New variant famine in southern Africa

Summary of presentation paper¹

A paper, presented to a SADC² Vulnerability Assessment Committee (VAC) meeting in Victoria Falls in October 2002, has argued that the famine currently gripping Southern Africa during the era of HIV/AIDS may represent a new and unfamiliar kind of famine, with implications for new roles for international assistance agencies. The paper describes the commonly understood characteristics of so called 'normal' or 'old variant' famines and compares these with what is happening now in HIV/AIDS endemic areas.

'Normal' famines show a number of demographic changes. Mortality is overwhelmingly concentrated among the very young and the very old, and more men than women die. The number of births declines and there is a fall in the dependency ratio. There are also economic and livelihood components. Resistance to drought amongst rural small holders is established through diversification of activities and hedging against risk. Adult household members also learn a range of skills to enable them to resist drought. These include specialist knowledge about drought resistant seeds, how to enable animals to survive, etc.

Households develop a range of coping strategies which are designed to enable them to return to their former livelihood. These are different to 'survival strategies' which are designed to preserve the lives of its members, but at the cost of abandoning former livelihoods for ones that are less desirable and less productive. For example,

• adults cut back on their food intake and suffer the pangs of hunger
• people - predominantly women - use their expert knowledge of wild grains, berries and roots to gather alternative foods
• food stores are consumed and excess livestock are sold
• better-off relatives and friends are sought to provide support
• asset sales
• amassing debts
• casual labour and income generation
• seeking relief.

The success of these strategies is based upon several factors including, the level of assets that the household possesses, the dependency ratio in the household, social networks, and skills and experience, especially among women.

What has changed with HIV/AIDS?

The paper examines the effect of HIV/AIDS in terms of four phenomena:

• 'The double burden of care'
• The squeeze on adults
• Higher dependency ratio
• Lowered adult life expectancy

'The Double Burden of Care'
Rural Africa has borne the costs of supporting and caring for people living with HIV and AIDS in the rural areas, and also of those who had been employed in the formal sector. The economic strategies of private sector and government institutions faced with the illness and death of employees has generally been to shift the burden by:

• Withdrawal of benefits, including health care, pensions etc.
• Outsourcing of services, shifting to subcontractors. By these means, a company is no longer obliged to provide for so many employees.
• Selective packages for the skilled, where key staff members may be given treatment and care packages while the less skilled are excluded.

The Squeeze on Adults
In 'old variant' famines, adults could live on one meal a day, growing desperately thin but still surviving and working, and making sure that their children survived. Adults who are living with HIV or AIDS, including those who are on anti-retroviral treatment, simply cannot go hungry. With their immune system compromised, cutting back consumption means they will fall sick with any number of diseases and be unable to work and care for children.

Higher Dependency Ratio
HIV/AIDS increases the dependency ratio. The premature death of adults means that fewer adults are available to support the same number of children, while 'well' adults may have to support sick adults within the household and from the extended family. This leads to a collapse in the labour endowment of the average household with the following consequences:

• a shift from high labour to low labour crops. This implies a decline in productivity and nutritional value.
• a reduction in marketing.
• high-input, high-return livestock (e.g. cattle) will be supplanted by those that require less labour but are less productive (e.g. goats).
• high labour, high return income-generating activities (e.g. craftwork, such as producing mats) will be supplanted by those that require less time and labour (e.g. commercial sex work).
• children will be called upon to work.

Furthermore, asset and networking strategies will become strained with their time limits becoming exhausted. After a while, households become locked into a downward spiral and abandon the prospects of 'bouncing back'.

Lower Adult Life Expectancy
HIV/AIDS has cut a decade or so off adult life expectancy in AIDS-afflicted countries, and more so in the worst affected. This has far-reaching impacts through reduced asset accumulation, costs of staff turnover, and loss of skills.

What happens when coping strategies break down?

In 'normal' famines where coping strategies remain intact, mortality may rise from a baseline of 15 per 1000 per year, to 30 or 40 per 1000 per year. In situations where there are no coping strategies left, we may see that rarest of phenomena - mass starvation. This kind of famine has never occurred in peacetime in Africa in recent history. According to de Waal, famine is displaying new characteristics, rarely seen before and which he describes as 'New Variant Famine'.

Implications for assistance

If correct, this analysis has far-reaching implications for international assistance to the famine-afflicted societies in southern Africa. Massive aid will be needed, and may require long-term welfarism, since the problem will not be resolved when the rains come. Interventions will need to include adults, not just children.

This new kind of famine will require new, improved monitoring tools. For example, dependency ratios are likely to be a major predictor of vulnerability, and adult mortality and nutritional levels should be measured as well as child nutritional levels.

Finally, strategies for rehabilitation, recovery and development will need to be carefully designed in the context of limited labour supply, lowered adult life expectancy, and the limited capacity of institutions.

¹New Variant famine in southern Africa. Presentation for SADC VAC meeting, Victoria Falls, 17-18th October, 2002. Alex deWaal.

²Southern Africa District Committee (SADC)