the genealogy and intractable nature of current challenges facing the country,
particularly within the health sector.”205 This scenario is repeated, to a large
extent, in the vast majority of other fistula countries. Seen this way, it
becomes quite easy to understand why countries perpetually populating the
bottom half of Transparency International’s Corruption Perception Index
(which measures the perceived levels of public sector corruption) are also
those with substantial fistula population: Afghanistan, Bangladesh, Benin,
Chad, Cambodia, Ethiopia, Niger, Nigeria, Pakistan, Uganda, Sudan, and
Somalia.206 Quite unsurprisingly, these same countries are also
underperformers according to the World Bank’s Worldwide Governance
Indicators (WGI)207 and other critical indicators of human development,
including those measured by the UNDP.208 As a group, countries in the
regions of sub-Saharan Africa and South Asia (fistula nations) are ranked
worst in the latest UNDP report.209
A recent paper, which analyzes factors it projects as “fundamentally
responsible for the dismal state of health and well-being of Africans,”210 has
it right when it blames docility—acquiescence to bad governance by failing
to use the democratic process to effect changes—as a major culprit.211 The
same is true in South Asia.212 But even so, the ability of ordinary citizens to
205. Obiajulu Nnamuchi, Kleptocracy and Its Many Faces: The Challenges of
Justiciability of the Right to Health Care in Nigeria, 52 J. AFR. L. 1, 12 (2008).
206.Se e Corruption Perceptions Index 2013, TRANSPARENCY INT’L, http://www.
transparency.org/cpi2013/results (last visited Nov. 9, 2015).
207. See The Worldwide Governance Indicators: Interactive Data Access, THE WORLD
BANK GRP., http://info.worldbank.org/governance/wgi/index.aspx#reports (last visited Nov.
9, 2015) (reporting aggregate and individual governance indicators for 215 economies over
the period of 1996-2014, for six dimensions of governance: Voice and Accountability,
Political Stability and Absence of Violence, Government Effectiveness, Regulatory Quality,
Rule of Law, and Control of Corruption); see also The Worldwide Governance Indicators:
Home, THE WORLD BANK GRP., http://info.worldbank.org/governance/wgi/index.aspx#
home (last visited Nov. 9, 2015).
208. See United Nations Dev. Programme, supra note 15, at 160-63 (indicating the
relevant countries rated low on the Human Development Index).
209. Id. at 163. The system used by the UNDP is known as the “Human Development
Index”— introduced in 1990, as an alternative to GDP, to measure of income, education and
health. Inequality, gender and poverty were subsequently added. Id. at 27.
210. Obiajulu Nnamuchi & Simon Ortuanya, The Human Right to Health in Africa and
its Challenges: A Critical Analysis of Millennium Development Goal 8, 12 Afr. Hum. Rts. L.
J. 178, 178 (2012).
211. Id. at 190-91.
212. See Governance & Public Sector Management in South Asia: Overview, THE
WORLD BANK, http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASI
34003707~theSitePK:496671, 00.html (last visited Nov. 9, 2015). Regarding the state of
governance in South Asia and its consequences, the World Bank recently concluded:
The region’s growth has been affected by weak governance. The rule of law
(especially property rights enforcement, and law and order) and judicial systems