Wall Street Jounral - June 28, 2001
Michael M. Phillips, Staff Reporter

But, ironically, the epidemic also is providing African governments and societies an opportunity to pull themselves together in ways that could some day help lift them out of their long, post-independence rut.

Indeed, some African leaders now say that the fight against AIDS is training them for the fight for development. "If we do switch ourselves on to deal with AIDS, other things could well follow," Francis Omaswa, director-general for health services at the Ugandan Health Ministry, told U.S. Secretary of State Colin Powell recently.

Rich countries, foundations and companies are getting out their checkbooks to launch a health Marshall Plan that the United Nations hopes will direct up to $10 billion a year to fight AIDS, malaria and tuberculosis in the Third World. A panel of experts will pass judgment on each expenditure, and donors will be watching carefully to make sure the money actually makes people healthier, or, better yet, prevents them from getting sick in the first place.

That's going to require African governments to do something they haven't done much recently: design and implement critical social-services projects quickly, efficiently and honestly. The governments that succeed in doing so will find themselves better able to cope with the ordinary challenges of economic development, from planning to budgeting to delivering services.

"If you're the kind of country that shows you're responsible with how you treat your own citizens, that makes you a more attractive destination for investment," Mr. Powell said last month after a trip to Africa.

Nobody should think this silver lining of the AIDS crisis in any way outshines the cloud. AIDS is a disaster of apocalyptic proportions in Africa. Some 25 million Africans carry the AIDS virus, 70% of the infected population world-wide.

The average Ugandan used to live to 48. Now, because of AIDS, life expectancy has dropped to 42. The virus has already claimed 800,000 lives here and infected an additional 1.7 million people -- one out of every 12 Ugandans. At the support center Mr. Powell visited, HIV-positive mothers paste family photos into memory books so their children, soon to be orphans, will remember who they are.

And the disease, which has spread fastest in urban areas, is killing the educated just when Africa needs them the most. "We know what we should do, but we don't have enough people to do it," says Botswana President Festus Mogae. More than a third of Botswanans between the ages of 15 and 49 have HIV -- and the diamond-rich country has asked the U.S. to resume sending Peace Corps volunteers to fill the gaps left by AIDS.

There is something of a chicken-and-egg dilemma here; the best-run governments respond the best to AIDS and also learn the most from it. President Robert Mugabe's violent efforts to lengthen his own tenure in office have allowed the killer disease to spread unmolested by government competence, while Ugandan President Yoweri Museveni,alarmed early on by the toll the disease was taking on hismilitary, has helped reduce prevalence rates by lending his personal credibility to prevention efforts.

"It's not clear whether competence follows HIV or the response to HIV is a response to competent government," says Mark Malloch Brown, head of the U.N. Development Program. Either way, "a successful response will leave very strengthened governments and societies."

Implementation of a complex prevention and treatment program will give governments practice in dealing with community groups, improving education, restoring basic health care, and controlling expenditures. Distributing complex AIDS drug cocktails to rural populations will prove especially challenging -- and rewarding. "It would augur very well for the future," says Nick Stern, the World Bank's chief economist.

But what if African governments come up short and fritter away huge sums through corruption or clumsiness? Mr. Stern is optimistic; he says the donors know progress comes slowly in poor countries.

Mr. Malloch Brown thinks the new global health campaign will succeed, too. But he fears the result if it doesn't. "Failure would make the region into a pariah for donors," he suggests.

In Uganda, Mr. Omaswa is well aware of the threat behind the West's offer of assistance. He recently told his staff that Uganda's effort to prevent mother-to-child HIV transmission will require them to provide better-quality health services on the cheap. "We shouldn't be the ones found wanting," he says, "in our ability to apply any help that we get from outside."

Write to Michael M. Phillips at michael.phillips@wsj.com

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