The Triple Threat: Southern Africa’s emergency behind the emergency

By George Aelion, WFP

A Junior Farmer Field Life School site in Swaziland, one of five pilots started in 2006.

George Aelion is Senior Regional Programme Advisor, with the World Food Programme in the Southern Africa Region. He has over 30 years of experience working in the development arena, including nine years as the Assistant Director of a Technology Transfer Centre at the University of Rhode Island and 14 years at the United Nations World Food Programme in various positions including Head of Training, Programme Advisor for a forestry project in India, Head of Programme in Kosovo and Regional Head of Programme in the Southern Africa Bureau.

Recent news reports of war-stricken Darfur and drought-stricken East Africa have shocked the world with images of skin-and-bones hunger victims and the dessicated corpses of cattle. By contrast, southern Africa's crisis is generating a dwindling response from the Western world - especially after this year's relatively good harvest.

Yet the crisis in southern Africa is one of toughest humanitarian challenges in the world today. This is because it is not caused by just one factor, such as weather or food insecurity. Instead, southern Africa is plagued by a deadly combination of inter-related factors. The region is the epicentre of the global HIV/AIDS pandemic; government agencies, whose productive employees are succumbing to the disease, cannot stem the progress of HIV/AIDS or provide their most vulnerable populations with basic healthcare, food and drugs to survive, or the education to develop long-term life skills; and chronic food insecurity is compounded by debilitating poverty. The United Nations (UN) and others active in Southern Africa call this combination the Triple Threat.

This presents a poor outlook for these communities to withstand any long-term stress factors. The Triple Threat's effects can be seen across southern Africa (in Malawi, for example, as much as 77 percent of the population relies on casual labour for their livelihood).

To understand better the effects of the Triple Threat across six southern African countries, the UN World Food Programme (WFP) and partner NGOs regularly compile information in the Community and Household Surveillance system, which monitors the coping strategies and diet diversity of both beneficiary and nonbeneficiary households. According to this system, just before the region's 'lean' season began late last year, at least one-third of sample households in Malawi, Mozambique and Zimbabwe were not eating even the minimum daily requirement of cereals and vegetables. These basic foodstuffs help keep vulnerable populations healthy, but when they become scarce, people with weakened immune systems tend to battle for survivial. In the same period, about a third of sample households in Swaziland were relying on remittances from relatives to keep food on the table, revealing the extent to which family incomes are supplemented from outside and the razor's edge of getting enough to eat.

Of the nine countries where WFP is working in the region - Angola, Lesotho, Madagascar, Malawi, Mozambique, Namibia, Swaziland, Zambia and Zimbabwe - six are on the list of the world's 10 highest national prevalence rates for HIV/AIDS. UNAIDS statistics for 2003 (the most recent available data) indicate that nearly half a million people were estimated to have died of AIDS in that year in these countries. In the same year, over 6 million people in these countries were estimated to be living with HIV. Swaziland leads the world at 43 percent prevalence, according to UNAIDS data for January 2006, based on the testing of pregnant women attending antenatal clinics.

The HIV-positive population includes government workers across the region, depleting the civil service in each country just when it is needed most to meet growing social needs. In addition, many medical workers, teachers and other skilled professionals tend to seek better employment opportunities outside of Africa, creating a regional 'brain drain' of skills.

In eastern and southern Africa, the average healthy life expectancy at birth is an average of just 46 years, or 21 years lower than the world average, according to UNICEF. Sub-Saharan Africa is the only region in the world where orphan numbers are increasing. According to UNICEF, the number of children in eastern and southern Africa who had lost one or both parents because of HIV/AIDS in 2003 was 7.9 million. Children made up 7 percent of the people estimated to be living with HIV in these regions in 2004.

How can humanitarian aid agencies make a difference in a region wracked by such a combination of deadly factors? Not responding is not an option. The most vulnerable people, such as children and women, are already tempted by dangerous and non-productive coping and survival strategies, such as foraging for wild foods, taking children out of school to look for food, and in the worst cases, prostitution or other crime. There is the risk of a domino-like collapse, starting at the family level and spreading into normally resilient community systems, to end potentially with already weakened government social services unable to respond to the desperate needs of communities and households. Trying to provide assistance at the end point of this vicious scenario will be too little, too late.

