The major focus in both national and international responses to HIV  pandemic is now on ensuring that as many positive people as possible have sustainable access to the specific drugs. But, whatever their medical efficacy they can only ever provide a partial solution to what has become a ‘post modern plague’ in so many of the poorest parts of the world. The coming decades are likely to be ones of increasing need and declining resources. Hence optimistic suggestions that drugs alone will soon bring an end to the pandemic will need to be treated with the greatest caution

by Lesley Doyal*

Emeritus Professor, School for Policy Studies

University of Bristol, UK

Why ’Big Pharma’ Alone Cannot End the AIDS Pandemic

 

Debates about the pharmaceutical industry have received new impetus over the past decade with the introduction of antiretroviral therapy (ART) for many of the millions diagnosed as HIV positive. Though these drugs do not offer a cure they do hold out the possibility of major improvements in wellbeing and life expectancy for those who are able to access them.

The major focus in both national and international responses to the pandemic is now on ensuring that as many positive people as possible have sustainable access to these drugs. But as we shall see, whatever their medical efficacy they can only ever provide a partial solution to what has become a ‘post modern plague’ in so many of the poorest parts of the world.

When ART first became available in the mid 1990’s, it was confined to high income countries with sophisticated health care systems. Some commentators argued against attempts to extend access to the poorer parts of the world on the grounds that lack of adherence would cause what they called ‘antiretroviral anarchy’. However many others campaigned against such a ‘double standard’, demanding a more equitable distribution of drugs (Chan 2015 ch3).

Early attempts to achieve more widespread dissemination were, of course, limited by the high cost of the drugs themselves. This led inevitably to lengthy battles with pharmaceutical firms over pricing as well as issues of intellectual property (Chan 2015). But aided by the production of substantial quantities of generic drugs in countries such as India and Brazil the wholesale price of first line drugs fell markedly after 2001. This made possible a dramatic increase in the number of people receiving treatment. By 2011 this figure had risen to a record 9.7 million compared to just over 8.1 million in 2011 – an increase of 1.6 million in one year alone (WHO,UNICEF& UNAIDS 2011). But many problems still remain.

First, there are still marked inequalities in access to ART. The most obvious of these are differences between rich and poor countries. Currently treatment in the US and Western Europe is accessed by more than 50% of all those known to be in clinical need. In Eastern Europe however the figure is only 21% and in the Middle East and North Africa it falls to only 11% (UNAIDS Fact Sheet 2014).

These inequalities partly reflect the wealth or poverty of individual countries and the strength or weakness of their national care systems. But lack of fairness is also evident within countries with members of marginalised groups being disadvantaged compared with their HIV positive counterparts. Studies from different parts of Africa, for example, have shown that men who have sex with men (MSM) are significantly disadvantaged while in the USA and Europe, injecting drug users (IDU’s) will also face additional challenges. In many settings, similar obstacles face male, female and transgender sex workers (Global Commission on HIV and the Law 2012).

If these inequalities are to be tackled, more attention will have to be paid to the social, cultural and economic obstacles facing disadvantaged groups or positive individuals who cannot make their way successfully through what has been called the ‘treatment cascade’ or care continuum.

Who tests and who does not?

The first stage of accessing care is of course testing, and many fall at this early hurdle. A recent estimate suggests that in the most affected African countries, only about 10-12% of people have been tested for HIV and know the result (Obermeyer and Osborn 2007). Worldwide, it is estimated that only about 40% of positive people are aware of their status. This reflects in part the lack of testing facilities. Though the number has increased significantly in recent years they are unevenly distributed with only around 5.5 per 100,000 people in low and middle income countries (WHO, UNICEF & UNAIDS 2011).

But even when facilities are available a wide range of factors may prevent individuals from testing. Of course many will simply be afraid of discovering that they have a serious and potentially fatal illness. But both women and men also report that they are afraid to test on the grounds that if they are found to be positive they may be treated badly by partners, family members and the wider community (Frank 2009).

In most settings women are more willing to be tested than their heterosexual partners. This is partly because they are offered (or required) to test in the context of their use of reproductive services. But it also reflects the reluctance of many men to threaten their masculine identity through appearing weak and vulnerable. As a result many are tested at a later stage than their female counterparts and hence will frequently have a worse prognosis (Skovdal 2011).

A number of studies have also shown that many are reluctant to test because the centres are perceived to be stressful. Most are overcrowded, with staff themselves under huge pressure and too often insensitive to the needs of those they are testing. Service users in many settings have reported a lack of respect as well as a marked lack of confidentiality especially if they test positive (Angotti 2010; Butt 2011).This will of course , be especially problematic in the small close-knit communities where many of the poorest people who are positive struggle to survive. This reluctance to test clearly presents a major obstacle to the success of any drugs based strategy.

What happens after testing?

Even if they are tested there will often be difficulties accessing treatment for those who are found to be positive. While some will have a CD4 count low enough to necessitate the immediate prescription of drugs others may have to wait until their condition worsens. As a result they may be lost to care in the intervening period. And even if treatment is successfully initiated there can be no guarantee that individuals will be willing and/or able to follow medical protocols.

When individuals do drop out of treatment this lack of ‘adherence’ is too often blamed on the individual’s irrationality or lack of will .However recent research has shown that a wide range of economic and social obstacles may face those who have both the need for the drugs and (at least theoretically) the access (Russell et al 2010; Nguyen et al 2007).

Recent US studies have identified the young, the less educated, the poorest, those who are black or Latino and those who do not have medical insurance as being least likely to continue their treatment (Horstmann et al 2010) Injecting drug users too are likely to drop out more frequently. While discrimination may be an important factor, it appears that in most parts of the world it is material and social deprivation that present the single most important obstacle to successful treatment.

Depending on the financial arrangements in place, antiretroviral drugs may be unaffordable for individuals. And even when they are free there may be charges for blood tests or any other treatments needed for opportunistic infections. There have also been a number of reports of corruption in settings where patients are forced to pay bribes (Zimbabwe Lawyers for Human Rights 2010).

As well as the cost of treatment itself the expenses of transportation to the clinic are frequently mentioned as obstacles to sustainability of therapy. Many studies from rural African settings in particular have highlighted the struggles faced by women in their attempts to balance the competing demands of transport, housing and school fees (Tuller et al 2010).

The cost or unavailability of food is also frequently mentioned as an obstacle to appropriate drug use across a range of settings. Lack of food is likely to exacerbate the side effects of ART as well as increasing the patient’s appetite and making them feel hungrier. Thus the medical requirement that the drugs be taken with meals may be impossible to fulfil in situations where food itself is short to come by (Hardon et al 2007).

Managing insecurity

The complexity of these obstacles in what are often very poor subsistence economies may well be exacerbated by the irregular supply of drugs and the lack of choice for service users. Being HIV positive is itself a major cause of insecurity with individuals having little knowledge of if and when their health is likely to deteriorate.

This will frequently be worsened in situations where drug supplies are intermittent as a result of inefficiency in distribution, corruption, social conflict or the natural disasters such as floods or earthquakes that are more common in resource poor settings. Not surprisingly, access to ART is often given little or no attention in the context of such crises yet for individuals it is of critical importance to their survival (Veenstra et al 2010).

A number of studies have shown that harm caused by institutionalised insecurity can be very severe and will often lead individuals to drop out of treatment. While they may begin with hope, this will often be dispelled in the case of drug shortages and lack of appropriate testing and monitoring equipment (Bernays et al 2010).

For many this will be highly stressful with increasing levels of insecurity and uncertainty. Not surprisingly patients find it especially difficult to deal with gaps in treatment or with unexplained changes of drug that appear to have no medical rationale. New combinations are often difficult to get used to and may produce side effects that individuals find unacceptable.

Many service users in situations of dependence also report feeling pressured to change their lifestyle as ‘positive living’ is increasingly stressed by heath workers, policy makers and funders (Nguyen et al 2007). A major requirement will be public disclosure of their status which many will be reluctant to do, having spent much of their time and energy trying to maintain secrecy.

