‘ ‘Policy verses Action’Policy verses Action’Population Growth and its’ Influence to the Population Growth and its’ Influence to the

Efforts Made to Improve the Health, Education and Efforts Made to Improve the Health, Education and Nutrition Situation in EthiopiaNutrition Situation in Ethiopia

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

ByByTirsit GrishawTirsit Grishaw

13, September 2010, Berlin13, September 2010, Berlin

Outline of the presentationOutline of the presentation Background information about EthiopiaBackground information about Ethiopia

Health, Education and Nutrition situation in EthiopiaHealth, Education and Nutrition situation in Ethiopia

Policies/strategies that have direct impact on the health Policies/strategies that have direct impact on the health education, and nutrition situation in Ethiopiaeducation, and nutrition situation in Ethiopia

- PASDEP (Plan for Accelerated and Sustained - PASDEP (Plan for Accelerated and Sustained Development Development to End Poverty)to End Poverty) - The 20 year Sector Development Programs (SDP)- The 20 year Sector Development Programs (SDP)

- Population policy in Ethiopia- Population policy in Ethiopia Limitations/ChallengesLimitations/Challenges

ConclusionConclusion

Background information about EthiopiaBackground information about Ethiopia________________________________________________________________________________________________________________Geographic and demographic tipsGeographic and demographic tips

1010thth largest country in Africa covering 1,104,300 sq kilometers largest country in Africa covering 1,104,300 sq kilometers

Ethiopia is the 2Ethiopia is the 2ndnd populous country form sub Saharan Africa populous country form sub Saharan Africa

with a total population 73.9 Million with a total population 73.9 Million (2007 census)(2007 census)

The pyramidal age structure of the population has remained The pyramidal age structure of the population has remained

predominantly young with 44% under the age 15 years.predominantly young with 44% under the age 15 years. According to the 2005 DHS birth per women declined to 5.4. According to the 2005 DHS birth per women declined to 5.4.

compared to 6.4 in 1990compared to 6.4 in 1990 (2007 Census)(2007 Census)

Cont’Cont’ Ethiopia’s economy depends heavily on the agricultural sector. Agriculture Ethiopia’s economy depends heavily on the agricultural sector. Agriculture

accounts for 83.4% of the labor force. over 45% of the Gross Domestic accounts for 83.4% of the labor force. over 45% of the Gross Domestic

Product (GDP) and 80% of exports. Product (GDP) and 80% of exports.

The regular droughts combined with poor cultivation practices, make The regular droughts combined with poor cultivation practices, make

Ethiopia’s economy very vulnerable to climatic changes. Ethiopia’s economy very vulnerable to climatic changes.

Real GDP growth registered from 2003 – 2005 is 5%. Recent data shows Real GDP growth registered from 2003 – 2005 is 5%. Recent data shows

that Ethiopia have registered double digit economic growth of 11.8%. that Ethiopia have registered double digit economic growth of 11.8%.

Compared to the 7% annual growth target that would be required to meet Compared to the 7% annual growth target that would be required to meet

the MDGs the above figures marks a significant progress. the MDGs the above figures marks a significant progress.

Ethiopia is one of the 189 member states that adopted the Millennium Ethiopia is one of the 189 member states that adopted the Millennium

Declaration in 2000.Declaration in 2000.

Health, Education and Nutrition Health, Education and Nutrition situation in Ethiopiasituation in Ethiopia

HealthHealth The major health problems of the country remain largely preventable The major health problems of the country remain largely preventable

communicable diseases and nutritional disorders.communicable diseases and nutritional disorders.

High rate of Morbidity and Mortality High rate of Morbidity and Mortality - - Life expectancy 53.4 for male and 55.4 for femaleLife expectancy 53.4 for male and 55.4 for female

- - Infant Mortality Rate (IMR) of 77/1000Infant Mortality Rate (IMR) of 77/1000 - - Under five mortality rate 123/1000 Under five mortality rate 123/1000 (more than 90% of the child death is due to (more than 90% of the child death is due to

Pneumonia, diarrhea, malaria neonatal problems and malnutrition and HIV/AIDs )Pneumonia, diarrhea, malaria neonatal problems and malnutrition and HIV/AIDs )

-- Maternal Mortality Rate (MMR)Maternal Mortality Rate (MMR) 673/100,000 673/100,000 (Obstructed/prolonged labor (Obstructed/prolonged labor (13%), ruptured uterus (12%) (13%), ruptured uterus (12%) Eclampsia (11%), malaria (9%) complication form abortion (6%). 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) Shortage of skilled midwives, weak referral system and lack of equipment and under financing of the service)

Source (Health sector development program IV (2010/11-2014/15Source (Health sector development program IV (2010/11-2014/15), DHS (2005)), DHS (2005)

Cont’Cont’

Ethiopia has the largest number of people living with HIV in the world Ethiopia has the largest number of people living with HIV in the world after South Africa and Nigeria (CAFOD/Trocaire, 2006)after South Africa and Nigeria (CAFOD/Trocaire, 2006)

The total number of People living with HIV/AIDs ever started on ART The total number of People living with HIV/AIDs ever started on ART has increased substantially and reached 150,136 (2008).has increased substantially and reached 150,136 (2008).

