The revolution in healthcare is one of the untold stories of modern Africa. According to Renaissance Capital, all but four countries in Africa recorded improvements in infant mortality in the five years to 2010. Ten countries improved more than 5%, and Senegal and Rwanda improved by almost 10%.
Maternal mortality has dropped sharply, and life expectancy (which was reduced by the HIV and AIDS epidemic) bottomed shortly after the year 2000 and is now in strong recovery in all but a handful of countries in the region. Much of this is due to better access to clean water. For example, where only 30% of rural Nigerians had access to adequate clean water supplies in 1990, today that figure is 43%, and rising.
This helps to explain why African countries are seeing a continued increase in the number of young people in the population even when birth rates are already falling (as they usually do as populations start to become richer). Legatum’s Prosperity Report points out that the UN Population Division forecasts that by 2030, Africa’s overall fertility rate will have halved from its 1990 level of six births per woman to three births, and that by 2050, it will have fallen below 2.5.
Eventually population growth will plateau and then finally start to decline some time after 2050 – but the improvements in healthcare and sanitation already achieved mean that a much larger proportion of the children born in Africa will survive to become demanding citizens who want to see even better health and wealth levels for their own children.
The challenge for governments is that the next stage of healthcare development is likely to be a lot more expensive than the previous stage: Africa’s coming generation will demand hospitals and high technology treatments where today there are often only basic rural clinics. Africa’s growth in populations and improvements in the quality of life have set the stage for much faster economic growth in the near future. But some fear that expectations of improvement could outstrip ability to deliver that improvement.
The Legatum Prosperity Report argues that this could lead to the emergence of ‘Two Africas’. In the upbeat version of Africa, a combination of youth, education and better infrastructure all combine to attract new investment and new technology, and end up creating much greater wealth quite quickly. But there is also a downbeat version of Africa, which is pretty much the opposite. In this unhappy Africa, the challenges of finding jobs for young and growing populations, and of funding roads and airports, and hospitals and universities, all proves too much of a challenge for governments that are still much poorer than the rest of the world. In downbeat Africa the huge numbers of young people who should be building the economy end up burning it down.
As it happens, the Prosperity Report shows that the majority of citizens of sub-Saharan countries already feel that their governments are not doing enough to reduce poverty, and only 35% of people in the region think that now is a good time to find a job – an important measure of whether people believe their lives are getting better. Governments will be hard pressed to convince such dissatisfied populations – especially in those countries with the largest proportions of young people (and in Ethiopia, Kenya, Liberia, Nigeria and Uganda more than two thirds of the population is under 30).