DRC: quo vadis?
As Kabila fights to retain power, opposition politicians must put political differences aside in the interests of the electorate
Children in Goma, capital city of North Kivu province, DRC © iStock
The 2006 elections marked the end of a dramatic decade in the Democratic Republic of Congo (DRC) after two wars (1996-1997 and 1998-2002) and a complex peace process. Joseph Kabila, who succeeded his assassinated father Laurent-Désiré in January 2001, was sworn in on December 6, 2006 as the first elected president of the Third Republic, in the country’s first reasonably fair and free multiparty election since independence. But the next election, in November 2011, was so contested that it brought the country to the edge of implosion. It was not organised to protect a fragile democratic process but to consolidate power. The regime used its control over the security forces and the electoral machinery against a weak and divided opposition. Since September 2014 President Kabila’s political family has attempted several times to push his reign beyond its constitutional limit of December 19, 2016. Aubin Minaku, the speaker of the National Assembly, tried to change the constitution in September 2014 but failed to mobilise the necessary majority. In January 2015 the government proposed passing a new electoral law that included a census that would delay the elections by several years. Once again, however, this was blocked—this time not by Parliament but in the streets. Protests were organised in several cities, including Kinshasa and Goma. At least 40 people died. Few expected the violence, and it was unclear who had instigated it. Given all this, the only strategy that has worked is slippage, le glissement: delaying the electoral calendar on the grounds that the government is not ready to organise elections; and the systematic non-disbursement of funds budgeted for phases of the electoral process. Since 2014 Kabila has found it increasing difficult to guarantee a cohesive government. It is likely that he exceeded his expiry date to take advantage of the superficial unity between the interest groups on which his regime is built. Through his father, Kabila is a member of the Balubakat people in North Katanga. Both Kabila regimes (père and fils) are perceived as representing a Swahili-speaking Katanga-based political fortress. More recently, signs of serious discontent have emerged among the Balubakat. The north of the province, where the Balubakat comes from, has been largely absent of the growth dynamics observable in the major cities such as Lubumbashi, Likasi and Kolwezi. The people there blame their leaders for this. After Laurent-Désiré Kabila took power, Balubakat leaders visibly enriched themselves, but there was hardly any return for North Katanga. Most Congolese politicians have used their mandate to develop their own regions by rehabilitating roads, building schools and hospitals, and so on. In 2013 three Balubakat leaders lost decisive positions in key sectors of public life. John Numbi ceased to be national police chief, Daniel Mulunda Ngoi was dismissed as president of the electoral commission and Jean-Claude Masangu ended his mandate as president of the national bank. At the end of 2014, Katanga turned against Kabila, a consensus incarnated in the personality of the then governor of Katanga, Moïse Katumbi. In March 2015 party leaders within the majority, including Pierre Lumbi, Olivier Kamitatu, Charles Mwando Simba and Kyungu wa Kumanza joined forces. Known as the G7, they share the conviction that further constitutional reform or slippage of the electoral process pose enormous risks for the country’s stability, and might undermine the achievements of the peace and democratisation process. Since then Kabila has struggled with the supporters of his challengers in 2006 (Jean-Pierre Bemba, who has since been tried and convicted in The Hague) and 2011 (Étienne Tshisekedi, who left the country in 2013, only to return in 2016). Most of all, he has struggled with members of his support base who won the 2006 elections with him, and who were the main reason Congolese and international public opinion considered the election to be reasonably free and fair. Some were key people in his regime during his first period in office. Lumbi was minister of infrastructure and, later, Kabila’s counsellor on security; Kamitatu, minister of planning; Vital Kamerhe, who left the president’s camp in 2010, was speaker of Parliament; and, of course, Katumbi. They are now leading opposition figures. Their success will depend on their capacity to mobilise the masses who are frustrated because they believe that the current regime has neither the capacity nor the political will to change the country. The mistrust is widespread, and directed at the entire political caste. Politicians are thought to be interested only in enriching themselves, their families, their clans and their own communities. Little distinction is made between the ruling party and the opposition. Congo’s political elite lacks moral authority and, therefore, the ability to manage social unrest. Tshisekedi recently returned to the country, cheered by an impressive crowd. But it remains to be seen whether he can translate this enthusiasm into an effective popular force for change. The opposition must provide a plan to govern the country differently, and take into account the DRC’s complex ethnic and regional puzzle. Congo’s