"The problem with taking a blood sample for your malaria test is that the cockroaches may eat it in the night," announced the nurse. "Ants are an even worse problem. The place is infested with them." Siavonga Hospital, on the shores of Lake Karibe in southern Zambia, is suffering. "We have to put patients with TB in the same room as women who are giving birth," says one of the four Cuban doctors who battle to run the place. They also have to charge fees for their healthcare, and patients have to provide their own medicines, syringes and clean needles. What if they can't afford to pay? The doctor shrugs. "What do you think? They die."
People are dying. Quietly, but in huge numbers, all over Zambia, lives are being wasted. Wasted not because of some accident of nature but as a direct result of economic policies imposed by faceless Western planners. For more than twenty years now the World Bank and the International Monetary Fund have been forcing "structural adjustment programs," or SAPs, on the bankrupt countries of Africa. Trapped between a near-religious belief in economic neoliberalism and the US-driven interests of big business, these two institutions are blind to the havoc they are causing. Almost every country on the continent has succumbed to their prescription. Across Africa, the vultures are circling.
The World Bank has claimed that Zambia's reformed healthcare system is a model for the rest of Africa. "It's true that there are no queues," says Dickson Jere, a freelance journalist formerly with the Zambia Post, an independent daily. "But that's because people are simply dying at home."
They're called BIDs--"brought in dead." At the casualty ward in Lusaka's University Teaching Hospital (UTH), they are increasingly common phenomena, especially among children. "If you want to see the impact of structural adjustment on Zambia," Emily Sikazwe, director of the antipoverty group Women for Change, told me, "Go to UTH."
I went to UTH. It is Lusaka's biggest hospital, where those who can't afford private healthcare end up. In a packed ward near the main entrance a man writhed in bed. "I'm dying," he moaned, while his wife stood helplessly by his side. Emaciated figures shivered under sparse bedclothes. Families crowded around beds or sat on the floor, bringing food to the sick to supplement the meager hospital rations of beans and maize meal. In another ward a preacher harangued a dying woman, whose family stood around with heads bowed. As he waved his Bible, she struggled to move her lips to acknowledge him.
Enter the children's ward and the smell hits you like a wall. A musty, medicinal odor--the smell of sickness and death. Rows of children lie on small beds, slowly passing away from preventable diseases like TB, malaria and pneumonia. On the other side of the building is a cleaner, neater ward, where half the beds stand empty. This is the fee-paying section, where families who can pay a 100,000-kwacha ($36) deposit can buy a slightly better chance of life. In World Bank language, this is "user-responsive healthcare."
Don't just go to UTH. Go also to Misisi or to any of the twenty or so shanty "compounds" that ring Lusaka. In Misisi, barely a kilometer from Lusaka's town center, Masauso Phiri stands outside the windowless concrete shed that is his house. Next door an old man nearly died of starvation--luckily, he was saved by the return of his son from the Copper Belt, where he worked in the mines. That's not unusual. People are dying of starvation in Misisi. But they do so quietly, wasting away in their houses, too ashamed to venture out. Things were not always like this.
Phiri, like many of his neighbors, has heard of structural adjustment. It was because of the SAP that he lost his job as a security guard. It was because of the SAP that he lost a child--a 3-year-old boy, who died of pneumonia in 1996. "I know it is meant to put the economy on the right track, but to me it seems to make us suffer," he says. "We can't eat policies." He looks at the ground. "I don't have any hope. I don't have any money, so I can't think of any future. My future is doomed."
Only one in five people in Misisi is employed. The unemployed are part of an army of jobless, created when economists from the World Bank and IMF decided that Zambia's public sector was "bloated" and that companies would benefit from the tonic of privatization and an opening of markets to international competition. The Zambian government boasts that it has the speediest privatization program in Africa. But half the companies sold out of the state sector are now bankrupt. More than 60,000 people have lost their jobs as a direct result of the economic liberalization program introduced after 1991. With many mouths dependent on one breadwinner, this has thrown an estimated 420,000 into destitution.
In their desperation, people turn on one another--crime is soaring in the compounds around Lusaka. I attended the funeral of one old woman, shot in her house by bandits as she tried to prevent them from entering. In the darkness outside her house, male friends and relatives sit around the fire in quiet contemplation. They will spend the night there, in the cold, just sitting, talking and remembering. Inside the house women wail. The robbers took nothing. The old woman had nothing to take.
"SAPs cause poverty," says Women for Change's Sikazwe. "And poverty has a woman's face." Women shoulder the main burden of providing for families, and girls are the first to be withdrawn from school when a father loses his job. Women like Esnart Banda, a widow with five children, who makes about 2,000 kwacha (72 cents) a day selling vegetables in a market near Misisi. Most days she can afford only one meal for her children, even though the youngest is suffering from TB. Her kids join 40 percent of Zambia's children in suffering from chronic undernutrition.