Three actions are needed to tackle the Triple Threat. The first is to stem the progression of the HIV/AIDS pandemic. The second is to assist governments to regain their role as responsible agents for protecting populations at risk. The third is to ensure households have access to basic essentials like food, sanitation, healthcare, education and agricultural inputs. Any progress in addressing these overwhelming challenges will only be possible through the coordinated efforts of governments, the donor community and aid agencies. Humanitarian assistance to chronically vulnerable populations is one way the international community can help ensure life-saving safety nets are in place to help the most critically in need while governments gear up their response.

In contrast to some of the protracted conflict emergencies (such as Darfur), southern Africa already has in place many of the pieces that could make a substantial difference. The World Health Organisation, for instance, is working with the ministries of health across the region to expedite the roll-out of antiretroviral treatment. Donors such as the Department for International Development-UK (DFID) and the European Union (EU) are also working to strengthen governments' capacity to respond to the crisis through long-term safety nets.

UNICEF, the Food and Agriculture Organisation (FAO), WFP, Oxfam International and CARE this year launched the Alliance on OVC Social Protection and Sustainable Livelihoods, to evaluate current initiatives and influence long-term government policy on orphans and other vulnerable children (OVCs). The alliance aims to ensure that children have basic opportunities to gain life skills that not only protect them but give them a chance for a productive future.

One relatively new intervention that is being replicated across southern Africa is the Junior Farmer Field Life School, a joint initiative of WFP, FAO, and now UNICEF and government agricultural ministries. Southern Africa's first Junior Farmer Field School opened in Namibia in 2002 with support from the Finnish embassy. Five pilot sites each catered for 25 to 30 adolescents aged 12 to 17. The students learned not only modern farming techniques but also social and life skills: if one of their crops failed, for example, the facilitators would use the opportunity to teach the students how to deal with disappointment and failure in other areas of life. As they planned the next season's planting, they would learn how to set and achieve goals.

The programme has since been introduced into Mozambique, Malawi, Zambia and Swaziland, and has reached about 2,000 children in the last three years. Because these children take what they have learned back into their communities, the programme has indirectly benefited as many as 10,000 people so far. To take the programme to scale will require a significant commitment from government, possibly through departments of education.

Children attending a Neighbourhood Care Point (NCP) in Swaziland. These are community points where local OVCs can come together and receive two cooked meals per day.

The Irish aid agency, GOAL, last year partnered with the Health Ministry of Malawi to develop a public awareness campaign about HIV/AIDS in rural village communities, as part of a WFP advocacy project. A large part of the campaign took place at WFP food distribution points, which draw up to thousands of people at a time each month. Before the campaign, the Nsanje District Hospital south of Blantyre tested an average of 100 people a month for HIV. After the campaign began, the hospital reported as many as 400 people coming each month for voluntary HIV testing and counselling.

Other projects in the region train homebased care volunteers on healthy cooking for the chronically ill; provide information on fighting gender-based violence; integrate nutrition information into hospitals' antiretroviral therapy programmes; teach on the importance of education for children; and train mothers to cook and preserve indigenous vegetables, and then to pass on what they have learned in their communities.

WFP has been supporting many of these initiatives by ensuring that food assistance is available to increase the impact and sustainability of the activities. But food alone will not address the emergency behind the emergency. In fact, no single entity or approach will successfully address the Triple Threat. It requires all of the actors - governments, donors, aid agencies and communities - to work together to coordinate a well designed, strategic response. The initial baby steps are encouraging but there needs to be a much more aligned and harmonised response that focuses on building government, community and household capacity to address hunger and HIV/AIDS and develop responsive social safety nets. In this context, food aid to chronically vulnerable groups is one small, but critically important, step forward.

For more information, contact: Patricia Lucas, Public Information Officer, United Nations World Food Programme, Johannesburg, South Africa. Tel: +27-11-517-1634. Email: Patricia.Lucas@wfp.org