political elite lacks moral authority and … the ability to manage social unrest. Katumbi is thought to be a likely challenger to Kabila. He has a good reputation as a businessman and manager, and is seen to be generous. He has the money, charisma and looks for a successful campaign, and has used his success in football and development to support his political ambitions. Yet it is unlikely that the Congolese population will accept a third president from the former province of Katanga. Moreover, dark shadows hang over his business past: questions could be asked about how he acquired his wealth. Many people think he lacks the strength of personality to be a leader at this level. He is not considered a sophisticated intellectual nor a visionary. He might play a crucial role in the future of the country, but a lot depends on the coalition he can mobilise. Tshisekedi considers himself the president elected in 2011, and his followers in his home province of Kasai believe it is their turn to provide the president after predecessors from the western (Kasavubu), northern (Mobutu) and eastern (the Kabilas) parts of the DRC. Other challengers are in the offing. In 2011, Kamerhe claimed much of Kabila’s 2006 electorate in the Kivu provinces. But can he manage the huge potential for grassroots anger and violence? Currently, every local conflict in eastern Congo is activated under pressure of local tensions. The Congolese state collapsed at the end of Mobutu Sese Seko’s kleptocratic regime and has not risen from its ashes. Its capacity to deal with local conflicts is limited. Political protagonists may try to manipulate these conflicts to position themselves on the political chessboard at provincial or national levels. Kabila has probably lost his capacity to hold together the antagonistic groups that comprise his regime. The opposition must prove that its leaders can unite to fight an election. They will have to build the country’s different local realities into a dynamic political force for change.
People displaced by Boko Haram conduct their daily businesses at a government-run camp in the Bulunkutu area of Maiduguri, Borno state, north east Nigeria, February 2019 (Photo by INI EKOTT)
Boko Haram: fight or talk?
Last year, the Nigerian military persistently denied media reports of an upsurge in attacks by Boko Haram in the country’s northeast. Then, in November 2018, the Islamist militant group raided an army base near the border with Niger and Chad and killed over 100 soldiers, according to Reuters news agency. The army admitted the attack in the town of Metele, but said the death toll was 23. But even that relatively lower figure represented a devastating turn for the Nigerian military.
Three years earlier, it had put the group on the back foot under the new government of Muhammadu Buhari, a former army general who came to power on a promise to defeat Boko Haram. Those early wins allowed the Buhari government to feel upbeat about rescuing hundreds of abducted schoolgirls and ending the conflict through negotiation. By 2016, the new president was urging the United Nations (UN) to mediate and offering to “bend over backwards” to solve the crisis. The talks that followed led to the release of 103 schoolgirls, but further negotiations failed. Over 100 of the girls kidnapped in 2014 from Chibok town amid global outrage remain missing.
Many analysts have linked the partial success in the negotiations to the recent rise in attacks on military targets, pointing at the huge payments the group received as ransom and the release of its commanders in exchange for the schoolgirls. “Going into negotiation with terrorists gives [them] a psychological sense of control over the authority, and somewhat legitimises their activities,” said Anietie Umoren, a psychologist and researcher at the Obafemi Awolowo University, Ile Ife, Nigeria.
Indeed, critics argue that the group has used the resources to regroup. With attacks persisting and the military response not as effective, such ironic outcomes raise the question of how the Nigerian government can best engage the group and end the crisis.
Only a few countries admit negotiating with extremists. Most western countries, for example, adopt a “no negotiation with terrorists” policy, especially with regards to the payment of ransom. Countries such as the United States, the United Kingdom and Israel maintain this policy, but do sometimes negotiate secretly, according to Alan Steinberg in a 2015 paper in the Journal of Peace, Conflict and Development. On the other hand, France, Italy, Germany and Switzerland are more open to negotiation, according to various reports. The successful Nigeria negotiation for the abducted girls was mediated by the Swiss government.
For decades, many policymakers feared that negotiating with extremists would weaken governments, legitimise extremism and incite violence, but some recent studies have countered that claim. Ostracising extremists may do more harm than good, argues Harmonie Toros, an expert on conflict resolution, in a 2008 research paper. Rather, a preparedness to engage in dialogue with extremists could help resolve conflicts. “Negotiations also enable groups to voice their grievances and strengthen factions interested in non-violent solutions,” she writes. “In contrast, naming groups as terrorists with the intention of delegitimising them can radicalise such groups and curtail attempts to resolve conflicts non-violently.”
