African crisis: the human dimension special UNICEF report on the future of Africa's children.

African Crisis: The Human Dimension Special UNICEF report on the future of Africa's children

So begins a special report, Within Human Reach: A Future for Africa's Children, prepared by the United Nations Children's Fund (UNICEF). According to UNICEF, neglect of the human costs of the African crisis has obscured a full understanding of the "scenario for disaster' that has been unfolding on that continent over the past two decades.

"In its day-to-day work in the continent, UNICEF is faced with the maluntrition and ill health which claim the lives of nearly 4 million African children each and every year--even when there is no drought, no famine, no camps, no epidemics, and no media coverage', states UNICEF Executive Director James P. Grant in a preface to the report. "This is the "silent emergency' which, exacerbated by war and drought, has suddenly become the "loud emergency' of which all the world has heard'.

However, adds Mr. Grant, "the first priority for action is to protect the lives and the normal growth of children. In times of emergency, the immediate, human argument for "children first' is an obvious one. But there is also a longer-term and more hard-headed case to be made. For there is a profound connection between the mental and physical development of the children and the social and economic development of their nations.'

UNICEF's response to Africa's "loud emergency' is a child-protection strategy based on low-cost, high-impact, widely relevant techniques relating to children's present needs as well as longer-term development goals. Foremost among them are immunization programmes against such life-threatening diseases as measles, tetanus and whooping cough, and widespread dissemination of oral rehydration therapy (ORT) to counteract diarrhoeal dehydration, the biggest single killer of Africa's children, claiming more than 1 million lives in 1985.

A third major prong of the strategy is malnutrition prevention, through such measures as growth monitoring, breast-feeding and vitamin A supplementation.

"Of particular relevance to Africa', notes Mr. Grant, "is the fact that most of these strategies depend as much on the empowering of parents as on the extension of services.' Even in the poorest countries, much can be achieved through a combination of low-cost techniques and social mobilization.

"The future of Africa's children and young people is threatened by a fashionable view of development which fails to look beyond the shortterm or beneath the surface of Africa's problems', states Cheikh Hamidou Kane, Senegal's Minister for Planning and Co-operation, in a foreward to the UNICEF report. "Saving hundreds of thousands of young children, who are at risk of dying from malnutrition or infection, is an immediate imperative. But it must only be . . . one element in the truly comprehensive approach, which in the long-term is the only way to enable Africa's children not only to survive the current emergency but to go beyond, into development.'

The following material on the "human dimensions' of the African crisis and priorities for action towards recovery and reform is drawn from the UNICEF report.

Human situation critical

The human situation in Africa today is still critical, and in many countries is worsening. A total of 150 million people have been affected by drought. Thirty million of them are suffering from malnutrition and starvation. Even larger numbers have been affected as well by war, "destabilization', rural neglect, management inefficiency and cut-backs in health, education and other essential basic services.

Among the most serious indicators of the declining situation is the evidence of rising malnutrition among children under 5 years old--the most vulnerable age group. At least 5 million children are estimated to have died from hunger, malnutrition and related causes during 1984--about 25 per cent more than would have died under "normal' circumstances--and millions more suffered physical and mental disability.

Food and water shortages, inadequate shelter and clothing, deteriorating sanitary conditions (particularly in areas where many drought victims have temporarily settled), contaminated water sources and inadequate access to basic health services have increased the spread of communicable and parasitic diseases and infections to which weakened children and mothers are susceptible.

Diarrhoea, measles and respiratory, skin and eye infections afflict many of Ethiopia's 9 million drought victims, for example. Measles, combined with malnutrition and/or diarrhoea, are the most common cause of child deaths in Mali.

Very high--and rising--infant mortality rates in the drought-affected countries testify to the terrible synergism of malnutrition and disease. In Mozambique, the infant mortality rate ranges from 200-250 per 1,000 live births, depending on the province. In Ghana, the infant mortality rate has steadily declined over the past 20 years to approximately 100 deaths per 1,000 live births; recently, it jumped to 120-130 deaths, rising as high as 250 in the northern regions of the country.