Telling partners can be difficult especially for women who may be afraid of a violent response. For men on the other hand the requirement to ‘live positively’ by avoiding alcohol, cigarettes and unsafe sex may mean the loss of what they perceive as central to their masculinity (Mfecane 2007). For both women and men the requirement to always engage in safe sex may also place major constraints on plans they may have for creating a family (Richey 2006).

It is clear then, that while ART may be effective in ideal circumstances this does not apply to the situation of the majority of HIV positive people in low and middle income countries. As we have seen many have no access at all while others are unable to optimise the potential effects of the therapy as a result of economic and social circumstances as well as the duties, responsibilities and attachments they have to others.

What of the future?

Despite these problems, universalising access to ART remains the central theme of the global response to HIV and AIDS. The notion of ‘Treatment as Prevention’, or TASP, is intended to end the pandemic by ensuring universal access to drugs at an early stage for those diagnosed as positive. It is assumed that this in turn will reduce their infectivity and hence limit the spread to others. But how effective is this likely to be in the wider context of economic recession and growing inequality?

Increased access to treatment will mean a huge increase in the number of people living with HIV who will continue to be in need of drugs throughout their lives. Many will eventually need the much more expensive second and third level drugs. Hence much more investment will be required not just in the production and distribution of drugs themselves but also in the strengthening of health systems and the training and employment of health workers.

However the last few years have seen a continuing decline in available funding. Over the past two decades multilateral, bilateral and philanthropic organisations including The Global Fund, PEPFAR and the Gates Foundation have provided about 60% of all external HIV and AIDS funding to sub-Saharan Africa (Ravishankar et al 2009). The Global Fund has been especially important providing one fifth of all resources for HIV .

The percentage of countries where antiretroviral treatment programmes were adversely affected by reduced external funding rose markedly between 2008 and 2009. Eastern Europe and Central Asia have been particularly vulnerable to the effects of reduced external funding and the economic crisis. Less than a quarter of people in need of treatment in the region are now receiving it with drug stock-outs common and government health expenditure on HIV and AIDS treatment programmes falling sharply.

Not surprisingly the burden of funding is now falling increasingly on individual countries. Domestic spending on HIV care in low- and middle-income countries is already increasing, going from USS$ 3.9 billion in 2005 to nearly $8.6 billion in 2011. Over the next decade the growth rate of a number of the middle income or BRIC countries (Brazil, Russia, India and China) should enable them to meet the needs of their own positive citizens, provided they have the political will to do so.

But the fact remains that for millions of people in the poorest settings, domestic funds will simply not be available. High levels of indebtedness, disadvantageous international trade policies and structural adjustment have limited the volume of national expenditures on health care (AIDS2031 2010). A recent UNAIDS document estimated that the cost of funding HIV treatment will have peaked by 2030 (UNAIDS Fact Sheet 2014). However the coming decades are likely to be ones of increasing need and declining resources.

In the context of growing global inequalities there will inevitably be major questions over the funding of treatment. And even more importantly there is little sign that the lives of those in the greatest poverty will be improved to the point where they can take optimal advantage of available services. Even with improvements in the availability and affordability of antiretroviral drugs, many of those who are HIV positive will not be able to optimise their wellbeing without radical economic and social change (Doyal with Doyal 2013 pp 169-172 and 183-185). Hence optimistic suggestions from New York and Geneva that drugs alone will soon bring an end to the pandemic will need to be treated with the greatest caution.

 

REFERENCES

-AIDS2031 (2010) Taking a Long Term View. London: Financial Times Press
-Angotti N (2010) Working outside the box : How HIV counsellors in sub-Saharan Africa adapt HIV western testing norms. Social Science and Medicine 71 (5) 986-993
-Bernays S & Rhodes T (2009) Experiencing uncertain HIV treatment delivery in a transitional setting: a qualitative study. Aids Care (3) 315- 21
-Butt L (2011) Can you keep a secret? Pretences of confidentiality in HIV/AIDS counselling and treatment in Eastern Indonesia. Medical Anthropology 30 (3) 319-38
-Chan J (2015) Politics in the Corridor of Dying: AIDS activism and global health governance. Baltimore: Johns Hopkins Press
-Frank E (2009) The relation of HIV testing and treatment to identity formation in Zambia. African Journal of AIDS Research 8 (4) 515-524
-Global Commission on HIV and the Law (2012) Rights, Risks and Health. New York: UNDP HIV/AIDS Working Group
-Hardon A et al (2007) Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa. Aids Care 19 (5) 658-65
-Horstmann E et al (2010) Retaining HIV infected patients in care: where are we ? where do we go from here? Clinical Infectious Diseases 150 (5) 752-6
-Mfecane S (2011) Negotiating therapeutic citizenship and notions of citizenship in a South African village. African Journal of AIDS Research 10 (2) 129-138
-Nguyen V-K et al (2007) Adherence as therapeutic citizenship: impact of the history of access to anti-retroviral drugs on adherence to treatment. AIDS 21 (supp 5) S31-5
-Obermeyer C & Osborn M (2007) The utilisation of testing and counselling for HIV: a review of social and behavioural evidence. American Journal of Public Health 97 (10) 1762-72
-Ravishankar N et al (2009) Financing of global health: tracking development assistance for health from 1990 to 2007. Lancet 373 (9681) 2113-24
-Richey L (2006) Gendering the Therapeutic Citizen: ARV’s and Reproductive Health. CSSR Working paper no 175 Cape Town: UCT Press
-Russell S et al (2010) Expanding anti-retroviral therapy provision in resource-constrained settings: social processes and their policy challenges. AIDS Care 22 (Supp 1) 1-5
-Skovdal M (et al) 2011 masculinity as a barrier to men’s use of HIV services in Zimbabwe. Globalisation and Health 15 7
-Tuller D et al (2010) Transportation costs impede sustained adherence and access to HAART in a clinic population in southwestern Uganda: a qualitative study. AIDS and Behaviour 14 (4)
-UNAIDS Fact Sheet: Global Statistics 2014
-Veenstra N et al (2010) Unplanned anti-retroviral treatment interruptions in Southern Africa: how should we be treating these? Globalization and Health 6 4
-WHO,UNICEF and UNAIDS (2011) Progress Report : Global HIV/AIDS Response. Epidemic Update and Health Sector Progress Towards Universal Access Geneva: UNAIDS
-Zimbabwe Lawyers for Human Rights (2010) Corruption Burns: Universal access to treatment. Harare ZLHR

——————————————————————
For further elaboration of these ideas as well as a broader commentary on the pandemic see Doyal L with Doyal L (2013) Living with HIV and Dying with AIDS: Diversity, Inequality and Human Rights in the Global Pandemic Ashgate

 

* Lesley Doyal is Emeritus Professor of Health and Social Care at the School for Policy Studies, Bristol University, and has just completed six years as a Visiting Professor at the University of Cape Town. She has published widely in the field of international health and health care with a particular focus on gender. In this capacity she has acted as a consultant for a number of organisations including WHO,UNDAW,Global Forum for Health Research and the British Council.In recent years she has worked extensively in the area of HIV and AIDS using a combination of political economy, ethnographic and intersectional perspectives. Her latest book has been widely acclaimed as the first attempt to provide a global and interdisciplinary approach to life with HIV. Entitled ‘Living with HIV and Dying with AIDS:inequality, diversity and human rights in the global pandemic’ it is published by Ashgate. 

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Surveillance of resistance to anti-TB drugs remains a cornerstone of any effective TB control programme worldwide. With the availability of new technologies and new drugs, and the prospect of new regimens for the treatment of TB and MDR-TB, surveillance of drug resistance is evolving and adapting to continue being a critical tool to inform public health actions to fight TB

by Matteo Zignol

and Mario Raviglione

Global Tuberculosis Programme
World Health Organization

Global Surveillance of Resistance to Anti-Tuberculosis Drugs

 

“Surveillance” is the systematic ongoing collection, collation and analysis of data for public health purposes and their timely dissemination for assessment and response as necessary (from the International Health Regulations, 2005, adopted by the 58th World Health Assembly).