Nigeria’s experience with extremism dates back decades, but it was the advent of Boko Haram that required the Nigerian government to formulate some form of official position on negotiating with radical groups. The jihadist sect, which emerged a decade ago, has now become one of the world’s most brutal extremist groups. Its activities have left over 30,000 people dead and more than 1.6 million people displaced, according to the UN’s 2018 Nigeria National Human Development report.
While the Nigerian government does sometimes admit to engaging in negotiations with Boko Haram, it denies paying ransoms. In 2016, Information Minister Lai Mohammed acknowledged the negotiation to free the Chibok girls succeeded after the mediation of the Swiss government and the International Red Cross, but denied that a ransom was paid. However, the Wall Street Journal and the BBC reported that between two and three million euros were paid to the group and also that some of its top leaders had been released.
That approach showed early signs of trouble. By March 2017, a Boko Haram propaganda video showed a man clutching an AK 47, claiming to be one of five commanders freed and threatening fresh attacks. The group, which has split into two factions, soon intensified its attacks in 2018, killing hundreds of soldiers and civilians. Security analysts point to several reasons for the new attacks, among them poor military strategy, demoralised troops and poor equipment. They also traced the problem to the government’s negotiation model, which funnelled millions of dollars to the militants and freed their skilled fighters, allowing the group to rebuild its arsenal and manpower.
The recent uptick in attacks by Boko Haram, also known as Islamic State in West Africa (ISWAP) in recognition of the group’s allegiance to the terror group ISIL, has three main causes, according to Cheta Nwanze of the Abuja-based SBM Intelligence. “The funding received by Boko Haram from the federal government came with the added benefit of experienced commanders being returned,” he told Africa in Fact. In addition, the security forces were increasingly attending to threats elsewhere, including clashes between herders and farmers in the central region and deadly attacks on villagers by bandits in the northwest. The government’s attention was further distracted by the looming general election in February this year. Moreover, Boko Haram was marking the 10th anniversary of the death of its founder, Mohammed Yusuf.
In March last year, Information Minister Lai Mohammed said the government was negotiating a possible ceasefire and an end to the conflict. But after the Melete army base attack and other similar raids, the government appeared reluctant to negotiate and pay ransoms. It gave a hint of this in August 2018 after the sect abducted three female aid workers and demanded a huge amount of money for their return, according to government insiders. The government rebuffed the threat and the militants murdered two of the workers in response.
President Buhari, who was at the time of writing seeking a second term in the February elections, has not stated clearly what, if any, non-military approaches he may apply in dealing with the crisis if re-elected. The government would, however, “consolidate on [Buhari’s] first-term achievements”, according to the campaign manifesto of the ruling party, the All Progressives Congress.
Meanwhile, Buhari’s main challenger in the election, former Vice President Atiku Abubakar, says he will use “diplomacy, intelligence and border controls” in tackling the problem. Taunting the Buhari administration for its prisoner swap policy, Abubakar added that he would not release captured Boko Haram fighters back into society. “It makes no military or practical sense to release hardened terrorists, who have taken the precious lives of members of the Nigerian Armed Forces, on the flimsy excuse that they have been deradicalised or are repentant,” Abubakar said on 12 January, according to the News Agency of Nigeria (NAN).
Analysts say the crisis may ultimately not be resolved militarily. Any negotiations, however, must be done from a position of strength, they warn. “You cannot rule [negotiations] out, but … you don’t negotiate from a position of weakness, which is where we are now,” Chidi Odinkalu, a lawyer and former head of Nigeria’s Human Rights Commission, told Africa in Fact.
The United States Institute of Peace, an American federal institution that promotes conflict resolution worldwide, says negotiations with extremists can help governments to gain intelligence and influence, and so ultimately contribute to ending conflict involving extremists. “The greatest benefit of engagement is to end the conflict, or at least its terrorist form. If the terrorists can agree to stop violent acts, the state can reciprocate by softening its ‘no engagement’ stance. This initial exchange can lead to further exchanges,” it says on an undated page of its website, Engaging Extremists.