Africa has long lived with the vagaries of nature. But the combination of man-made factors and natural disasters in recent years has caused a far more serious and long-range problem than that caused by periodic "meteorologic cycles' of the past. A disaster of unparalled proportions occurred when the 1982-1984 drought struck countries which still had not recovered from the mid-1970s drought.

WAR AND DESTABILIZATION; Civil unrest has affected almost one-third of the sub-Saharan countries during the past decade. In seven countries-- Angola, Chad, Ethiopia, Mozambique, Somalia, the Sudan and Zimbabwe--90 million people are affected by both drought and war or civil strife. Angola, Mozambique and other countries of southern Africa suffer additionally from South African "destabilization' measures.

By early 1985, the combination of man-made and natural disasters had made refugees of some 4 million people in Africa, according to the United Nations High Commissioner for Refugees. Adding the people displaced within their countries by drought or armed conflict, the total number of uprooted Africans reportedly exceeds 10 million.

Although military spending as a proportion of gross national product (GNP) remains relatively modest in most African countries, it rose from $8.5 billion in 1970 to $14 billion in 1982, and still represents a diversion of scarce resources that could significantly contribute to meeting basic needs. It is estimated that the value of arms flowing into Africa equals one third the value of all non-military machinery and equipment imports.

ECONOMIC DECLINE: Added to the difficult climatic and political conditions of the last decade has been an equally disastrous international economic environment. Trade terms for African countries were worse in 1982 than at any other time in the past 30 years.

Money has been flowing out of Africa as a result of deteriorating terms of trade and rising interest rates. At the same time, the flow of money to the continent--in aid, foreign investment and lending--has slowed. Between 1980 and 1983, official commitments fell by 31 per cent, and private capital commitments dropped from $1.5 billion to $137 million.

By the end of 1983, 25 African countries had responded to the economic crisis by adopting some form of short-term adjustment or stabilization programme. Important national objectives--expanding employment, ensuring a minimum income, providing basic services--have become secondary to measures to improve the balance of payments, repay debts and reduce inflation in order to set the stage for longer-range growth.

Ironically, the result of such stabilization programmes has in many cases been an aggravation of the economic crisis as well as the human crisis, as unemployment rises, import-dependent industries cut production, public services are curtailed, and public discontent and political instability grow.

FOOD AND AGRICULTURE: Between 1960 and 1970, food production in sub-Saharan Africa fell 7 per cent per capita; over the next decade, it fell 25 per cent. In 1975, regional food production fell below 140 kilograms of cereals per capita per year--the minimum for a healthy diet set by the Food and Agriculture Organization (FAO). By 1984, estimated production had slipped below 100 kilograms per year.

Priorities for improving the situation have focused on the need to develop national strategies emphasizing greater food self-sufficiency. What have been largely ignored, however, are such critical elements of national food security as the importance of mixing food crops, cash crops and animal raising to ensure adequate food and income, the overwhelming reliance of most Africans on self-provisioning through family food production, the traditionally dominant role of women in providing the food, and the need to design agricultural systems that maintain the fragile balance between land capacity and the people's needs.

POPULATION PRESSURES: Africa has the fastest growing population of any region in the world, with increases of more than 3 per cent a year. The population is expected to double in just 20 years to more than 1 billion. In 1984, the Second African Population Conference, while avoiding specific references to population growth, called for programmes to reduce the "current high levels of fertility and mortality and to alleviate the uneven distribution of population' on the continent, suggesting a reversal of earlier pronatalist positions.

The consequences of high population growth in sub-Saharan Africa are visible in the destruction of the physical environment, the reduced productive capacity of land and the declining well-being of mothers and children. Africa is often mistakenly described as a continent with low population density and abundant land resources--a misperception that ignores the unfavourable environment for agriculture, the unpredictable and low rainfall, and the poor soils. In 1975, 15 sub-Saharan countries--comprising half the people in the region--were found not to have adequate usable farm land to support their populations.

