Continent of mothers. Continent of hope. Understanding and promoting development in Africa today



Birte Twisselmann

Technical editor, BMJ, BMA House, Tavistock Square, London WC1H 9JR, England (email:



Author: Torild Skard
Publisher: London and New York: Zed Books; 2003
ISBN: 1 84277 106 X (Hb); price: UK£ 45.00, US$ 65
ISBN: 1 84277 106 8 (Sb); 256 pages; price: UK£ 14.95, US$ 22.50

Torild Skard reports on her four-year stint as UNICEF's regional director for West and Central Africa from 1994, during which she had "the intense experience" of getting to know "some two dozen African countries". Her material is gripping, but presented as a somewhat disjointed mixture of first-hand experience and background information on Africa's history, politics, culture, and economics, not necessarily in chronological order. This does not make for easy reading, and the book could have done with a clearer structure, though this might have reduced the sense of involvement.

Skard's work with women and children takes up about half of the text, and is the more interesting half. Every section concludes with an element of hope, or a campaign or programme showing some success, which offers some relief from a situation that comes across as, on the whole, grim.

The author sets the scene with a description of the conflicts in Liberia and Sierra Leone and the gruesome phenomenon of child soldiers, before moving on to the AIDS pandemic that holds the continent in its grip. The impact of this disease is intensified by migration, economic and political crises, increasing poverty and urbanization, weakening family and social structures, women's lack of sexual self-determination, malnutrition, and many other debilitating factors. All converge to increase and multiply the devastation caused by HIV/AIDS.

She does not point the finger at the West for failing to make antiretrovirals affordable, choosing instead to explain poignantly why the epidemic has become so ingrained. There is hope, however. In Senegal, far-sighted planning and participation by government, UNICEF, local administrations, voluntary organizations, and youth and women's groups have led to an effective national campaign against HIV/AIDS. The Ivory Coast started following this example in 1997, but its efforts came to an untimely end after a coup d'état in 1999, which has resulted in prolonged unrest. The Senegal campaign highlights a theme that runs throughout this book: the situation can be improved, but only if local people are involved and local culture respected. Mere financial or managerial help is not effective.

Skard describes her reluctance to make polio eradication a priority, explaining some of the difficulties encountered in politically unstable environments, such as the Democratic Republic of the Congo. However, immunization campaigns have shown that public health goals can be achieved if national leaders and international donors are sufficiently determined and cooperate with the local authorities, she concedes. In the end, the idea of using the campaign to strengthen local health systems prevails. She concludes with two success stories: the eradication of guinea-worm disease and iodization of drinking water, both achieved with simple means and highly effective in their outcome.

During the 1990s, decentralization of health care in West and Central Africa led to the establishment of local primary health care centres, with international donors playing a vital part in financing them and managing their establishment. Donors maintained a steady supply of essential drugs while gradually handing over the control of the centres to local people. Skard stresses that understanding the situation of local women and children is essential for success, as is the involvement of local people in health activities. She illustrates this vividly in her chapter on female genital mutilation and safe motherhood.

Her analysis of the current situation and its historical and political origins is detailed and sharp, her commitment to her work and love for that part of the world are obvious. The scenes and situations she describes are acutely observed, beautifully detailed and evocative.

World Health Organization Genebra - Genebra - Switzerland