The fact that a split has recently emerged within the group may, however, make talks more difficult. One faction is led by the better-known Abubakar Shekau – a former deputy of the group’s founder, Mohammed Yusuf – who has been reported killed several times, only to re-emerge as apparently alive and well. The other faction is led by Abu Musab al-Barnawi, a son of Yusuf’s, who acted as the spokesperson of Boko Haram before it split in 2016. Shekau has repeatedly turned down previous attempts at negotiation, while al-Barnawi has been open to dialogue. In 2016, President Buhari admitted that the split had made it difficult to find credible leaders with whom to negotiate.
“We have to find a way to draw the more pliable faction into local politics, in a manner that is not hostile to the Nigerian state and its citizens,” says SBM’s Nwanze. “This is because [the extremist group] is increasingly gaining acceptance among some locals as an alternate government.”
One community where such an alternate government may operate is the fishing town of Baga in Borno state, where the militants launched a deadly attack in December 2018. The army, which initially denied the group had taken control of the town as widely reported in the media, later announced it had recaptured it. Weeks after that claim, residents said Boko Haram militants remained in control of Baga, and were issuing “movement permits” that allowed residents to move in and out of the town, the newspaper Premium Times said in a 5 February report.
Negotiating with a Boko Haram faction that operates as an alternate government raises the fear that the Nigerian government is flirting with a threat to its legitimacy, or even the possibility of a secession, if it allows the group to consolidate its gains. Whether it decides to do so will be determined by a range of factors, including whether Buhari successfully retains the presidency. In the meanwhile, though, Nigeria’s approach to engaging with the extremists looks more like dithering than purposeful, considered action.
A billboard in Maidugari, Borno state, the birthplace of Boko Haram, shows Nigeria’s President Muhammadu Buhari and other politicians ahead of recent general elections. Political leaders will play roles in deciding on possible talks with the deadly Islamist group. February 2019 (Photo by INI EKOTT)
Sustainability – it has become all too easy to subsume the cure for the world’s ills under this throwaway word. The word refers to the ability to be maintained at a certain rate or level, or to avoiding depletion of natural resources to maintain an ecological balance. The 2019 Global Assessment Report on Biodiversity and Ecosystem Services was released recently – we are literally facing a real and present cataclysm.
We thus chose the subject of Sustainable Development Goals as the topic for our special 50th issue of Africa in Fact. Not only does this issue mark a milestone for us as the flagship publication of Good Governance Africa, but it is also a turning point towards a new urgency of engagement. AIF Issue 50 suggests that the success of the SDGs will rest on three pillars: political will, cooperation and partnerships, and investment in reliable data.
This issue is on sale now from Exclusive Books, C N A, Spar and PnP stores nationally.
A man unloads meat as tyres, which were set alight during service delivery protests, burn behind him on June 2, 2010, in Monwabisi Park, Khayelitsha, about 30Km from the centre of Cape Town. South African police on June 1, 2010 arrested 26 protestors who burned tyres, threw stones and blocked roads over the removal of open-air toilets which have caused a stink for Cape Town officials. Police reacted to three separate uprisings in Khayelitsha, a poor shack-filled area in the east of the city, firing rubber bullets at two of the crowds. AFP PHOTO/ RODGER BOSCH (Photo by RODGER BOSCH / AFP)
South Africa: dying for change
In early 2012, Ayanda Kota, leader of the Unemployed People’s Movement (UPM) in the Eastern Cape, made his way to the Grahamstown police station. As an activist, he’d had an eventful year – to the extent that he had won some local fame, featuring in reports in Grocotts Mail, a community newspaper.
His visit to the station that day, however, had nothing to do with his public life; he was there to attend to a personal matter. Kota had misplaced some books he’d borrowed from Rhodes University sociology lecturer Dr Claudia Martinez-Mullen, who had laid a charge of theft against him in August 2011.
But the fact that he was now a media figure would have nasty consequences. He was about to experience violence that would shock the Grahamstown community. Arriving at the station, accompanied by Rhodes sociology lecturer Dr Richard Pithouse, Kota was recognised by six police officers who proceeded to assault him.
“A whole group of them just assaulted him,” Pithouse, who said he had witnessed the incident, told GroundUp in an October 2016 article. Forced to the ground, he was held down and kicked and punched. To humiliate him further, the police officers pulled down his pants and dragged him down a corridor while the abuse continued. “Look who is the newsmaker of the year now,” one of the policemen reportedly said.