The basis for global surveillance of drug resistance in tuberculosis (TB) was set during internal discussions within the World Health Organization (WHO) in 1993. A global project on anti-TB drug resistance surveillance was initiated in 1994 with the aim of collecting and evaluating data on drug resistance in TB in a systematic way around the world. Surveillance is needed to measure the frequency of drug resistance as an indicator of the effectiveness of prevention and control activities; to accurately forecast the need for drugs and plan accordingly; to design standardized regimens for the treatment of drug-resistant TB; to assess epidemiological trends; and to identify local outbreaks of drug-resistant TB for a timely response.

Within the standardized methodological framework designed by WHO, two main mechanisms of surveillance are used to collect data on drug resistance that are representative of a geographically-defined population allowing comparison across and within settings over time: surveillance based on routine drug susceptibility testing of all TB patients and periodic surveys of sampled TB patients.
A network of 33 WHO Supranational TB Reference Laboratories covering all six WHO regions supports global surveillance of drug resistance in TB.

Since 1994, therefore, data on drug resistance have been systematically collected and analysed from 144 countries worldwide (74% of 194 WHO Member States). Half of them (72 countries) have established continuous surveillance systems based on routine diagnostic drug susceptibility testing (DST) of all TB patients. The remaining 72 countries rely on ad-hoc epidemiological surveys of representative samples of patients. All countries with high burden of TB and/or multidrug-resistant (MDR*) TB (a total of 36 countries) have either established a continuous surveillance system or conducted at least one survey over the past two decades to monitor drug resistance.

* defined as a form of tuberculosis that is resistant to at least isoniazid and rifampicin

Continuous surveillance for MDR-TB, based on routine DST of TB patients and systematic collection, collation and analysis of data, is the most effective approach to monitor trends in drug resistance over time. The number of countries that can rely on data generated by continuous surveillance systems is increasing, due to efforts invested in scaling up the availability of culture and DST services. Among the 36 countries classified by WHO as suffering from a high TB and/or MDR-TB burden, 10 have put in place high quality surveillance systems to monitor drug resistance. All these countries are in Eastern Europe and Central Asia where the burden of MDR among TB cases is the highest world-wide.

Ad-hoc surveys still represent the most common approach to investigating the burden of drug resistance in resource-limited settings where routine DST is not accessible to all TB patients due to lack of laboratory capacity or resources. Of the 36 countries with high TB and/or MDR-TB burden, 26 have generated drug resistance data through special surveys. Half of them (13 countries) have conducted surveys in the most recent years between 2010 and 2013.
Central and Francophone Africa remain the regions of the world where drug resistance surveillance data are the scarcest, largely as a result of the current weak laboratory infrastructure.

Globally, 3.5% (95% CI: 2.2–4.7%) of new TB cases and 20.5% (95% CI: 13.6–27.5%) of previously treated cases are estimated to have MDR-TB. These estimates are essentially unchanged compared with recent years. The highest proportions of MDR-TB are found in countries of Eastern Europe and Central Asia where in some settings up to 50% of all TB cases have MDR-TB.
Globally in 2013, an estimated 480 000 (range: 350 000‒610 000) new cases of MDR-TB emerged worldwide and 210 000 (range: 130 000‒290 000) died from MDR-TB.

Extensively drug-resistant (XDR**) TB had been reported by 100 countries globally by the end of 2013. A total of 80 countries and territories reported representative data from continuous surveillance or ad-hoc surveys regarding the proportion of MDR-TB cases that had XDR-TB. Combining their data, the average proportion of MDR-TB cases with XDR-TB was 9.6% (95% CI: 8.1%–11%). The proportion of MDR-TB cases with resistance to fluoroquinolones was 17.0% (95% CI: 12.0–22.0). A total of 29.8% (24.3%–35.3%) of patients with MDR-TB have resistance to a fluoroquinolone, a second-line injectable agent, or both. These patients would likely be eligible to receive bedaquiline and/or delamanid, the new bactericidal drugs recently approved for use in patients with MDR-TB.

** defined as a form of tuberculosis which is resistant to at least four of the core anti-TB drugs. XDR-TB involves resistance to the two most powerful anti-TB drugs, isoniazid and rifampicin, also known as multidrug-resistance (MDR-TB), in addition to resistance to any of the fluoroquinolones (such as ofloxacin or moxifloxacin) and to at least one of three injectable second-line drugs (amikacin, capreomycin or kanamycin)

Surveillance of drug resistance is gradually expanding from the main first-line anti-TB drugs, rifampicin and isoniazid, to cover novel and repurposed drugs. For example, fluoroquinolones and pyrazinamide are now considered key drugs for future new regimens for the treatment of TB and MDR-TB. In this context, understanding the background prevalence of resistance to fluoroquinolones and pyrazinamide at the population level is critical to assessing the feasibility of the introduction of new drugs and shorter regimens. A new project to measure levels of resistance to fluoroquinolones and pyrazinamide among TB patients is being implemented in 7 countries (Azerbaijan, Belarus, Bangladesh, Pakistan, Philippines, South Africa and Ukraine). Correlation between phenotypic testing and genetic mutations, and levels of cross-resistance between fluoroquinolones are also being assessed. Results of this project will inform laboratory practices for surveillance and diagnosis of drug resistance and provide guidance to the development of diagnostic algorithms and to the introduction of new treatment regimens.

Molecular technologies are being increasingly incorporated into drug resistance surveys to simplify logistics. GenoType® MTBDRplus (Hain Lifescience, Germany) was used in the national survey completed in 2012 in Nigeria and is currently being used in the national survey in Sudan. In Pakistan, Xpert® MTB/RIF (Cepheid, USA) identified additional cases missed by culture in the national survey completed in 2014. In ongoing surveys in Papua New Guinea and Senegal, Xpert MTB/RIF is being used to screen specimens for rifampicin resistance and identify those requiring further testing at national or supranational TB reference laboratories. This approach greatly reduces the workload for laboratories and decreases the cost of national surveys.
In addition, high-throughput sequencing technologies are now increasingly being used for surveillance purposes. In a few years these technologies will likely completely revolutionize the way in which surveillance of drug resistance in TB is currently conducted.

Surveillance of resistance to anti-TB drugs remains a cornerstone of any effective TB control programme worldwide. With the availability of new technologies and new drugs, and the prospect of new regimens for the treatment of TB and MDR-TB, surveillance of drug resistance is evolving and adapting to continue being a critical tool to inform public health actions to fight TB.

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The professorship outlined here aims to establish a crossover between the tourism and health economies, developing innovative services that fit the changed needs of both inhabitants and visitors on healthy living related services/products and have an economic and social value

by professor Tomas Mainil ^1.2.3 

professor Olaf Timmermans ^1.3

1.HZ University of Applied Sciences, Vlissingen, the Netherlands, 2.Breda University of Applied Sciences, Breda, the Netherlands, 3.University of Antwerp, Antwerp, Belgium

Crossing over to an Associate Professorship, Focusing on the Development and Monitoring of Regional Challenges and Global Transformations

 

Globally, countries need to overcome demographic tensions in their populations. The challenge for the Dutch province of Zeeland is to develop social innovation in response to key societal challenges in tourism and health: Coastal regions are confronted with demographic changes, especially ageing of inhabitants as well as visitors (tourists) and their changing needs health-related issues. A cross-border cooperation, wherein a common approach is developed to explore problems and enhance opportunities, benefits the possibility to address this challenge.

Location of Zeeland in the Netherlands. Coordinates 51°34′N 3°45′E

Therapeutic landscapes feature unique natural assets, wherein inhabitants work and live and visitor (tourist) come over for holidays to recover from working life. Trends in some regions, however, show the aging of both inhabitants and visitors, as well as use of the unique physical environment to enhance healthy behavior. Tourism in these regions originated in exploitation of the environment towards healthy living related services and products. This associate professorship Healthy Region aims to overcome this challenge by establishing a crossover between the tourism and health economies, developing innovative services that fit the changed needs of both inhabitants and visitors on healthy living related services/ products and have an economic and social value. Economic because existing and new initiatives will benefit result in smart, sustainable and inclusive growth in both tourism as well as health economy. The social value relates to the prevalence of innovative services on healthy living for inhabitants. The shared facilities, product and services stimulating an active and healthy lifestyle will be developed by combining the needs of users, Sme’s (Small and medium enterprises) and policy makers and social innovation processes.

