By Sylvia Muyingo
NAIROBI, Jul 24 2024 – Prior to the COVID-19 pandemic, approximately 116 million people in the African region were living with mental health conditions. A large proportion of mental disorders is caused by depression and anxiety, and these conditions take a significant toll on health and wellbeing of people aged 15 to 59 years who are most affected.

In West and Central Africa (WCA) the prevalence of mental health disorders as reported in a book review by Juma et al ranges between 2-39%, with anxiety and depressive disorders as the leading causes of mental health disorders.

There is limited data on prevalence or burden of mental health disorders in West Africa, reflecting the insufficient attention given to mental health problems.

In one of few countries where a survey has been done, for example in Nigeria the most populous country in Africa estimated 12-month prevalence of anxiety at 4% from the Nigerian Survey of Mental Health and Well-Being – the first large scale mental health survey in SSA 2001-2003.

Furthermore, in SSA prevalence data for children and adolescents is available for only 2% of target population that is represented by available data on any mental health disorder.

The treatment gap i.e. the proportion of those in need who go untreated for formal mental health disorders in Sierra Leone was estimated at 98.8%. The population of young people in WA in particular is expected to double over the next decade. Many individuals may experience mental health challenges due to rising pressure from currently highly competitive labour market and infectious diseases.

Mental health is not only a problem in Sierra Leone, Nigeria or West Africa, it is a universal global problem and globally 1 in 8 (908 million people are living with a mental health disorder. Addressing these issues requires targeted interventions and support systems to ensure vulnerable age group receive care and resources needed.

In West Africa mental health systems face significant constraints partly due to local belief systems that often interpret mental health issues as spiritual rather than psychological or medical in nature. In West Africa, mental health problems are often viewed as spiritual or cultural diseases rather than as physical ailments.

Mental health is a legendary story in many African settings. Despite negative media attention about harsh practices used by traditional healers, they provide cheap services to individuals with mental illnesses including severe illnesses at spiritual centers or rustic facilities. These paraprofessionals far outnumber the medical professionals and hold social capital in communities because they fill a societal need.

Dr. Sylvia Muyingo

Mental health is influenced by cultural beliefs, stigma, and barriers to accessing healthcare. It affects more women globally, recent World Health Organisation research indicates that about 3.8% of people worldwide suffer from depression and it affects roughly 5% of adults, affecting 4% of men and 6% of women.

In WHO ATLAS report 2021, the availability and reporting of sex and age disaggregated mental health data was available for 43% and 54% in WHO AFRO region respectively versus 78% and 82% in high income countries. The availability of mental health data varies across the region, the low burden of disease may reflect the lack of data in some places. With only a few data points available in some places, regional trends are difficult to assess.

The acute shortage of qualified mental health specialists in West Africa is a major obstacle to tackling mental health issues in the region. Psychiatric services are hard to come by, particularly in primary healthcare settings when patients most need them. In 2017, 24% of countries in Africa did not have standalone Mental health policies and the proportion of MH worker was 9.0 per 100,000 according to a WHO MH survey.

In West Africa Policy makers have grappled with how to enable healthcare systems to deliver better health services with limited resources, infrastructure and access to trained mental health professionals. One strategy to close this gap has been task-shifting, in which non-specialist healthcare professionals receive training to deliver fundamental mental health services. Nevertheless, the general lack of healthcare resources and the requirement for extensive training programmes limit this approach’s efficacy.

It is over 20 years (2001) since the WHO and AU rolled out a comprehensive programme for promoting, development and integrating traditional medicine and mainstream medicine as another way of enabling affordable and accessible healthcare for the ever-growing African populations.

The reality is political commitment is one of the obstacles highlighted and collaboration, lack of policies or inadequacies of implementation, and absence of common treatment pathways. Many of the traditional medicine healers lack education and training as an enabler of integration because the lack of policy input to support integration activities is absent.

Mental Health exists on a complex continuum with substantial influence on well-being, economic and social impacts. At any one time the interaction of individual, family, community and structural factors intersect to influence a unique dynamic that may protect or undermine one’s mental health continuum. Increased attention from governments towards mental health including commitments to improve mental health disorders is needed in achieving the commitment of SDG Target 3.4 which calls for the promotion of mental health and well-being.