POSITIVE SIGNS: UNICEF notes a growing recognition on the part of both the African Governments and external aid providers that the development path requires rethinking.

In 1984, at least 10 Governments announced plans to shift agricultural responsibilities to village or farmer associations, and 16 countries either raised farm prices or removed price controls. Some 24 countries had undertaken monetary adjustment under the International Monetary Fund.

On the domestic front, the potential for a "child survival revolution' to protect children's lives even in times of scarce economic resources was being demonstrated throughout the continent. Immunization of all children in Africa by 1990 appeared to be an achievable goal.

Priorities

The impressive famine relief efforts of the past few years have helped save lives, but too little has been done to address the causes of famine and Africa's long-term needs for recovery. According to UNICEF, what is urgently needed now is a broadening of economic reform and adjustment, to concentrate attention on the neglected human dimensions of the recovery process. Priorities for action in six crucial areas are outlined in the report.

Food security

The primary cause of starvation, even on the scale experienced in Ethiopia in 1984 and 1985, is not scarcity of food but rather a breakdown of the food distribution system.

A household gets its food from its own production; through exchanges; by claims on the extended family; or through welfare from the state. Famine results when this system collapses. For those who must leave their communities in search of food, the situation is critical, since their only remaining source is food relief in feeding centres.

When famine victims become so desperate they abandon their homes for relief shelters, the famine emergency programme has essentially failed. At that stage, authorities must provide basic survival needs--food, shelter, water, health care--and prevent further disintegration of family and community life, as well as try to preserve morale and begin planning for the future.

Crowding, and lack of sanitation and safe water in relief shelters, are as seriously threatening to the survival of famine victims as the starvation and disease from which they have fled. Children are especially vulnerable to the infections and parasitic diseases rife in the camps.

Immunization, basic sanitation and clean water, oral rehydration therapy for treatment of diarrhoea, and nutritional supplements for critically malnourished children and mothers are the essential elements of an emergency relief programme.

FOOD, CASH FOR WORK: In food-for-work projects, food is offered as the wage for useful public works or for farming designed to increase food availability for the participants. Cash-for-food projects provide cash to households so they can purchase food and other essential items locally; eliminate the problem of distribution; and help keep destitute families within their own locales.

Experimental cash-for-food projects begun in Ethiopia in 1984 with UNICEF assistance showed promising results. Families provided one or two days' labour a week for community projects in return for cash. In a UNICEF cash-for-meat project in Ethiopia and Mali, cattle facing death due to lack of forage and water were bought for cash from herders, then slaughtered. The beef was dried and distributed to the needy.

A strategy of household food security must be built on full exploitation of available foodstuffs. Nutrition education can inform people about alternative crops, and fish and animal products raised locally.

Protecting the health of young children and pregnant women--the most vulnerable groups when food is scarce--requires a special surveillance effort, including nutritional supplementation through feeding or distribution programmes. A special food supplementation programme in Zimbabwe, initiated by several non-governmental organizations in 1980, then taken over by the Ministry of Health and expanded as drought continued, eventually reached 270,000 children at 10,000 feeding points throughout the country.

LONGER-TERM MEASURES: The current African crisis shows the importance of pursuing policies that encourage greater national self-reliance and food security. It is a matter of balancing traditional self-provisioning in food with agricultural development and the forces of the world economy.

Measures affecting family food production are particularly important--and are often neglected in strategies advocated by Governments and external agencies.

Small-scale farmers and herders make up 50 to 75 per cent of the population in most sub-Saharan countries. In addition to producing their family's food, farmers of both sexes should be encouraged to grow some surplus for the market or an exportable crop to provide household income while meeting the food needs of the non-farming population. In most countries, a much larger proportion of agricultural investment should go to supporting those small-holders and subsistence producers. Also, greater attention should be given to cultivating food crops (particularly root crops and coarse grains) that are the staples of groups most likely to be nutritionally vulnerable.