Insight in the needs of the users in the cooperating coastal regions to guide the development of shared facilities; Establishment of social innovation processes in the participating regions, wherein shared facilities are developed by multidisciplinary participation and empowerment of users in the quadruple helix; Development by multidisciplinary participation and empowerment of users in the quadruple helix. These might be the urgent strategies to overcome the austerity crisis in the EU. All the points mentioned above need to be steered by an integrative, multi-level organizational platform, which urges the capacity building of the associate professorship.

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Although new technology is essential, social change and social progress depend upon people, not on technologies. Social progress relies on understanding complex systems and the people who inhabit them first and foremost

by Sara Gorman*, PhD

Department of Health Policy & Management, Columbia University Mailman School of Public Health

Is More Technology Really the Answer to the World’s Global Health Problems?

 

There is no question that technology, both medical and non-medical, has had a major, transforming effect on the course of global public health over the past few decades. New vaccines have eliminated diseases, antiretrovirals have turned HIV/AIDS from a death sentence into a manageable illness, and portable diagnostics have allowed people to get treatment for illnesses they might otherwise never have known they had. More recently, there has been a lot of excitement around the potential of smartphones to solve global health problems. Everything from SMS medication reminders to novel surveillance techniques have been proposed and attempted in various locations around the world, including some of the least developed regions. Organizations like the Gates Foundation thrive on the notion that more technology is the answer to the world’s global health issues.

But is more technology really the answer to the world’s global health problems? A small yet vocal minority in the global health field is beginning to argue perhaps not. A new book by Kentaro Toyama called Geek Heresy: Rescuing Social Change from the Cult of Technology argues that technology is not, in fact, the main driver of social change, including improvement in global health. Based on his own observations working for Microsoft in India, Toyama persuasively asserts that social change and social progress depend upon people, not on technologies. Social progress relies on understanding complex systems and the people who inhabit them first and foremost.

In a similar vein, Julia Robinson, Director of Advocacy Programs at Health Alliance International, has argued that, although new technology is essential, it is not the sole answer to the world’s most pressing global health issues. Robinson also focuses on people, noting that in her experience, the most common problem in resource-limited health systems is the lack of qualified health professionals. As Robinson notes, health technology is important but even more important are the people needed to implement that technology.

None of this means that new technologies are useless in the quest for better global health. The issue is more that we must continuously evaluate our efforts and collect constant feedback from those benefiting from these technologies. As Robinson points out, simply engaging more deeply with people living in resource-limited settings can yield different insights on the problems actually faced by developing country health systems. These new insights should lead us to different kinds of solutions. These solutions may of course include technology but not without a deep understanding of the human experience of healthcare in resource-limited settings and a commitment to listen to genuine and much-needed feedback on everything the global health community does in these settings.

———————————————————————————-

 

*Sara Gorman, PhD is an MPH candidate in Health Policy and Management at Columbia University Mailman School of Public Health. She has written extensively about global health, HIV/AIDS policy, and women’€™s health, among other topics, for a variety of health and medical journals, including PLoS Medicine and International Journal of Women’€™s Health. She is currently working as a consultant for Janssen (the pharmaceutical companies of Johnson & Johnson) in Global Public Health division. She has worked in the policy division at the HIV Law Project and as a researcher at the Epidemiology Department at Harvard School of Public Health. She has also analyzed mental health policy under the ACA for the Vera Institute of Justice and researched the effectiveness of semi-mobile HIV clinics in rural Kenya for HealthRight International. 

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 Despite the relevant Chinese commitment in Africa, concern still remains about the actual Chinese efforts, but also about the effectiveness of the Chinese agricultural projects in Africa. These weak points are strengthened by the fact that regional stakeholders often complain about the lack of coordination and governance of the projects financed by China all over Africa. In addition, even if investment in agriculture seems to be intended to solve Africa's hunger issues, many still view China as engaged in a self-interested, exploitative grab for resources to feed its fast-paced growth

by Pietro Dionisio

Degree in Political Science, International Relations

Cesare Alfieri School, University of Florence, Italy

China-Africa Agricultural Cooperation: for the Sake of Whom?

 

Since the 1960s China has been tangibly present in Africa. This is proved by the fact that the Chinese authorities have implemented approximately 220 agricultural aid projects including several sectors, such as farming, animal husbandry and fishery and farmland water conservation.

This involvement in African agricultural affairs improved considerably after the Forum on Africa and China Cooperation Beijing summit in November 2006[1], that showed the commitments to the agricultural sector and the diversity of Chinese investments in Africa. According to this summit, in accordance with its African partners China agreed to build 14 agricultural centers in 33 countries, to send 100 senior agricultural experts and to train 15000 talents in various fields (1500 of them were to be agricultural technology professionals).

This major Chinese involvement in Africa is in accordance with a general view of the Central government. In fact, the former premier Wen Jiabao announced additional steps to reach UN Millennium Development Goals[2]. He maintained that it was necessary to intensify efforts to provide foreign countries with more agricultural aid [3].

China has become one of the principal players through several agreements signed with various African countries. For instance, the Government invested US$ 800 million in Mozambique to modernize agricultural infrastructure. This modernization should be achieved through the dispatch of 100 Chinese agricultural experts working in several research stations within the country. The duty of these experts is to work in collaboration with local groups to improve field yields and find other ways to increase the overall performance in the agricultural sector.

Despite the relevant Chinese commitment in Africa, concern still remains about the actual Chinese efforts, but also about the effectiveness of the Chinese agricultural projects in Africa. These weak points are strengthened by the fact that regional stakeholders often complain about the lack of coordination and governance of the projects financed by China all over Africa.

In addition, even if investment in agriculture seems to be intended to solve Africa’s hunger issues, many still view China as engaged in a self-interested, exploitative grab for resources to feed its fast-paced growth[4].

Historical Perspective

Especially in the last decade China has strongly increased its presence in African agriculture. Despite this constant presence on the African ground, it is still not clear to what extent the Chinese engagement has produced results in terms of agricultural development in African countries.

In this respect, information on investment and data on actual activities are very difficult to be obtained.

China could play an important role in Africa thanks to its previous experience. In fact, the challenge for food security holds lessons in several areas such as the application of technology and mechanization on agriculture, the improvement of social protection and agricultural and rural development.

China has always made clear that agriculture plays a key role in its aid programs for Africa. However, current discussions between China and African authorities have not produced considerable results due to many reasons. In fact, two main problems are at issue. First of all the presence of a mutual suspicion on both sides. Secondly, China’s preference to directly consult private entrepreneurs instead of a jointly coordinated partnership with regional bodies, such as CAADP[5], is another obstacle in the relations with African authorities[6].

The Chinese involvement dates back to the 1950s. The Bandung Conference of Non-Aligned Nations in 1955 can be considered as the beginning of the Chinese interests towards Africa[7].

At that time China was looking for new partners in Africa so as to become the third pole, thereby counterbalancing the Soviet Union’s hegemony and the Western “imperialism”.

The first event that can be cited as the beginning of the agricultural cooperation between China and African countries is the grant of food aid to Guinea in 1959. After that, China undertook several other agricultural projects on the continent[8].

The history of the Chinese agricultural involvement in Africa can be divided into three main phases:

“Non Reimbursable Assistance” (1959-1969): this period was characterized by Chinese  unilateral assistance and by the support to national liberation movements of African countries.

China’s agricultural assistance was intended as a tool in order to support the consolidation of political independence of the African countries linked with the aim of developing diplomatic relations between China and African countries.

In this period the efforts made were focused on the construction of agricultural technology, experimental stations, promotional stations, large farms and water conservancy facilities.

At the beginning, the projects had a positive impact, but soon after the handover to national governments, they began to deteriorate. This was the consequence of lack of financial inputs and inadequate management experience[9].

