Dear United Nations General Assembly,
We know you have a lot to discuss at the 78th session of the general assembly, which is taking place this week. You've got pandemic preparedness, universal health coverage, climate change, poverty, hunger, global inequality and a special focus on bringing an end to the scourge of tuberculosis.
We'd humbly like to suggest adding a few overlooked topics to the agenda.
Who are we to boldly offer you advice? A doctor from Nigeria and an entomologist/chemical ecologist and researcher from Kenya.
Here are our suggestions, with a focus on the African continent that is our homeland.
Figure out how to get the most mileage from the extraordinary sums that come to Africa from people in the African diaspora
You might understandably think that foreign governments and aid agencies send the most money to the continent. Or that private investors are huge players.
Let's look at the data.
According to the 2023 Global Philanthropy Tracker, official development agencies provide $70 billion in assistance. Charities from other countries provide $70 billion as well. Private capital investments are responsible for $400 million.
All that pales when compared to the money sent in from the African diaspora.
Africans living outside the continent remit $590 billion – transfers of money and goods to families and friends in their home country. Simply put, African remittances are more than twice the amount donated by foreign governments, philanthropists and investors.
Even though the money is sent to an individual, it is still a form of aid, helping people cover the expenses of daily life, from housing to food to health care.
It's critical that African leaders find innovative ways of making remittances work better for Africans – and that this topic be discussed by attendees at the General Assembly. For example, what if governments were to call for a penny of every remitted dollar to be set aside to provide health insurance for the uninsured? That's an argument made in a previous piece by Ifeanyi Nsofor. Too many Africans do not have health insurance and therefore pay for health care out-of-pocket. According to the World Bank, one in three individuals in sub-Saharan Africa who face out-of-pocket expenditure on health is 33%. This rate of out-of-pocket payments ranges from 75% in Nigeria to 5% in Botswana.
Don't just focus on big name diseases
We need to also pay heed to "Neglected Tropical Diseases" that afflict the poor around the world and could be prevented or treated effectively if there's early detection.
There are the infectious diseases everyone pays attention to – starting of course with SARS-CoV-2 in this pandemic era. This year there's also a big emphasis on bringing an end to tuberculosis.
Then there are what the World Health Organization calls "Neglected Tropical Diseases" – illnesses that mostly affect impoverished communities and often disproportionately affect women and children. Two examples are Hansen's Disease (the preferred name for what is also known as leprosy) and noma. Both can be debilitating in severe cases and cause deformations.
In Africa, more than 30,000 new cases of leprosy are detected every year; about 1 million people across Africa are affected by complications that have resulted in irreversible disabilities like the loss of sensation due to nerve damage and eventual loss of limbs.
Noma starts as a wound in the gum of the mouth. If untreated, the wound can become infected and destroy the soft tissues and bones of the mouth, causing the mouth and parts of the face to become gangrenous in malnourished children. It's mainly prevalent in sub-Saharan Africa. There are 148,000 new cases detected each year; the mortality rate is 90%.
There's a campaign for the U.N.'s World Health Organization to officially classify noma as a "Neglected Tropical Disease," which would be helpful in bringing more resources to treatment (antibiotics are effective if the disease is diagnosed early) and to research.
Invite Africa to the table for Artificial Intelligence discussions
The era of artificial intelligence (AI) is here. If you're wondering exactly how AI works, well, that's a complicated question. But in simple terms, great databases of information can be mobilized to solve problems, including health issues. As the National Institutes of Health has written: "AI has made it possible to process and analyze a massive amount of brain signals and data to discover insights and correlations which are not completely obvious to the human eye." That could mean diagnosing diseases and predicting pandemics.
Where does the data that shapes artificial intelligence come from?
In the world of technology, it's no secret that Western countries dominate. But for artificial intelligence to be global in scope, for it to address the intricacies of disease around the world, what's needed are inputs from all the countries of the world, including the often excluded Global South countries. Just look at how they've been at the mercy of the West in COVID-19 vaccine development and distribution for an idea of how disenfranchised they are. In South Africa, one company was given the challenge of replicating the Moderna vaccine for COVID because Moderna won't share the recipe.
The U.N. needs to make sure that African countries and other regions get training in AI and contribute to the growing databases. There are several tech innovation hubs in Africa to support this initiative. These include Co-Creation Hub in Lagos, Nigeria; iHub in Nairobi Kenya; and UNDP Rwanda Accelerator Lab in Kigali. These organizations have the capacity and should be invited to the table.
Promote the use of locally available nutritious foods to tackle malnutrition for children
The world is having a hunger crisis, worsened by conflict and by the toll climate change takes on local agriculture. The U.N.'s World Food Programme offers these staggering numbers: "Over 40 million people across 51 countries are in emergency or worse levels of acute food insecurity in 2023. Furthermore, 45 million children under 5 years of age are estimated to suffer from acute malnutrition."
The United Nations World Food Programme runs programs to help. And the idea that locally grown foods are part of the solution is a critical topic that should be on the table at the GA. In our view that's a more sustainable way of providing nutritious meals to children at risk than by importing food from the West. The Food and Agriculture Organisation of the U.N. profiles the Kenya home-grown school feeding program as an example: It works with local smallholder farmers to provide schoolchildren with safe, diverse and nutritious food. The report shows that the school feeding program has prompted an increase in farming of native vegetables, crops like maize and poultry.
Ndidi Nwuneli, founder and executive chair of African Food Changemakers, says, "given the rising levels of food insecurity and malnutrition linked to climate change, conflict and economic crises in many emerging economies, it is imperative that governments prioritize funding for school feeding programs with a focus on locally sourced and nutritious food options."
It is also imperative to extend such nutrition programs to the more than 42 million African children who are not enrolled in school.
And in conclusion ...
The global community has so far succeeded in eradicating smallpox and two strains of the wild polio virus (type 2 and type 3). These required collaborations involving global health organizations, national governments, the private sector, philanthropic foundations and others. The African diaspora was missing at the table in previous eradication efforts. Their voice should be heard.
Financing is a major catalyst for universal health care. African leaders should focus more on remittances from the African diaspora than chasing donor funds. Making wise use of these remittances will make the continent less dependent on the Global North — and truly independent.
Ifeanyi Nsofor is a public health physician from Nigeria, a global health equity advocate and a senior New Voices fellow at the Aspen Institute.
Esther Ngumbi is a researcher at the University of Illinois Urbana Champaign and a New Voices Fellow at the Aspen Institute. She is from Kenya.
