Japan's health revolution to be bestowed on Africa
Post-war Japan tackled several tropical diseases with community action - now it will help Africa do the same
Co-editors Journal of Public Health Policy
After the devastation of the Second World War, Japan was mostly rural and in a state not unlike that of sub-Saharan Africa today - but using the concept of 'village living' it succeeded in creating massive improvements in national health, and in the economy, within two decades. Malaria, leprosy, schistosomiasis and filariasis were eradicated. Through its new Health Development Initiative, and research in the Millennium Villages Project, Japan aims to encourage Africa to follow a similar path, towards and beyond the UN's Millennium Development Goals.
>by Andy Crump(i) and Taro Yamamoto (ii)
Japan is bringing its resources and own unique philosophy to bear on Africa, as part of a major new initiative to help achieve the Millennium Development Goals (MDGs). This will be a key element of the new US$5 billion Health and Development Initiative (HDI)(iii), which will help extend Japan’s “village living” concept to communities across Africa.
Japan ’s overseas development assistance (ODA) had been in decline following the bursting of the Asian economic bubble. Nevertheless, at the 2005 G8 Summit in the UK - at which all donors agreed to increase aid to Africa - Prime Minister Junichiro Koizumi reported that Japanese ODA would double, with a further US$10 billion being given over the next five years. This included a pledge to double Japan’s aid to Africa over the next three years, much of the new aid being disbursed through the new, comprehensive US$5 billion pro-equity HDI.
So will the HDI be more rhetoric, another initiative that will fail to meet its goals and drift into obscurity along with the many African-centred programmes that have preceded it? The evidence suggests not - and prospects for it having a substantial impact are good.
The Japanese experience
Japan has successfully undergone full-spectrum development in modern times. In post-World War II Japan, the picture was much the same as that prevailing in many of the sub-Saharan nations today. However, the nation rapidly developed the infrastructure, skills and resources needed to promote development, improve health and wellbeing and alleviate poverty.
Over less than 20 years, Japan drastically reduced its own infant and maternal mortality rates, eradicated infectious diseases such as malaria, leprosy, schistosomiasis and filariasis, markedly cut the impact of killer diseases such as tuberculosis, established a thriving economy, and produced world-leading living standards and social welfare systems for its entire population(iv).
This was accomplished through a comprehensive, community-based approach encompassing school-based interventions, improved nutrition, provision of potable water and sanitation, community involvement, building of institutional capacity, cohesive operation of research and control programmes, and via the creation of effective and reliable health systems and insurance with universal coverage.
A comprehensive strategy engaged all sectors, promoting community ownership, using science-based technologies and proven products, making best use of funds provided from local and external sources. Public and private sector agencies were engaged to ensure that knowledge was transferred and that best practices could be extrapolated into nationwide use. That is the philosophy behind the assistance that Japan is offering to Africa.
The global scene
On the global stage, Japan has already played a leading role in efforts to eliminate diseases such as smallpox, polio and leprosy, and has originated several global health ventures that benefit the developing world, particularly with regard to infectious diseases. These include the Global Issues Initiative on Population and AIDS (1994), the 1997 International Parasite Control Initiative (also known as the Hashimoto Initiative), which proved to be the forerunner of the Global Fund to Fight AIDS, TB and Malaria (GFATM), and the Okinawa Infectious Diseases Initiative (IDI), which began in 2000.
In 1993, Japan recognised the decline in global interest in Africa following the end of the Cold War, and consequently convened the first Tokyo International Conference on African Development (TICAD). Since then, it has extended over US$12 billion in aid to the continent and regularly holds TICAD conferences, the next being scheduled for 2008.
In addition, Japan has just announced the establishment of the Hideo Noguchi Prize, a US$1 million award envisaged as the equivalent of a Nobel Prize for outstanding contributions to medicine in Africa, to be awarded every five years at each forthcoming TICAD.
Japan ’s ODA
Japan ’s ODA approach is unique. The nation’s policy pays great respect to self-help characteristics and ownership and allocates funds purely upon the request of recipient nations. This creates a great deal of uncertainty over what will be funded and where, but also enables a great deal of flexibility to meet changing needs and circumstances, and helps ensure country ‘ownership’.
Japan ’s ODA, which it astonishingly began to dispense only a decade or so after it began rebuilding its own nation, helped drive the economic boom in East Asia and the Pacific, where ODA funds were initially targeted. Now the focus is switching to Africa. Japan is proactively boosting health improvements, last year canceling US$4.9 billion of debt owed by impoverished African nations and now committing a similar amount to the HDI.
Even with no initial itemized budgeting, Japan’s funding promises have always been honoured. The IDI, for example, was planned to see expenditure of US$3 billion over 5 years, yet some US$4.1 billion was spent in 4 years (Fig 1), as well as 735 experts being engaged, 3,088 volunteers participating in activities and 15,278 individuals from developing countries traveling to Japan for expert training.
Another example is that of January’s International Pledging Conference on Avian and Human Influenza in Beijing, where participating nations pledged a total of US$1.9 billion, out of which a meagre US$300 million was disbursed as of the end of April 2006. Japan was one of the few donors that fully disbursed the funds that it had pledged (US$155 million).
