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Beans
On my way to Africa
On my trip to Africa, I'm thinking about malaria, public health systems, farm productivity, and beans. Yes, beans.
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Bill Gates travels to Africa

This week I’m in Africa, a place I go a couple of times a year to see our foundation’s work in the field. The reason I go on these trips is to see for myself what’s happening and I come away with success stories, notes on things that we need to get smarter about, and a better understanding overall. This time I’m visiting Ethiopia and Zambia, which should be very interesting.

Eliminating malaria in Zambia
I’ll be looking at malaria intervention in Zambia, because that’s where we supported the first major efforts to distribute bed nets and get people to use them. After we began this work, the U.S. started the President's Malaria Initiative, which essentially expanded what we were doing in Zambia and replicated the program in other countries.

Malaria deaths are way down from their peak in Zambia. Bed nets have been very effective. But we’re still looking for answers to some questions about them. How much do they help long term? How quickly do they wear out? Despite them, do malaria deaths eventually rebound, as we’ve seen somewhat in Zambia (particularly in the north)? Why the increase - is it because people didn’t use the nets, because they’re torn, because mosquitoes adapted, or simply because mosquito numbers vary from year to year?

Nobody ever thought bed nets alone would drive malaria to zero.  They’re a really good tool, but you'll need a couple other tools that you use in a deep way to ever get to eliminating malaria in a particular location or community. Everything we’re learning is equipping us to achieve our long-term goal, which is to eliminate malaria locally in a whole lot of communities, building to eventually emptying the malaria map.

New kind of government partnership in Ethiopia
We’ve been working in Ethiopia for more than a decade. In that time we’ve made over 125 grants to partner organizations that are doing health and development projects there. Our engagement deepened a few years ago when Prime Minister Melas Zenawi came to us and said he really wanted to improve agricultural productivity. Agriculture contributes about half of Ethiopia’s GDP and employs roughly 80 percent of the workforce.

But the Prime Minister said he wanted to try something different from the normal way donors come in and support particular projects. He wanted to step back and look at everything involved in farm yields – seed companies, farmer education, fertilizer costs, everything – and then figure out an overall plan. And then ask donors to support things that fit with the plan. So, about a year and a half ago, Ethiopia formed the Agricultural Transformation Agency.

This is exciting, because areas in the Horn of Africa are often on the edge of famine. The situation in Ethiopia is nowhere near as bad as in Somalia, but the eastern part of Ethiopia has had recurring food problems. Improving the amount of food farmers can raise would make a big difference in the lives of those families living there.

Now that ATA has new policies in place, donor money is going to support projects in line with an overall plan. A lot of the focus is on increasing the productivity of small farmers. Part of the plan involves using new types of seeds. I’ll get to see how that’s going.

Community health outreach
I’ll also get to see the results from Ethiopia really bulking up its community health outreach. About 20,000 young women have been trained and placed in newly built health posts, as they’re called. I’ll be interested to see how that’s going and what the challenges are. One surprise is that pregnant women aren’t coming into the health posts to deliver their babies, at least not as much as expected. What would it take to change that, since the health of the mother and the baby are so dramatically improved by delivering in a clinic? I’m also interested in getting a clearer idea of Ethiopia’s vaccination rates. There are conflicting data on that.

Legumes – beans, basically
I'm also visiting an agricultural research station in Ethiopia where they’re doing very interesting work with legumes – beans, basically. The project is developing new varieties and helping farmers learn how to process them for sale to urban markets, which small farmers weren’t getting to before.

Beans are interesting because they’re a staple for really poor people almost everywhere. The most basic or world diets consist of some kind of bean and some kind of grain: beans and rice, beans and wheat, beans and millet. That combination gives you the complete proteins you need to live. So, nearly everywhere, subsistence farmers grow beans. They’re not only a staple, but also a fertilizer for farmers’ other crops, because beans return nitrogen back into the soil, which most every other crop takes out. Coming up with even better varieties could help farmers and improve nutrition in many places.

As always, throughout this trip I’ll be meeting with local representatives of donor groups and leaders of aid projects. We get together and they talk openly about what’s working and what’s not. That’s always very helpful, hearing from people in the field.

When I come back from Africa I plan to share some of the stories and photos of what I’ve seen in the field so that others can have a glimpse of what’s going on in the poorer part of the world. And by providing that glimpse, I hope it draws people in to want to know about and care about these issues.

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