1,005 HIV/AIDs Care Treatment sties established as result of the 1,005 HIV/AIDs Care Treatment sties established as result of the Millennium AIDS campaign. Millennium AIDS campaign.

Number of facilities PMTCT and ART has increased to 719 and 353 Number of facilities PMTCT and ART has increased to 719 and 353 respectively in 2008. respectively in 2008.

Cont’Cont’NutritionNutrition Nutritional disorder are the main causes of morbidity and mortality.Nutritional disorder are the main causes of morbidity and mortality.

Protein-energy malnutrition and micronutrient deficiencies such as Protein-energy malnutrition and micronutrient deficiencies such as vitamin A, Iron and Iodine are the major problems.vitamin A, Iron and Iodine are the major problems.

During the implementation of HSDP III 90% of children 6-59 months During the implementation of HSDP III 90% of children 6-59 months have got access for nutritional screening every three months at Health have got access for nutritional screening every three months at Health post level.post level.

47 percent of children under –five in Ethiopia were stunted 47 percent of children under –five in Ethiopia were stunted (DHS 2005)(DHS 2005)

Cont’Cont’ 27 percent of all women of childbearing age were found to 27 percent of all women of childbearing age were found to

suffer from chronic energy deficiency (DHS 2005)suffer from chronic energy deficiency (DHS 2005)

In addition to food insecurity, Other factors such as In addition to food insecurity, Other factors such as improper feeding practices, poor child and maternal care improper feeding practices, poor child and maternal care practices, as well as social and traditional factors contribute practices, as well as social and traditional factors contribute to malnutrition. to malnutrition.

Cont’Cont’

EducationEducation Gross Enrolment ratio at primary school in 2008 is 96.7% (Girls 91 %, Gross Enrolment ratio at primary school in 2008 is 96.7% (Girls 91 %,

boys 102.4%).boys 102.4%).

Net Enrolment ratio in 2008 reached 84.4%.Net Enrolment ratio in 2008 reached 84.4%.

In 2008 the number of primary schools in the country reached 23,235. 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 Out of 1,992 primary schools constructed in 2008, 80% are constructed in rural areas with improved awareness of the community towards girls in rural areas with improved awareness of the community towards girls education.education.

Aiming at addressing the education need of pastoral and semi-pastoral Aiming at addressing the education need of pastoral and semi-pastoral areas special programs such as Alternative Basic Education areas special programs such as Alternative Basic Education Centers( ABECs) established.Centers( ABECs) established.

Policies/strategies that affect the Health, Policies/strategies that affect the Health, Education and Nutrition situation in EthiopiaEducation and Nutrition situation in Ethiopia

Plan for Accelerated and Sustained Development to End Poverty Plan for Accelerated and Sustained Development to End Poverty (PASDEP(PASDEP)) - - Main development objective of the Ethiopian government is poverty Main development objective of the Ethiopian government is poverty

eradication eradication -- Hence the objective of the PASDEP is to define the nation’s overall Hence the objective of the PASDEP is to define the nation’s overall

strategy for development for five years.strategy for development for five years. - - This document is strategic guiding framework for the five-year period This document is strategic guiding framework for the five-year period

2005/06-2009/102005/06-2009/10 - - PASDEP represent the second phase of the Poverty Reduction PASDEP represent the second phase of the Poverty Reduction

Strategy program (PRSP) process which has begun under the Strategy program (PRSP) process which has begun under the Sustainable Development and Poverty Reduction Program (SDPRP)Sustainable Development and Poverty Reduction Program (SDPRP)

Important strategic direction of the PASDEPImportant strategic direction of the PASDEP - - PASDEP carries forward important strategic directions pursued PASDEP carries forward important strategic directions pursued

under under the sustainable development and poverty Reduction the sustainable development and poverty Reduction program (SDPRP)program (SDPRP)

Cont’Cont’

In addition to Important strategic direction of SDPRP i.e In addition to Important strategic direction of SDPRP i.e infrastructure and human development, rural development, infrastructure and human development, rural development, food security and capacity building, PASDEP embodies food security and capacity building, PASDEP embodies some bold new direction that include; some bold new direction that include;

