COMMISSION ON HIV/AIDS AND GOVERNANCE IN AFRICA
CHGA INTERACTIVE, ACCRA, GHANA 18TH - 19TH NOVEMBER, 2004
HIV/AIDS AND THE WORLD OF WORK

BY FRED SAI

In 2004, 38 million people were estimated to be living with HIV globally, and the number is rapidly increasing. Africa remains the hardest hit continent. With just over 10 per cent of the total global population, the continent has 25 million or two-thirds of all HIV/AIDS cases in the world. Over 20 million Africans have already died from HIV-AIDS related causes. Do these very huge numbers register with the majority of our populations?

Sometimes I wonder? What should be remembered is that each AIDS death represents a personal tragedy which could translate into family disaster, a community problem or a loss for a whole society. The implications of this human tragedy reach into the structure of economies, the capacity of institutions, the integrity of communities and the viability of families. HIV/AIDS is also diminishing the capacity of African states to maintain what has been secured over past decades in terms of social and economic development. It even impacts negatively on many cherished cultural norms and practices.

I am informed it was this African predicament that compelled the UN Secretary-General Kofi Annan to establish the Commission on HIV/AIDS and Governance, CHGA, in 2003.

CHGA’s main output is the Final Report, which will be released in June, 2005. The report will address gaps in responses to HIV/AIDS and knowledge of its side impacts. It will focus on the challenge of governing a country – including maintaining essential public services, keeping economic development on tract, maintaining rural livelihoods, tackling the gender dimension of the epidemic, and ensuring national security – despite the fact that large numbers of adults will be living with HIV and AIDS, and children will be orphaned. CHGA’s has evolved a methodology which will help ensure that its messages are informed by the institutions and organization at the sharp end of the response to the epidemic. Our meeting here is one in the series of sub regional interactive sessions organized by CHGA for this purpose.

The impact of the HIV/AIDS epidemic cuts across all sectors of economic activity and all areas of social life. There is hardly a need to remind this audience that the epidemic has its primary impact on the reproductive and working-age population; preventing those infected and affected – both men and women- from participating fully in economic and social activities.

The ILO has estimated that by 2010, the total labour force will be over 9 per cent smaller in 35 countries of sub-Saharan Africa affected by the epidemic, with losses surpassing 20 per cent of the total labour supply in the most affected countries. By 2015 the losses would reach 12 per cent and the labour supply would be as much as 30-40 per cent smaller in the highest prevalence countries.

There are also likely to be consequences for the gender distribution of the labour force, with more and younger women entering the labour market in the short-term, but the overall proportion of women falling in the long-term because of the higher proportion of women infected. Let me emphasize at this point one of the most upsetting statistics out of the HIV epidemic in Africa and that is the higher prevalence among women and girls. Whereas in Europe and America there are several men to every women infected, in Africa currently 60 to 66% of all infections are in women; and the proportion of younger women to their age mate men is even higher. Our rate here is 63% women.

HIV/AIDS impacts all key sectors of the socio-economic development, including the state sector.

The fundamental organizational principles of the state, such as long trajectory career paths, its dependence on highly skilled and educated human resources, and lengthy procedures of recruitment and replacements to ensure unbiased treatment, are thrown into question by the early deaths from AIDS. It is already clear that many ministries in Southern Africa are unable to fill an increasing number of vacancies, the majority resulting from HIV related sickness and mortality.

The issue is not simply one of costs that are directly identifiable such as those caused by absenteeism due to sickness and related disruption of production, including medical cost, funeral costs, early pensions, recruitment of new staff and training. In both the medium and long-term the key issue is how to prevent the hollowing out of state structure and sustain the capacity of the state to supply essential goods and services, with effects not only on public services, not only on public services, but more broadly on the rest of the economy.

