The Nigerian government’s successful handling of Ebola contrasts sharply
with its blunders in tackling Boko Haram. One factor in that disparity
is whose interests were at stake in each case: Ebola had the potential
to kill indiscriminately across classes, while Boko Haram has so far
directly affected mostly lower classes.
 |
| Boko Haram jihadist. |
By Akong Charles Ndika
On 20 October 2014, the World Health Organization officially declared
Africa's most populous country ‘Ebola free’, 42 days after the last case
was confirmed in Nigeria. The ‘world class’ swiftness and forceful
response to quash the scary epidemic that killed seven of its citizens
pales greatly when compare to the dysfunctional response of the
government so far in the face of Boko Haram, a terrorist group that has
killed more than 1500 civilians in just the first three months of 2014.
Boko Haram, in fact, still holds more than 250 girls in captivity —
despite international outcry and the Nigerian government’s recent
announcement of having reached a deal with the Islamic militants for the
girls’ release.
Much ink continues to spill on how the government accomplished such an
epidemiological feat, which so far seems to elude even the US, the most
resource-endowed healthcare system. But without understanding why
Nigeria got everything right on Ebola, few applicable lessons could be
drawn from the unparalleled success. Nigeria so far remains a country
with many stories: at different points in time, islands of good
governance have surprisingly emerged, pulling the whole system to
deliver when particular interests were threatened. The Nigerian middle
class felt more threatened by Ebola than by Boko Haram, resulting in a
successful coalition with the ruling class to prevent the scariest
scenario imagined: an uncontrollable Ebola outbreak in Lagos, Africa’s
most populated city.
MY HOUSE, MY CAR, THE FUTURE
Nothing in recent memory has so far threatened to melt in a frightening
manner the growing divides between rich and poor in Africa. Ebola
introduces in an increasingly unequal Nigerian society a horrifying
prospect: the random possibility of death. A poor, underclass and rural
Nigerian has almost same chance of dying of Ebola as an urban,
rich–-middle or upper class—citizen, everything being equal. And for
once, the ruling elites together with the affluent middle class don’t
have the option to pay their way into safety and protection through
flying abroad for treatment, while abandoning a crumbling health care
system, neglected for so long through chronic underinvestment by the
government.
The middle class perceives Ebola as an existential threat to its way of
life, which has risen spectacularly with Nigeria’s economic fortunes.
While no standard definition of what constitutes a middle class exists,
according to a recent study, the number of Nigerians earning $15-$115
daily has swollen sixfold— 600 per cent—since 2000 (Standard Bank 2014).
That is three times more than the average growth of the top economies
in Africa, which were studied. That one in ten Nigerian households are
middle class is no news. But taken in context, it is simply staggering,
given how long it has taken to lift 23 million of its citizens into the
middle class. This is more than the population of the three Ebola-hit
countries together.
While it is difficult to lump them all together, those in the emerging
category of the consumer class who have disproportionately benefited
from the economic growth are marked by their visible affluence. They
have more than sufficient income after meeting their basic needs, enough
to spend on cars, houses and leisure—the fruits of their sweat, which
they will do anything to protect jealously. According to one survey, 53
per cent of them owned cars that were less than five years old and 35
per cent of their households have at least one family member with a
foreign passport. Over 18 per cent of them were planning to move into
newly-completed, self-owned apartments (Renaissance Capital 2011).
Their numbers are projected to more than triple by 2030. With most of
them being graduates, Nigeria’s middle class are not only the most
informed segment of the electorate, they also wield significant
influence on Nigerian politics as well as share similar interests with
the ruling class—at least to prevent the status quo from crumbling in a
costly manner.
Populated in Lagos and Port Harcourt, the two cities that were directly
exposed to the deadly Ebola trail, a coalition of middle class and
ruling class interests in those richest states of the Federation shocked
a muddled Nigerian government into steering an effective response
against the virus.
PREPAREDNESS IN WAITING
At the time when Ebola first appeared, public health infrastructures
generally were ill-prepared. And even now, it’s not yet clear whether
they have been effectively stepped up after the initial success to
prevent any future outbreaks. In fact, the index patient from Liberia
landed in Nigeria when health workers were striking against their poor
working conditions. The ruling elites have consistently underinvested in
systems to protect the population against epidemics.
Nigerian preparedness to deal with a crisis like Ebola has been below
the African average. As of April 2014, Nigeria had implemented only 58
per cent of minimum core capacities that countries have collectively
agreed to put in place in order to better prevent and protect their
populations against outbreaks of international public health concern
(World Health Organization 2014). That was below the African average of
60 per cent. Nigerian progress in putting in place national preparedness
plans was very slow, with only 40 per cent success against the agreed
minimum. And regarding appropriate surveillance and control measures,
only four per cent of minimum requirements had been put in all the ports
of entry in Nigeria, far below the African median of 35 per cent.
The Ebola outbreak was therefore a wakeup call. It was a terrifying full
stop to the growing trend where the ruling elites and middle class
Nigerians opt to travel abroad for health care. Nigerian politicians and
senior civil servants are the largest market for medical tourism in
Africa, travelling frequently abroad for even routine medical check-ups.