Among nomadic peoples, the emphasis should be on protecting and improving the household economy based on livestock. The 60 million pastoral and nomadic peoples living in 14 African countries are the group most vulnerable to climatic variability, and they have been the worst hit by the recent drought.

Mali nomads called the severe drought of 1973 "the year of deep humiliation'. Pioneer programmes are being developed in the most severly affected regions of the country-- Mopti, Timbuktu and Gao, where communities are undertaking self-help activities, including establishing seed stores, constructing dykes for water control and introducing intensive gardening to extend the growing season.

Basic services

Even in countries with low per capita income, basic services--health care, clean water, education--can be provided to all people. Moreover, the expansion of basic services is essential for creating a favourable environment for attaining other economic objectives.

PRIMARY HEALTH CARE: All Governments in sub-Saharan Africa have supported, at least in theory, the idea of primary health care as the strategy for "Health for All by the Year 2000'. Many have conceded the inappropriateness of a health system that fails to reach the large majority of rural people.

Child survival measures such as immunization, oral rehydration, nutrition monitoring and supply of essential drugs are being encouraged in many countries. Some have embarked on expanded immunization programmes. In 1984, more than 70 per cent of children under five were immunized against measles in eight African countries: Botswana, Burkina Faso, Cape Verde, Gabon, Gambia, Guinea, Liberia and Tanzania. The city of Addis Ababa, Ethiopia, expected to achieve universal immunization during 1985.

Oral rehydration programmes are gaining ground in Gambia, Cote d'Ivoire, Kenya, Nigeria, Sierra Leone and Uganda.

Growth monitoring is carried out mainly within maternal and child health services and supplementary feeding programmes.

The health of pregnant and lactating women has become a matter of increasing concern. Maternal mortality rates range from 300 to 1,500 per 100,000 births in sub-Saharan Africa. In Ethiopia the rate is reported to be 2,000 per 100,000 live births in some parts of the country--30 to 200 times the rate in industrialized countries.

The health of both mothers and children is adversely affected by the high fertility rate of African women. In parts of rural Africa, 50 per cent of women who start childbearing at age 15 or 16 die by the age of 50 from fertility-related causes. Twenty-five per cent, or 20 million, of all women between the ages of 15 and 44 in sub-Saharan Africa are pregnant each year, compared with less than 10 per cent in industrialized countries.

Evidence from Africa suggests that much can be done to improve the health of children and mothers even in the absence of general economic and social development.

Recommendations include: redeploying health resources to serve the majority who are currently unserved; adopting child survival measures as the "leading edge' of primary health care; adapting child survival strategies to each country; adopting a policy for essential drugs; and using communications to help prevent or cure children's basic health problems.

WATER: During a drought, water is the primary need. In 1983 in Ethiopia, most people left their homes because they lacked water, rather than food. In the Gondar region, for example, people had to walk up to 12 hours to fetch a bucket of water.

Distance from water sources, drought and seasonal fluctuations affect the availability of water and severely strain the time and energy of women, the traditional collectors of water and fuel. In Somalia the time spent in fetching water can increase by a factor of up to 20 in times of drought. The effect of such increases in the price of water is traumatic: there is no substitute for water, and most poor families already get very little for drinking, cooking and infrequent bathing.

Women and children in Africa will be the chief beneficiaries of any improvement in water supply and sanitation. Access to water saves time, reduces drudgery, enhances growth of kitchen gardens and raises the standards of health and sanitation.

EDUCATION: Education has a fundamental role in moving sub-Saharan Africa out of its present tragic state. In Africa, basic education would consist of primary education for all children; literacy and non-formal education programmes for youth and adults; and early childhood care and education programmes to promote normal physical, psychological and intellectual growth of infants and pre-school children.

