Africa Facing Major challenges: Population growth and development impact on poverty By

1. ‘Policy verses Action’ Population Growth and its’ Influence to the Efforts Made to Improve the Health, Education and Nutrition Situation in Ethiopia Africa Facing Major challenges: Population growth and development impact on poverty By Tirsit Grishaw 13, September 2010, Berlin

2. Outline of the presentation Background information about Ethiopia Health, Education and Nutrition situation in Ethiopia Policies/strategies that have direct impact on the health education, and nutrition situation in Ethiopia - PASDEP (Plan for Accelerated and Sustained Development to End Poverty) - The 20 year Sector Development Programs (SDP) - Population policy in Ethiopia Limitations/Challenges Conclusion

3. Background information about Ethiopia________________________________________________________ Geographic and demographic tips 10th largest country in Africa covering 1,104,300 sq kilometers Ethiopia is the 2nd populous country form sub Saharan Africa with a total population 73.9 Million (2007 census) The pyramidal age structure of the population has remained predominantly young with 44% under the age 15 years. According to the 2005 DHS birth per women declined to 5.4. compared to 6.4 in 1990(2007 Census)

4. Cont’ Ethiopia’s economy depends heavily on the agricultural sector. Agriculture accounts for 83.4% of the labor force. over 45% of the Gross Domestic Product (GDP) and 80% of exports. The regular droughts combined with poor cultivation practices, make Ethiopia’s economy very vulnerable to climatic changes. Real GDP growth registered from 2003 – 2005 is 5%. Recent data shows that Ethiopia have registered double digit economic growth of 11.8%. Compared to the 7% annual growth target that would be required to meet the MDGs the above figures marks a significant progress. Ethiopia is one of the 189 member states that adopted the Millennium Declaration in 2000.

5. Health, Education and Nutrition situation in Ethiopia Health The major health problems of the country remain largely preventable communicable diseases and nutritional disorders. High rate of Morbidity and Mortality - Life expectancy 53.4 for male and 55.4 for female - Infant Mortality Rate (IMR) of 77/1000 - Under five mortality rate 123/1000 (more than 90% of the child death is due to Pneumonia, diarrhea, malaria neonatal problems and malnutrition and HIV/AIDs ) -Maternal Mortality Rate (MMR) 673/100,000 (Obstructed/prolonged labor (13%), ruptured uterus (12%) Eclampsia (11%), malaria (9%) complication form abortion (6%). Shortage of skilled midwives, weak referral system and lack of equipment and under financing of the service) Source (Health sector development program IV (2010/11-2014/15), DHS (2005)

6. Cont’ Ethiopia has the largest number of people living with HIV in the world after South Africa and Nigeria (CAFOD/Trocaire, 2006) The total number of People living with HIV/AIDs ever started on ART has increased substantially and reached 150,136 (2008). 1,005 HIV/AIDs Care Treatment sties established as result of the Millennium AIDS campaign. Number of facilities PMTCT and ART has increased to 719 and 353 respectively in 2008.

7. Cont’ Nutrition Nutritional disorder are the main causes of morbidity and mortality. Protein-energy malnutrition and micronutrient deficiencies such as vitamin A, Iron and Iodine are the major problems. During the implementation of HSDP III 90% of children 6-59 months have got access for nutritional screening every three months at Health post level. 47 percent of children under –five in Ethiopia were stunted (DHS 2005)

8. Cont’ • 27 percent of all women of childbearing age were found to suffer from chronic energy deficiency (DHS 2005) • In addition to food insecurity, Other factors such as improper feeding practices, poor child and maternal care practices, as well as social and traditional factors contribute to malnutrition.

9. Cont’ Education Gross Enrolment ratio at primary school in 2008 is 96.7% (Girls 91 %, boys 102.4%). Net Enrolment ratio in 2008 reached 84.4%. In 2008 the number of primary schools in the country reached 23,235. Out of 1,992 primary schools constructed in 2008, 80% are constructed in rural areas with improved awareness of the community towards girls education. Aiming at addressing the education need of pastoral and semi-pastoral areas special programs such as Alternative Basic Education Centers( ABECs) established.

10. Policies/strategies that affect the Health, Education and Nutrition situation in Ethiopia Plan for Accelerated and Sustained Development to End Poverty (PASDEP) - Main development objective of the Ethiopian government is poverty eradication - Hence the objective of the PASDEP is to define the nation’s overall strategy for development for five years. - This document is strategic guiding framework for the five-year period 2005/06-2009/10 - PASDEP represent the second phase of the Poverty Reduction Strategy program (PRSP) process which has begun under the Sustainable Development and Poverty Reduction Program (SDPRP) Important strategic direction of the PASDEP - PASDEP carries forward important strategic directions pursued under the sustainable development and poverty Reduction program (SDPRP)

11. Cont’ In addition to Important strategic direction of SDPRP i.e infrastructure and human development, rural development, food security and capacity building, PASDEP embodies some bold new direction that include; - greater commercialization of agriculture - enhancing private sector development - Industry - Urban development and - Scaling up of efforts to achieve the Millennium Development Goals *** (MDGs)

12. Cont’ Selected MDGs indicators synchronized with PASDEP Targets and process (2007/08)

13. Sector Development programs • The Ethiopian Government adopted 20 years sector development program which mainly include education, health and food –security strategies. • The three sector development programs mainly Health Sector Development Program (HSDP), and Education Sector Development Program (ESDP) have been implemented since 1997/98. • Health sector reform, Human resource development and health facility construction and expansion are major achievements of HSDP.

