By Sam Agatre Okuonzi
Dec 21 - 27, 2003
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If as Ugandans we are going to truly reduce poverty, and develop this country, we will have to face all the facts, whether positive or negative. We will need to understand poverty in its entirety.
Which is why I found Mr Keith Muhakanizi's article (Let's Not Put A Spin On Poverty, Sunday Monitor December 14) intriguingly selective of positive aspects and short on the analysis of official statistics. If this was deliberate, it was dishonest of him. This is especially so since he advocates for scientific objectivity based on facts. Which is a welcome development because poverty and economic growth have been highly politicised. The definition of poverty on which Uganda's entire economic and social policy is based is unbelievably oversimplified. It is misleading. The official working definition is the spending of less than a certain amount mainly on food. That level of spending is far below what is required to provide adequate food, first for human survival, and then for social and economic development. It leaves out all known definitions of poverty, the commonest being the inability to meet basic needs. Basic needs are many and include adequate food, housing, clothing, education, health care, and security. Failure to meet these needs can and does manifest conspicuously as high mortality, illnesses, illiteracy, and unemployment, among others. Other dimensions of poverty include hopelessness, exclusion, inequity and powerlessness, according to Uganda Participatory Poverty Assessment Reports. Surely, all these elements of poverty cannot possibly be collapsed into the "poverty (that has) reduced from 56% to 38%". According to the Human Development Report 2003, 82.2% of Ugandans live below one US dollar a day. This is a far cry from the rosy official poverty statistics. It would be magical to reduce poverty on one US dollar a day. Some will argue that this is not the official statistic and by implication not correct. There is nothing special about official statistics. Those like Keith, who find great comfort in official statistics, should know these statistics are not God-given. They are mere estimates of reality. No amount of legislation will and can make official statistics legitimate if they are not consistent with reality. Different people using different perspectives see the reality. But if there is no consistence and convergence in what different people observe, statistics, official or not, will be meaningless. The manifestations of persistently high levels of poverty abound. But it is easier to understand death as a manifestation of poverty. Premature and preventable deaths are the final point on which all aspects of poverty converge. It is therefore the most accurate measurement of poverty. Most deaths are caused by lack of basic services. And there are no grey areas between life and death. Unlike economic growth and income estimates, the line between death and life is not arbitrary. We can only argue about numbers, but once that is settled, the high number of deaths makes an emphatic and undeniable statement about poverty. So what are the death facts - facts of unchanging poverty in Uganda? Let us begin with official statistics. Infant and under-five mortality apparently increased between 1995 to 2000 from 81 to 88 per 1000 births, and from 147 to 156 deaths per 1,000 live births respectively. These are apparent, not real increases in mortality. There are no convincing explanations as to why more children died after 1995 when socio-economic conditions - economic growth, reduction in HIV/Aids prevalence, universal primary education - were reportedly dramatically improving. There had been another apparent, but dramatic change in infant mortality between 1990 and 1995. It was a reduction of IMR from 119 per 1000 to 81 per 1000 without significant nationwide social interventions on the ground. In fact the conditions during 1990-1995 were worse for child survival than from 1995-2000. And yet more children reportedly died during the period when conditions were relatively better. However, recent analyses of demographic trends have revealed that these were mere variations in statistics, not a reflection of the reality on the ground.