The theft charge for not returning borrowed books was later withdrawn, but Kota’s treatment at the hands of the police outraged fellow activists across South Africa, who offered solidarity and support. With the help of the Socio-Economic Rights Institute of South Africa, Kota sued the South African Police Service (SAPS), which resulted in a R120,000 settlement. “What I experienced was hard and painful but the struggle must go on,” he said.
This was not the first time that Kota’s activism had resulted in violence and intimidation. Prior to founding the UPM, Kota was national secretary for political education for the Azanian Students Convention (AZASCO), a youth wing of the Azanian People’s Organisation (AZAPO). He left the organisation in 2001 after he received death threats and was assaulted by fellow members angered by his opposition to AZAPO leader Aaron Mosibudi Mangena’s appointment as deputy minister of education, which Kota believed was an ANC attempt to neutralise AZAPO.
Kota is unapologetic about his activism. As leader of the UPM, which he founded in 2009, he has consistently opposed the Makana Municipality of which Grahamstown is part. The UPM campaigns for better housing, water, sanitation and municipal services for Grahamstown residents. They also demand that South Africans are allowed more involvement in political decision-making processes that affect the country. Kota’s activism has given him a media profile on radio, in newspapers and online. As a form of protest, he has also been known to take faecal material to the premises of Makana Municipality as an expression of his contempt for the local authority’s failure to provide residents with clean water.
Both he and other UPM members have been subjected to telephonic death threats from anonymous callers, and the police have responded to UPM protest action with rubber bullets, baton charges, pepper spray and arrests. “What intimidation has taught us as activists for change,” Kota says, “is we must always be ready to take off the coat of fear.”
The UPM is not the only South African grassroots organisation whose members have been assaulted and intimidated, even killed, for challenging the status quo. Abahlali baseMjondolo (AbM) is a shack dweller’s movement, which campaigns against evictions and for public housing. Founded in 2005 and based largely in KwaZulu-Natal (KZN) – although it also has branches in various parts of South Africa – the organisation has about 50,000 members. Its general secretary, Thapelo Mohapi, claims that under the auspices of the ANC, activists are regularly assaulted and their homes raided. He gave the example of one incident in Cato Manor, Durban on 16 November last year, when the doors of people’s homes were reportedly kicked in and the properties raided. The home invaders assaulted people, five of whom were badly injured.
Abahlali baseMjondolo says its members have been tortured in police custody, while at least one activist has been murdered; two ANC councillors are currently serving life imprisonment for the 2014 assassination of Abahlali baseMjondolo member Thuli Ndlovu. And last year, Durban police confirmed there had been an attempt on the life of Abahlali BaseMjondolo member S’bu Zikode. His car was tampered with on two occasions and he was forced to go into hiding. Last year, too, armed men interrupted an Abahlali baseMjondolo meeting on the East Rand in Gauteng and threatened to fire shots in the air if the meeting was not stopped.
“Our members have faced torture and death threats from the police and members of the executive committee of the ruling party at branch level,” Mohapi said, speaking from Durban.
In 2014, Sello Mokhalipi, a former provincial chairperson of the Treatment Action Campaign (TAC), which campaigns for the treatment of HIV/AIDS was the target of intimidation. Mokhalipi, who split from the TAC and started a rival organisation, was part of a fierce battle the TAC waged against the Free State province health department over deteriorating health services. In an article on the Daily Maverick website in January 2016, Mokhalipi described receiving a threatening anonymous phone call demanding he stop his campaigning. “My activities were going to have a negative impact on the ANC and that it [sic] cannot be tolerated, especially while elections are around the corner,” he said. Mokhalipi was told he would be harmed if he disobeyed the caller.
A June 2018 article in South African weekly newspaper the Mail and Guardian reported there were 284 political killings across South Africa between 2000 and 2017, the majority of them in KZN. An earlier report, in 2013, noted there had been 447 political killings in KZN since 1994.
So why have South Africa’s independent civic activists and organisations found themselves on the wrong side of the police and members of the ruling party? In 2014, the Socio-Economic Rights Institute of South Africa released a report, which claimed that police and local government were criminalising protest action. According to the report, local authorities were manipulating legislation to enable them use force against people who were exercising their right to protest publicly.