By the 1980s, many countries in Africa were poised at two extremes: those close to achieving universal (80 per cent or more) primary school enrolment (Botswana, Cameroon, Cape Verde, Comoros, Congo, Kenya, Lesotho, Madagascar, Mauritius, Nigeria, Sao Tome and Principe, Swaziland, Togo, Tanzania, Zambia and Zimbabwe), and those with enrolment of one third or less (Burundi, Burkina Faso, Chad, Guinea, Mali, Mauritania, Niger and Somalia). Another dozen countries were in between.

In 1980, according to the United Nations Educational, Scientific and Cultural Organization (UNESCO), half of all Africans over age 15 were illiterate; among women, the figure was more than 70 per cent. In many rural areas today, female illiteracy exceeds 90 per cent. UNESCO found that in only 4 of 30 countries studied were more than 10 per cent of illiterates participating in literacy programmes.

Throughout Africa, educational infrastructure, deficient to begin with, has deteriorated further in recent years due to such factors as inadequate teacher training and supervision, and lack of such basic items as books, equipment and classrooms. The educational landscape is littered with incomplete and rundown institutions and projects, broken equipment and low morale.

Affordability, and relevance of educational programmes to daily living, are particularly important in Africa, in light of growing concern about productive employment for young people. Dropout rates reach 50 per cent between enrolment in first grade and completion of primary school.

Attempts to stress vocational and practical skills in primary education generally have not produced satisfactory results. A more flexible approach, combining formal and non-formal programmes, is desirable for helping older adolescents and adults prepare for the world of work, particularly in the informal sector.

Africa's short-term need for food and other assistance has given education and other "non-emergency' activities a lower priority. But the long-term challenge of improving education and developing human resources is urgent if future tragedies are to be averted. External aid donors must find a way to work with African Governments to avoid a piecemeal approach to projects, and avoid projects that do not suit recipient countries' priorities.

Women

In the Chilozi language of Zambia, a woman is namoyo, the giver of life; among the Luo in Kenya, she is ero, the granary and wealth. In traditional African mythologies woman reigns over the harvest. Today, however, social roles, cultural practices and changes in agricultural systems and other economic activities have turned the rural African woman into one of the most underprivileged of all human beings.

Women supply 60 to 80 per cent of household food needs in many parts of sub-Saharan Africa. They are the key actors in ensuring the survival and well-being of children. Their educational level is the single most important factor related positively to high infant survival rates. Therefore, expanding women's social and economic opportunities, and increasing their control over household finances and their participation in community affairs, are the most significant measures that can be taken to enhance children's health and the welfare of families.

Agricultural development programmes generally have failed to recognize that women traditionally have been responsible for growing most or all the family food. Efforts directed towards cash and export crops have diverted fertile land and family workers from food production, putting additional strain on the already overburdened woman without relieving her of the responsibility for providing the family food.

In the southern Volta region of Ghana, for example, before cocoa was introduced as a cash crop, husbands and wives worked together to produce the staple food--yams. When cocoa was introduced, the best land and men's labour went to its production. Women then had to assume more responsibility for food production, while also assisting their husbands in cultivating cocoa. The result was that yams were replaced as the staple by the less labour-intensive and less nutritious cassava root, while women's work burden increased considerably.

Land reform and consolidation programmes have worked to women's disadvantage. For example, the dismantling of the feudal land tenure system in Ethiopia and transfer of control over land to farmer associations --although a positive change in one sense--has left women dependent on the male household head. Similarly, land reallocation programmes in Cote d'Ivoire and Senegal, and land tenure reform in Kenya have neglected women's interests while eliminating the traditional allocation of household fields to the wives.

Migration of men from their rural homes to pursue employment possibilities elsewhere has left the burden of child care totally on women in many parts of Africa. The International Labour Organization estimates that in the rural areas of Zambia, for example, up to half the households are now headed by women. In areas of extensive migration, such as parts of Senegal and Burkina Faso, women bear the entire responsibility for growing bear the because their husbands are absent much of the year. In Lesotho, where 60 per cent of the men work as migrant labourers in South Africa, women are responsible for farming and managing the household.

