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Ethiopia Advances in Human Development

(Abebech Akalu)

12-19-15

The Human Development Report was released this week at a ceremony in Addis Ababa. The report, titled ‘Work for Human Development’, calls for equitable and decent work for all. In doing so, it encourages governments to look beyond jobs to consider the many kinds of work, such as unpaid care, voluntary, or creative work that are important for human development.

The report suggests that only by taking such a broad view can the benefits of work be truly harnessed for sustainable development. Speaking at the occasion, Prime Minister Hailemariam Dessalegn said, “Employment can be a great driver of progress, but more people need to be able to benefit from sustainable work that helps them and their families to thrive.”

Ethiopia's GDP growth of the past decade has become an internationally recognized fact. It has in fact started to change the image the country. The main development agenda of the Ethiopian government has always been poverty eradication. All the country's development policies and strategies have been directed towards that goal.

Ethiopia's vision, which guided the development plans for more than a decade, states:

" to become a country where democratic rule, good-governance and social justice reign, upon the involvement and free will of its peoples, and once extricating itself from poverty to reach the level of a middle-income economy as of 2020-2023."

The country's vision, specifically on economic sector, includes:

"building an economy which has a modern and productive agricultural sector with enhanced technology and an industrial sector that plays a leading role in the economy, sustaining economic development and securing social justice and increasing per capita income of the citizens so as to reach the level or those in middle-income countries."

The Sustainable Development and Poverty Reduction Program (SDPRP), which covered the years 2002/03 -2004/05) and A Plan for Accelerated and Sustained Development to End Poverty (PASDEP), that ran from 2005/06 to 2009/10 have been directed towards that goal. During these plan periods, remarkable achievements of economic growth, social development, and good governance were registered.

Since 2003/04, the economy shifted to a higher growth trajectory and the growth momentum was sustained during the PASDEP period. Infrastructure development and social services have expanded. The participation of private investors and the community in general was very substantial. Domestic resource mobilization increased the capacity of the country to finance development projects itself. The process of laying-out a foundation for democracy and good governance was given due attention in reform programs undertaken during the PASDEP period.

As the recent National Human Development Report 2014 attested:

The incidence of poverty declined markedly between 2004/05 and 2010/11. The headcount poverty rate fell from 38.7 percent in 2004/05 to 29.6 percent in 2010/11, using a poverty line of US$0.60/day. As indicated in Table 3.13, the incidence of poverty has continued to decline, falling to 26.0 percent in 2012/13. This implies that Ethiopia is on track to achieve the MDG target of reducing poverty by half by 2015 from a baseline of 44.5 percent in 1990. Over the same period, the poverty gap was also reduced but not the severity of poverty. Head -count poverty fell in all regions of the country.

Indeed, Ethiopia set ambitious goals and worked day and night in the past five years. UNDP's National Human Development Report for Ethiopia confirmed that since 2005, 2.5 million people have been lifted out of poverty. The rapid economic growth of the past decade has been generally accompanied by improved per capita income and a decline in poverty. However, because of high population growth, the absolute number of the poor has remained unchanged at some 25 million over the past 15 years.

These progresses had been achieved across sectors.

Educational progress

The Human Development Report commended the impressive progress in educational attainment has been made in the past 20 years.

After all, it is a public knowledge that, throughout much of the twentieth century, Ethiopia was one of the most educationally dis­advantaged countries in the world. The majority of the population has had little access to schooling, a legacy that continues to affect the country’s human resources.

Great strides have been made in education since 1992(1999/2000). Almost all children of primary-school age now in school, while enrollment growth has also been impressive at the secondary level, for which the gross enrollment rate has more than doubled since then.

As publicized in the 2011 Welfare Monitoring Survey (WMS), the levels of literacy and numeracy (among the population over 10 years old) have increased significantly over time. Literacy rates have risen since 2004 from 37.9 per cent to 46.7 per cent in 2011. Literacy rates in Ethiopia are on target for males but lower than expected for females, even when taking into account levels of income. This is occurring despite major improvements in literacy for both sexes since the mid-2000s. Overall, the female literacy rate has increased from 27 to 39 per cent between 2004 and 2011, and male literacy from 49 to 59 percent for persons aged 10 years and older.

