Select Committee on International Development Minutes of Evidence

Examination of Witness (Questions 120 - 139)



Mr Worthington

  120. The most basic thing in the face of this epidemic is: can the state hold together? Looking at the impact of this on the public sector, when you go to Zambia and find out they are losing more teachers through AIDS than they are possibly able to train, can you take us through that area about the impact on the public sector of the epidemic?
  (Professor Whiteside) When one looks at the public sector one is looking at a very peculiar set of problems. What you are finding is that in Africa the public sector is generally a sector which has been a very generous employer of people, and basically it has got very generous employment conditions. What AIDS is doing is, where in the past you would lose one or two people per year in the ministry because of cancer, diabetes, kidney failure or whatever, now you are looking at very large numbers of people who are unable to function in the public service, and are unable to be replaced in many instances. I think as a matter of urgency we need to look at the effect the epidemic is having on the state sector, on schooling, on the ability of the state to actually function. Unfortunately, nobody has done this. I wish I could come in and present you hard data, but I cannot. You have referred to the Zambian paper and that is about all there is. It tells us that in Zambia there are more teachers dying than are being trained at the moment. The education sector is a particular concern of mine because if you lose a teacher then that class does not get taught. That class will not get taught until there is a replacement teacher. The trouble with HIV is that it is different from other causes of death because it is quite a long-term process. At least with a death in a motor accident it is an event, and once the event has happened you can put in place your contingency plans. With HIV in the public sector you are constrained by the terms and conditions of service, and you will keep somebody on for six months on full pay, six months on half pay, and then you may medically board them after another few months, so there is a long-term process. I am not saying that is a bad thing, because for many families that is the only source of support, but it does have an effect on the state. We need to look at that as a matter of urgency.

  121. We need to look at it as a matter of urgency, but the logic of what you are saying is that you are advocating removing benefits and good conditions from sick people?
  (Professor Whiteside) No, what I am advocating is understanding what those conditions mean for the state funding, for the state revenue and for the efficiency of the Civil Service. What I may be advocating, and maybe this is the extent we have to go to, is to say, "Okay, let's look at some sort of support to central ministry finances, in order that they can employ more people. Let's stop doing structural adjustment, and start looking at not slimming down the Civil Service but expanding it, because we are going to need those people".

  122. The picture I see is of these states being held back by an appallingly paid middle-class that has been destroyed in sub-Saharan African states by lack of wages and lack of conditions so that you do not attract the talent?
  (Professor Whiteside) Absolutely, I think that is correct.

  123. For a moment you seemed to be saying that we are wasting resources on sick people; we should put it into other things. You are not saying that?
  (Professor Whiteside) No, I am saying you need to look at how you are using your resources, and you need to look at the changing use of your resources, and you need to understand that there are trade-offs. For every person you treat with HIV and AIDS, according to the World Bank, you could educate ten primary school children. At the country level we have to make choices; at the international level we have to make choices; what I am also saying is that I am appalled we have this whole concept of slimming down civil services in African countries, making them leaner and meaner, because by the time they are lean and mean we have an AIDS epidemic eating in and we are losing people from lean and mean civil services.

  124. Is education the worst affected sector in your view?
  (Professor Whiteside) I think it is the most important sector that has been affected, simply because it holds in charge the next generation. Probably the worst affected sector is the health sector. I think HIV levels are the same in the health sector as in the general population. There is a whole question of morale among health sector staff. It must be absolutely soul-destroying to have to sit in a clinic in rural Kwazulu-Natal and watch people die, and people you know. Probably the morale of the health sector is the worst affected. On the education sector there is another problem here we need to be aware of. First of all, the epidemic is not impacting only on the Civil Service, it is impacting across societies. What we are looking at is a situation where, if I am running the Coca Cola plant in Swaziland and my industrial chemist dies then I would probably go and look for a school chemistry teacher in the first instance, pull them with higher wages, train them up and use them rather than starting training again. Because the education system trains people in a broad range of disciplines, I suspect we are going to find them being lost to the private sector and to other state sectors as well out of teaching. I would put education at the top of my list where we need to respond. That, by the way, is where DFID is doing very good work. There they are getting an A+ on my report card.


  125. Are there any lessons to be learned from Uganda, which seems to have tackled this HIV/AIDS problem rather earlier than South Africa, and the disease is arguably most advanced there? Is there any evidence of the effect of AIDS on the public sector in Uganda?
  (Professor Whiteside) I am not actually aware of any, I have to say. That is something which I really ought to look at. I think we certainly have seen demographic effects. We have certainly seen effects on population pyramids, and that is hard evidence I have seen from Uganda, but the other sectors I have not seen. One of the really ironic things is, the poorer you are the harder it is to find the impact. There is so little interchange between the state and the citizens. In a society like Mozambique a person sitting out in Tete Province might not interact with the state at all. He may not seek health care, he may not have children in school, he may not use the road so there is no interaction. Whereas in a country like South Africa, or Zimbabwe, where there is that social contract between the state and the citizenry we are running into a serious problem.