Advocacy and education initiatives play a critical role in improving mental health outcomes in West Africa. Community-based initiatives that involve people who have personally experienced mental health problems can be very successful in influencing attitudes and motivating others to get treatment. Local mental health champions who can offer peer support and function as reliable information sources in their communities can also be identified and trained by these programmes.

In my opinion many mhealth and ehealth technologies among people with mental health disorders feasible and acceptable and improves access and health outcomes.

Preliminary evidence suggests a combination of accessible technologies and trained individuals delivering interventions in the field help transform the role of prayer camps or traditional healers in serving people with mental disorders. However further investigations are required to draw conclusions about their effectiveness and cost benefit in this population and how to scale up.

Most of the projects are rarely evaluated and few serve marginalised areas or populations and contribute to improvement in care for mental health disorders. While investments in these technologies has increased, poor infrastructure and power, insufficient skills and policies and lack of government ownership lead to projects that are not scalable.

We need to consider a multisectoral approach because the factors determining mental health are multisectoral. Another approach is to extend services beyond the clinic and make mental health a priority in West Africa’s public health. A substantial impact can be achieved by expanding the pool of qualified mental health workers via specialised training initiatives, enhancing the healthcare system, and incorporating mental health services into basic healthcare.

Policies that raise awareness of mental health issues, lessen stigma, and guarantee that everyone, regardless of gender, socioeconomic background, or place of residence, has fair access to care are also essential.

Initiatives such as the Mental Health Data Prize – Africa, aim at leveraging existing data to address mental health challenges across Africa and contributing to a more resilient future for all.

The prize delivered by the African Population and Health Research Centre (APHRC) in partnership with the Wellcome, aims to close data gaps and improve our understanding of how to tackle anxiety, depression, and psychosis while also enhancing evidence-based decision-making in Africa.

Since January 2024, APHRC has been running an open capacity-building program, which has included sessions in mental health research, data science and machine learning, lived experience and evidence-based policy decision-making. The five-month capacity strengthening initiative seeks to bring together researchers, data scientists, policymakers and those with lived experiences to address research leadership, policy and management gaps, to facilitate future sustainability and innovation

In conclusion, mental health solutions in West Africa will require a concrete plan that takes into account technology improvements and data insights in expanding access to care, education and joint multifaceted efforts involving governments, healthcare providers, and communities to make significant progress on improving mental health outcomes in the region.

Dr. Sylvia Muyingo is a research scientist at African Population & Health Research Centre

By Deborah Nyokabi
NAIROBI, Kenya, Jul 24 2024 – Thandi*, a 14-year-old girl from Malawi, is both a child and a mother. After she and her siblings were orphaned, they were left in the care of their grandmother, who struggled to provide for them.

Thandi recalls with sorrow how two years ago, her grandmother ‘sold’ her to a much older man for a bride price of 15,000 Malawian Kwacha (approximately USD $8.65). This meager sum was only enough to buy a week’s worth of food for the family.

Forced to drop out of school to become a wife, Thandi’s dreams of education were abruptly curtailed when she left education in Standard 7 (Grade 6). She explains, “Watching my friends continue with their schooling while I grappled with the challenges of marriage has left lasting scars.”

Over 6,000 kilometers away in Nigeria’s north-western Niger State, at the end of May 2024, the local government orchestrated marriages for 100 young women. Most were orphans who lost parents in the frequent bandit attacks that plague the region. Local officials claim that all the brides were aged over 18, but there are serious concerns that many were minors.

Child marriage remains widespread across Africa

A new report by Equality Now, Gender Inequality in Family Laws in Africa: An Overview of Key Trends in Select Countries, reveals pervasive discrimination in family laws across Africa, where child marriage remains widespread.

The continent is home to 127 million child brides. Although global rates of child marriage have declined from 23% to 19%, current trends suggest that by 2050, nearly half of the world’s child brides will be African.

The causes of child marriage are multifaceted. Challenges such as climate crisis, conflict, and socio-economic instability disproportionately affect women and girls, putting them at greater risk of human rights violations.