“Cooperation Based on Mutual Benefit” (1970-1999): during the 1970s, due to the implementation of the “open-up policy” and the weakening of ideological factors, the Chinese-African relationships no more experienced a unilateral non reimbursable cooperation, but a bilateral beneficial one linked with a gradual introduction of multilateral cooperation.

The principal tools used were technology sharing, talents output and personnel training[10].

In this phase, enterprises became the main bodies to implement plans for assistance. By the late 1970s, several Chinese firms invested in the development of new agricultural projects using funds from China’s foreign aid and preferential loans[11].

“Comprehensive Development” (2000-to date): the rapid economic development of the Chinese economy marks a new impulse in the Chinese-African cooperation. The establishment of the Forum on Chinese-African Cooperation (FOCAC) is an important step in this direction.

This partnership focuses on improving the independent development of agriculture in Africa through a set of comprehensive measures.

In order to favor these plans, China uses several funds including funds for foreign aid and from international organizations, and State funds for Africa.

These comprehensive plans include several projects concerning technology information sharing, the launch of pilot centers for agricultural technologies and the dispatching of agricultural experts with the aim of launching vocational education in agriculture or technological training. This approach is confirmed by China’s African policy as published in 2006:

“Focus will be laid on the cooperation in land development, agricultural plantation, breeding technologies, food security, agricultural machinery and the processing of agricultural and side-line products. China will intensify cooperation in agricultural technology, organize training courses of practical agricultural technologies, carry out experimental and demonstrative agricultural technology projects in Africa and speed up the formulation of China–Africa Agricultural Cooperation Program.”[12]

Agricultural engagement in Africa is defined as “South-south” cooperation[13]. This definition underlines the idea of a reciprocal partnership with mutual benefits. This policy continues to increase political relationships and soft power, developing commercial opportunities for national enterprises and enhancing China’s resource security[14].

For the period from 2012 to 2015, several measures have been established under the China-Africa cooperation:

1. To support CAADP (Comprehensive Africa Agriculture Development Program) for a ‘growth-oriented’ agricultural agenda for Africa
2. To send teams to train African agricultural technicians
3. To support agricultural vocational education system and send teachers
4. To build more agriculture demonstration centres
5. To provide technical support for grain planting, storage, processing and circulation
6. To encourage Chinese financial institutions to support corporate cooperation in planting, processing, animal husbandry, fisheries and aquaculture
7. To support UNFAO ‘Special Program for Food Security’
8. To facilitate access for African agricultural products to the Chinese market
9. US$20 billion credit line for infrastructure, agriculture, manufacturing and African SMEs
10. To publish and translate agricultural technology materials; joint participation in book fairs in China and Africa[15].

Tools Employed

Several actors play a role in this partnership, the main one being the Chinese Ministry of Commerce backed by the Ministry of Agriculture and the Ministry of Science and Technology.  Altogether, these institutions coordinate agricultural programs.

The patronized plans are implemented afterwards by Chinese institutes, state-owned enterprises and private firms through a competitive bidding process.

The China Development Bank and the Export Import Bank of China are tasked with financing these projects in the form of development commercial finance or export credits.

In 2006, the China-Africa Development Fund was established with the aim of enhancing Chinese-African commercial ties. It is noteworthy that this fund signed an agreement with  the China State Farm Agribusiness Corporation in order to establish joint company financing agricultural investment[16].

The Forum on China Africa Cooperation was implemented in 2000. Meetings are held every three years, allowing discussions among partners about projects and future engagements. Moreover, an increasing number of Chinese NGOs is committed in the implementation of agricultural plans in Africa.

It is not easy to estimate the amount of aid provided. In fact, the Chinese authorities are often more interested in emphasizing the impact on the ground of their action than the loans given[17].

Agricultural aid is mainly provided only to those countries that recognize the “One China Policy”[18], and particularly in two forms: either monetary aid or in kind payment. These loans are designed to support food production, breeding, storage and transport and infrastructure development. Furthermore, aids are given in terms of agricultural equipment, trainings, technical assistance and scholarships[19].

Chinese investment is another increasing factor. Several actors, including state owned enterprises, have a role in this sector, which makes it difficult to figure out the concrete management of the system. According to Scissors and in spite of what we might think, it seems that China is not engaged in large-scale African farming for export. In fact, to our knowledge China seems to have only 54 overseas projects covering 4,9 million hectares of land, of which only 463,792 hectares are in Africa[20].

Chinese Agricultural Investments in Africa

Figure 1: China’s outward FDI stocks in Africa ($10,000), 2003–09

Source: MCC, 2009 Statistical Bulletin of China’s Outward Foreign Direct Investment. MCC, National Bureau of Statistics of China & State Administration of Foreign Exchange of China, Beijing, 2010

China has strongly increased its Foreign Direct Investments (FDI) in Africa since the third Ministerial Conference of  FOCAC in 2006[21]. This increasing volume of direct investments has not been interrupted. In fact, it grew from US$ 30 million in 2009 to US$ 82,4 million in 2012.

Despite the fact that the share of Chinese agricultural investment is only 3,1% of the total investment in Africa, this amount is expected to increase considerably in the near future because agricultural cooperation is becoming a priority not only in China but even in some African countries.

Figure 2: China’s outward cumulative FDI stocks in Africa by industry (%), 2009

 

 

 

 

 

 

 

 

Source: Helen Lei Sun, “Understanding China's agricultural investments in Africa", 2009

According to the Millennium Development Goal (MDG) n.1 that establishes the eradication of extreme poverty and hunger, the Chinese authorities have supported agricultural investment in Africa, since they consider it as a necessary tool to achieve the MDG n.1[22].

Having laid emphasis on agriculture as an effective tool to reduce poverty, China is focusing its efforts mainly on rural infrastructure.

In fact, the productivity of the African land is usually low due to poor water irrigation systems and water resources. It is noteworthy that in Sub-Saharan Africa less than 4% of renewable water resources are used for agriculture. There are several barriers that have limited the efficiency of agriculture in Africa. These include lack of financial and human resources, poor performance of rural infrastructure and agricultural technology and an inadequate market access.

China has been extremely active in this sector. It has provided several countries, such as Zambia and Nigeria, with loans and implemented over 500 agricultural infrastructure projects[23].

The case of Zambia is relevant. To enhance the country’s storage capacity and consequently food security, the Chinese authorities signed an agreement with the Zambian government for the construction of twelve major grain storage facilities, covering a total area of 30 000 square meters equal to a storage capacity of 100 000 tons.

The Zambian example is just one among many. In fact, the Chinese Ministry of Commerce has signed agreements with 35 African countries for the building of large-scale infrastructure. The bulk of the investment (almost the 70%) is in Nigeria, Angola, Sudan and Ethiopia, but other projects concern Congo, Mali, Mozambique and Tanzania[24].

Moreover, several Chinese professionals, as already mentioned, are dispatched in Africa to build agricultural demonstration bases. Training courses are organized on issues such as rice and vegetable cultivation , meat processing and correct use of agricultural machinery.

Cameroon, Ethiopia, Benin, Liberia, Mozambique, Sudan, Tanzania and Uganda were the first countries in which China began to establish agricultural technology demonstration centers in 2009. In these centers, Chinese experts have to share their knowledge with local people thereby strengthening the African agricultural development. In this respect, 11 rice demonstration areas were established in Guinea-Bissau covering an area equal to 2 000 hectares. The results were really remarkable. For the majority of the products planted the output increased over three times encouraging the expansion of the covered area to 3 500 hectares[25]. Moreover, in this country China State Farm and Agribusiness Corporation collaborated with the China Hybrid Rice Engineering Research Center to introduce high-yielding hybrid rice.

It is noteworthy that the investment of Chinese firms in agriculture has considerably increased grain supplies in Africa, improving the domestic agricultural productivity of those countries included in the agreements.

Several situations can be cited. For instance, in Mozambique, Chinese investment has supported the establishment of 300 hectares of experimental paddy fields. Thanks to the efforts of the Chinese rice experts dispatched there, local farmers have the possibility to increase their yields per hectare by about two tons more than the previous yields. In addition, Chinese firms have invested in the improvement of local farmland, water conservancy systems and agricultural production conditions.