The Human Development Report had commended the progress in terms of Gross and Net Enrollment Rates. The report noted:

While the recent expansion of education has taken place at all levels, the Government has made particular efforts towards universal primary education. Gross enrolment rates in primary school are 98.2 per cent for boys and 92.4 per cent for girls, while for secondary schools the gross rates are 40 per cent for boys and 37 per cent for girls.

Ethiopia has thus seen an enormous and rapid increase in enrolment in primary education that has contributed to reducing the gender imbalance within education.  The Government aims to achieve universal primary education for those aged 7-14 as a GTP target by 2014/15.

As part of expanding educational opportunities over the past two decades, net enrolments in primary school have almost tripled since monitoring began in 1994. Currently, 85.7 percent of Ethiopian primary age children are attending primary school.

Indeed, earlier reports attested these progresses. Primary school completion rates (Grade 8) show ongoing improvement, reaching 52.8 percent in 2012/13, representing a marginal improvement over the previous year (52.1 percent). Male completion rates reached 53.3 percent while females were at 52.2 per cent. The latest data show a lower drop-out rate from primary school for girls (15.4 per cent) than boys (15.9 per cent).

Moreover, as pointed out in the Human Development Report:

Secondary school enrolment has risen too, but remains at quite low levels, especially in rural areas, and among the poorest groups. Only in the last five years did the gender gap start decreasing at this level of education.

Primary school (Grades 1-8) net enrolment rose from 68.5 per cent in 2004/5 to 85.7 percent in 2012/13, but it remained virtually unchanged over the last two years of that period. Lower primary net enrolment rate (Grades 1-4) reached 95.3 per cent, having improved by 3.1 percent -age points from the previous year. While net enrolment for both boys and girls are showing improvement, boys’ net enrolment is ahead of girls’ by 5.3 percentage points.

If it was possible to get reliable age specific data, NER (Net Enrollment Rate) is the best way of measuring participation and is a more refined indicator of coverage in terms of explaining the proportion of pupils enrolled from a specific age group. However, unfortunately, due to various reasons it is very difficult to use this indictor seriously as the age specific data we get from schools has low quality.

Nonetheless, the data on primary net enrolment ratio shows an increasing trend as the GER does. Both the GER and NER of Primary, indicate that access is improved through time. In 2005 E.C. (2012/13) NER has increased by 0.5 percentage points from the previous year and is 2.9 percentage points higher than in in 2001 E.C. (2008/09)

The Human Development Report did also recognize the progress made in tertiary education. The report described:

 Turning to the tertiary level, university education in Ethiopia has a history going back some 63 years. The first higher education institute in Ethiopia was established in 1950 as Addis Ababa University College. When the current Government came into power in 1991, there were only two government universities and 16 colleges. Currently, there are 32 government universities (plus 75 private higher education institutes).

The student intake (new enrolments), which was less than 15,000 when the current Government came to power in 1991, has reached about 467,843 currently. The education budget, which was only 16.7 per cent of the total budget in 2004/05, reached 25.2 per cent in 2012/13. A total of 237,877 students were studying in technical and vocational institutions (TVET) in 2012/13. In 2012/13, 79,786 students graduated from government and private higher education institutions.

Statistics show that access to higher education institutions is improving through time for both sexes; and it confirms that the role of non-Government institutions is significant.

In the year 2005 E.C. (2012/13) the total undergraduate enrolment (government and non-government; regular, evening, summer and distance programs) is 553,848 of which 166,141 are females which accounts for 30% of the total enrolment. In addition, 474,198 (85.6%) of the total undergraduate enrolment is in government institutions. The postgraduate program is a specialized program offered under the schools of graduate studies to students who already have their bachelor’s or first degree. Completion of this program is certified by awarding either a Masters degree or equivalent, or a PhD.

The significant increase in postgraduate enrolment in the past five years of which 90.3% are from government institutions. In 2005 E.C. (2012/13), the percentage of female postgraduate students is 19.5% which is lower by 0.7 percentage points when compared to the year 2004 E.C. (2011/12).