Rather than addressing systemic issues like poverty, sexual violence, and poor access to social support and reproductive healthcare, communities often resort to marrying girls off.

Governments are failing to protect girls

As in Thandi’s case, child marriage is commonly treated as a socio-economic band-aid. In her home country of Malawi, the practice has been completely illegal since 2017, when the government took the commendable step of raising the age of marriage to 18 for both boys and girls without exception.

However, child marriage remains widespread amongst a population that has over 70% living below the international poverty line, with 2020 data showing that 38% were married before the age of 18,

The situation is similar in other African countries. Niger is reported to have the world’s highest rate of child marriage among girls, with 76% married before 18. While in Mauritania, World Bank research cited that girls from the poorest households are almost twice as likely to marry compared to those living in the richest households.

Child marriage reinforces gender inequality, with girls viewed primarily as wives and mothers. What is especially concerning is how these harmful societal norms are sometimes state-backed by governments less willing to uphold girls’ rights.

In Mali, a watershed judgment by the African Court on Human and Peoples’ Rights in 2018 found Mali’s Personal and Family Code, which allows girls to marry at 15 or 16 while setting the same for boys at 18, violated Mali’s international and regional human rights obligations.

The African Court directed Mali to revise its Family Code to set the minimum age of marriage for both girls and boys at 18. Mali’s government has not yet implemented the judgment, rendering girls vulnerable to becoming child brides.

In Tanzania, a landmark judgment in 2016 mandated the government to set the minimum age of marriage for both boys and girls at 18, but Tanzania has yet to amend the Law of Marriage Act. This failure to enforce the judgment is leaving girls unprotected and is compounded by challenges that pregnant girls and adolescent mothers face in accessing education.

Tanzania’s long-term policy of expelling pregnant students from school was ruled by the African Committee of Experts on the Rights and Welfare of the Child (ACERWC) in 2022 to be a violation of girls’ human rights.

While the government has subsequently officially withdrawn this policy, the provisions in the Education Act that authorise exclusion from school of girls who are married, pregnant, or mothers remains unchanged, and there are serious concerns about the impact of Tanzania’s failure to fully implement ACERWC’s decision.

Girls across Africa who become pregnant may face the trauma of being forced to marry as a way to uphold family “honour” and avoid the social stigma associated with pregnancy outside of wedlock.

A cycle of abuse is perpetuated with young wives often denied access to education and economic opportunities, leaving them dependent on their husbands and in-laws. This makes them more susceptible to domestic violence and limits their ability to seek help or escape abuse.

African States have legal obligations to protect girls from early marriage

Child marriage is a gross violation of human rights and is prohibited by Article 16(2) of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), Article 6 of the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa (Maputo Protocol), and Article 21 (2) of the African Charter on the Rights and Welfare of the Child (the African Children’s Charter).

The Constitutive Act, which established the African Union, recognizes the promotion of gender equality as a fundamental principle of the Union. Guidance on how Member States can end child marriage is provided by instruments such as the Joint General Comment of the African Commission on Human and Peoples’ Rights (ACHPR) and the African Committee of Experts on the Rights and Welfare of the Child (ACERWC) on Ending Child Marriage.

The Southern African Development Community (SADC) Model Law on Eradicating Child Marriage and Protecting Children Already in Marriage is another great source for states to consider.

Government progress has been slow and inconsistent

Equality Now’s family laws report notes laudable progress, with comprehensive bans on marriage under 18 years introduced in various countries, including Côte d’Ivoire, the Democratic Republic of Congo, Egypt, Kenya, Malawi, Mozambique, and The Gambia.

However, progress overall has been protracted, inconsistent, and impeded by setbacks, insufficient political will, and weak implementation. Challenges are compounded by the plural legal systems in many African countries, where religious and customary legal provisions often contradict regional and international human rights standards.

In countries such as Cameroon, Nigeria, Senegal, South Sudan, Sudan, and Tanzania, discriminatory age limit provisions permit girls to be married younger than boys, while in nations including Angola, Algeria, and Tunisia, exceptions on civil or customary grounds remain.

Education is a remedy for child marriage

Urgent action is needed by 2030 to ensure all girls complete a full cycle of basic education. African leaders must work fast to develop and accelerate the implementation of progressive education policies that align and integrate with laws and policies addressing child marriage.

