kenya did receive more substantial funding from the Bank in the early 1990s, however these projects focused more broadly on sexually transmitted infections (STIs). Although the World Bank’s relative inactivity during this period echoes the dormancy of other multilateral organisations, and the general misunderstanding and stigma surrounding HIV/AIDS at the time, as academic Chris Simms argued the World Bank’s significant influence and leadership in the region should have warranted a greater response against the disease. Undoubtedly, the World Bank’s inactivity and its agenda for reform through SAPs contributed to the catastrophic impact HIV/AIDs would have on sub-Saharan Africa. In fact, between the early 1980s and 2000s, people living with HIV infection in sub-Saharan Africa increased from less than one million to 22 million.

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However, the growing severity of HIV/AIDS on sub-Saharan African development, and its threat to human and national security in the absence of an effective cure would eventually prompt the World Bank to take emergency action against the disease. Thus, in 2000  the Multi-Country HIV/AIDS Programme (MAP) was launched. Under the MAP, the World Bank would pledge over $1 billion into the fight against HIV/AIDS, drastically expanding the Bank’s financial commitments against the disease. The programme was designed to scale up state-led responses to the epidemic, underpinned by a multi-sectoral framework that encouraged the participation of the public and private sector, NGOs and community organisations in anti-HIV/AIDS projects in the region. The MAP elevated HIV/AIDS governance to the pinnacle of the organisation’s development agenda in sub-Saharan Africa.

The MAP and the extensive impact of the disease on development in the region provoked a shift in the way the World Bank financed governments in sub-Saharan Africa. In contrast to the stringent conditionalities under the SAPs, MAP funding was issued without a specific link to macroeconomic performance. This allowed countries to scale up their response to HIV/AIDS without the explicit strain of further economic liberalisation. However, although the MAP appeared to represent a ‘softer’ financial relationship between the World Bank and sub-Saharan Africa, the organisation’s wider policy of ‘good governance’ and its neoliberal dogma remained intact. MAP funding may have not imposed strict economic conditionalities on sub-Saharan Africa, but it still required states to meet specific eligibility criteria that encouraged the decentralisation of HIV/AIDS governance.

It is true that the MAP did facilitate a number of breakthroughs in the governance of HIV/AIDS in sub-Saharan Africa. The MAP increased the political commitment towards HIV/AIDS at the highest government level, particularly through the creation of national AIDS councils. The programme also succeeded in promoting a multi-sectoral, decentralised response to HIV/AIDS by allowing national, regional and local actors to play an active role against the disease. Furthermore, the MAP also helped to mobilise larger donor initiatives such as the GFATM and the President’s Emergency Plan For AIDS Relief (PEPFAR), strengthening the response to the disease. As of 2008, development partner funding had increased by 2,240% and 502,958 people infected or affected by the disease were receiving support.

However, the MAP should not be exempted from its flaws; the programme had a consistent issue relating to the non-accessibility of funding for projects, particularly damaging for the most vulnerable in the region. This was as a result of the MAPs inability to remove the weak institutional capacity within sub-Saharan African governments, harming service delivery and the coordination of donor efforts to public and private actors, and communities. The MAP also failed to support effective monitoring and evaluation systems, which affected the veracity of HIV/AIDS outcome indicators, though efforts were made to address this in phase 2 of the MAP in 2006. The clearest indication of the MAP’s shortcomings is that HIV prevalence and infection rates have remained relatively unchanged in sub-Saharan Africa. Thus, while the MAP revolutionised sub-Saharan African HIV/AIDS governance, and produced a number of positive outcomes, its overall success is questionable.

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The World Bank’s restructuring of sub-Saharan African governance through the SAP significantly undermined the capacity of the region’s governments against HIV/AIDS, with the adjustment programmes enervating vital preventative functions against the disease, and as a result, propagating its escalation. However, by the new millennium the growing impact of HIV/AIDS on the development of sub-Saharan Africa would inspire the World Bank to redefine its approach to HIV/AIDS, and its governance reform measures in the region overall. This led to the formulation of the MAP, placing the fight against HIV/AIDS at the centre of the World Bank’s relationship with sub-Saharan Africa, and drastically increasing the organisation’s obligation towards reducing the effects of the epidemic. However, the MAP has failed to convincingly tackle HIV/AIDS, and has once again demonstrated the uneasiness in implementing the World Bank’s philosophy on governance in sub-Saharan Africa. As such, it remains unclear whether the World Bank can be considered as the perpetrators or defenders against HIV/AIDS in sub-Saharan Africa. However, could the World Bank – or indeed any other organisation have done more against the disease?

Should we question the integrity of the Conservatives victory in the 2015 General Election?