Mr Worthington

  126. I want to move on to look at the impacts on family structures and, in doing that, to really look at the psychology and sociology which is around here. If I can use a parallel with the fall in family size—it was said that occurred when infant mortality rates fell very considerably; and people saw it necessary to have a large family in order to ensure they were looked after themselves in their pensionable years. I am trying to imagine what is happening to the psychology in African families about moving towards smaller families. What is the impact of AIDS on that movement? Are they saying, "We now have to have larger families to make sure that some survive?" Have you done any research, has anyone done any research on that?
  (Professor Whiteside) There is no research on that I am aware of. There has been one study in rural Tanzania by a gentleman called Gabriel Rugalema where he looked at how families cope. There is certainly no evidence that families are changing the structure or the size in response to the epidemic. In fact, if anything I think there is a growing feeling of absolute despair and dismay in many African communities as they watch mortality go up. Of course, in parenthesis, one might like to realise it is not just the young that are orphaned, it is also the elderly because they are losing the people who would care for them in states where there is no social security system. In fact, they are having to care for the orphaned grandchildren now at the very time of life when they are least able to do so.

  127. Can we move into the issue of orphans. Both states and village people are going to have to think about this and how they cope. What has your view been of how this need to adjust is developing? What should be the response of ourselves, or states, and what is the mixture of responsibilities between the state and individuals?
  (Professor Whiteside) There is a myth that the African extended family absorbs the orphans that are left. I think the problem is that the very few studies that have been done of the impact on households have missed one glaringly obvious fact, and that is the worst affected households have disappeared. You cannot measure what is not there. Households which have collapsed, where the children are living under the bushes (and there are those households) are not being measured. If anything, we are tending to under-estimate the scale of the problem. The idea that the household can cope is not the case. One of the whole emphases, particularly in Southern African countries with rapid urbanisation, has been towards a more nuclear family. In a setting where you are living in a township house, it is not designed for an extended family, so we have some serious, serious problems there. What should be done? For me the priority is the orphans and the education of the children, because I think without them we do not have a state, we do not have a society. What we have got to do is start finding imaginative ways to provide care and support to children and to the communities in which they are lodged. I think this is going to involve doing some things which development people do not like doing, like transferring money; like accepting that maybe 10 per cent is going to be syphoned off to buy a truck or two to build houses, but the 90 per cent will reach those communities. I really am of the opinion that we need to be moving towards some sort of support for households and communities to take care of children in distress; and I would not include just AIDS orphans or just orphans either, I think we need to expand it. If you do any form of discrimination in favour of orphans then you are creating a problem just as much as if you do nothing.

  128. What will it mean in terms of the developed community, are we going to look at residential child care?
  (Professor Whiteside) No, that is the last thing I would do. I think that would be tremendously detrimental. What I would suggest, and I have put this forward in South Africa, is maybe we should look at providing some sort of grant for surrogate mothers; identify responsible people in the community, perhaps through the churches, and say to them, "Okay, what we would like you to do, we have identified these children who are still in their households perhaps with sick parents or no parents, and we would like you to take responsibility for those. Here is a grant which will cover the cost of caring for the children. Here is a little bit extra for your time. Now you become the surrogate mother". That is the one route I think one could take. At the same time I think the state, through the municipalities or through the town councils, whatever, is going to have to recognise that those households no longer have an income and cannot pay the tariff for the water, the rates for the house, the rent for the house, or the cost of the electricity in settings where you have those things. We now have to have some sort of reserve, contingency money, to ensure we can keep those people in a house and recognise they are not going to pay for the basic services which they are going to get. It has to be through partnerships.

  129. It is difficult to see how you set up a one purpose welfare state with child benefit payments for one cause—AIDS?
  (Professor Whiteside) We would not.

  130. You are talking about huge change.
  (Professor Whiteside) I talk about children in distress generally. I would extend it far beyond AIDS orphans. I would extend it to children who are in distress because of adult death. We are talking about quite a considerable change. We are also talking about partnerships which have not been there before. It would be a partnership between the municipality, the Ministry of Welfare, the church group (if that is who you decide), the NGOs whom you may charge with actually dealing with the money. It would be a partnership with the local police forces as well to make sure there is some sort of monitoring of some of the things which go on.

