The African always feels endangered. Nature on this continent strikes such monstrous and aggressive poses, dons such vengeful and fearsome masks, sets such traps and ambushes, that man lives with a constant sense of anxiety about tomorrow, in unabating certainty and dread. Everything here appears in an inflated, unbridled, hysterically exaggerated form. If there is a storm, then the thunderbolts convulse the entire planet, the lightening tears the sky to shreds; if there is a downpour, then a veritable wall of water pours from the heavens, threatening at any moment now to drown us and pound us into the ground; if there is a drought, then it is one that does not leave a drop of water behind, and we die of thirst. There is nothing here to temper the relations between man and nature- no compromise, no in-between stages, no gradations. Only ceaseless struggle, battle, a fight to the finish. From birth until death, the African is on the front line, sparring with his continent’s exceptionally hostile nature, and the mere fact that he is alive and knows how to endure is his greatest triumph.
-Ryszard Kapuscinski, The Shadow of the Sun (1998)
More than a half-century of persistent efforts by the World Bank and others have not altered the stubborn reality of rural poverty, and the gap between rich and poor is widening. Most of the world’s poorest people still live in rural areas and this will continue for the foreseeable future. The day when the goals for international development will be met is still far off in many parts of the world.
-The World Bank, Reaching the Rural Poor (2003)
In early August 2005, I sat in a cushioned chair in an air-conditioned conference room at the US Embassy in Nairobi, Kenya with Warren “Buck” Buckingham, Interagency Coordinator for the United States Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR). He was explaining to my colleagues and me the war the US government, his agency, the governments of various countries, and NGOs around the world are waging against the AIDS pandemic. During our meeting, Mr. Buckingham outlined for us how by working with Kenyan government and non-governmental organizations, USAID and PEPFAR were making it possible for people living with AIDS in Kenya and other countries to receive antiretroviral drugs (ARVs) that assist in pro-longing life by increasing the capacity of the immune systems in a most ARV recipients. My colleagues and I were moved by the progress we assumed was being made through the coordinated efforts of the various groups involved. We felt that real change was being accomplished.
About a week after meeting Buck Buckingham, I sat in a wooden chair in the mud-walled home of Clarice, a 35-year-old mother of three who was dying of AIDS related illnesses in a small fishing village in western Kenya. Prior to falling ill, Clarice, whose husband died of AIDS years earlier, was the breadwinner of the family, supporting her children and her elderly mother. Once Clarice was too sick to work, the family lost all monetary income and now survives by farming a small piece of land adjacent to their home. When I sat down to talk with Clarice she was lying on a thin plastic mattress on the floor of the home and had been lying there for 8 months, suffering from bedsores and lacking even the strength to sit up.
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Kunya Village, on the shores of scenic Lake Victoria is one of the most beautiful places that I have ever visited. On the day of my team’s arrival, a brief rainstorm had moved through the area and left behind it a massive and stunning rainbow that hung over the lake and distant mountains. We stared up at the rainbow in awe, snapped pictures of one another beneath it, and walked around as if in a world we had never known existed. In many ways, we were in a world we had never known existed. As American, middle-class college and graduate students, we were traversing unfamiliar territory. We were walking around in a community that our privilege afforded us ignorance of. While Kunya Village is extraordinarily beautiful, it is also extremely poor and geographically isolated from more developed parts of Kenya; the nearest adequately equipped hospital is in the city of Kisumu, two hours away by vehicle. And there is a scarcity, if not a complete absence, of vehicles in Kunya Village.
Fishing is the main source of revenue in Kunya. Fishermen from various parts of western Kenya travel to villages like Kunya to take advantage of Lake Victoria’s bounties. The fishermen bring money and the basis for village markets, however small those markets may be. The fishermen are recognized as having money, and in a poor rural village this creates a lot of opportunity for transactional sex to take place. It is not abnormal for women living in extreme poverty in Kenya to trade sex not just for money, but more often for food, clothing, or other basic items for themselves or their families. The consequences of this practice are stark: in Kenya the HIV infection rate on average is about four percent of the population, but in Kunya Village, with a population of about 3,000, community health workers estimate that 1 in 5 people is HIV-positive.