On Friday 8th May 2015, David Cameron stood victorious in front of the British media after witnessing the Conservative Party defy the polls and sweep to an unexpected triumph in the general election. In what was one of the most anticipated elections in recent history, the Tories would defeat their election opponents across the country and collect an unprecedented 331 seats. This would ultimately be enough to form an outright majority and eradicate the prospect of a successive coalition government. No longer bound by the chains of the Liberal Democrats – soundly beaten during the general election, and with Labour and UKIP also left with some ‘soul-searching’ to do, Cameron gleefully returns to 10 Downing Street with the future of the United Kingdom in his hands.

Despite David Cameron’s now infamous victory, a burning question remains of great interest to political commentators and the public as a whole; did the Conservative Party actually deserve to win the general election? Yes – if the result of the general election is taken at face value. The Tories won five more than the 326 seats required to form the slender majority administration, with the Party seizing 24 seats from its political rivals and surprisingly increasing its percentage of the vote.

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However, if we are to assess the Conservative Party’s share of the vote, and more importantly the often disputed ‘First-Past-The-Post’ voting system, there is an argument that challenges the Tory supremacy over the House of Commons. The Conservative’s did muster an impressive 36.8% of the public vote, but if this percentage is calculated under a system that adheres to proportional representation, the Tories would not have reached the impressive number of seats it tallied at the end of the election.

Arguably as telling was the detrimental effect of ‘First-Past-The-Post’ on the other political parties. Although Labour’s share of seats would have only seen a minimal decrease if it was reflective of the public vote, UKIP and the Liberal Democrats suffered immensely as a result of FPTP. Despite gaining 12.6% and 7.9% of the vote respectively, only 9 seats were gained between UKIP and the Liberal Democrats. Conversely, the SNP – widely applauded for their success in the general election, gained 56 seats despite only obtaining 4.7% of the vote. Whilst the Conservatives would have remained the largest party under a proportional representative voting system, they would have certainly been forced into forming another coalition government and contend with a greater number of diversely affiliated MPs in Parliament. Unfortunately however, the Conservatives can expect a somewhat ‘muzzled’ resistance against their governance over the next five years as a result of the flawed FPTP system.

Another arguement that questions the integrity of the Conservative victory was the indecisive nature of the British electorate and the increased use of ‘scare tactics’ within right-wing politics. The opinion polls right up to the general election suggested that the final result would be too close to call, with Labour fighting tooth and nail with the Conservatives for the right to be in power. However the exit poll would paint an entirely different picture, teasing a Tory victory by implying that they were inches away from the majority they required to govern solitarily.

The ‘Shy Tory Factor’ has been used to theorise the disparity between the opinion polls and the outcome of the general election. Seemingly like in the 1992 general election, a large portion of the British public ‘disguised’ their support for the Conservatives until poling day as a result of their ‘shame’ towards their inclinations to the blue corner of british politics. However, whilst this theory may be true for a portion of the ‘silent’ Tory vote, it appears that many balloters were simply undecided as to who to vote for and made the decision to vote Conservative without having a clear and definitive allegiance to the party on (or days before) polling day.

The decision-making of the ‘undecided voter’ during the election was a reflection of how the right had instilled fear into the electorate. The Conservatives – and more profoundly UKIP, flooded the British public with misconceptions over Labour’s destruction of the economy and immigration, whilst also igniting the subject of Britain’s exclusion from the European Union. This ultimately proved to be a successful tool in dramatically increasing the share of the vote for the Right and consequently destroyed the possibility of the Labour Party gaining a majority in Parliament. Roy Greenslade expressed the view that in the five years leading up to the election, the right-wing press continually propagated the views of the Conservatives and UKIP and gave ‘disproportionately favourable coverage to Nigel Farage and his party.’

Building from this fact, the role of the media cannot be underestimated in swaying public opinion, and fundamentally providing the Conservatives with the platform to win the general election. The Conservatives were backed by six major newspapers – The Sun, The Telegraph, Financial Times, Daily Mail, The Independent and the Times, all of which bombarded its readers with Tory propaganda and anti-Labour hyperbole in attempt to maximise the Conservative vote. The Sun’s insistent character assassination of Ed Miliband was particularly noteworthy in the lead up to the election, damaging the reputation of the former Labour leader and his credentials as the future Prime Minister. The newspaper’s ‘Save Our Bacon’ headline a day before the elections was decisive in sealing the fate of Miliband’s election campaign and was arguably the pinnacle of the Sun’s attempts to persuade its 5 million-plus readership to support David Cameron.

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Broadcasters also appeared to be pro-Conservative; Sky News – another media organisation that Rupert Murdorch has vested interest in, unsurprisingly reproduced the favouritism it showed towards the Tories in the 2010 general election. This was evident during the first televised election debates, where there was no question that Ed Miliband received a far stringent assault against his character from Jeremy Paxman and Kay Burley than his Conservative adversary, including personal jibes at his relationship with his brother.