Strengthening legal frameworks to ensure the minimum age of marriage is set at 18 without exceptions is essential. Prosecution and punishment of perpetrators should be accompanied by behavior change campaigns that shift social norms and raise awareness about the harms of early on girls, their children, and the wider society.

Underpinning this all should be the application of a multi-sectoral approach entailing coordinated efforts across multiple sectors, including the state and civil society. Government policy and funding must prioritize women’s rights and define the responsibilities of different government arms, including health, finance, justice, social welfare, youth, and education agencies.

Providing scholarships and financial incentives, such as conditional cash transfers, can help keep girls in school and diminish the economic incentives for early marriage. Rwanda is a good example, having achieved significant increases in girls’ school enrolment and a corresponding decrease in child marriage.

The country has made education free and compulsory through secondary school, and the state is investing heavily in teacher training and school infrastructure.

Another noteworthy case is Ethiopia’s investment in the Berhane Hewan programme, which combines education with community awareness. Girls who participated were 90% less likely to be married before the age of 15 compared to those not in the programme.

Enhancing the capacity to collect, analyse, and use sex-disaggregated data for policymaking is also crucial for informed decisions. This data can highlight disparities and guide targeted interventions.

Moreover, implementing education programs that include comprehensive sex education is vital. Such programs empower girls with knowledge about reproductive health and their rights, thereby reducing rates of child marriage and early pregnancies.

In Mozambique, the Gender Strategy for the Education Sector aims to create equal rights and opportunities for girls in the education sector. While a strategy like this is geared towards equality in education, if data collection around child marriages is incorporated it can produce results on strategy’s impact on child marriage.

Governments must tackle the root causes of child marriage

To genuinely protect and empower young women, governments must address the underlying causes of girls’ vulnerabilities. This includes tackling drivers such as conflict and climate crisis, improving social protection systems, introducing legal reforms to prohibit child marriage without exception, and ensuring the effective implementation of laws.

Efforts must also be made to challenge and change harmful cultural and religious practices that undermine the rights of women and girls.

Critically, African Union Member States must universally ratify and implement the Maputo Protocol and the African Children’s Charter. To adequately equip girls to thrive in the 21st century, they must also discharge the education and gender equality obligations they have committed to under Agenda 2063 and Africa’s Agenda for Children 2040.

*Thandi is not her real name.

Deborah Nyokabi is Gender Policy Expert, Equality Now.

IPS UN Bureau

Follow @IPSNewsUNBureau
!function(d,s,id){var js,fjs=d.getElementsByTagName(s)[0],p=/^http:/.test(d.location)?’http’:’https’;if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+’://platform.twitter.com/widgets.js’;fjs.parentNode.insertBefore(js,fjs);}}(document, ‘script’, ‘twitter-wjs’);  

By Jomo Kwame Sundaram
KUALA LUMPUR, Malaysia, Jul 24 2024 – Many low-income countries (LICs) continue to slip further behind the rest of the world. Meanwhile, people in extreme poverty have been increasing again after decades of decline.

Jomo Kwame Sundaram

Falling further behind
World output more than doubled from $36 trillion in 1990 to $87 trillion by 2021 (in constant US dollars), but this growth has not been evenly distributed, causing most LICs to fall further behind.

Many of the world’s poorest economies have had meagre growth since the 1960s. As most developing countries have made progress, income gaps among nations have declined.

World economic stagnation adversely affects most countries and people, especially developing countries relying on commodity demand and prices. As much of the world grew, most LICs fell further behind.

Hundreds of millions are stuck in extreme poverty, with incomes per capita in many post-colonial countries barely changing. A World Bank paper argues the poor are especially worse off.

Many poor nations have not caught up, let alone diversified their colonial-type economies. Meanwhile, many poor nations remain mired in conflict, deepening their stagnation.

Poverty has risen due to poor progress as populations grew. Another World Bank report found lower growth correlated with conflict deaths and institutional fragility. Unsurprisingly, these countries often had the world’s highest poverty rates.

