Lifeblood
Page 14
For Woods, Nigeria is also a chance for religion to show its best side. The size of the country and the baggage religion carries there make it tough. But the antagonism between Christianity and Islam in Nigeria also raises a tantalizing possibility. Just as fighting malaria in Ghana resolved the resource curse, might bringing together Christians and Muslims to combat malaria offer peace to Nigeria? “It’s always on our minds that we are fighting more than just malaria here,” says Woods. “Nigeria has a tortured history of religious conflict and manipulation. A lot of religious people here know that, but they need a vehicle on which to collaborate. Malaria is that vehicle, something to help isolate the extremists on both sides. Hopefully Christians and Muslims will say to each other: ‘I just did a training session with you last week. So I know you care about my family.’” If it works, adds Woods, the campaign will be an example to the world. “We’re not doing this just because it’s a good idea, or because we want to feel good. Malaria is a way for these two great faith communities to come together and solve their problems. This is the birth of something that will dramatically change the landscape of how development is delivered and sustained on this continent. It should also be a model of integrating the faith communities that can be replicated elsewhere.”
To that end, Woods wants not only to prove religion’s case but also to have it seen to be proved verifiably “with a rigorous monitoring and evaluation.” So CIFA is mixing aid and religion and business by employing the consultancy KPMG to assess the campaign’s performance to “world-class standards.” “Our business is to translate faith into action,” says Woods. “It is not our business to close our eyes and pray when people suffer.” In words that echo Chambers’s, he adds: “Nigeria is proof of concept.”
The scale of what Chambers and Woods are attempting in Nigeria becomes apparent when they address thousands of imams at Abuja’s Central Mosque. This is, Woods tells the gathering, “the largest Christian-Muslim collaboration in the history of the world.” Onno Rühl adds it is also “the largest public intervention in the history of the world. Nigeria will succeed. Nigeria is the next world power, and the entire international community is with you.”10
Chambers tries to inspire the crowd. “We are at a unique moment in time,” he declares. He tells the story of Sachs’s pictures of children in malarious comas. “I will never be able to get that image of those angelic children out of my mind’s eye.” Three hundred thousand people, mostly children, die like that every year in Nigeria, says Chambers. Seventy-five million Nigerians have contracted the disease. Malaria costs the country $10 billion a year. A third of the children in Nigeria who die in their first year die from malaria. “The eyes of the world are on Nigeria. It is the biggest country in Africa, it has the highest incidence of malaria, but it is also the country with the greatest potential. What you are doing here represents to President Obama a template that needs to be followed throughout the world. This is no longer us and them. We need to come together as one. This is the type of irrational commitment and unconditional love that you need to put an end to this disease. It’s an unleashing of an army of kindness. The destiny and dignity of Nigeria’s children are in your hands. I know those hands are responsible. What do I see in the distance? Children who no longer die.”
It’s the most moving speech I’ve heard Chambers give. But the imams are not listening. Chambers can hardly make himself heard above the hubbub. There is silence, however, when the Sultan of Sokoto, Alhaji Muhammad Sa’ad Abubakar, effectively the most senior Islamic cleric in Nigeria, takes the stage for a few brief words. There is silence too for the head of Nigeria’s Methodist church, Archbishop Sunday Ola Makinde. “A mosquito goes to a mosque and goes to a church,” says Archbishop Sunday. “A mosquito worships on Friday and Sunday. Malaria kills all of us. It is the killer of your brothers and your mother. Our business is not just to gather but to translate words into action.” The archbishop sits down to thundering applause.
Suddenly it’s clear how badly Chambers needs not just a higher authority, but a Nigerian one as well. He may be the UN special envoy for malaria, a friend to titans of business, and able to enlist the world’s elite in his plans. (Former president Bush and former prime minister Blair will both follow him to Nigeria in February.) But in Abuja’s Central Mosque, Chambers is just another white man in a suit telling people what to do.