Rwanda is another case in which Chinese efforts have produced some good results. The Rwandan government has signed an agreement for a farmland improvement project aiming at increasing the utilization of water resources. The loans provided come from the African Development Bank and from Chinese enterprises[26].  In Ghana, too, there is a strong presence of Chinese investment. Here the efforts are mainly focused on the development of agricultural infrastructure[27].

Table 1: Chinese-aided agricultural technology demonstration centers in Africa

Country	Implementing Organization	Main demonstration Field
Benin Republic	China National Agricultural Development Group	Corn & Vegetables
Cameroon	Shaanxi Land-reclamation, Agriculture & Industry and Commerce corporation	Rice
Congo (Brazzaville)	Chinese Academy of Tropical Agricultural Sciences	Cassava
Ethiopia	Guangxi Bagui Agricultural Science & Technology Co.,Ltd.	Cash Crops
Liberia	Yuan Longping High-tech Agriculture Co.,Ltd	Rice
Madagascar	Hunan Academy of Agricultural Sciences	Rice
Mozambique	Lianfeng Agricultural Development Corporation	Seed breeding & Livestock
Rwanda	Fujian Agriculture & Forestry University	Paddy and Silkworm
Sudan	Academy of Agricultural Science	Corn and Wheat
South Africa	China National Agricultural Development Group	Aquaculture
Tanzania	Agricultural Tech Company	Rice
Togo	Huanchang Infrastructure Construction Company	Rice
Uganda	Huaqiao Fenghuang Group	Aquaculture
Zambia	Jilin Grain Group	Corn and Wheat
Zimbabwe	Research Institute of China agricultural Mechanization	Agricultural machinery & Irrigation

Source: Rex Ukaejiofo, “China-Africa agricultural co-operation Mutual benefits or self-interest?”, 2014

However, according to a recent study of AFD-CIRAD[28], it seems that some of the 100 Chinese projects are awarded as grants and the rest as private or public loans covering a small number of countries, namely Benin, Mali, Senegal, Ghana, Zimbabwe, Tanzania and Mozambique[29].

Special Program for Food Security

The Special program for Food Security is an important initiative started in 1994. The goal of this plan is to help low-income countries face food deficit and increase food security. In addition, a second aim is the promotion of the global south alliance in addressing food security. An important element of the plan is the establishment of partnerships through which the member countries should share their experience and knowledge in order to address the food issue also in other contexts.

Since 1996 the Chinese Ministry of Agriculture has managed to sign an agreement with FAO and countries in the global south in order to find a solution for some important issues such as agriculture and food security.

As a result, until now China has dispatched more than 700 agricultural experts mainly to seven countries: Nigeria, Ethiopia, Sierra Leone, Gabon, Mali, Mauritania and Ghana.

According to this program, China committed itself to donate US$ 30 million for the establishment of a trust fund aimed at boosting agricultural production capacity and increasing export and assistance for such countries in Africa.

The program focuses on important issues such as agricultural economy, agricultural planning, agricultural management, crop cultivation, animal husbandry and veterinary, aquaculture, processing of agricultural goods, agricultural machinery and agricultural engineering. Chinese firms have mainly invested in such fields as breeding of improved seeds, grain and cash crop planting, and processing of agricultural products[30].

Important investment was made in Nigeria where, starting from 2004, almost 500 experts and technicians were dispatched. In this country, together with local partners, experts implemented comprehensive techniques such as China’s swine methane-fruit tree ecological agricultural model and the raising of ducks in paddy fields. Moreover, new productive methods were experimented, ranging from a strong rice seedling on upland fields to a reasonable compact planting, regulation and control of moisture and fertilizers through production.

All these experiments and demonstrations were collected in a book, “Booklet on Practical Technologies for China-Nigeria’’, that gained a considerable importance because it became a guideline book for agricultural production not only in Nigeria, but also in other African countries[31].

Sierra Leone is another country which benefits from Chinese investment. Here four country stations were implemented in Kono, Kabala, Moyamba and Makali. In each of these stations a different technology is used. These technological devices include bio-gas digestion, honey bee culture, fish ponds and small scale agricultural mechanization. Moreover, teaching basic skills in rice, vegetable and poultry production is considered another key element of the country project.

Due to language difficulties, experts used different teaching methods. In fact, the “teaching by doing” method, based on practical demonstrations, was quite often applied in order to share practical skills. Moreover, each of the four stations implemented concrete demonstration of high yields.

The team dispatched there also performed some consolidation work: for example, the rebuilding of the irrigation system at Makali farm, a project built through Chinese investment in the 1970s[32].

Chinese Engagement in Mozambique

Chinese engagement in Mozambique began immediately after the independence of this country in 1975. In fact, in that year 120 Chinese agricultural experts were dispatched from the province of Sichuan. The aim was to help Mozambique develop 230 hectares of the Moamba state farm and the Matama farm in the Niassa province.

The partnership was strengthened in the mid 1980s when China decided to send farm machinery and an agricultural team to provide aid for  the implementation of the “Green Zone program”  in Maputo’s urban area[33]

In the same period, Chinese firms began to invest in the country and it was only after the end of the Mozambican civil war in 1992, that the two countries started to talk about the possibility of establishing joint venture. Things went slowly. By 2000 Mozambique received only one investment from China, coming from Anshan Grain and Oil Export Import Company, that invested in 20 hectares near Maputo and US$ 500 000 in the Zhongan vegetable farm[34].

Despite this slow beginning, the partnership went on and, between 2000 and 2011, nine additional enterprises invested in the country.

Two of these nine projects are particularly worth mentioning. The first one was a proposal by China Grains and Oils Group Corporation to invest US$ 6 million. The second one regarded Hubei Liangfeng, a provincial firm, that would invest US$ 1,5 million in the country.

Moreover, the Chinese authorities decided to finance the establishment of an agro-technology demonstration center that was to be built between 2006 and 2012.

In 2005 a joint venture between Mozambican businessman Zaidi Ali and China Grains and Oils Group was established for the implementation of a big project aimed at the production and processing of soybeans in Sofala province. Despite the efforts, the project failed. Unfortunately, there was evidence that the field was not appropriate for this commodity. Additionally, machinery imported from China was not suitable for the conditions of Mozambique and the venture could not secure work for the Chinese dispatched technicians[35].

Table 2: Chinese planned and approved agricultural investment in Mozambique (2000–11)

Source: Brautigam D., Ekman SM., "Briefing rumours and realities of Chinese agricultural engagement in Mozambique" (2012)

In 2004 another relevant plan was launched. This project was part of the Chinese “friendship farm” plans. The term friendship pinpoints a plan requested by the hosting country and considered politically important for its authorities. In 2004 the Mozambican government asked its Chinese counterpart to help develop its rice sector. After having studied the feasibility of the plan, China agreed to build a demonstration farm in the Gaza province. The Chinese firm Hubei State Farm Agribusiness Corporation accepted to invest US$ 1,2 million in the project[36]. The plan was based on two main purposes. Firstly, part of the Chinese political task was to solve Mozambique’s food limitations focusing on improving grain and vegetable yields. But the venture made experiments also for other products, such as soybean, tobacco, rapeseed and organic vegetables, in order to sell them in the European and Chinese markets.

At the beginning the farm was quite small. It consisted only of 100 hectares devoted to rice production. In 2008 a joint venture was formed with a Chinese private enterprise,  the Xiangyang Wanbao Group, which helped boost the production of soybeans, vegetables and other cash crops. By December 2011 the planted land reached 200 hectares and Chinese experts and workers were employed to build, develop and maintain the irrigation systems.

It is noteworthy that this plan was implemented with the contribution of the Bill and Melinda Gates Foundation that decided to finance it and use it as a test for the Gates Foundation’s  “Green Super Rice” program[37].