One example given in the report was a 2014 incident in Philippi East, Cape Town, in which police used live ammunition to fire on protestors. Another Cape Town incident in 2014, which aroused public attention was a police raid on Siqualo, an informal settlement in Mitchell’s Plain. Police reportedly assaulted and arrested several people, including community leaders suspected of leading local protests against voter registration. A Siqualo resident, Lungiswa Bashe, whose shack was damaged in the raid, claimed that the police involved told residents they were acting on President Zuma’s instruction.
Clearly, members of community organisations who protest against poor state health care, lack of public housing and other government service delivery failures are being intimidated and harassed. The question is: why? According to Rhodes University sociology professor Lucien van der Walt, one reason is that politicians have a lot to lose in an environment where officials stand to corruptly benefit from private-sector tenders. “Politicians have a material stake in political intimidation and have a great deal to lose in leaving office,” he told Africa in Fact.
Proceedings before the South African Parliamentary Standing Committee on Public Accounts (SCOPA), which oversees the management of state funds, have exposed numerous examples of dodgy tender processes. Private-sector tender submissions to government are riddled with irregularities. Bidding processes that are supposed to be competitive have been nothing of the sort, with kickbacks to politicians and other state officials. Van der Walt suggests that state officials benefit financially from tendering processes to such an extent that they are afraid of losing these benefits, giving them a material stake in the intimidation of activists who threaten the status quo.
Dr Johan Burger, of the Institute for Security Studies (ISS), concurs that government members feel threatened by their opponents because they don’t wish to lose power. Government members, he says, feel so threatened by their opponents that intimidation is now a feature of South African politics. If government members feel threatened by their opposition, it is reasonable to assume that the likes of Kota instil significant fear in them. “And as there is an election pending,” Burger says, “acts of intimidation in some instances are likely, as they are part and parcel of our politics.”
Hugo van der Merwe, director of research at the Cape Town branch of the Centre for Study of Violence and Reconciliation (CSVR), says the right to protest is regularly violated and met with violence. “The issue of the right to protest is not sufficiently recognised and is often met with excessive violence,” he says. “This is an issue of great concern.” Both Burger and van der Walt suggest that the fear of losing power is a driving factor in the way government officials and their proxies respond to community-based protest action and service delivery activism. Kota’s assault at the Grahamstown police station and the intimidation and violence experienced by other community activists is illustrative of this fear.
These examples all amount to an abuse of critical human rights, including the right to protest, and clearly reveal an unmanaged fear of grassroots opposition that is defensive and suggests psychological inadequacies. Indeed, one is compelled to assume that some people in government, driven by fear of grassroots opposition, demonstrate poor psychological health in their intimidation of people who seek to bring change to South Africa.
Sub-Saharan Africa: mental health
This paper sets out to investigate mental health disorders in sub-Saharan Africa, and the extent to which they are influenced by various aspects of the government or state. Mental health disorders, in this context, are classed the mainstream way: depressive disorders, anxiety disorders, eating disorders, schizophrenia, and bipolar disorder; drug and alcohol use are included for purposes of comparison. The aim is to identify the extent to which government/state related variables predict mental health in sub-Saharan Africa. In other words, the aim is to obtain some indication of the extent to which government policies might help to “create” mental ill health in the population.
One might, from this perspective, understand mental health as consisting of two factors. The first of these is an innate predisposition to mental ill health that individuals might “carry with them”. These are theorised to be either genetic or socialised into individuals at a very young age. Factors such as a family history of mental ill health, as well as early adversity such as domestic abuse, bad parenting and bullying, among others, might play a role here.
The second major component consists of precipitating factors, which are external influences, or stressors. When paired alongside the predisposition, these can cause mental ill health to become manifest. This predisposition-threshold model is widely accepted within the discipline of psychology. The analysis seeks to identify some of the precipitating factors, rather than the prevalence of the innate aspects. If government policies or state bureaucracies have an impact on mental ill health, it is most obviously at this external point that they come to do so.
First, the prevalence of various categories of mental ill health is described. Secondly, those afflictions with the greatest prevalence were selected. Thirdly, these were correlated with contextual variables, to identify any government or state-related variables that influence mental ill health in the region.
The mental health data was obtained from various sources, including the Institute for Health Metrics and Evaluation (IHME), a research institute focusing on global health statistics at the University of Washington in Seattle.
