Afro-pessimism
Sub-Saharan Africa is the most dramatic loser. Here poverty is at its most stark and marginalisation from the global economy most pronounced. The continent contains 33 of the world’s 50 poorest countries. Improvements in health, education, and living standards have reversed in the past two decades, and standards continue to fall.

By the end of the decade, two thirds of Africans will live in "absolute poverty.More than half still lack safe water and 70% are without proper sanitation; 40 million children are not in primary school. Infant mortality is 55% higher than in the rest of the world’s low income, developing countries, and average life expectancy, at 51 years, is 11 years less.

Malaria and tuberculosis are increasing, and in parts of central, southern, and eastern Africa 30-40% of pregnant women are now HIV positive.Poverty causes ill health, but ill health also imposes immense economic costs on individuals, their families, and society. African productivity could increase by 15% if illness and disability were attacked more strenuously.

The economic cost of malaria is estimated at 1% of gross national product, while AIDS strikes adults in their most productive years.

In families with AIDS, the children are forced to leave school early to work, weakening their long term financial prospects. New ways of coping with the cost of illness (selling cattle or land) cause further long term economic hardship .

Where does blame lie?
Many of Africa’s setbacks have been associated with global economic policies over the past two decades which, in a complex way, reinforce the legacies of colonialism and imperialism and exacerbate Africa’s internal problems.

But Africa too must bear responsibility for its current state. Poor governance, tribalism, pervasive corruption, and a lack of democracy have caused social and political tensions resulting, in extreme cases, in collapse of states, with devastating humanitarian consequences.

Weakness of political commitment to fund better health and social services, accompanied by a disinclination to develop preventive and primary health, has meant that few people (mainly those in cities) have benefited from health expenditure. Failure to value women’s contribution to society and the denial of women’s rights has had a huge negative impact on the health of African women and their families.

Can Africa’s relentless slide be halted?
However, these generalisations are only part of Africa’s reality and it is neither fair nor objective to overlook the resilience of the African people or their achievements. For example, after independence, Zimbabwe’s primary education increased from 36% of school age children enrolled in 1960 to 79% in 1980, and child mortality halved. More recently, peace has returned to Angola, Ethiopia, Eritrea, and Mozambique. In South

Africa, apartheid and its evil legacy has been dismantled without civil war, which brings hope that fundamental shifts can occur through thinking and acting in the best interest of future generations.

Highly Indebted Poor Countries Initiative
1996 brought an unprecedented opportunity to diminish the debt crisis of the poorest countries. The World Bank and International Monetary Fund accepted that some debts cannot be repaid and that the flow of money from poor to rich countries must be stopped. Although there are problems in the design (slow implementation, thresholds of debt sustainability too high, and debt relief not adequately set into a broader programme of human development), the initiative provides new thinking.   But already the initiative has received a setback.

Uganda, with an excellent economic track record and six years of adjustment programmes, was to be the first to benefit (followed by Ivory Coast and Burkina Faso), but relief was blocked for one year by political in-fighting among donors. This delay means Uganda will receive £119 million ($193 million) less than hoped for (and six times Ugandan government spending on health)—money the Uganda government had already planned to use for health and education.

The harsh requirement of six years’ adherence to adjustment programmes means that Ethiopia will not qualify till the end of 2000 (despite drought and postwar reconstruction); Mozambique, Tanzania, Niger, and Zambia will not qualify till 2002 or later; and Rwanda may not qualify at all despite its post-genocide reconstruction.
There is an increasing groundswell of demand for a one-off debt cancellation of the poorest countries to mark the start of the new millennium.

This "once only” gesture would not set a precedent for repeated cancellation—the "moral hazard” so feared by the international financial institutions—but would accept that both creditors (like the Swiss banks accepting the illegal booty of dictators) and debtors have made mistakes. Starting the new millennium by such a gesture, and structuring new loans with greater accountability, could remove a great barrier to progress and justice.
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