Nor are women's responsibilities limited to food production. Rural African women work 9 or 10 hours a day in the fields, then spend 7 or 8 hours fetching water, collecting fuelwood, caring for children and the elderly, and helping to store and market crops. In addition, they may have a side enterprise, such as a food-stall or raising chickens, to earn cash for school fees or to buy salt and sugar.

Particularly in West Africa, women also play a prominent role in producing cash crops. Farm data from Ghana show that women make up one thid of the farmers producing cash crops such as cocoa, rice and sugar-cane; about 25 per cent of tobacco, coconut and oil palm producers; and 60 per cent of all cotton farmers.

Two dozen African countries have or are developing national food policies and strategies with the encouragement of the World Food Council and FAO. As these strategies are formulated, the opportunity exists to include policies that strengthen women's role in food production.

Current farmer training programmes and extension services should be reoriented to serve women farmers. Credit, financing and subsidies should be provided to women both through traditional agricultural financial institutions and credit programmes, and through women's associations and networks.

Appropriate labour-saving technologies, when adapted to local circumstances and acceptable to women, can reduce the drudgery of slow, monotonous and physically burdensome work typically performed by women.

Health needs of women require special attention, particularly those of female adolescents and pregnant and lactating women. Women must also be given access to birth-spacing information. Education activities are also needed for women, oriented to specific age groups and relevant to women's daily needs and multiple roles.

Environment

Climatic variation and man-made factors have combined to set in motion a process of environmental degradation that now threatens the life-support capacity of sub-Saharan Africa. While low and variable rainfall determines the vegetation and soil character of the dry regions, it is human intervention in the form of deforestation, over-grazing and over-cultivation that cause desertification.

Much of the energy crisis in Africa is a crisis of domestic fuel, over 90 per cent of which comes from wood. Scarcity is an acute problem in the northern areas of Chad, Mali, Mauritania, Niger, and Sudan, as well as in Somalia and parts of Burkina Faso, Ethiopia, Kenya, Lesotho and Nigeria.

Even in the capital cities of the Sahel, 90 per cent of the households cook with wood or charcoal. A daily morning sight in cities such as Niamey, Niger, is a caravan of camels carrying fuelwood into the city, contributing to the growing circle of deforestation in the surrounding areas.

Increasingly, desertification, defined as "a breakdown of the established balance between natural resources of water, land and vegetation', is causing migrations of large numbers of people. In Ethiopia, for example, the Government has been encouraging the movement of people from areas where the over-grazed and over-tilled land has become unfit for farming, to the southern regions of Bale and Sidamo and the western region of Wellega. But although migration can be a means of relieving pressure on land, the migrants often replicate their agricultural systems on marginal lands in their new locations, thus creating the conditions for desertification all over again.

Efforts to combat environmental degradation in the arid and semi-arid zones of Africa must centre on preserving the delicate balance between man and nature by managing existing land and water resources and restoring the regenerative capacity of land, according to UNICEF. Projects should be small in scale and adapted to local skills and technology. Local organizations should be used to oversee those projects and to mobilize resources for them. Two main types of activities are needed: restoring vegetation cover and managing land and water use.

Tree planting in the Sahel should be increased by 20 to 30 times to reverse the onslaught of the desert and meet demands for wood, according to the United Nations Environment Programme (UNEP). Cook stoves must be improved to increase fuel efficiency.

Changing land-use patterns and cultivation methods to minimize topsoil erosion--another key activity-- requires sensitivity because the required changes affect long-established behaviour. One successful programme, undertaken in Kenya with Swedish financial assistance, trained 1,300 agricultural officers and 3,500 soil and water management technicians, established 50 tree nurseries, and distributed 127,000 fruit trees to farmers. A key to its success, according to observers, was that it combined both short- and long-term economic benefits.