The extent of mental ill health was measured in Disability Adjusted Life Years (DALYs). One DALY can be thought of as one lost year of healthy life. The sum of DALYs throughout the population can be thought of as the disease burden or the gap between actual disease situation and the ideal, where the population lives to an advanced age free of ill health. This is adapted from the WHO’s definition.
The external, government related variables were obtained from World Bank indicators and the United Nations Development Program (UNDP).
The IHME provides an indication of disease burden globally. Using their data, Richie and Roser (2019) created a series of visualisations of mental health and substance abuse disease burden. Their mappings are used in figures 1, 3 and 4. Considering figure 1, which maps global mental disorders and substance abuse, it appears that Africa is relatively devoid of these phenomena, and that these appear to be afflictions of the more advanced economies. Note, however, that the identification of psychological disorders is to an extent a western practice, and a number of arguments can be made about the validity of measuring western notions of mental health in an African context.
Figure 1: Global mental disorders and substance abuse (from Richie and Roser, 2019)
If we break mental ill health in sub-Saharan Africa down into its constituent afflictions, the prevalence of mental health issues in that region shows a high degree of variation.
Figure 2: Various classes of mental disorder in sub-Saharan Africa
It is evident that depressive and anxiety disorders are the major mental health challenges in this region. The IHME displays this graphically:
Figure 3: Global depressive disorders (from Richie and Roser, 2019)
The prevalence of depressive disorders in Africa is heterogeneous, and is closer to the severe end of the spectrum, globally. The heterogeneity suggests some complexity to the aetiology of depression throughout the region. Anxiety is far less prevalent across the region.
Figure 4: Global anxiety disorders (from Richie and Roser, 2019)
The question is: to what extent these patterns can be explained by factors at least partially under government control or as related to states’ service provision?
The following graph illustrates the risk factors associated with depressive and anxiety disorders. It is evident that problems in family dynamics account for a large portion of depressive aetiology – a pattern seen uniformly across the world. Of course, these family dynamics are very likely caused by contextual factors themselves. In the following sections, the analysis will move beyond these immediate family/household–related factors. As mentioned, we want to focus on the factors that push people over the threshold into mental ill health. This puts the focus onto the contextual stressors rather than on innate and biological factors or early life socialisation (such as bullying and childhood maltreatment).
Figure 5: Risk factors associated with depressive disorders in sub-Saharan Africa (from IHME data)
There is some indication in the literature of the broader contextual factors that might predispose individuals to depressive episodes. The most obvious of these are income and education. Both of these variables have been shown to have some relevance to depression globally. These are therefore included in the analysis.
But this analysis goes further by investigating additional variables obtained from World Bank data. These include air pollution, access to basic services, migration and refugees, rural-to-urban shifts, gender equality and government expenditure on health. The choice of which variables to include in the analysis was constrained, to a large degree, by the available data. It was hypothesised, however, that all of these contextual factors would have some impact on the prevalence of depression and/ or anxiety disorders in the country.
In order to do so, a correlation matrix was created for the variables in question. Ideally, a multiple regression would have been used, but the available data precluded this. From this, the most influential external factors were selected. In our analysis, only the rural urban shift proved to have a measurable impact on depression, alongside income and education.
The government/state factor was included in the analysis in the way that the measures were constructed. While services were not found to be clearly related to depression, investment in education was found to be related. The significant outcomes were plotted on a graph, which also reflected gender differences.
Figure 6: Education, income and rural-to-urban migration as related to depressive disorders in sub-Saharan Africa.
Figure 6 presents data for three stressors: education, income and rural-to-urban migration when related to depressive disorders, measured in number of DALYs lost. Each dot represents a sub-Saharan country, broken down by gender (DALYs lost by females and DALYs lost by males in that country). The position of the dot is then determined by the coordinates of the female and male score. The vertical line indicates the switch from female to male bias in the impact of depression.
The graph, therefore, allows one to see gender bias in depression burden by noting whether the dot falls above or below the vertical line. It also allows for an understanding of the severity of the burden. Dots further towards the top right represent higher burdens. Not all sub-Saharan countries are plotted – only those in which depression could be reliably linked to the stressors in the analysis were included. Also, the names of the countries were not included. Although this would be an interesting addition, it was felt that this might detract from the overall message/pattern in the data. For a similar reason, a broad indication of the severity of the burden was included on the x and y axes, rather than the exact DALY burden.