Contrary to popular belief, The BBC have also been noted for their bias towards the Tories. As Phil Harrison eloquently put it in his article ‘Keeping An Eye On Auntie: The BBC & Pro-Tory Bias,’ the BBC lent increasingly towards the right in order to appease the ‘status quo’ of capitalist realism that has been promoted by the Conservatives. The lack of media attention across all of the major broadcasting organisations following the recent protests against the government only days after the election only perpetuates the overwhelming media disposition towards the Tories.

Now that the dust has settled from an extraordinary general election, the Conservatives will go down in folklore as the ‘conquerers of coalition politics’ despite the universal expectation of a hung parliament. However as this article indicates, the Tory victory seeps of unworthiness, not least due to a widely criticised voting system, an electorate with ambiguous political affiliations and a media environment that showed considerable support towards David Cameron and his party – as well as the Right in general. Of course it would be wrong to deny the deficiencies in the Labour election campaign, though there is sufficient evidence to suggest that the Conservatives were given more than a helping hand towards their election achievements. Nevertheless, be sure to expect the Conservative’s austerity programme go into full swing and the continual vilification of Labour’s ability to govern the country again by a pro-Conservative press. Oh the despair of another five years with Mr Cameron at the helm of this wonderful country.

The regeneration of Hackney – the saviour of a borough in despair

Historically, the London Borough of Hackney was renowned as one of the poorest areas in Britain, plagued by widespread poverty, unmanageable social tensions and tormented by an endemic of criminal activity. From the derelict-stricken housing estates to the considerable deficiencies within the borough’s schools and hospitals, throughout all walks of life its residents encountered incredible scenes of marked deprivation. However, since the turn of the century Hackney has emerged as a vibrant centre of affluence, propagated by the booming property market in the area and a growing incentive by local government to address the wealth inadequacies – supported by the advent of the 2012 Olympics. With that said, an influx of middle class “voyagers”  have solidified in Hackney coinciding with the flourishing atmosphere within the borough, submerging with a working class population well aware of the relative indigences of yesteryear. Ultimately however, it would be difficult to argue against the fact that the emanation of the regeneration and gentrification of Hackney has not only revitalised the borough, but removed Hackney from its incredibly ruinous past.46_big

Over the last two decades Hackney has made a considerable effort to purge the economic and social shortcomings. Initiated in the late 1980s, the Council planned to rid the borough of its “sink estates” resulting in the demolition of Trowbridge, Clapton Park, Nightingale (right), Holly Street (where 80% of residents had applied for a transfer) and the Kingshold Estate. The Woodberry Down, Haggerston, Kings Crescent and Pembury Estates are also currently facing reconstruction. In its place more traditional low-rise housing has appeared, along with a plethora of privately-owned developments. Moreover, since 2006 under the Decent Homes programme the Council have invested over £184 million in renovating thousands of existing homes.

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The closure of Hackney Downs school, Kingsland school and Homerton College of Technology due to the below-par performances of its students and recurrent behavioural issues stimulated the emergence of innovative academies, commenced by the Mossbourne Academy in 2004. This, along with the Learning Trust’s dominion over education in Hackney has led to the rebuilding of all secondary schools and the implementation of constructional improvements to primary schools across the borough, decisively improving education. From 2006 to 2013, GCSE results (5 A*-C) increased from 50.9 % to a staggering 79.6%. Corroborated by the advancements in health care and transport – particularly with the expansion of the London Overground subsequent to the completion of the East London Line, ultimately the fortunes of the borough have taken a considerable turn for the better. There have also been increased attempts by the Metropolitan Police (and more specifically Operation Trident) to tackle the eminence of gangs in Hackney after the ill-fated riots of 2011.

Undoubtedly, the recent trends in Hackney have not only statistically reduced crime and poverty rates across the borough, but more importantly have been effective in dissolving the established adverse reputation of the borough. The Metro newspaper recently ranked Hackney as the 2nd best borough in London – remarkable considering Hackney was perceived in the past as the worst place to live in Britain. Furthermore, benefit claimants have reduced by 6% since 2006, employment rates have steadily risen in the same period to 63.7% and across Hackney deprivation has seen a sharp fall, particularly in the Haggerston, Clissold and Lordship wards. These factors have intertwined with the shift in the demographics in the area from a low-income, impoverished community to a prosperous and blossoming place to reside and visit.

Whilst it would be difficult to suggest that the regeneration of Hackney can completely disguise the remnants of poverty in the borough and avoid an ‘indigenous’ population grieving with antagonisms towards the appearance of wealthier newcomers, it generally has had a positive impact in rescuing the borough from further distortion. 697392-120810-hipstersHow long will the social prosperity last? It is difficult to estimate, however  what is for certain is that there is evidence to suggest that gentrification has conserved my place of origin from returning to the social horrors it was once accustomed to.