Quality of education is another key aspect of the progress. The rapid expansion in access to and enrolment in education is a necessary but not a sufficient condition to ensure that Ethiopians have the knowledge and skills that will enable them to create or find employment that is more productive. There are multiple factors that come into play in this, including quality of education, employment opportunities, and the requisite environment to create or expand productive employment. 

The Government is trying to improve the quality of education through the School Improvement Program financed under the General Education Quality Improvement Program (GEQUIP). This program lays the ground -work for improvements in student performance. Examples include the creation of a conducive school environment, the improvement of school facilities, and the use of cluster resource centers, tutorial classes, student peer networking, and greater participation via student parliaments / councils.

As reaffirmed in several other reports as well, some indicators of education quality have begun to show progress. Examples include the mass hiring of new teachers that has led to the reduction in pupil-teacher ratios from 66:1 in 2004/05 to 49:1 in 2012/13 for primary education, and from 51:1 to 29:1 for secondary education. The national pupil-teacher ratio also improved slightly from 50:1 to 49:1 in the same period.

In the same period, the proportion of qualified primary school teachers increased from 60.6 per cent to 64.7 per cent, with qualified women slightly outpacing men. In addition, some 95 percent of teachers and supervisors currently meet basic professional teaching standards and receive ongoing in-service training. The Government further plans for some 220 educational institutions to complete qualification standard assessments. And teachers’ qualifications will be upgraded through professional development arrangements with US and UK educational organizations.

Similarly, efforts are being made to increase the use of tutorial classes for low performing students (mainly girls), purchase additional reading materials, promote improvements in libraries and laboratory facilities, and establish cluster resource centers for multi-purpose educational uses.

According to surveys of school directors, teachers and students, there have been visible changes in teaching methodology. The tendency of shifting from a lecture (“chalk and talk”)  approach to an active learning approach is be -coming more common in schools.

Progress in health access and health gains

Ethiopia has also shown progress trends in health access and health gains show dramatic improvements in the past 10 years. The government has shown strong political commitment and leadership, which has resulted in impressive health service coverage, including enhanced responsiveness to community health needs. Health planning and interventions are based on extensive consultation and consensus-building with multiple stakeholders.

Indeed, as the report observed the overall gain has led to increased life expectancy for both men and women, which is a key component of the human development index.

These gains had been elaborated on the World Health Organization (WHO) report last year on May. It's to be recalled that WHO's report had underlined:

"At the national level, 24 countries gained more than 10 years in life expectancy (both sexes combined) between 1990 and 2012. Of these countries, 12 were in the WHO African Region and five in the WHO South-East Asia Region, along with Afghanistan, Cambodia, the Islamic Republic of Iran, the Lao People’s Democratic Republic, Lebanon, South Sudan and Turkey.

The top six individual gains recorded were in Liberia (19.7 years) followed by Ethiopia, Maldives, Cambodia, Timor-Leste and Rwanda. Among high-income countries, the average gain was 5.1 years, ranging from 0.2 years in the Russian Federation to 9.2 years in the Republic of Korea."

Life expectancy is important because it tells much more than the estimated length of life. It also summarizes the mortality pattern that prevails across all age groups in a given year – children and adolescents, adults and the elderly.

However, with regard to Ethiopia, the decrease in mortality rate had been registered in specific areas as well.

As the Human Development Report confirmed:

Ethiopia is making noteworthy improvements in maternal and child health. Children are now vaccinated against major diseases and most pregnant women get antenatal and post -natal care.

"...between 2005 and 2010 contraceptive prevalence increased to 29 per cent from 15 per cent and good improvements were achieved in the  under-five mortality rate, which fell from 123  (per 1,000 live births) in 2005 to 88 per 1000 live  births in 2010.

Infant mortality dropped from 77 to 59 per 1,000 live births during the same period. According to the Welfare Monitoring Survey, the prevalence of general illness dropped from 23.8 per cent in 2004 to 16.9 per cent in 2011.