Analysis and projection of trends of child mortality from 1950 to 2000 indicate that there has been very little change in IMR since 1970. A steep reduction of IMR occurred between 1950 and 1970 from 250 to 120 and has since plateaued at over 100 per 1000. The statistical fluctuations in mortality do not reflect the reality on the ground for a number of reasons. First, population characteristics do not change that much, suddenly in magnitude, but less so in direction, in short periods of say, five years. Second, for population conditions such as mortality rates to improve, there has to be consistent and comprehensive nationwide improvement in health care, social protection and education, among others. Apart from UPE whose benefits are yet to be felt, and immunisation, there are virtually no significant improvements in social services in the country. A good immunisation coverage is far from adequate to improve child welfare. While immunisation coverage has been increasing, Uganda's complete infant immunisation is below the critical threshold of 80% to curb infant mortality rates. And this threshold has to be maintained for decades for it to have a lasting impact on immunisable diseases, and eventually on child mortality. Third, the health of infants and of mothers is intricately linked. The health of one group cannot improve without that of the other. But Uganda's official statistics show that while infant mortality reduced significantly, maternal mortality remained at the same level of over 500 deaths per 100,000 live births for the past 25 years. The World Health Organization estimates Uganda's maternal mortality at about 1,200 per 100,000. Uganda's mortality rates are higher than those of its neighbours some of them having worse economies. Uganda has been listed as one of 8 countries that account for most maternal deaths in the world. These countries are Bangladesh, Ethiopia, India, Indonesia, Nepal, Nigeria, Pakistan and Uganda. It has the third highest total fertility rate in the world after Yemen and Niger. These are indicators of deepening poverty, not of development. For the sake of argument, even if the official statistics that Keith Muhakanizi loves to quote were correct, infant mortality of 88 (and increasing) per 1000 puts Uganda in the worst group of countries on the poverty scale. But the steepness of the apparently increasing trend of infant mortality indicates that the true IMR has stagnated at over 100 deaths per 1000. So, if both child and maternal mortality have stagnated at levels consistent with extreme poverty, and there are no significant indications of improvement, why should Muhakanizi wonder why Mr Fredrick D. Musoke is not surprised that more Ugandans are poor? What is a more authentic statement on poverty than death? That Uganda has achieved a significant economic growth over the past 17 years is undeniable. The evidence even without the statistics is visible. But what is not often qualified about this economic growth is that the bulk of it is from external aid and foreign investment. Internal production and growth are relatively insignificant. This has far-reaching implications on who benefits and in what way. The beneficiaries of foreign investment are foreign investors, not Ugandans. Furthermore, the economy is highly inequitable, with inequity rising. This is not good for social policy and goes against the constitutional provisions on economic and social rights. It also does not augur well for social and political stability of the country. Therefore the policy producing these results cannot be described as "good" or "appropriate". It is true budgets for social services have increased year after year. But actual spending shows that apart from UPE, allocation to social services has not increased significantly. And yet Uganda could do much better. Other countries at Uganda's level of economy have far better social services. Uganda has the potential, at the current level of the economy, to provide much better social services, save millions of lives, and lift people out of misery and death, than is currently the case. Why we are not doing so is because of our policies. It is also true that socio-economic transformation cannot occur overnight. But 17 years is hardly "overnight". Many countries with the correct policies have reversed mortality trends (i.e. pulled people out of poverty) in just 15 years. Uganda's policies are generally clear from its constitutional provisions and other major policy documents: generate as much wealth as is feasible, whilst ensuring a fair wealth distribution through social and economic rights. But these policies are not implemented. Instead, we implement a pre-packaged set of policies, imposed on us as conditions of external aid, upon which we heavily depend. Ideally, left on our own, we should determine the goal for our development - whether we want to achieve economic growth at all costs, or whether we want economic growth for human betterment. We should then, based on this goal, control the economic parameters (such as inflation, public debt, balance of payments, public expenditure and money supply) in a manner that produces the required balance between economic growth, wealth distribution and human development. This can be narrowed down to the balance between investment and public expenditure. But because of the global economic system and the foreign aid on which we depend, and through which the system operates, we do not have much room to manoeuvre policy in our favour. People like Muhakanizi have embraced this policy unquestioningly and appear to have given up any effort at finding some space, however small, of manoeuvring the policy towards real human development. As far as they are concerned, economic growth rate of 7% is satisfactory even it means a large number of children and mothers whose lives we can save continue to die as a result of the policy. The western world never used such policies to develop, and countries that have developed recently (e.g. the Asian Tigers) resisted most of these policies. And tragically, Uganda's economic transformation cannot come about as a result of these policies, now embodied in the much-publicised Plan for Modernisation of Agriculture (PMA). It is intended that through PMA, incomes and food production will be improved through better technologies, specialisation, market-orientation and commercialisation. It is envisioned that as food prices come down, people will abandon subsistence farming and embark on other economic activities that will propel the country into prosperity. It is easy to see PMA as a route to better food production, and some modest foreign exchange earning. But it is difficult to see, under the current global economic system, where a group of countries protect their markets and apply agricultural subsidies, that Uganda's agriculture will become specialised, market- and export-oriented, and therefore become the vehicle for delivering the country out of poverty. No country has had an economic breakthrough via agriculture. All developed countries arrived at where they are through industrialisation. Developing countries that have made rapid strides in development have not used agriculture but minerals, tourism or oil. PMA for food production and some little foreign exchange is laudable. But Mr Muhakanizi, please, PMA will not be the vehicle for delivering this country from poverty. Dr Okuonzi is General Secretary of the National Council for Children, and a Public Health and Social Welfare consultant. The views expressed here are his and not those of the Council.
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© 2003 The Monitor Publications
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