Worse, global warming disproportionately harms poor tropical nations and their populations much more. Climate change is expected to push well over a hundred million into extreme poverty by 2030.

Left behind
Paper co-author Paul Collier identified 58 countries in Africa, Asia and Latin America, with about 1.4 billion people in 2021, as the ‘Bottom Billion’. Collier argues most still face problems and have failed to progress since.

These nations have long suffered from persistent poverty, low growth, and failure to develop. Their plight has been exacerbated by civil conflict, geographic constraints, and, often, the inability to use their natural resources to accelerate economic development.

Since the 1980s – not the 1960s and 1970s, as the Bank paper claims – the Bottom Billion countries have failed to grow, falling behind instead. By contrast, the few former LICs that sustained high growth now enjoy per capita outputs at least thrice that of other Bottom Billion countries.

Except for these few notable exceptions, most of the 58 Bottom Billion countries remain LICs or have become lower-middle-income countries. Only six have achieved upper-middle-income country status in the past decade, mainly due to rapid growth thanks to oil and gas.

Although the Bottom Billion countries exist in all regions, about two-thirds (38 of 58) are in SSA. They account for 77% of the Bottom Billion population. Over half have abundant natural resources, but most have not used their mineral wealth to sustain economic progress.

In 2012, the IMF classified 34 of the 58 Bottom Billion countries as ‘resource-rich’, with non-renewable resource exports and revenue often exceeding 20% of their total exports and government revenue, respectively. But most still experience lacklustre growth, if any.

Since 1990, Sub-Saharan Africa (SSA) averaged barely 0.8% annual per capita income growth. Meanwhile, global growth rates doubled as regions like East Asia registered more than 6% yearly per capita growth rates.

Anaemic growth meant that the average incomes of Africans and other slow-growing LICs slipped further behind the rest of the world. Using the World Bank’s global poverty line, the number of poor Africans grew by tens of millions.

If current growth and poverty trends persist, many slow-growing or stagnant LICs, mainly in Africa, will be unable to end extreme poverty, let alone catch up with the rest of the world.

Poorest worst off
Conventional growth models imply that countries lagging behind should grow faster than those already ahead. East Asian industrialisation – supposedly emulating earlier European growth – supports this notion.

Growth in many LICs has slowed since the turn of the century. The paper finds that “The Bottom Billion fared worst of all”, as per capita output barely rose.

The poorest Bottom Billion did not experience convergence by catching up with the others. While some studies suggest overall income convergence, the world’s poorest are relatively worse off.

Now, the Bottom Billion are ‘falling behind’ while those in extreme poverty may be rising again. Incomes of the world’s poorest countries and people are likely to fall behind, even if only relatively, despite some convergence among countries.

The situation has worsened since 2022. In addition to the commodity-price collapse since 2015, the COVID-19 pandemic, the Ukraine and Gaza wars, and geopolitically driven unilateral sanctions have ensured protracted stagnation.

Bottom Billion countries lack the policy and fiscal space to cope with, let alone address, the impending debt crises. The situation has been exacerbated by tighter credit with high interest rates set by the US Fed.

Despite decades of recognising LIC characteristics, the World Bank has yet to develop strategies, policies and means to overcome their poverty. It is unclear why the Bank has endorsed the Bottom Billion designation, although it has not enhanced our understanding of poverty.

IPS UN Bureau

Follow @IPSNewsUNBureau
!function(d,s,id){var js,fjs=d.getElementsByTagName(s)[0],p=/^http:/.test(d.location)?’http’:’https’;if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+’://platform.twitter.com/widgets.js’;fjs.parentNode.insertBefore(js,fjs);}}(document, ‘script’, ‘twitter-wjs’);  

By Ignatius Banda
BULAWAYO, Zimbabwe , Jul 24 2024 – As the African diaspora continues its growth, agencies are seeking ways to tap into this vast demographic to help with the continent’s development.

Remittances from millions of Africans scattered across the globe have been hailed for sustaining local economies, but a new initiative is aiming to form upscale diaspora investments for longer-term economic development.

In June 2024, the International Organization for Migration (IOM) partnered with the African Development Bank and the African Union Commission (AUC) towards the implementation of a USD5.2 million project. 