According to the Nigerian Medical Association, over 5,000 Nigerians
travelled abroad monthly for medical care, taking along almost half a
billion dollars out of the economy every year. This is over 10 per cent
of what the government spends on health care for the entire population
of 200 million. That is the amount of almost a whole year’s expenditure
on healthcare in the Ebola-hit Guinea and Liberia combined. Nigerians
even travel to peer countries like Egypt, which received over 3,500
Nigerian patients last year. The Nigerian government spends only $29 per
citizen on health care. With only seven per cent of the budget
allocated to health, Nigeria spends just a little above South Sudan in
percentage terms—50 per cent less than the continental benchmark (World
Health Organization 2010)
FRINGE AFFAIR
Boko Haram has exploited in part the government’s neglect and
underinvestment in social and economic development of the northeast of
the country to create an able fighting force that has given the national
army a run for their money. The extreme Islamist group has taken swaths
of territory in the north and unleashed a sustained campaign of
violence, including kidnappings, against countless civilians. But unlike
Ebola, the middle class, predominantly living in the south, have not
felt their interests threatened enough to force the government into
mounting a sustained and effective counter-response.
While the group has undertaken some sporadic attacks in Abuja, its
impact has been localized in the poorer north, where 72 per cent of the
population live in extreme poverty compared with the 27 per cent in the
booming south. The insurgency has driven almost one million people from
their homes and killed over 13,000 Nigerians in the past five years.
From 2009 to 2013, Boko Haram killed more people than Al-Shabaab and
Al-Qaeda in the Arabian Peninsula together and was responsible for 5.9
per cent of overall fatalities linked to terrorism (US State Department
2014). Only nine per cent of all Boko Haram targets were military.
Because of the risks of attacks, most people working across the
agriculture value chain, the mainstay in the North, fear moving outside
protected areas.
A whole generation of underclass Nigerians is emerging. More than 10.5
million children between the ages of 6 and 17 are not in school—that is
one in six of the world’s out-of-school children. In the poorest areas
of the country, only 30 per cent of children even start primary school
(The Economist 2014). Even in terms of numbers, Boko Haram has
disproportionately killed more poor people than rich folks.
Basic health indicators are dismal in the north. While Ebola landed in
Lagos via airplane as a ‘middle class disease’, cholera has remained
endemic in the north over the past years as a result of a weak health
system. In 2010 alone, 1,500 people were killed. And in the first
quarter of 2014, the Nigerian Centre for Disease Control reported 106
deaths from an outbreak caused by poor sanitation. And if Ebola has to
find its way again into the country through the ungoverned areas in the
north, it is highly unlikely that government will repeat the success.
NOT ANY PRICE
To be fair, the Nigerian middle class is seriously concerned about
security, in particular Boko Haram’s limitless campaign of terror. In a
survey, the majority of them expressed dissatisfaction with the
government’s performance in maintaining safety and security and in
managing the Moslem and Christian sectarian divide, fueled in part by
Boko Haram (Afrobarometer 2014).
While the middle class feel strongly about governance—the underlying
causes of the government failure—it is not clear what price they are
willing to pay for good governance. In fact, when asked to rank their
concerns over the next 12 months by a Renaissance Capital survey, they
listed electricity and unemployment (19-23 per cent) as top priorities,
followed by insecurity (5 per cent) and corruption (3.5 per cent).
When they perceive their interests to be sufficiently threatened, the
Nigerian middle class can wield a decisive impact on the government
through joining forces with the ruling class. When necessary, the middle
class may also form coalitions with the poor and underclass to stop or
change the course of government’s in(actions). One example is the
successful 2012 Occupy Nigeria protest, which forced the government to
reverse the highly unpopular proposal to abolish the inefficient $8
billion per year fuel subsidy, which so far has disproportionately
benefited the car-owning-middle and upper classes on a per capita basis.
This is more than what the government spends on education.
While the same level of success was achieved with the ‘textbook’
response to contain Ebola, the fortune of the middle class-inspired
mobilization remains a work in progress. Without their full commitment
to the Bring Back Our Girls campaign, it is unlikely that the Nigerian
government will do more for the release of the girls kidnapped by Boko
Haram.
For all its many failings, Nigeria, Africa’s lodestar nation, remains a
country with many faces. Like a paradox, the good, the bad and the ugly
faces of its governance exist side by side. But depending on whose
interests are threatened, the opportunity presented, as well as strength
of class coalitions formed, one story may struggle or even triumph over
others. And for Ebola, thank God, it was good governance at its best.
____________________________
WORKS CITED
Afrobarometer (2014) Results from the Afrobarometer Round 5 Survey in Nigeria
Renaissance Capital (2011) A Survey of Nigerian Middle Class, Johannesburg: Renaissance Capital.
Standard Bank (2014) ‘Understanding Africa’s middle class’, Lagos: Standard Bank
The Economist (2014) Nigeria: A Divided Nation
US State Department (2014) Country Reports on Terrorism 2013, Washington, DC: US State Department
World Health Organization (2010) Health System Financing: the path to universal coverage, Geneva: World Health Organization
World Health Organization (2014) International Health Regulations (2005)
Summary of States Parties 2012 Report on IHR Core Capacity
Implementation, Geneva: World Health Organization
*Charles Akong is a global affairs blogger writing at
http://mettaboy.blogspot.com/
Reprinted with permission from Pambazuka News.