Kunya Village has no water or sewer systems. The entire village collects water from Lake Victoria to wash clothes and cook. Residents often wade into the lake to bathe. Some residents must come from several miles away to collect water, and while some enjoy the luxury of donkeys to transport heavy water buckets, others (mostly women) simply balance buckets and basins on their heads to get the water to their homes. The guidebooks that my colleagues and I had with us warned us not even to dip our toes in the waters of Lake Victoria, much less drink it, due to infestations of water parasites.
Kunya Village doesn’t have electricity, emergency response service, organized trash collection, or public transportation of any sort. The conditions in Kunya Village are almost standard in rural parts of Kenya. While USAID and PEPFAR initiatives should be applauded, they cannot help the vast number of people living in villages like Kunya, where even when residents know that resources (such as government provided ARVs for HIV-positive citizens) exist, they do not expect to have access to them.
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While the conditions in Kunya Village are not unique to rural communities in Kenya, it has two things that countless villages like it don’t: Mama na Dada Africa and the Kunya Clinic. Mama na Dada is a small, non-governmental grassroots organization created in Kunya Village in the late ‘90’s by Joyce Oneko, an attorney by trade who now runs the organization full-time. “When I started Mama na Dada (mother and sister in Swahili) what I wanted was to encourage girls to stay in school because I felt the longer they stay in school the less vulnerable they become and they become wiser. So, as we went on encouraging girls to stay in school we found all these other problems in the community.”
One fundamental problem that Joyce and her staff encountered was that most people in the village did not have the means to eat more than one meal a day, “if you don’t have food, there is no way you can do anything else.” Focusing on women, Mama na Dada developed programs to teach sustainable agricultural practices using goat breeding, efficient farming methods, and nutritional education. The organization also started a sewing group that provides young women vocational training they can use to generate an income for themselves and their families. Without the support of the sewing group and lacking vocational skills, members of the group would likely engage in transactional sex with fishermen to provide for their families.
Mama na Dada initiates numerous community meetings to provide residents of Kunya Village with health measures they can take to avoid preventable diseases like malaria and typhoid. Avoiding preventable diseases is simple in theory but the reality in Kunya Village is complicated. Water borne disease and illness, like typhoid or diarrhea, are extremely common because residents use contaminated water from Lake Victoria for everyday use. While boiling the water is a healthy option, Joyce explains that in Kunya Village, “you have to make a choice: are you going to drink water or are you going to cook food? There isn’t enough firewood for both.” Malaria can be prevented through correct use of mosquito nets but most residents don’t have the money it takes to purchase them. The work that Mama na Dada is doing is an obvious benefit to its community, but it is a small organization with few resources and its reach is limited.
In 1999, the Kunya Clinic was established in Kunya Village. Several community members identified the need for a health facility in the region and donated land for the clinic’s site. Funds were drawn from the World Bank’s Lake Victoria Environmental Project to have the clinic erected. Once the clinic was in place, the Kenyan government provided a government employed community health nurse, David Olouch. “My work is to improve the health status of this community through treatment, education, and immunization.”
David is the clinic’s only paid employee and after 6 years the clinic still lacks adequate supplies and storage facilities. Every three months the clinic receives rations of “essential medicines” from the Ministry of Health, but the supply does not reflect the actual needs of the community. Once a week, the clinic offers basic immunizations for people in Kunya Village, but because the clinic has no refrigeration, all of the vaccines must be used the day they are received from the district hospital. The consequences of this are that the number of people who show up for vaccinations may be larger than the number available, so they are told to come back the following week. Disappointed by being turned away the week before or burdened by other responsibilities, residents often don’t return, so vaccinations go to waste. “This can be solved,” explains David, “If we had a solar panel and a refrigerator, we can immunize them anytime they come. And then we can plan, we can calculate how much we need and then (the vaccines) are always accessible.” The inconsistency in resources affects the credibility of the clinic in the community, “If they have no faith in us, we can’t teach them.” Until the clinic becomes more stable in resource provision, the community will not depend on it as a source for health treatment and education.