In 2011 the Chinese firms increased their presence in the country. Just to make an example, the Shandong Xinwei Grain and Oil Food Corporation launched Xinwei International Mozambique Co. Ltd. in Nampula. The company employed 130 Mozambicans and mechanized cultivation of 140 hectares of land. The main commodities planted were maize, groundnuts, sesame and mung beans. Moreover, a Chinese cotton company set up operations in Mozambique (and Malawi), buying cotton from contract farmers and processing the cotton locally[38].

Even though China is continuing its investment in Mozambique, its efforts are not easily applicable. In fact, Chinese companies investing in the country face several obstacles in accessing lands, because investors have to consult with local communities and obtain their acceptance, before lodging formal application with the authorities in charge. Nevertheless, it is not easy to negotiate with local communities due to the arising land identification problems. Moreover, especially in some contexts, it is difficult even to identify the legitimate authority representing the tribal communities occupying those lands.  For example, definitely due to these issues, China-Africa  Cotton Mozambique[39] adopted a new method. In fact, through this model, China-Africa Cotton Mozambique provides training and inputs to local peasants and, in return, purchases raw cotton from them. Working this way, it can strongly reduce costs associated with accessing land[40].

Another relevant problem that Chinese investors have to face is the poor condition of infrastructure, especially poor transportation and damaged irrigation systems, that often impede the implementation of activities such as expanding production or the adoption of new technology.

In Mozambique many problems are caused by a poor information system for the investors. In fact, the State is unable to provide correct information about lands in order to ensure the success of investment operations. In 1997 the National Land Cadastre was established in order to improve the situation. Theoretically, the aim of this institution is the collection of information about different types of occupation and land uses, soil fertility, hydraulic reserves and mining exploration zones. In addition, it should organize the use of land, its protection and conservation. In practice, the institution neither can collect information to guide agricultural investors, nor achieve the above tasks[41].

This lack of information produced the failure of the above mentioned China Grains and Oils Group in the Sofala province. Operations failed due to poor planning. In fact, the company did not get correct information about the type of soil. As a consequence, it brought seedling and machinery from China that were not suitable for that field, which caused the company to give up the project.

Chinese investment in Mozambique is still insignificant if compared to other forms of investment related to natural extractive resources. In fact, agriculture accounts only for 1% of China’s FDI to the country and only 12% of the Mozambican export goes to China (data of 2008).

Nonetheless, the two countries could gain more from their relationship; China in terms of imports and Mozambique in terms of agriculture and rural growth policies, farming technologies and institutional capacity building[42].

Unfortunately, Mozambique is still not able to absorb lessons because of its inefficiency. The poor capacity of the Mozambican state to effectively implement agricultural policies, build and conserve agricultural infrastructure and ensure a concrete agricultural development, is considerably jeopardizing the possibility to gain some advantage from this partnership[43].

At the same time, the increasing Chinese interest in agricultural partnerships has raised concerns about potential land grab[44]. This is true especially if we consider the social and economic implications that the hosting country has to face trying to address the increasing vulnerability of traditional subsistence farmers[45]. In this respect it is important to stress that the agreements signed at a governmental level often disregard the interests and the rights of local populations. In fact, the implementation of Chinese interest means the displacement of Chinese workers in rural areas directly damaging the livelihood of local communities. Moreover, other issues can arise. For instance, the increasing competition between Mozambican and Chinese producers in local markets, the increase of cash crop production at the expense of food crop production for local consumption.

Chinese Presence Impact on Africa

As stated above, in the last decade China has improved and differentiated its investment in Africa.

China’s presence in African agriculture has a huge potentiality. First of all, it can contribute to agricultural growth and poverty reduction as well as provide useful lessons through its own experience.

Unfortunately, often potentiality is not matched because of the vulnerability of African institutions. In fact, Chinese investment is hindered by social, economic, political and environmental perspectives. Moreover, indigenous institutions also affect the outcomes of China’s investment in agriculture.

In order to address its food needs, China sources agricultural products and commodities from Africa. This process can produce two main results. On one hand, the demand of the Chinese market can result in growing profit and business for African farmers but, from another perspective, as already analyzed in the case of the Mozambican situation, Chinese presence can result in changes of the livelihood of local communities and in a decreasing role of local peasants in the local markets in favor of Chinese farmers.

Figure 3: Export of Sub-Saharan Africa to China (US$ millions)

Source: Shenggen Fan, Bella Nestorova, and Tolulope Olofinbiyi, “China’s Agricultural and Rural Development: Implications for Africa”, 2010[46]

Despite these two relevant main effects, it is definitely sure that Africa needs foreign financial assistance to develop its agricultural sector and that, in this respect, China is an important partner providing knowledge sharing on technology and production.

Moreover, Africa could learn lessons especially on agriculture and rural growth, evidence-base policy making, pro-poor policy and institutions and capacity.

As for the first point, African countries should increase their investment in agricultural infrastructure such as irrigation systems. In addition, investment in agriculture resources must be increased and tailored to the African context in order to be able to concretely address social needs.

As for policy making issue, African countries should gradually implement their policies. First of all, they could test policies in some selected district or community, and after having controlled results, governments could implement them nationwide. In this respect, monitoring and evaluation capabilities must be improved.

Furthermore, policies have to be targeted to the  poor in order to reduce hunger and poverty. In this respect, a community base approach could turn out to be really positive. Programs should target vulnerable people in both rural and urban areas.

Unfortunately, African institutions lack the political power to attain their objectives. For this reason, African leaders should sustain their commitments to reform and provide more power to those institutions willing to cooperate with them. In addition, new institutional arrangements should be experimented to provide new development opportunities.

 

Notes 

[1]Source:  http://www.iprcc.org/userfiles/file/Li%20Jiali-EN.pdf

[2]FOCAC. 2012. The Fifth Ministerial Conference of the Forum on China-Africa Cooperation Beijing Action plan (2013-2015). FOCAC. Source: http://www.focac.org/eng/zxxx/t954620.htm  [2014, April 17].

[3]These major efforts to foreign countries should be materialized  by increasing the number of agricultural technology demonstration centers in developing countries to 30, doubling the number of agricultural experts and technical personnel dispatched. Moreover, in 2009, at the 4th FOCAC ministerial meeting, Premier Wen Jiabao further announced eight new measures in increasing Chinese investments in African agriculture. These measures entailed the establishment of twenty demonstration centers and fifty agricultural technology groups in Africa to take part in the training of up to 2 000 agricultural technical personnel.

[4]Buckley, L., “Narratives of China-Africa Cooperation for Agricultural Development: New paradigms’?”, Future Agriculture CBAA working papers no 053, 2013.

[5]The Comprehensive Africa Agriculture Development Program (CAADP) was established as part of NEPAD in July 2003 and focuses on improving and promoting agriculture across Africa. CAADP aims to eliminate hunger and reduce poverty through agriculture. It brings together key players – at the continental, regional and national levels – to improve co-ordination, share knowledge, success and failures, to encourage one another, and to promote joint and separate efforts to achieve the CAADP goals.

[6]Rex Ukaejiofo, “China-Africa agricultural co-operation Mutual benefits or self-interest?”, Center for Chinese Studies, Stellenbosch, South Africa, September 2014, p.14

[7]The Bandung Conference of Non-Aligned Nations was a meeting of Asian and African states, most of which were newly independent, and took place on April 18–24, 1955 in Bandung, Indonesia. The twenty-five countries that participated in the Bandung Conference represented nearly one-quarter of the Earth’s land surface and a total population of 1.5 billion people. The conference was organized by Indonesia, Burma, Pakistan, Sri Lanka, and India and was coordinated by Ruslan Abdulgani, secretary general of the Indonesian Ministry of Foreign Affairs. The stated aims of the conference were to promote Afro-Asian economic and cultural cooperation and to oppose colonialism or neocolonialism by any nation. The conference was an important step toward the Non-Aligned Movement. The participating countries were: Kingdom of Afghanistan, Burma, Cambodia, Ceylon, People’s Republic of China, Cyprus, Egypt, Ethiopian Empire, Gold Coast, India, Indonesia, Iran, Kingdom of Iraq, Japan, Jordan, Laos, Lebanon, Liberia, Libya, Nepal, Pakistan,Philippines, Saudi Arabia,Syria, Sudan, Thailand, Turkey, Yugoslavia, Democratic Republic of Vietnam, South Vietnam, Kingdom of Yemen

[8]Jiali, L., “Sino Africa Agricultural Co-operation Experience Sharing”,2014, March 19. Web source: http://www.iprcc.org/userfiles/file/Li%20Jiali-EN.pdf

[9]Brautigam, D., and X. Tang. “China’s Engagement in African Agriculture: Down to the Countryside”. China Quarterly, December, 2009.