This need to woo a Nigerian power makes sense of the zeal and flattery I have seen Chambers and Minister Osotimehin deploy in Abuja. The night before, Osotimehin told a dinner of one hundred health officials and aid workers: “We are here tonight with a great deal of hope. There’s nothing stopping us now. We’ve learned to cede leadership to the true leaders of the country. And with the unparalleled emissaries we have now taking control of mobilizing the people, the kind of thing we see happening here now is unprecedented.”
Chambers went further. “I have fallen in love with Nigeria, and I love Nigerians,” he said, to broad smiles and emphatic nods around the room. “I have never encountered this type of partnership, the talent, the spirit. That does not exist anywhere else. You are blessed. If you feel the passion in my voice, it’s there. This group here is about to do something that has never been done anywhere in the world: take a disease that kills a million people a year, and bring it to its knees. Nigerians are the chosen people.”
When I query his effusiveness later, Chambers tells me: “In business, I have learned that if you can take a crisis or opportunity and turn it into a chance to build and move forward, the outcome is likely to be so much better than if you just criticize. Dwelling on the negative just doesn’t make sense.”11
Chambers’s sweet words seem to work, at least on the Catholic archbishop of Abuja, John Onaiyekan, and the Sultan of Sokoto. Both reply that they see the malaria campaign as a natural extension of pastoral care and a way to calm tensions between their religions and avoid what Archbishop Onaiyekan calls “the two to three times a year when the mad dogs take over.” The archbishop continues: “We’ve been able to build up the kind of organization whereby both religions are not only working together but also working with government and international agencies. That’s the first time that’s happening, and if it works for malaria, it should work for any other area of human development. This is open-ended. I really think we’ve started something here. It’s like we’re on an airplane on a runway gathering speed. We’re about to take off.” The Sultan adds that fixing malaria was restorative not only for his country but also his faith. “The more we have religiously strong people doing what is right for their country, the stronger Nigeria will develop,” he says. “Coming together for a human cause is very sweet music to listen to. We are totally committed, not just to eradicating malaria but all other diseases.”12
In private, Chambers is fretting. He tells a breakfast meeting with Nigeria’s malaria community on his last day in Abuja that “this is the most impressive public-private partnership I have seen, and the results so far—fifteen to seventeen million nets delivered, with a 63 percent utilization even initially—justify the effort.” But he worries about that 63 percent. “That’s good for Africa, historically,” he says, “but it’s still unacceptable. The question is: what do we have to do to achieve this daunting and sometimes unrealistic target?”13
Chambers is most dismayed by Nigeria’s funding problems. The Global Fund has handed out grants of $300 million, and the World Bank even more. Even after all that, Chambers’s entire campaign now hangs on a shortfall of a few million dollars needed to buy the last 9.5 million nets and $1 million to pay each of Nigeria’s thirty-six states to hand them out.
Onno Rühl declares: “There is no state organ in Nigeria that does not have $1 million. It’s a complete joke to accept that. Anyone who tells you that is lying.” The trick, says Rühl, is not to present the gap as a gap. “If you say it’s a gap, they’ll say: ‘We have not mobilized because you haven’t got the $1 million.’ This is meant to be a partnership. So let’s stop calli
ng it a gap. Let’s start calling it ‘missing state and local contribution.’ And call all the state governors together and say: ‘Everyone in your state is getting two nets per household and it’s only costing you $1 million.’ They should go for it. That’s a very good deal.” Caroline Vanderick from an NGO called Support to the National Malaria Program agrees the aid world needs to turn the tables on the governors. “Our experience is that the governors will wait until the last minute,” she says. “They know we will come and fix it. They know we want to do this.”
After an hour of discussion, Chambers calls a halt. “We have twelve months, and it’s a daunting target,” he declares. “We need an irrational commitment to making this happen. We have this unique funding window, and it’s not going to stay open. We have to get through that window. We have to meet these targets.”