It's worth pausing here to look at the figures. In 1980, under the former socialist government of Kenneth Kaunda, the under 5 mortality rate was 162 deaths per 1,000 births. It's now 202 per 1,000. That means one in five children in Zambia dies before reaching the age of 5. The average life expectancy has fallen from 54 in the mid-eighties to 40 now. With the AIDS epidemic raging, this can only get worse. Over the same period the primary school enrollment rate has plummeted from 96 percent to 77 percent. Half a million children are now out of school, out of a total national population of only 9 million.
These last figures are not accidental. They reflect the results of cuts in public spending and the introduction of school fees. For example, whereas in 1991 the Zambian government spent about $60 per primary school pupil, it now spends just $15. Cuts in public spending--the slimming down of a "bloated" public sector--are a central plank of structural adjustment, as promoted by the World Bank and the IMF. In one of SAP's greatest ironies, the World Bank is now recasting itself as a "Knowledge Bank"--even as it condemns millions of children across Africa to a lifetime of ignorance and illiteracy.
"What if the IMF was to pack its bags and leave Zambia? Do they imagine the situation would get worse for us?" asks Sikazwe. "What would they say if we took them to the World Court in The Hague and accused them of genocide?" How does she sum up the impact of structural adjustment on Zambia? "Devastating."
Half a world away in Washington, the architects of this human disaster dine in comfort and seclusion, spending more on one meal than Masauso Phiri's wife makes in a year of selling buns in their shantytown. Although most World Bank staff work at its Washington headquarters, those unlucky enough to be posted in the Third World receive ample compensation for their misfortune. This includes subsidized housing (complete with free furnishings), an extended "assignment grant" of $25,000 and a "mobility premium" to defray the cost of child education. Salaries are tax-free and averaged $86,000 in 1995, according to a General Accounting Office report to Congress. No "structural adjustment," then, for this privileged coterie of bankers and policy analysts. Meanwhile, in Africa a hidden genocide lays waste the continent.
"It's not right for a bank to run the whole world," says Fred M'membe, editor of the Zambia Post. "They do not represent anybody other than the countries that control them. What this means in practice is that the United States runs our countries." He continues: "Look at any African country today, and you'll find that the figures are swinging down. Education standards are going down, health standards going down and infrastructure is literally breaking up."
In the midst of this chaos, what remains of Africa's wealth is being plundered. And this, argue many, is the real impetus behind structural adjustment. "They say if you perform well, there'll be a flow of foreign direct investment," says M'membe. "Investment" like Shoprite Checkers, the South African supermarket chain that is colonizing Zambia with the help of a massive government tax rebate. Shoprite has ravaged the economies of entire towns, undercutting local traders and putting out of business stores run for generations by one family.
To make matters worse, Shoprite buys nothing locally. Tax-free produce--even maize and potatoes--is trucked in from Zimbabwe and South Africa. Meanwhile, Zambian maize rots in the fields, because the farmers who grow it cannot find a market. Under the previous government an agricultural marketing board was responsible for collecting and distributing produce from the whole country. Under structural adjustment, the private sector is left to do its worst. But with the poor state of the country's roads, private traders find it cheaper to import subsidized maize from the United States. Some farmers are so desperate that they give their produce away to Lusaka-based dealers, who promise to return with the earnings. Of course, they never do.
The majority of privatized Zambian businesses have been sold off into foreign ownership. In the case of Zambia Breweries--producers of the country's famous Mosi (Victoria Falls) lager--South African Breweries is now in charge. Zambia Consolidated Copper Mines--which has acted as a mini-government in the country's Copper Belt region--is now being sold off to a Canadian and Swiss consortium under pressure from international lenders, who have refused to give Zambia balance-of-payments support until the mines are privatized. Many more home-grown companies have simply gone bankrupt or are struggling to survive.
"Africa can only develop with the participation of its own people," says Emily Sikazwe. People-centered development is a strategy to which the UN, NGOs and even the World Bank--which sprinkles its publications with high-minded concepts--have signed on. Meanwhile, organizing together into a Campaign Against Poverty, Zambian NGOs are issuing a challenge to the World Bank and the IMF to allow Africans to participate in deciding how their countries are run.
If the neoliberal economists of the World Bank are interested in heeding this call, they will have to leave their plush offices in Washington. They'll have to go to Lusaka, to Nairobi and to Harare. They'll have to go to Misisi, to UTH, and they'll have to listen to what people there say.