The progresses in terms of reduction of under age 5 mortality rate had been confirmed by several international organs.

Last year, the UN IGME - the UN Inter-agency Group for Child Mortality Estimation, stated in its international report that:

"Many countries have made and are still making tremendous progress in lowering under-five mortality. Of the 61 high-mortality countries with at least 40 deaths per 1,000 live births in 2012, 25 have reduced their under-five mortality rate by at least half between 1990 and 2012.

Of them, Bangladesh (72 percent), Malawi (71 percent), Nepal (71 percent), Liberia (70 percent), Tanzania (68 percent), Timor-Leste (67 percent), and Ethiopia (67 percent) have already reduced the under-five mortality rate by two-thirds."

Similar gains have been registered in other areas from 1991 to 2015. Maternal mortality ratio (per 100,000 live births) declined from 1,400 to 420; the proportion of population without access to improved drinking-water sources declined from 13% to 52%; and proportion of population without access to improved sanitation rose from 2 to 24% and the figure of underweight children (aged < 5 year) decreased from 43.3% to 29.2%.

These are impressive figures when compared to what had been two decades ago. In 1990, 204 children in every 1,000 in Ethiopia died before the age of five. In that regard, Ethiopia was among the bottom six countries in the world. The progress is observed in terms of Adult mortality rate as well. Adult mortality rate, or the probability of dying between 15 and 60 years of age per 1000 population, declined from 478 to 212.

The source of this impressive progress in health was nothing but the government’s health policy and its political commitment to the sector. The Human Development Report attested that:

In line with the Growth and Transformation Plan and Health Sector Development Programs (HSDP), the Government has been making strong efforts to expand and provide health services at all levels.

The Government’s health policy emphasizes preventive measures as most health problems in the country are related to communicable diseases. Hence, the Government has had comparable success in expanding health services at the community level.

Indeed, the achievement attests the quality of leadership and policies applied both in the health sector and the nation in general as demonstrated in the rapid growth in the construction of health facilities, the training of health professionals and the budgetary resources allocated to the sector.

Indeed, since the 1993 national health policy, the government has always emphasized the importance of achieving access to a basic package of quality primary health care services by all segments of the population, using the decentralized state of governance.

In order to achieve the goals of the health policy, a twenty-year health sector development strategy has been formulated, which is being implemented through a series of five-year plans.

The implementation of the first health sector development program (HSDP) was launched in 1997, and now the second HSDP is under way. The main trust of the HSDP implementation is based on sector-wide approach, encompassing the following eight components: Service delivery and quality of care; Health facility rehabilitation and expansion; Human resource development; Pharmaceutical services; Information, education and communication; Health sector management and management of information systems; Monitoring and evaluation and Health care financing.

The HSDP introduced a four-tier health service system which comprises: a primary health care unit, (a network of a health center and five health posts), the hospital, regional hospital and specialized referral hospital. A health post is now being staffed by two health extension workers. These new cadres are trained for one year and their training emphasizes disease prevention measures. A health center is at the highest level of a primary health care unit. It includes services such as in-patient and out-patient services including surgery, and with laboratory services.

A health station used to give services that a health center does, but at a smaller scale.  Health Station is now being phased out. According to the current health sector development program (HSDP), a primary health care unit comprises of 5 health posts and a health center serving as a referral point.  Therefore, when the HSDP is fully implemented, a health center will serve 25,000 people.

Indeed, the achievements demonstrate the quality of leadership and policies applied both in the health sector and the nation in general. The Human Development Report listed down that:

The number of health posts rapidly increased to reach 16,048 in 2013, up from 4,211 in 2005 and 6,191 in 2006. At present, the Government is planning to expand the health service system further through constructing more than 15,000 health posts, 3,056 health centers, and 800 new primary hospitals.

One of the most innovative approaches had been the deployment of health development army. As the Human Development Report summarized it:

A Health Development Army has also been formed as a means to meet priorities set in the HSDP and GTP. The Army consists of 2,026,474 one-to-five peer networks that have been established nationwide. Priority is given to mass mobilization in pastoral areas.