It is evident from the graph that there is some variation in the influence of gender, depending on the predisposing factor. Education is seen to be more of a factor for females than for males. This effect was found to be of moderate strength. Income, on the other hand, was found to be more influential for male depression. The third factor – rural-to-urban migration – did not display a noticeable effect between gender, and was less influential overall
These findings suggest that government investment in education has an unintended consequence of boosting mental health within the population.
The same methodology was applied to anxiety disorders. As with the depressive disorders, a correlation matrix was constructed for the variables in question. Once again, from this, the most influential external factors were selected and included in the analysis. Only one variable emerged, alongside education and income. This was access to services. To preserve some comparability, the rural-urban shift was also included in the plot.
Figure 7: Traditional, family and household factors as related to anxiety disorders in sub-Saharan Africa.
From this graph it is evident that there is no single overarching causal factor regarding anxiety disorders. Is it possible, however, that broader socio-political issues also have an impact on the high anxiety disorder burden in sub-Saharan Africa? To gain some idea of this, a number of contextual factors were investigated; air pollution, access to basic services, migration and refugees, rural-to-urban shifts, gender equality and government expenditure on health.
Figure 8: Education, income, rural-to-urban migration and services as related to anxiety disorders in sub-Saharan Africa.
In the case of anxiety disorders, investment in education was clearly more influential than the other factors. In addition, there seemed to be less of a gender bias in this effect, with no noticeable difference being exhibited between females and males. Income showed no clear correlation with anxiety, and neither did rural-to-urban migration. Services, however, showed a noticeable effect on anxiety disorders. The services scale included factors such as access to sanitation and the provision of safe drinking water. It is worth noting, however, that the services included in the analysis were not exhaustive; rather, they were constrained by the available data. Anxiety related to access to services showed a noticeable bias towards females.
Figure 9: Education, income, rural-to-urban migration and services as related to depressive and anxiety disorders in sub-Saharan Africa.
It is possible, merely by superimposing the depressive and anxiety graphs, to observe the combined effect of the four variables that came out as significant. When combined, the gender biases are less obvious, except in the case of services – which is unsurprising, since services appeared as significant in anxiety disorders only. The other variables show very little bias.
The analysis suggests that Africa is not as badly affected by mental health issues as more westernised/industrialised countries. Although the terminology is difficult, it might be said that this state of affairs may be expected to change as Africa moves more in line with globalisation. Depression and anxiety are, currently, the major disorders regarding mental ill health. These disorders have a large social component – as opposed to a condition like schizophrenia, which appears to be more biologically/genetically based.
The IHME data indicated that the risk factors associated with these two classes of disorder are largely family/household related, and include factors such as having an abusive partner or being bullied, among others. Beyond these factors – which are typical of global mental ill health aetiology – the broader context was found to have some impact on the expression of these disorders. Income and education – the latter was measured via government-related variables, such as investment in education, among others – were found to be related to both depression and anxiety, although in different ways. This suggests that mental health is affected by the environment in which individuals find themselves.
More importantly, these mental disorders are to a significant part affected by the diligence of government. The state’s underinvestment in education and services, and the failure to protect a basic level of income has a noticeable impact on their citizens’ levels of depression and anxiety.
This is a bold claim, and it opens up some questions for future research and clarification. Most obvious is the suitability of the data collected. Critics of mainstream psychology have noted that these disorders emerged from a western, industrialised context. Some powerful critiques have questioned the extent to which these are valid concepts in an African context. One might suggest that the more industrialised/westernised/globalised Africa becomes, the less the importance that should be attached to this question. The problem of whether these are appropriate constructs, however, remains. Future research might be directed toward this issue.
Another area for further investigation relates to the issue of how these issues should be addressed. A strong critique of psychology has been that it offers no effective cure for the ills that it describes. Typically, psychotherapy has been seen as the remedy to psychological problems. The effectiveness of psychotherapy has been questioned, but the real problem with psychotherapy probably has more to do with the fact that it is slow and typically expensive.
It seems unlikely, at least for the foreseeable future, that Africa’s mental health challenges will be addressed by armies of psychotherapists working at affordable rates. How, then, should these issues be tackled? One way is by conducting this kind of investigation into the uniquely African predisposing factors, and then addressing these factors via activism or some other means. Considered from this perspective, the most important message of this brief exploration is that a much more thorough investigation of the contextual and state-related predisposing factors to mental ill health needs to be carried out.