According to officials, the fund aimed at eight African countries will “strengthen investment, human capital and philanthropic engagement from the diaspora in eight African countries.”

Most diaspora remittances in Africa go directly to beneficiary families to support anything from buying food to school fees.

The Streamlining Diaspora Engagement to Catalyze Private Investments and Entrepreneurship for Enhanced Resilience’’ (SDE4R) project will help The Gambia, Liberia, Madagascar, Mail, Somalia, South Sudan, Togo and Zimbabwe identify the best methods for effectively mobilizing the human and financial capital of the diaspora.

This follows the signing of a protocol agreement in Addis Ababa, Ethiopia, in December 2023.

The project will “support socioeconomic development by reviving the domestic private sector or recovery from political or humanitarian crises by leveraging the expertise and networks of Diaspora groups,” according to the IOM.

The fund will go towards supporting socioeconomic development by reviving the domestic private sector and recovering from political and humanitarian crises by leveraging the expertise and networks of diaspora groups.

“The African diaspora, with its vast resources, skills, and networks, holds an unparalleled capacity to drive economic growth, innovation, and resilience in our home countries,” said Lamin Drammeh, a manager at the African Development Bank financial intermediation and inclusion division.

“This multi-country intervention will contribute towards strengthening private sector development, which will foster economic growth as well as socioeconomic resilience in the beneficiary countries,” Drammeh said.

The initiative will also enhance “business development by leveraging diaspora-oriented financing opportunities and tools and entrepreneurship initiatives,” Drammeh added.

The African diaspora has been hailed by the continent’s governments for driving human development through annual multi-billion dollar remittances, but with little formalized investment.

The IOM’s partnership with the AU and the AfDB seeks to change that.

“Acknowledging the important role diasporas play in their countries of origin, several governments in Africa have developed policies that seek to harness the potential of their diaspora in national development through financial and social remittances,” said Mariama Cisse Mohamed, Director of the IOM Special Liaison Office in Addis Ababa.

“However, there are persistent challenges, including governments’ constraints on data collection among diaspora to facilitate meaningful engagement, limited dialogue between African governments and diaspora and the high transfer costs associated with remittance transfers,” Mohamed said.

With an ever-increasing number of African migrants making perilous journeys to developed countries seeking better economic opportunities, agencies are calling for the formalization of the continent’s development agenda with the Diaspora.

The multi-million-dollar SDE4R project is expected to address the needs of Africa’s most vulnerable populations, with the incentives also expected to stem the dangerous and usually illegal journeys African migrants continue making.

“It is further expected to contribute to reinforcing socioeconomic resilience of vulnerable populations, particularly women, youth, rural dwellers and forcibly displaced populations,” said Angela Naa Afoley, Head of Division of the African Union Commission’s Citizens and Diaspora Organization Directorate.

This will include assistance “through diaspora-related humanitarian, educational, health and other resilience-building support and the temporary return of skilled and qualified diaspora members,” Afoley said.

“By streamlining processes, reducing barriers, and providing strategic support, the SDE4R project will unlock new opportunities for investment, spur entrepreneurial ventures, and ultimately enhance the resilience of communities, nations and the continent,” Afoley added.

According to the IOM, the USD5 million project is expected to have 10,000 direct beneficiaries and 40,000 indirect beneficiaries in communities affected by conflict, climate change and other humanitarian and environmental disasters.

The IOM is implementing the project over three years with strategic oversight, guidance and advisory from the African Union Commission.

The initiative is part of the IOM’s Humanitarian Development and Peace (HDP) program, which focuses on the implementation of strategic frameworks and shared priorities among humanitarian agencies.

According to agencies, an estimated 160 million Africans are in the diaspora, remitting USD96 billion in 2021, more than double the USD35 billion recorded in official development assistance that flowed into Africa in the same year.

IPS UN Bureau Report

Follow @IPSNewsUNBureau
!function(d,s,id){var js,fjs=d.getElementsByTagName(s)[0],p=/^http:/.test(d.location)?’http’:’https’;if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+’://platform.twitter.com/widgets.js’;fjs.parentNode.insertBefore(js,fjs);}}(document, ‘script’, ‘twitter-wjs’);