Because both want to uplift the community, Mama na Dada and the Kunya Clinic work in partnership. “We work as partners because our aim is one,” says David, “We work as partners because we cannot do it alone.” Many of their joint efforts go into raising the level of awareness on HIV/AIDS in the community through outreach and education. In examining the obstacles that Mama na Dada and the Kunya Clinic are facing it becomes clear that mobilizing a community to invest in its own future health is difficult when a majority of the residents who make up the community struggle day to day to obtain basic resources, like food.
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In 2000, the United Nations created its Millennium Declaration, described by Kofi Annan, UN Secretary, as “an unprecedented promise by world leaders to address, as a single package, peace, security, development, human rights and fundamental freedoms.” The Declaration outlines eight Millennium Development Goals: to eradicate extreme poverty and hunger, achieve universal primary education, promote gender equality and empower women, reduce child mortality, improve maternal health, combat HIV/AIDS, malaria and other diseases, ensure environmental sustainability, and develop a global partnership for development; all of this by the year 2015. In a progress report released this year to measure the progress made, Annan asserts that the Millennium Goals, “form a blueprint agreed by all the world’s countries and all the world’s leading development institutions- a set of simple but powerful objectives that every man and woman in the street, from New York to Nairobi to New Delhi, can easily support and understand” (3).
The objectives are easy enough to understand. The difficulty lies in their implementation. While the UN’s Declaration documents the agreement of various countries to scrutinize development issues around the world it does not show how to approach those issues effectively. The UN’s progress report, written prior to the September summit of world leaders to assess “how far their pledges have been fulfilled,” demonstrates that poverty in sub-Saharan Africa, already the poorest geographical location in the world, has worsened over the last 15 years. Nearly one-third of children in sub-Saharan Africa are malnourished. Two-fifths of the populations do not have access to safe sources of drinking water. The number of people in sub-Saharan Africa who die of AIDS each year is roughly equivalent to the number of those who become newly infected.
The rhetoric currently dominating development discourse orbits around the concept of civil society as the solution that will lead communities, cultures, and countries away from the social problems that affect them. Governments and international aid agencies are lauding NGOs, people’s organizations, religious groups, professional associations, civic clubs, and the media as holding the key to social progress. Literature found on the World Bank’s website defines civil society as, “the groups and organizations, both formal and informal, which act independently of the state and market to promote diverse interests in society,” and goes on to say that “while individual groups form the building blocks of civil society, the concept’s value lies in the extent and density of relations among groups as well as the synergy between civil society, state and market.” CIVICUS, an international “alliance” whose mission is to “strengthen citizen action and civil society throughout the world,” produced a collection of essays called Civil Society at the Millennium (1999), which is full of statements like, “Civil society has become a force for challenging existing policies and institutions to work for the poor, and in so doing, is reshaping the rules of the game” (p. 138).
I’m not sure what the original rules of the game were, but it seems as though the new ones are still exclusionary. Essentially, “civil society has been called upon to shoulder an increasing share of the responsibility for eradicating poverty” (p.137). Yet, for civil society to be effective in social development, some modicum of sustainability must already exist. Civil society thrives in “an intellectual space, one in which it is recognized that all individuals through their diverse associations and organizations have the right to contribute to discussions about how to organize their society, deal with its problems, and ultimately define what kind of development is required and desired” (Howell and Pearce, 2001, p.13). If the groups that constitute civil society are organized enough to affect government or policy, then they are already included in a system that recognizes them as agents of change:
While civil society has always existed, it is an arena fully realized only in social formations dominated by the capitalist mode of production and only alongside the existence of the bourgeoisie. Civil society is where the bourgeoisie exercises its social and economic power, and the state is an artificial unity that gives true freedom only to those who own the means of production (33).