The Human Development Report observes the progress in several other areas. It reported that with respect to immunization, its coverage at the national level in 2012/13 was 87.6 percent for Pentavalent-3 vaccine and 71.4 per cent for full immunization coverage. This compares with 70.1 per cent for Pentavalent-3 and 44.5 percent for full immunization in 2004/05.

In terms of the quality of health care, apart from achieving the global MDG 4 target of declining child mortality, improvements can be observed in malnutrition, anaemia, and immunization rates. The percentage of children vaccinated against DPT3 reached 87.6 per cent in 2013, up from almost 85 per cent the previous year.

Antenatal service coverage has improved. The number of pregnant women receiving antenatal care for the first time from a health provider raised from 89 per cent 2012 to 97.4 per cent in 2013. This is a very promising trend given that only 82 per cent of women were receiving such care in 2011. The percent -age of skilled health care deliveries increased from 20 to 23 per cent. However, there is great variation between regions, ranging from 14 percent in Gambella to 73 per cent in Addis Ababa.

Expounding the coverage vaccination the Human Development Report pointed out that: Girls are slightly more likely to be fully vaccinated (26 per cent) than boys (23 per cent). Urban children are more than twice as likely as rural children to have all basic vaccinations (48 per cent compared with 20 per cent). Children whose mothers have secondary education are more likely to be fully immunized than those born to mothers with no education (57 and 20 percent, respectively). Similarly, 51 per cent of children in the highest income quintile are fully immunized, compared with 17 per cent of children in the lowest income quintile.

Another area Ethiopia had registered strides is in HIV/AIDS. The Human Development Report commended Ethiopia as follows:

 With respect to HIV and AIDS, over the last two decades Ethiopia has taken strong measures to address the epidemic, as a result of which HIV incidence has declined by 90 per cent. Death from HIV and AIDS has also declined by 53 per cent. HIV prevalence has also declined from 2.4 percent in 2009/10 to 1.3 per cent in 2012/13.

Moreover, the number of people who get HIV tests has increased from fewer than half a million to 12 million. HIV prevalence is now 3.8 percent in urban areas and 0.5 per cent in rural  areas. HIV prevalence varies from region to re -gion. Prevalence rates are highest in Gambella  (5.5 per cent) and Addis Ababa (4.4 per cent).

As development experts say, the most challenging part of a government's commitment is the financing aspect. Governments set big goals but they are not committed to allocating the necessary budget.

In this aspect, the government of Ethiopia stands out as an exemplary one. Since 1992 there have been several major changes in the structure of the government budget to the health sector.

First, the proportion of salaries in the recurrent budget has declined to 53 percent in 1996 as a large share of the recent increases in health spending has gone to drugs and other non-salary items. Second, there has been a reallocation of resources away from facilities in Addis Ababa and to primary care facilities. Since 1994, capital expenditure on health centers and health stations has risen from 17 to 40 percent of the capital budget.

Third, support for public health services has increased with more than half of total regional recurrent expenditures focused on Primary Health Care-related services. Fourth, control over health expenditure has shifted to the regions, which have, since 1994, controlled between 83 and 88 percent of the health expenditure and which in 1996 controlled 83 percent of the recurrent budget and 95 percent of the capital budget.

The Human Development Report gave its testimony in this regard as follows:

"In sum, increased health-related expenditure has led to significant improvements in the health status of the population. With respect to the health budget, the health-related share increased from 5.6 per cent to 8.5 percent between 2005 and 2010, and has remained at the same level for the past three or four years. 

Health expenditures per capita have been rising for a longer period, but especially rapidly since the mid-2000s. Total public health expenditures now average around 2.5 per cent of GDP, which is in line with the average for a country of Ethiopia’s income level."

Indeed, as the Human Development Report attested:

At the center of the country’s strong economic and social performance has been the Government’s proactive and leading role in shaping socio-economic policy. With its goal of making  Ethiopia a middle-income country no later than  2025, the Government, among other things,  has been investing heavily in economic and social infrastructure, streamlining public services,  revamping the tax collection system, and sup -porting small and medium enterprises (SSMEs).

 


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