The Africa side
Africa is full of entrepreneurs and overflowing with enterprise. African nations themselves have already embraced mechanisms to tackle problems in concert, creating the New Partnership for African Development (NEPAD) in 2001, a strategic framework for elevating living standards through improved local governance, better global trading and financing and intensified focus on priorities such as education, health and building critical infrastructure.
Japan will provide some essential supportive resources and technical assistance specifically targeted to curb the spread of infectious diseases, reform and strengthen national health systems and staff, improve education and promote agriculture and private sector development.
In particular, to support the improvement of rural lifestyles and self-reliance in Africa, based on the notion of human security and mindful of its own post-war progress, Japan is promoting an African Village Initiative, through which it will support rural community development and empowerment of communities. It will be working closely with the UN Millennium Project to promote the innovative African Millennium Village (AMV) initiative(v).
Each of the 12 clusters of AMV is located in a distinct agro-ecological zone - arid or humid, highland or lowland, grain-producing or pastoral - to reflect the range of farming, water, disease, and infrastructure challenges facing the continent and to show how tailored, science-based strategies can overcome each one of them.
The AMV will come in three types, with each village having guaranteed funding for five years. The Millennium Research Villages (Type 1) represent the fundamental core, where interventions will be rigorously monitored, their outcomes quantified, and proof-of-concept established. The villages, each with an aggregation of about 5 000 people, aim to demonstrate a model for achieving the MDGs that can be scaled up in all senses: concept, implementation, financing, monitoring and evaluation. Japan, is supporting research villages in Ghana, Kenya, Malawi, Mali, Nigeria, Senegal, Tanzania and Uganda.
Upon ‘proof of concept’ of their broad-based, community-led development strategies, the interventions will be scaled up to encompass 330 000 people in Type 2 AMV, which will be clustered around the Type 1 villages. This will enable communities to benefit from economies of scale in infrastructure, including roads, district hospitals, electricity grids, water and local market expansion. Through the concentric expansion of Type 1 village programmes, costs can be lowered, investments shared, and knowledge distributed.
The key elements of rural development strategies are known, yet the full range of essential interventions has thus far neither been applied at scale as part of a community-led development initiative nor subject to realistic budget constraints or critical scientific monitoring. Millennium Research Villages are designed to rectify this.
Geoffrey Sachs, Director of the UN Millennium Project, indicates that the “groundbreaking partnership between the Millennium Project and the Government of Japan will be fundamental in showing the world that through practical and affordable interventions combined with community empowerment and leadership, the fight against extreme poverty can be won, even in the most impoverished and difficult areas in the world.”
Countering past criticism, much of the HDI funds will be disbursed in the form of grants - not loans - including an additional non-HDI US$500 million for GFATM. Since July 2005, Japan has extended well over US$312 million in bilateral Grant Aid (Exchange of Notes) to sub-Saharan Africa.
This includes US$32.8 million for underprivileged farmers, US$49.5 million to health programmes, primarily for infectious disease prevention in children, US$40.9 million for school building and development, together with US$22.6 million for water development projects and irrigation schemes. Japan has been the largest donor for water/sanitation projects since the early 1990s ( Japan gave US$4.6 billion between 2000-2004, representing 41% of the global total). The new Water and Sanitation Broad Partnership Initiative (WASABI), announced at the 4 th World Water Forum in Mexico in March, will strengthen Japan’s contribution still further.
The flexibility inherent in Japan’s approach is illustrated by the fact that US$2.5 million has already been spent in Nigeria and Niger on public awareness campaigns related to the recently-recognized Avian influenza problems. In August, Japan provided UNICEF with US$4.5 million for life-saving vaccines, bednets and other health-care services for Sudan, adding to the US$10 million already provided for Sudan-based activities this year. UNICEF was given a further US$4.2 million grant for polio immunization and malaria prevention in Nigeria.
In all, during fiscal 2005, well over US$620 million has been provided in HDI bilateral grant and loans, excluding technical cooperation. It is likely that, at the conclusion of the HDI, disbursement of funds may well resemble the distribution seen at the end of the IDI (Fig. 1).
Prospects for halving the number of poor and malnourished in sub-Saharan Africa appear bleak, and according to UNESCO’s World Science Report (2005), there are “woeful shortcomings” in Africa’s science and technology capacity, which will be essential to help find and implement solutions.
However, in collaboration with its partners, Japan’s HDI - based on the policies that enabled the country to bestow world-leading longevity on its own citizens, create excellent health, welfare and economic systems and establish the nation as a true world leader, all within 20 years - will go some way toward accelerating equitable progress and enhancing the lives, freedoms and opportunities of those most in need.
For more detailed information, please contact Taro Yamamoto at: [email protected]
(i) Visiting Professor, Kitasato University & Kitasato Institute, 5-9-1 Shirokane, Minato-Ku, Tokyo 108-8642, JAPAN
(ii) Deputy Director, Aid Planning Division, Economic Cooperation Bureau, Ministry of Foreign Affairs, 2-2-1 Kasumigaseki, Chiyoda, Tokyo 100-8919, JAPAN
(iii) Japan ’s Health and Development Initiative
(iv) A comprehensive review of Japan’s successful post-war health successes can be found in: JICA (2005) Japan’s experiences in public health and medical systems. Japan International Cooperation Agency (JICA). Tokyo, Japan.
(v) The Millennium Village Project