What about those individuals or groups who still exist outside of an organized and systemic society? What about the people and the communities clinging to the grassroots, literally struggling to stay alive? “Time and money are both crucial to the functioning of civil society. Engagement in voluntary public activity assumes surplus time and energy, which may be unevenly distributed across society in terms of age, class, and gender and across societies” (108).
Millennium Goals declarations publicize the living conditions of a huge number of people around the world. Initiatives such as PEPFAR are admirable attempts to address pressing issues. Yet, they do not serve to strengthen the foundations of the countries they are working in. Employing civil society in development rhetoric creates assumptions that any group can organize themselves to the point of political viability, which doesn’t account for the social structures that must be in place for civil society to be an effective option. According to Adigun Agbaje (1991), donor efforts to strengthen civil society are “not likely to add up to a meaningful intervention in the development process if (they are) not complimented by appropriate action to repair the state to enhance its capacity for development oriented activity,” especially in African nations where, “in a situation of increasing poverty and international debt, African states are simply unable to attain high levels of grassroots development or to support non-state action…Given the reality of state failure and incapacitation, where is self-help voluntary action expected to get the resources…to do the job?” (pgs. 25,34). In the late 1990’s institutions like the World bank recognized the “need for some state intervention to guarantee minimum living standards,” but there are still no clear outlines for assisting developing governments in becoming capable of such intervention (Howell and Pearce, 2001, p.66).
The huge, deep-pocketed, donor agencies that assert themselves as the main players in international development are now a third sector, replete with bureaucracy susceptible to political pressure and blind to the social complexity that plagues under-developed countries. The World Bank makes it possible for projects like the Kunya Clinic to exist but it doesn’t ensure that such projects will be operational. While the third sector is successful in employing millions of people around the world in various civil society agency and advocacy departments, it has been ineffective in making accessible continuous support for small, localized, and effective grassroots efforts:
The realization that there are barriers to entry into civil society, and that civil society is as much a captured field as the state and economy, underpins the growing interest among donors, politicians, and policymakers in the idea of “social exclusion.” In the context of unequal economic and social power, is it possible to have parity of association and participation in civil or political society? How can “the poor” and those on the margins of society find a voice in civil society? How can they finance associations and campaigns when the resources of corporate capital and privileged social groups are so much greater? Whose interests do donors promote in their civil society strengthening programs? (86).
Joyce explains that, “the government has not been really helpful. And when I talk about the government, it also involves the other agencies that give funding, people like UNICEF, OXFAM, the CDC. They do not want to deal with the smaller agencies that are not known, so people like us who are doing grassroots work on the ground find it difficult to get money. About 15-20 years ago when the civil society, the non-profit organizations, started trying to do development work in the country there was so much money that an NGO would get people together and just do handouts. That has been so engrained in people in communities that it has taken their power away.”
According to Joyce, governments and development institutions should “teach people that we can actually use the resources we have to improve our lives.” Instead, these institutions are propagating verbose and romantic rhetoric about development potential, imposing a development standard that may not be realistic for communities struggling with sustainability, or failing to follow through on the efficacy of development efforts. Joyce cites the misuse of water in Kunya Village, noting that the village is on Lake Victoria, “we have a lot of water and we still have famine when it doesn’t rain. Why can’t we use this water to do irrigation? If the government gave a little bit of assistance and gave education to the people to explain that if you use this resource you will still be able to get the food you need, it would help.” The suggestions Joyce makes are simple: she argues “attitude change is one of the biggest challenges we (in Kenya) are facing.” An attitude that combines grand declarations with ground-level pessimism means that organizations and communities like hers don’t get the type of support that would make a sustainable difference.
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My aim is not to suggest that donor and development institutions and industries are unnecessary or that their efforts are unquestionably futile. Social strides have been made in developing countries, particularly concerning the public dissemination of information on basic human rights, since donor and development institutions began operations 60 years ago. Development is a concept that demands fundamental cultural shifts to be successful, which requires the participation of citizens of developing nations. It has become clear in the last two decades as the West has attempted to aid countries like Kenya in creating economic and social sustainability that there is no tried and true model to employ to ensure a projected outcome. And as the rhetoric has shifted from a top down to a civil society initiated development approach, funding has spread out to address a wider variety of development issues and initiatives. Civil society, however, has its limits and is largely an intellectual theory that needs a basic social infrastructure in place to be effective.