For private sector business in sub-Saharan Africa, HIV/AIDS is raising the cost of labour at the same time as reducing the number of consumers and impoverishing many of those who remain. It therefore affects the private sector internally, by reducing productivity and raising he costs of labour; and externally, by making inputs more expensive, and by reducing the number of people who can afford to purchase goods and services.

The consequences of HIV/AIDS for businesses vary widely. High unemployment rates in many countries make it relatively easy to replace unskilled workers lost to HIV/AIDS; at the same time, a skills shortage in many fields makes the loss of a skilled or professional worker much harder to overcome.

What then are the challenges, what are the key issues that we should be discussing here today?

First, there is the challenge of sustaining human capacity. In the worst-affected countries, sustaining human capacity is no longer feasible by replacing, in the traditional way, those that have been lost due to HIV/AIDS. They are simply to many, and replacements cannot be trained quickly enough.
Part of the answer may lie in changing training and other requirements for employments, but part of the answer may also lie in structural changes in the way that services and outputs are produced. This means looking again at the most effective way of organizing public services.

Second, there are the challenges to governance that are posed by the HIV/AIDS epidemic’s impact on the private sector.

The private sector plays a number of key roles in society. These includes provision of employment; generation of tax revenue, investment capital, and foreign exchange; development of human capital (training); and provision of social services to employees and communities. The ability of the private sector to achieve each of these is being challenged by HIV/AIDS.

African companies are already finding it difficult to compete on global markets. To the extent that HIV/AIDS is raising production costs and making investment in Africa even riskier, the epidemic can be expected to diminish even further the competitiveness of African firms.

A number of firms, some of which are represented here today, have taken the challenges posed by HIV/AIDS very seriously, and have responded in different ways. Some firms are voluntarily implementing programmes for their employees and communities. Among such programmes are health promotion, HIV/AIDS prevention, treatment care and support for those infected and the affected relations and orphans. However, many others are either doing nothing or are responding in ways that transfer responsibility for HIV/AIDS to other sectors of society.

The public and the private sector need to advance together on this critical issue.

Governments have a number of tools at their disposals for influencing how the private sector responds to the epidemic. The toolkit for influencing private firms includes both “sticks”, such as regulations and taxes, and “carrots,” such as provision of infrastructure, subsides, trade agreements, and training programmes. For example, a government could offer a training subsidy to help firms replace skilled employees lost to HIV/AIDS or pass a regulation requiring firms to provide a specified level of medical care for HIV-positive employees.

The African countries with greatest success in addressing the complex issues of HIV/AIDS have in general been those where the policy environment has been most open and supportive of discussion and policy development across sectors and levels.

The challenge is to develop policies that are supportive of an effective response to HIV/AIDS in areas such as employment, protection against discrimination in terms of HIV testing, hiring and retention, access to sickness and other benefits, and so on. It is also necessary to develop effective social policies to support affected populations in areas such as children’s access to education, employment generation for youth and programmers relating to nutrition and food security.

Central to the success of all policies and programmes are activities that focus on social inclusion and social mobilization. Building partnerships across sectors and between civil society and government, within policy frameworks that are supportive of a national response, is essential for effective responses.

Ensuring the full and active involvement of employers’ and workers’ organizations in National AIDS Councils, Country Co-coordinating Mechanisms (CCMs), National Action Plans (NAPs) and in all relevant areas is essential for widening the national response and ensuring the full representation of the interests of labour and employment. This will require expanded efforts to strengthen the capacity of the social partners so that they can play their full role in the response to AIDS.

Ghana is actively trying to follow this route. With the President as the Chair of the Ghana AIDS Commission, and with all sector represented on the Commission we seek to ensure a truly holistic approach in the national response. The national policy, recently approved by Government seeks to ensure the best labour practices are followed. We are aware that many countries are more experienced in dealing with the epidemic than we are, and we are ready to learn from them. We hope that our small experience will also hold some important lessons for some other countries. This gathering should help Africa move forward in tackling this most devastating and challenging epidemic.

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