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13 May 2021 | Story Dr Bright Nkrumah | Photo Supplied
Dr Bright Nkrumah, Free State Centre for Human Rights, University of the Free State (UFS)

The year 2021 marks the 58th anniversary of the establishment of the Organisation of African Union (OAU) on 25 May 1963. The month of May is therefore celebrated annually as Africa Month. This piece, in essence, is a craving to respond to an often-articulated question: is Africa Month a moment of celebration or introspection? The former would have been preferred had the various freedoms offered by the organisation been more realistic and dealt with the concrete challenges bedevilling the continent’s population. 

At the onset, it ought to be acknowledged that the organisation was not forged with the intent of improving the living conditions of its population but to safeguard the recently won independence and sovereignty of its member states. Against this backdrop, the notion of non-interference in the domestic affairs (Uti Possidetis Juris) of states became its guiding principle, thereby fostering a culture of silence on abuses perpetuate by African rulers against their citizens.  Having said that there were notable illustrations of leaders such as Julius Nyerere, Kenneth Kaunda, and Samora Machel, who individually and collectively ‘invoked the notion of humanitarian intervention’ and waged crusades to relieve Ugandans from the jaws of Idi Amin. 

Indeed, one of the significant achievements of the OAU during this era was the adoption of the African Charter on Human and Peoples’ Rights (Charter) in 1981. The instrument may be seen as a trumpeting of freedom, as it considers the rights and wellbeing of Africans sacrosanct and uncompromising. It is important and perhaps enthralling that all African states are parties to the Charter. While the large-scale ratification could enhance its moral force, it could also be used as a red herring to cover up various atrocities in hostile countries.

Where are we?

In 2002, African rulers meeting in Durban, South Africa, adopted the Constitutive Act, transforming the OAU into the African Union (AU). The new Act perhaps seems to be breathing fresh air into Africa’s rights struggle. In stark contrast to its forerunner, the Constitutive Act authorises the AU to intervene in a situation where citizens are threatened by grave danger perpetrated by their governments or external forces. Remarkably, article 3(k) calls for raising the ‘living standards of African people’. Going by these aspirations, one might speculate that Africans are in for a cheery and jolly ride.

Remarkably, while the Act addresses several aspects of the continent’s socioeconomic issues its operationalisation remains the captive of competing for national interests of AU states. Four key setbacks merit consideration here.

Instability: The landscape of Africa is punctuated by rulers’ embezzlement of public funds, ethnic privilege, and siphoning resources to one’s home village to the detriment of others. This bias tends to incite discontent and hostilities, even as one of the popular rhetoric of the infamous Boko Haram is to addressing Nigeria’s North-South resource disparity. By the same reckoning, hundreds of women and children have been displaced or killed from avoidable hostilities in geographical enclaves such as Cameroon, DR Congo, Mozambique, and Sudan.

Injustice: State security agencies and specifically the police force have evolved to be intimidators rather than the protective machinery they ought to be. More disturbingly, access to justice seems to be a pipe dream, as legal fees and prolonged trials make it burdensome for victims to seek remedies. As a common practice, many judicial systems across Anglophone, Francophone, and Lusophone countries are still modelled on ancient colonial systems, with lawyers and judges using convoluted legal jargon which frustrates rather than assists victims of abuse. 

Poverty: 40% of the continent’s population lives in extreme poverty or on <$1 (approx. R14) per day. Indeed, this figure is sobering. A reader might agree that the New Partnership for Africa’s Development (Nepad) may be seen as the primary document for reversing this trend. The document has, however, been criticised as given superficial treatment to the basic entitlement of vulnerable groups, and without feasible strategies on issues of underdevelopment.  It speaks to enhancing greater access to services, but segregates this aspiration from how the impoverished could access these essentials. Without a commitment to enforceable socioeconomic goods, such as health care, education, food, social security, the document may be seen as placing a stamp on the skewed access to resources already pervasive in local communities.

Covid-19: The onset of the pandemic calls for total marshalling of the continent’s fiscal and human resources. Sadly, the virus has claimed the lives of eminent cadres, teachers, and trade unionists who could have played a key role in this regard. South Africa alone has recorded more than 54,620 deaths, leaving behind hundreds of orphans.   Still, the ramifications are likely to be more significant, altering the structures of society and putting a strain on the financial resources of weak states. 

What ought to be done?

One golden thread running through these challenges is the weakness of the AU to forge effective institutions to restrain the excesses of states, monitor the government’s compliance with human rights obligations, and accountability. If the organisation seeks to improve human rights in Africa, it ought to revive debates towards Pan-Africanism and regional integration. At present, artificial borders erected by colonisers have created states which are simply not viable economic and political units. To this end, continental integration is the effective means of accelerating economic growth, uplifting the least developed countries, and domestically-based transformative development.

Opinion article by Dr Bright Nkrumah, Free State Centre for Human Rights, Faculty of Law, University of the Free State.

 


News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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