Academic journal article Journal of International Affairs

Healing Governance? Four Health NGOs in War-Torn Eastern Congo: The Most That Health Organizations Can Hope for Is to Contribute Indirectly to Better Governance. but They Can Continue to Save Lives

Academic journal article Journal of International Affairs

Healing Governance? Four Health NGOs in War-Torn Eastern Congo: The Most That Health Organizations Can Hope for Is to Contribute Indirectly to Better Governance. but They Can Continue to Save Lives

Article excerpt

Disasters visit Eastern Congo on a continual basis: war, volcanic eruptions, ethnic strife, epidemics, refugee inflows and perhaps worst of all, for most people, a lack of hope. Expatriates who initially work there with idealistic goals) end to leave the region seeing it as a place where life only gets worse. The region barely knows a government or governance system, unless one calls warlord politics and a war economy functioning governance systems. The war and absence of a well-functioning state have exacted a terrible toll on the health of the people living in Eastern Congo. Mortality and morbidity are extremely high, probably the highest in the world.

This article studies the current health system in Eastern Congo. Based on field research conducted during the summers of 2001 and 2002, it explains the overall political situation and its relationship to the ailing health system. Four non-governmental organizations (NGOs)--the Association Regionale d'Approvisionnement en Medicaments Essentiels (ASRAMES), International Rescue Committee (IRC), Malteser and Medical Emergency Relief International (MERLIN)--are attempting to improve this system and bring down mortality and morbidity, which in turn has implications for strengthening governance in Eastern Congo.

FROM MOBUTU TO WAR

During his long reign, Mobutu Sese Seko slowly hollowed out the Congolese state. From the 1960s to the late 1980s, Mobutu used the Congo's immense natural wealth, as well as Cold War support, especially from the U.S., France and Belgium, for an extensive patronage network. Government bureaucracies were slowly destroyed by corrupt management and milked for resources for patronage. Agricultural output, an important tax base, went into steep decline with the Zairization process of the 1970s. Many farms were distributed to the regime's cronies, who were frequently unable to run the farms effectively. Mining companies, a central part of the economy, suffered from underinvestment and were gradually stripped of their assets. Ever since the assassination of Patrice Lumumba, the elected leader of Congo's independence, in 1961, democratic movements have been curtailed. When necessary, Mobutu used the army and secret services to crush opposition.

Building on the colonial heritage of exploitation and violent oppression, Mobutu centralized and personalized his control of the Congolese state. Foreign companies and local citizens became dependent on Mobutu and the cronies of the ruling regime to make progress. Mobutu never attempted to build a well functioning state, nor did he want to foster a productive private sector or a vociferous civil society. These would have hampered his patronage system. As a result, the basic elements of good governance were slowly demolished in the Congo.

By the early 1990s, disaster was looming as the resources for Mobutu's patronage system, and hence his ability to buy loyalty, were drying up. The economy had been in decline since the 1980s. The International Monetary Fund (IMF) and World Bank promoted structural reform and, with the end of the Cold War, Mobutu lost the support from his patron states. Only France continued to support him on and off in its increasingly futile attempts to play a major role in the Great Lakes region and support la francophonie. As the 1990s progressed, Mobutu resorted to increasingly desperate measures. He used the Central Bank to print money to pay his expenses, causing hyperinflation. He also used ethnic tension between the Kasai and Katangese to diminish support for his main political opponent, Etienne Tshisekedi, who was an ethnic Kasai. Similarly, he promoted violence against Congolese of Rwandan descent in Eastern Congo. Through this violence, his clients obtained new wealth by stripping the assets of these population groups. Mobutu then asserted his authority because the ethnic groups needed him to mediate and asked for his protection. He also exploited the refugee inflow after the Rwandan genocide to regain international political support. …

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