CHAPTER 10
Committed
Once again, I am flying across Africa with Chambers, along with Suprotik Basu and Tim Castano, on Chambers’s plane. From Nigeria, we are heading to Nairobi. And as we cross the continent from west to east over the vast green rainforest of the DRC and the misty Ruwenzoris at the western edge of the Great Rift, the team reviews the campaign. They now have twelve months and twenty days to cover the world in bed nets. They have handed out two hundred million, leaving a hundred fifty million still to do. The deadline consumes their every waking minute. “I know the world doesn’t end on January 1, 2011,” says Basu. “But I’m just not concerned about that right now. Without this maniacal focus, we lose.”1
In their effort to end malaria, the team has co-opted business and religion. They have used all the media they can, from American Idol to Twitter, the New York Times to the New Times of Rwanda. They have leveraged everyone they can think of too, including the White House, Bill Gates, and God. And after eighteen months, they are beginning to see results. Slowly, says Chambers, Africa is changing. “People in Africa used to accept that malaria was their lot, part of their lives. They had more children because they knew they were going to lose a few. We’re now seeing that change—because nets are going out there. We’ve penetrated more than half the population, and it doesn’t take long for word of the benefits to spread. The new dynamic is not ‘It’s our lot in life’ but ‘If they have a net, we want it too.’ You can feel this new self-confidence rising across Africa.” Basu says the new mood is most palpable in Nigeria. “People have been so down on Nigeria for so long. So the symbolism of Nigeria getting this right is immense. Nigeria would so dearly love to be able to say: ‘Look what we did.’ And other African countries are saying: ‘My God, Nigeria’s moving. We’ve got to be able to do better than that.’”
Ethiopia and South Sudan are all but done. Tanzania is now on track. Nigeria seems possible but needs constant encouragement. Progress has been, and continues to be, hard won. “Each of these countries has its own problems,” says Chambers. Basu is blunter. “Every day there’s another crisis,” he says.
In three countries—Uganda, the DRC, and Kenya—crisis seems to be a permanent state of affairs. In Uganda, the testy relationship between Kampala and the Global Fund has not improved. Chambers is sending in a group of consultants to assist Quality Chemical to plot its future. He has also spent much of the last few months trying to persuade the Fund to ditch its two-step plan of initially distributing bed nets only to pregnant women and children under five, then following on with a second delivery of nets to everyone else. Why not cover everyone at once? The Fund’s plan requires at least two visits to every affected house in Uganda. Chambers’s plan would cut that to one. But the Fund is reluctant to change at this stage, says Basu, so “we’re working on getting the first two to three million nets out to pregnant women and children, and if that goes well, we’ll ask them again if we can make it universal. The nets should begin arriving in January. If we can get the first three million out by March, Ray can go back to the Global Fund and say: ‘OK. Now release the rest.’” It’s a very tight timetable. “Uganda is still within play,” insists Chambers. “But there’s no room for slippage at all. You know, Protik, we should start talking to the Fund in February. These talks take a month.” Basu sighs and says, “At least it’s in play. When you were there in August, it wasn’t even that.”
The DRC and Kenya are even bigger problems. Though Chambers has identified the distribution network he wants to use in the DRC—the emergency NGOs and, possibly, the UN peacekeepers—the country is still short of the cash to pay for ten million nets. Chambers is talking to the World Bank and China about more funds, though the timetable is such that it now looks harder and harder for the DRC to make the December 31, 2010, deadline. Basu is wondering whether, when that deadline arrives in a year’s time, the team shouldn’t adjust their presentation of results to include smaller African countries outside the core seven that have achieved universal coverage.
Meanwhile, the catastrophe that has long threatened to engulf Kenya is now upon it. Malaria had fallen from ten million cases in 2007 to six million in 2008, saving sixty-four thousand lives and almost halving the chances of a Kenyan child dying from the disease. But since 2006, the Global Fund has rejected all Kenya’s applications for funding, and a month ago it rejected the fifth in a row, saying it was worried about inefficiency. The insecticide on thirteen million bed nets protecting tens of millions of Kenyans from malaria is now expiring. Kenya needs $125 million to give new and replacement bed nets to everyone who needs one, but it has grants of only $35 million.