14. Cont’

15. Cont’ • Education reforms based on ESDP are intended to achieve universal primary enrolment by 2015. • ESDP III major objective is to provide demand driven skilled human labor to the economy through improving the quality of education, increasing access to educational opportunities with enhanced equity, equality and relevance. • The ESDP provides a sector-wide policy and implementation framework for educational development. One of its main purpose is to coordinate government and donor inputs in the education sector. • Both HSDP and ESDP III spanning for the years 2005/06-2009/10 are under implementation.

16. Cont’ The national Nutrition Strategy • Emanated as result of the implementation of HSDP. • The National Nutrition strategy aims at ensuring optimum nutrition for all citizen with main priorities and focus on pregnant and lactating women, infants and children under-five years of age, people living with HIV/AIDs, Food in secured house hold, and displaced population groups. • To address the problem of food security, the government established rural development extension strategies and related programs. • Nutrition has also been made part and parcel of the Health extension program.

17. The national Population Policy of Ethiopia The national Population Policy of Ethiopia • The national population policy of Ethiopia has been prepared by taking in to consideration the interrelationship between demographic factors on the one hand and developmental variables on the other. • The policy boldly emphasize the influence rapid population growth, young age structure and uneven spatial distribution of population fuelled by high continuing fertility have on the state of underdevelopment that characterize the Ethiopian reality. • Ethiopian population policy therefore aims at pursuing the following major objectives - close the gap between high population growth and low economic productivity - Expediting economic and social development process through holistic integrated development programs - Reducing the rate to urban migration

18. Cont’ • Maintaining/improving the carrying capacity of the environment. • Raising the economic and social status of women by freeing them form the restrictions and drudgeries of traditional life and making it possible for them to participate productively in the community. - Significantly improve the social and economic status of vulnerable groups.

19. Limitations/Challenges General Challenges • Lack of coordination of all concerned bodies at national level towards achieving the goals set. • Absence of accurate and up-to-date data on some targets and indicators • The attitude of crucial government officials (policy makers and implementers) towards population growth, family planning and related issues. • Socio- cultural issues related to Nutrition, family size, and health seeking behavior.

20. Cont’ Specific Challenges Population growth/carrying capacity of the economy • Ethiopia still gets almost 2 million people a year in a highly unfavorable economic and environmental context. • Despite the fact that the government announced 11 percent economic growth, due to population growth and uneven distribution of wealth economic and social indicators are declining to most of the populations. • Majority of the population is economically inactive: Over half are too young or too old to work

21. Cont’ Subsistence farming with low technological input • The mainstay of the national economy (agricultural sector) is less productive per capita today than it was 25 years ago. • Agricultural out put and export income is still minimal and the country is heavily dependent of foreign assistance. • Arable land is overcrowded, over cultivated, and under –maintained. Lack modern production techniques and over dependent on rainfall. • Drought in Ethiopia which used to happen every 10-15 years in the past are now almost permanent features due to more environmental degradation and growth of population.

22. Cont’ Health and Education infrastructures not keeping pace with population growth • Various reports from CSOs and world bank affirms that at the current pace achieving the child survival objective of MDG will be challenging. • The MMR is still the highest when compared with other Sub-Saharan African countries. • Still only 50% of the population lives within five kilometers (one hour’s walking distance) of a health facility. • Unmeet need for contraceptive is 14 percent (government) 21 percent (other sources) • The ration of health professionals is still extremely low (Source: UNDP, WHO, UNICEF and others)

23. Cont’ • Though gross enrolment rate increased all over the country, There is significant drop out specially of girls and this is not well detected and addressed. • Unfortunately, improvements in coverage have been accompanied by a sustained deterioration in educational quality. • Important polices such as agricultural policy, PASDEP and even the millennium development projects in Ethiopia have not focused on population despite its causal role.

24. Conclusion • As demonstrated above the root of Ethiopia’s challenge is its runaway population growth. All efforts has to be made to assure sustainable population growth in the country that will allow healthy and sustainable economic growth. • Ethiopia’s demographic and developmental challenges are multifaceted and needs multi- sectoral approaches that should be carried out in well coordinated manner. • Government has to continue showing good commitment to the implementation of its’ population policy designed in 1993. • Government has to work hard in sustaining already started initiatives with regard to health, education and nutrition and look for mechanisms that could ease the existing foreign aid dependency. • The issue of quality should get necessary attention in all sectoral development programs.

25. Thank You