Mr Robathan

  131. If this was a small problem I could accept what you say, but actually this is a huge problem as we have identified. If you are going to start saying to the people, "You will be exempt from municipal tax etc", do you not think you will find there is a major problem with the entire breakdown in the way in which the state is funded?
  (Professor Whiteside) I do not think we have a choice, frankly. I think we either have to be imaginative and look at some of these options. I am not giving you the blueprint. I am just giving you some thoughts which we have been developing over the last year or on things that you might do. Obviously one is not saying we are going to say to people, "You don't pay rates because you are taking care of an orphan", but what we might say is, "Here's a small package so you are not out of pocket for taking care of this person". That will be immeasurably cheaper than putting that person in an institution. That is the sort of thing I am talking about. It requires imagination and is building a social contract between the state and the community, and that in turn will have a preventative effect on the AIDS epidemic.

Mr Colman

  132. I was a bit surprised that you were talking about the NGOs being the ones who should administer the money. I would have thought, rather like happens in the UK, this is very much a central local government function. I attended the Commonwealth Local Government Forum which took place at the same time as CHOGM in Durban last year and certainly social services were being discussed as a natural function for local government to be involved in. Why do you feel that local government cannot be trusted with administering such a proposed policy and why would NGOs be involved?
  (Professor Whiteside) I do not think it is axiomatic that local government would not be trusted or that NGOs would be involved. I think it would be specific to every setting. In South Africa we have just developed quite a major tool kit/manual for local government so we are looking at this issue. It may be that the local government would like to devolve some of these functions on to NGOs. In other settings there may not be a local government that can do this. Here one would look at countries like Mozambique. It is not a one size fits all solution. We have to look at the peculiar circumstances for each country.

Barbara Follett

  133. Apart from the obvious example, what political leadership is there in sub-Saharan Africa to spearhead a response to HIV/AIDS? What is being done to remove the stigma from those with HIV and protect their human rights?
  (Professor Whiteside) What is the obvious example you see?

  134. I was getting myself into trouble there. I was going to talk about President Mbeki and what he had said, which might be questionable in terms of leadership.
  (Professor Whiteside) I think there is an obvious example of leadership, and that is President Museveni. Coming back to an earlier questions, what are the lessons from Uganda: I think the main lesson we can learn from Uganda is leadership at every level, but leadership from the top to start with because that makes the whole thing respectable and makes it possible to have leadership all the way down. What is being done in terms of leadership. I have to say, I am hugely disappointed by the lack of leadership we are seeing. When we look at a problem like HIV and AIDS I think there are three stages in our response. I think that we, working in the HIV and AIDS community (and I am sure there are people behind me in that community), have made two very serious mistakes. The first mistake we made was to go out and say, "There is a problem". We went out and said, "AIDS is a problem". Eventually people were convinced there was a problem called AIDS, but what we had not done was shown them that it was a general problem, and one which they needed to take on board. Then we get to the second stage in terms of what we have done, and we have made everyone convinced that it was our problem. We did it in such a way that they did not see what they could do about it. We had everyone convinced that there was a problem, that it was their problem, but they did not know what to do with it. That is the paralysing result. People cannot see where to go. With a problem on this scale it is very easy to get to that point. It is rather like global warming. We all know the climate is changing. What are we doing about it? I take my tin cans down to the recycling plant religiously but that is about it. We have that effect in terms of AIDS. We just paralyse people. We now need to get to the third stage, which is: there is a problem; it is our problem; and this is what we are going to do about it. That is the point we need to get to with leadership, to show that they do not have to stand there like rabbits transfixed in the headlights, watching for the train coming down the track. There is something they can do, and it does not have to be done by a group of people parachuting in from Washington, London or Paris.

  135. Do you think much has been done to remove the stigma from HIV/AIDS in South Africa, or in other parts of sub-Saharan Africa?
  (Professor Whiteside) I think there are one or two places where it has been addressed and addressed successfully. I think Uganda is the one example of a place. It can never be normal for someone to be living with HIV and AIDS, but it is, to some extent, accepted. In South Africa, no, absolutely not. The stigma involved in admitting you are HIV positive is huge. It is terrible, because there are growing numbers of people who are living with HIV and AIDS and who are unable to admit to it. In one provincial parliamentary grouping there was a person who was admitted to hospital living with HIV and AIDS. A friend of mine from an NGO was called in to counsel that person, and the hospital administrator said, "This member of the provincial cabinet said he did not want to see anyone from government because then they would know he was HIV positive". That is the scale of the problem we are looking at.