The World Bank, UNICEF, and other funders have indicated a willingness to step in. The Fund is also telling Kenya to appeal its rejection and come back with a better application. And Chambers is asking the Fund to take $23 million of grants it has previously approved for other types of antimalaria efforts and put that money in nets. “The Fund does feel a certain amount of responsibility,” he says. “They got net coverage from 6 percent to 40 percent in the first place, and with the loss of this grant, there is a danger that slips down from 40 percent to 20 percent—plus those 20 percent will be especially vulnerable because they’ll have no immunity.” Still, it’s a disaster. “The words ‘humanitarian crisis’ are being bandied about,” says Castano. This is not something that can be resolved with a clever idea, like using business or religion or borrowing a prime-time TV show. With time now running out, this is going to require something less subtle. Chambers is going to Nairobi to hustle.
The next day, December 11, 2009, begins in Nairobi with a breakfast roundtable with leading Kenyan businessmen. Each delegate is handed a fact sheet entitled “Avoiding Tragedy in 2010.” Encouragingly, not only does everyone in the room seem to understand the situation and how to beat malaria, but they get the economic case for it too. “If we can get people to sleep under a bed net for eight months, we’ll have broken the malaria chain,” says Patrick Obath, chair of the Federation of Kenyan Employers. “Business already has the distribution network to reach everyone in Kenya. Safaricom [a mobile phone operator ] has agents in every corner of the country. So has Shell. So have the banks. So has Coca-Cola. And if we can get a long-lasting, insecticide-treated net into every homestead in Kenya, how many more people can we release to be productive?”
Chambers decides the atmosphere is receptive enough for him to issue a call to action. “There could be a crisis here in Kenya,” he says. “The nets you distributed in 2006 are expiring. Children and pregnant women who have been covered by nets for three years have not had a chance to build their immunity. These children are now the most vulnerable in the world to being killed by malaria. You can feel the urgency. This is a critical time. We need to move quickly. Kenya did a terrific job previously. But now there is a danger of that being reversed.” He also underlines the business case for fighting malaria. “Malaria costs Kenya $500 million a year. That’s a big chunk of Kenya. It’s in everybody’s self-interest to pitch in and help. We need to use the same type of creative marketing techniques that we all use every day in our businesses. The private secto
r can also make sure that these applications to the Global Fund are as good as they can be. Can you envisage a public–private sector board meeting on malaria every month where you ask: ‘What are the shortages? What’s the budget? Where are the opportunities for new funding? How do we distribute nets?’ Here in Kenya there is a lack of awareness. People don’t know how they get malaria. They don’t know that nets prevent it. Can Safaricom text everyone and let them know? Without that public-private partnership, I just don’t think Kenya is going to succeed.”
Safaricom’s founding CEO, Michael Joseph, who grew the company into one of the most successful mobile companies in Africa and a world leader in mobile banking, flinches at the second mention of his company’s name. “When we built Safaricom,” he interrupts, “we didn’t do it by coming along to breakfast talk shops. We did it by getting up off our arses. We need to come up with concrete suggestions and actions so that we don’t forget everything we say here by lunchtime. I’ve been to too many CEO breakfasts where nothing ever happens. That’s why I’ve all but stopped coming to them. We need to be able to come back in three months and say: ‘This is what we’ve done.’” Chambers loves what he’s hearing. “Really good energy,” he says afterward as he hatches a plan with Basu to have a management consultant call all the lead speakers in the room and form a Kenyan antimalaria business task force within twenty-four hours. “These are the guys you need to get this done.”
Then the day goes downhill. Chambers takes a short ride across town to meet Public Health Minister Beth Mugo at her offices. She’s not there. Chambers is shown into a waiting room. Ten minutes, then twenty, then half an hour pass. Finally Mugo—a fifty-something lady in a smart suit and coiffed hair and gold glasses—arrives, and we are shown into her office. So many of her officials come with us that we crush up against each other and jostle for seats. Chambers starts straight in. “Right now, the major funding gaps for universal coverage are the DRC and Kenya,” he says.2