[10]Yan, H., and Sautman, B., “Chinese Farms in Zambia: From Socialist to “Agro-Imperialist” Engagement?”, African and Asian Studies, 2010, pp. 307-333.

[11]One example of this can be demonstrated through the China State Farm Agribusiness Corporation utilizing Chinese preferential loans to buy farms in Zambia for agricultural development, primarily in grain, vegetable and livestock production.

[12]Chenchen Wu, “China’s Foreign Policy towards Africa.”, The School of Government and International Affairs, Durham University. United Kingdom. Web source: http://www.pol.ed.ac.uk/__data/assets/word_doc/0018/15633/chenchen_wu_paper.doc.

[13]South–South Cooperation is a term historically used by policymakers and academics to describe the exchange of resources, technology, and knowledge between developing countries, also known as countries of the global South.

[14]Buckley, L. (2013). Chinese Agriculture Development Cooperation in Africa: Narratives and Politics. IDS Bulletin, 44.4 Web source: http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1759-5436/issues

[15]FOCAC (2012), The Fifth Ministerial Conference of the Forum on China-Africa Cooperation Beijing Action Plan (2013-2015), Forum on China Africa Cooperation, July 23. Web source: www.focac.org/eng/zxxx/t954620.htm

[16]Buckley, L. 2013. “Narratives of China-Africa Cooperation for Agricultural Development: New paradigms’?”. Future Agriculture CBAA working papers no 053.

[17]Davies estimated total aid to Africa between 1949 and 2006 to be valued at US$5.6 billion. Davies, P. (2006), “China and the End of Poverty: Towards Mutual Benefit?”, Diakonia Report, Sundyberg, Sweden: Alfaprint Press

[18]The One-China policy refers to the policy or view that there is only one state called “China”, despite the existence of two governments that claim to be “China”. As a policy, this means that countries seeking diplomatic relations with the People’s Republic of China (PRC) must break official relations with the Republic of China (ROC) and vice versa.

[19]GOV (2010), “China-Africa Economic and Trade Cooperation”, Information Office, State Council of the People’s Republic of China. Web source: http://english.gov.cn/official/2010 12/23/content_1771603.htm

[20]Scissors, D. (2010), “Tracking Chinese Investment: Western Hemisphere Now Top Target”, The Heritage Foundation.  Web source: http://www.heritage.org/research/reports/2010/07/tracking-chinese-investment-western-hemisphere-now-top-target

[21]Helen Lei Sun, “Understanding China’s agricultural investments in Africa”, South African Institute of International Affairs, Occasional paper n.102, November 2009, p. 9.

[22]Sammis JF, ‘Statement by US Deputy Representative to ECOSOC John Sammis at the First LDC IV Intergovernmental Preparatory Committee’, US Mission to the UN, 10 January 2011. Web source: http:// usun.state.gov/briefing/statements/2011/154233.htm

[23]Chinese Academy of International Trade and Economic Cooperation, China–Africa Trade and Economic Relationship Annual Report, 2010.

[24]Ibid. p.17.

[25]Ibid. p.17.

[26]Ayodele, T., & Sotola, O. 2014. “China in Africa: An Evaluation of Chinese Investment”. IPPA Working Paper Series. Lagos.

[27]Amanor, K. S. 2013. “Chinese and Brazilian Cooperation with African Agriculture: The Case of Ghana”. Future Agriculture CBAA working papers no 052.

[28]It is a French research center working with developing countries to tackle international agricultural and development issues. It works with developing countries to generate and pass on new knowledge, support agricultural development and fuel the debate on the main global issues concerning agriculture.

[29]Rex Ukaejiofo, “China-Africa agricultural co-operation Mutual benefits or self-interest?”, Center for Chinese Studies, Stellenbosch, South Africa, September 2014, p.21.

[30]Li, X., Qi, G., Tang, L., Zhao, L., Jin, L., Guo, Z. And Wu, J., “Agricultural Development in China and Africa: A Comparative Analysis.”, Routledge. 2012.

[31]Li X. 2010. “Comparative perspectives in Development and Poverty Reduction in China and Africa.” IPRCC. Beijing.

[32]Brautigam, D., and X. Tang., “China’s Engagement in African Agriculture: Down to the Countryside”, China Quarterly, December, 2009.

[33]Wolfgang Bartke, “The Economic Aid of the PR China to Developing and Socialist Countries”, K. G. Saur, Munich, 1989, p. 92.

[34]Sérgio Chichava, “China in Mozambique’s agriculture sector: implications and challenges”, Institute of Social and Economic Studies (IESE), Maputo, November 2010, p. 5. Web source: http://www.iese.ac.mz/lib/noticias/2010/China%20in%20Mozambique_09.2010_SC.pdf.

[35]Brautigam D., Ekman SM., “ Briefing rumors and realities of Chinese agricultural engagement in Mozambique”, Oxford University Press, May, 28, 2012, p.6.

[36]Duncan Freeman, Jonathan Holslag, and Steffi Weil, “China’s foreign farming policy: can land provide security?”, Brussels Institute on Contemporary China Studies, 2009, p. 19.

[37]Chinese Academy of Agricultural Sciences, “Green Super Rice for the Resource Poor in Africa and Asia”, Semi-Annual Report, submitted to the Bill and Melinda Gates Foundation, July 2009.

[38]Brautigam D., Ekman SM., “ Briefing rumors and realities of Chinese agricultural engagement in Mozambique”, Oxford University Press, May, 28, 2012, p.8.

[39]Established in 2009, China-Africa Cotton Development Ltd  joint-ventured by China-Africa Development Fund, Qingdao Ruichang Cotton Industrial Co., Ltd and Qingdao Huifu Textile Co., Ltd, with a plan to invest about $64.72 million US dollars, and actual investment of $52.08 million US dollars as of today. As the parent company, China-Africa Cotton invests in many projects in various African countries, including Malawi, Mozambique, Zambia, Zimbabwe, Chad,Togo and Mali. Company focuses on seed researching, plantation, cotton purchasing and processing, cotton seed oil processing and textile making.

[40]Asanzi P (2014). “UNDERSTANDING THE CHALLENGES OF CHINESE AGRICULTURAL INVESTMENTS IN AFRICA: AN INSTITUTIONAL ANALYSIS”. Acad. Res. J. Agric. Sci. Res. 2(5): pp.76-87.

[41]Land law n° 19/97. Web source http://www.portaldogoverno.gov.mz/Legisla/legisSectores/agricultura/LEI%20DE%20TERRAS.pdf

[42]Roque, Paula C. (2009) “China in Mozambique: A Cautious Approach Country Case  Study”, South African Institute of International Affairs Occasional Paper No 23.

[43]African East-Asia Affairs, the China Monitor, “China-Mozambique relations: support and governance challenges”, Center for Chinese Studies, issue 72, June 2012, p. 22.

[44]This attitude has induced some scholars to suggest that Chinese land grab would turn Mozambique into the first China’s agricultural colony: Horta, Loro (2008) „The Zambezi Valley: China‟s First Agricultural Colony?‟, Web source http://csis.org/publication/zambezi-valley-chinas-first-agricultural-colony

[45]Bräutigam, D. and Xiaoyang, T. (2009) “China’s Engagement in African Agriculture: Down to the Countryside”, The China Quarterly, 199: pp.686-706.

[46]Shenggen Fan, Bella Nestorova, and Tolulope Olofinbiyi, “China’s Agricultural and Rural Development: Implications for Africa”, China-DAC Study Group on Agriculture, Food Security and Rural Development,  Bamako, April 27–28, 2010.