  136. My daughter lives in South Africa (and I spent a great deal of my life living there) and recently her domestic was raped. This is a woman who has had three sexual partners in her 37 years of life. As part of the test after the rape she had an HIV test. She was found to be positive. Two weeks had not elapsed since the rape so it was not from the rape. This is a very respectable churchgoing woman in deep, deep shock at what has happened to her. What has shocked my daughter has been the lack of back-up that this woman has received. The back-up has come because my daughter has hassled. There has been no counselling or help, and the stigma has been huge on this totally respectable and probably almost blameless woman, who is now trying to adjust to life with this disease. Therefore, I agree with what you are saying and I think the scale of the problem is huge. To turn to the economy, obviously this will have an effect on GDP. Are there any points on the scale where infection would have more of an effect on GDP? Is there some point where it meets on the graph where it definitely would have an effect on GDP?
  (Professor Whiteside) You are asking an economist this. As you probably know, economists have successfully predicted 27 of the last nine recessions, so I am not quite certain how to answer this! I think there are a number of bench-marks, and at these points you start to get seriously worried. I think the first one is when 5 per cent of the antenatal clinic attenders are infected; because I think at that point you are probably on that exponential stage of the curve. I think the next one is probably 10 per cent because then you are not succeeding in slowing it, and it is then going to go the way it is going to go. The World Bank has done some modelling on this. Basically what they are saying is that HIV has the potential to slow economic growth down. The way they look at it happening is through diversion of resources to savings. The reason that is important is because that is not going into investment for production. The second one is through the loss of skilled people. I think we are making something of a mistake, in that we are not understanding the totality of the society, politics and economics and how they interact. I have just completed a book with somebody you will probably know called Clem Sunter. Clem and I when we were writing the book speculated about doing a correlation between South African firms' listing on the London Stock Exchange and HIV prevalence levels; and then we decided, no, that would be very naughty because it is rather like looking at penguins and sales of ice cream in the United Kingdom — there is no correlation. There is not a correlation, and I would like that in the record! I suspect that HIV does have an impact on the ability of a country's economy to operate, on investment perceptions and whether or not people are going to be there. I know there are many people in countries like Zambia, Zimbabwe and Swaziland, who are looking at the epidemic and saying, "What is this going to mean?" It may mean government inefficiency. It will mean less in the way of savings that you can access. I think that the circular effects of the epidemic is one we have not unpacked. That is one area where some donor actually needs to start saying, "Let's look at what HIV and AIDS means to societies in terms of how we interact, not just in economic terms".

  137. It will obviously have an impact on government tax revenues at some point?
  (Professor Whiteside) Absolutely.

  138. Do you think South Africa is going to be worse hit than other sub-Saharan African countries, or not?
  (Professor Whiteside) I think the other thing which is quite an important point to make is that none of this is written in stone. The fact that we are sitting here talking about this means we can change the way things are going to happen. That is what this Committee is about, I feel—looking into the future and saying, "These are the choices, let's try and choose different roads". To come back and try and answer the question: I think, yes, it has the potential to be worst affected because the citizenry of South Africa has, understandably and quite rightly, a greater expectation of what they can get from the state and what they are going to give to the stage. So we have more of a social contact there. From that point of view, it could be worse. Also healthcare and education are available and people are entitled to that. They will make demands, so from that point of view the impact could be worse. On the other hand, we have far more resources to deal with this. We are a country that has come through years of apartheid, and we have seen several miracles happen. Maybe we can do something about it. We have to hope and pray for that.

  Chairman: That leads us directly to what is happening in the private sector.

Mr Colman

  139. I look forward to seeing the work that you have been doing with Clem Sunter and being more direct, rather than listings on the UK Stock Exchange. Is there any evidence that HIV/AIDS is affecting company profits in South Africa and in other areas that you know about and is there any evidence to date of the impact of HIV/AIDs on foreign investment and on domestic savings? In a sense, you have answered the second part by saying that there is a propensity to save more. What effect has there been on company profits that you have been able to track, and how has that affected foreign investment?
  (Professor Whiteside) Let me answer with a case study. In South Africa there is a company called the Joshua Doore Group—their stores include Bradlows, Russells, Score, Electric Express—and in 1998 they carried out a study that looked at issues around HIV/AIDS and they asked whether AIDS would affect their operations. They said that it would. They said that the prevalence of HIV is currently 15 per cent and that it will rise to 27 per cent among customers by 2015. They said that they expected there to be a demographic impact, "resulting in an 18 per cent decline in customers by 2015 in all provinces bar the Western Cape". They also expect a 14 per cent decline in customers by 2010 in Swaziland, Lesotho and Botswana. They said that the "consumption patterns will change as disposable income is reallocated" and that they needed to reposition themselves. They took decisions including "that of remaining within its core competencies and strengthening its market position; that of leveraging its existing infrastructure to cater for other customer needs; and that of diversifying geographically away from the HIV/AIDS epidemic". As a result, it has expanded into Eastern Europe and is opening shops in Czechoslovakia and Poland. That is what a perceptive company in South Africa has done. Yes, I believe that it will affect company profits. I believe that it has to. I believe that companies are caught between a rock and a hard place as they look at the impact on their operations and how they treat their employees in terms of benefits. I do not know quite how they will resolve some of the conflicts with which they are faced.

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