To date, agricultural development efforts have not sufficiently exploited the possibilities for small-scale water management projects such as small dams, reservoirs, rain-water collection and better adaptation to rain-fed and dry-land farming. However, such technological solutions can be implemented effectively only if they are accompanied by educational support to impart skills and raise ecological awareness.

Community organization

Strategies of self-provisioning and self-reliance--critical to sub-Saharan Africa's efforts to meet basic human needs and build a foundation for future development--require strong local organization and meaningful popular participation. Entrusting communities with responsibility for development is also a means of mobilizing new resources to supplement government budgets. In addition, community involvement can enhance a sense of proprietorship, improving the care and maintenance of projects.

Greater local responsibility for planning and management does not mean, however, that central authorities will be divested of significant involvement. It has been found that strong and confident central governments are more successful at carrying out decentralization campaigns.

In addition to decentralization, other means to promote local responsibility in development include making credit available to communities; giving high priority to investment in rural infrastructure; providing educational support for local development programmes; and relying on volunteer community workers and organizations to complement the work of local organizations.

Economic adjustment

The severity of the economic crisis in Africa calls for adjustment, but if development is to stay "within human reach', any adjustment package must, in UNICEF's view, fulfill several objectives.

It must be designed to protect human needs, particularly those of children and other vulnerable groups, since human beings are the driving force behind development. Government spending could be cut in the area of defence rather than health services, for example. Instead of eliminating food subsidies, Governments could reduce consumer spending by increasing taxes on luxury items. Where food subsidies are removed, food stamp programmes could be introduced for particularly vulnerable low-income families.

Another essential element of adjustment packages is that they must secure a viable balance of payments for the medium term, improving the trade balance by reducing imports and increasing exports. Adjustment packages that concentrate solely on reducing imports are likely to produce short-term improvements but may actually undermine long-term prospects, if the export sector is weakened by a short-age of essential imports.

Adjustment measures that support human potential must lay a foundation for self-sustaining, long-term development. In Africa, that would involve encouraging agricultural production, both of food for local consumption and cash crops for export, while ensuring the availability of enough consumer goods, so that farmers had a real incentive to earn more money. Desperate shortages of goods in countries such as Ghana, Tanzania and Zambia, where the crisis has been long-lived, can make any financial incentives to agricultural producers largely ineffective.

In short, "adjustment with a human face' calls for such steps as adequate financing on favourable terms and reduced-spending plans that impinge least on low-income households and vulnerable groups.

International action in that regard must include support for a broader approach to adjustment by both recipients and donors, as well as international agencies such as the International Monetary Fund, the World Bank and the World Food Programme. The financial requirements of a broader approach to adjustment are greater in sub-Saharan Africa than in many other developing countries, partly because structural problems are more prevalent in economies heavily dependent on primary products, and the current flow of development funds is nowhere near sufficient.

Increased assistance to Africa could also take the form of measures such as reducing tariff barriers and import restrictions on African exports, to help increase earnings. Rescheduling debt and retroactively adjusting terms of existing debt are also urgently needed.

External assistance alone will never solve Africa's problems. But internal reform will be much more difficult without increased international financial support.

"One might call this a long-term Marshall Plan for Africa', suggests UNICEF. "The Marshall Plan was built on a careful adaptation of the support provided to the specifics of each country, which would obviously be necessary in any programming for Africa. But the urgent and overwhelming need is to ensure that a sufficient quantum of financial support is made available on a stable and sustained basis.'

Photo: "Stark images of death, starvation and refugees'

"Saving hundreds of thousands of children who are dying from malnutrition or infection is an immediate imperative.'

Photo: Growth monitoring in Angola.

Photo: Children from Raga, Sudan obtain clean water from a UNICEF-provided handpump

Photo: Schoolchildren in Burundi.

Photo: Bedouin children in Tunisia, North Africa.

Photo: Boys on home-made bicycles, United Republic of Tanzania.