Development has become a competitive enterprise in which struggling grassroots organizations and communities must fight to gain access to the most basic resources. For a community to be deserving of the types of infrastructure that would allow it to be sustainable, local, politically viable organizations savvy to the language of donor institutions must exist within it. Those communities that lack the types of organizations that could fight for their rights are completely off the development radar which means that the most disenfranchised, the most geographically isolated and the poorest people in the world are unaccounted for by civil society, development institutions, and their governments. So, while the United Nations creates its bulleted list of global problems to address in the next 15 years, a person like Clarice, who lives in a country now capable of supplying her with drugs that could prolong her life and allow her to provide for her family, remains a casualty of the present lack of infrastructure.
Toward the end of our trip in Kenya, my colleagues and I met once more with Buck Buckingham, the interagency coordinator for USAID and PEPFAR. We talked with him about how his agency’s efforts weren’t reaching people in rural parts of Kenya, that in those areas people were dying of, rather than living with, AIDS. We asked him what a country like Kenya needs in order to effectively deal with a problem like HIV/AIDS, especially when so many Kenyans are more concerned with eating than with being educated on the disease. He responded by saying that until countries like Kenya have sound governance that citizens have faith in, it doesn’t matter how much money and aid foreign bodies funnel in to deal with specific problems; it simply won’t be enough. President Bush’s PEPFAR program is committing 15 billion dollars over five years to fifteen developing countries. It is an ambitious project that demands the efforts of many people around the world. But until individuals, civil society, and donor institutions and industries are committed to strengthening the governments of developing nations so that infrastructures that citizens can build a society on exist, we can expect disappointment. The rhetoric may change, but the reality won’t.
Works Cited:
Agbaje, Adigun. “In search of Building Blocks: The State, Civil Society, Voluntary Action and Grassroot Development in Africa,” Africa Quarterly. Vol. 30, Num.3-4, 1991.
CIVICUS: World Alliance for Citizen Participation: http://www.civicus.org
Howell, Jude and Jenny Pearce. Civil Society and Development: A Critical Exploration. Lynne Rienner Publishers, Inc: Boulder, CO. 2001.
Kapuscinski, Ryszard. The Shadow of the Sun. Vintage Books: New York, NY. 1998.
Weisen, Caitlin, Geoffrey D. Prewitt and Babar Sobhan. “Civil Society and Poverty: Whose Rights Count?,” Civil Society at the Millennium. Kumarian Press, Inc: West Hartford, CT. 1999.
The United Nations Millennium Development Goals and The Millennium Development Goals Report 2005 (book downloaded): http://www.un.org/millenniumgoals/index.asp
The World Bank. Reaching the Rural Poor: A Renewed Strategy for Rural Development. The International Bank for Reconstruction and Development/The World Bank: Washington, DC. 2003.
The World Bank: http://www.worldbank.org
Interviews:
Buckingham, Warren “Buck.” Interagency Coordinator, PEPFAR. August 9, 2005. Nairobi, Kenya.
Oluoch, David. Community Health Nurse, Kunya Clinic. August 22, 2005. Kunya Village, Kenya.
Oneko, Joyce. Founder and Director, Mama na Dada Africa. August 22, 2005. Kunya Village, Kenya.
Works Referenced:
Allen, Chris. “Who Needs Civil Society?” Review of African Political Economy. Vol. 24, Num. 73, September 1997.
Chazan, Naomi, et al. Politics and Society in Contemporary Africa. Lynne Rienner Publishers, Inc: Boulder, CO. 1999.
Easterly, William. The Elusive Quest for Growth: Economists’ Adventures and Misadventures in the Tropics. MIT Press: Boston, MA. 2001.