- greater commercialization of agriculture - greater commercialization of agriculture - enhancing private sector development- enhancing private sector development - Industry- Industry - Urban development and- Urban development and - Scaling up of efforts to achieve the Millennium - Scaling up of efforts to achieve the Millennium

Development Goals *** Development Goals *** (MDGs)(MDGs)

Cont’Cont’Selected MDGs indicators synchronized with PASDEP Targets and process Selected MDGs indicators synchronized with PASDEP Targets and process

(2007/08)(2007/08)MDMDGsGs

ComponentComponent SelectedSelectedTargetTarget

Base lineBase line(2004/0520(2004/0520

OutturnOutturn(2005/06)(2005/06)

ProgressProgress(2007/08(2007/08

PASDEPPASDEPTargetTarget2009/102009/10

Goal 1Goal 1 Eradicate extreme Eradicate extreme poverty and poverty and hungerhunger

GDP growth GDP growth raterate

10.610.6 0.60.6 11.611.6 7.3 (period 7.3 (period average)average)

% of People % of People under poverty under poverty lineline

3939 36.636.6 32.632.6 29.229.2

% of people % of people who are below who are below food poverty food poverty lineline

3838 35.635.6 31.531.5 27.627.6

Goal 2Goal 2 Achieve universal Achieve universal primary educationprimary education

GERGER (1-8 in%)(1-8 in%)

79.879.8 91.391.3 96.796.7 109.7109.7

Goal 4Goal 4 Reduce child Reduce child mortalitymortality

Child mortalityChild mortality 140/1000140/1000 123/1,000123/1,000 123/1,000123/1,000 85/100085/1000

Goal 5Goal 5 Improve maternal Improve maternal healthhealth

Maternal Maternal mortalitymortality

871/100,000871/100,000 673/100,000673/100,000 673/100,000673/100,000 600/100,000600/100,000

Source UNDP, 2010Source UNDP, 2010

Sector Development programsSector Development programs The Ethiopian Government adopted 20 years sector The Ethiopian Government adopted 20 years sector

development program which mainly include education, health development program which mainly include education, health and food –security strategies.and food –security strategies.

The three sector development programs mainly Health Sector The three sector development programs mainly Health Sector Development Program (HSDP), and Education Sector Development Program (HSDP), and Education Sector Development Program (ESDP) have been implemented since Development Program (ESDP) have been implemented since 1997/98.1997/98.

Health sector reform, Human resource development and health Health sector reform, Human resource development and health facility construction and expansion are major achievements of facility construction and expansion are major achievements of HSDP.HSDP.

Cont’Cont’FacilityFacility HSDP I (1996/7)HSDP I (1996/7) HSDP II (2003/4)HSDP II (2003/4) HSDP III (2009/10)HSDP III (2009/10)

Health PostsHealth Posts 7676 2,8992,899 14,41614,416

Health centersHealth centers 412412 519519 2,6892,689

HospitalsHospitals 8787 126126 195195

Human resources to population Human resources to population

SpecialistsSpecialists 1:103,0981:103,098 1:91,6981:91,698 1:78,9211:78,921

General General practitionerspractitioners

1:54,3851:54,385 1:58,2031:58,203 1:68,6351:68,635

NursesNurses 1:5,6131:5,613 1:4,9801:4,980 1:3,9281:3,928

MidwivesMidwives 1:77,9811:77,981 1:55,7821:55,782 1:57,3741:57,374

HEWHEW -- 1:23,7751:23,775 1:2,3351:2,335 Source HSDP IIISource HSDP III

Cont’Cont’ Education reforms based on ESDP are intended to achieve universal Education reforms based on ESDP are intended to achieve universal

primary enrolment by 2015.primary enrolment by 2015.

ESDP III major objective is to provide demand driven skilled human ESDP III major objective is to provide demand driven skilled human labor to the economy through improving the quality of education, labor to the economy through improving the quality of education, increasing access to educational opportunities with enhanced equity, increasing access to educational opportunities with enhanced equity, equality and relevance.equality and relevance.

The ESDP provides a sector-wide policy and implementation The ESDP provides a sector-wide policy and implementation framework for educational development. One of its main purpose is to framework for educational development. One of its main purpose is to coordinate government and donor inputs in the education sector. coordinate government and donor inputs in the education sector.

Both HSDP and ESDP III spanning for the years 2005/06-2009/10 are Both HSDP and ESDP III spanning for the years 2005/06-2009/10 are under implementation.under implementation.

Cont’Cont’

The national Nutrition StrategyThe national Nutrition Strategy

Emanated as result of the implementation of HSDP. Emanated as result of the implementation of HSDP.

The National Nutrition strategy aims at ensuring optimum nutrition for The National Nutrition strategy aims at ensuring optimum nutrition for all citizen with main priorities and focus on pregnant and lactating all citizen with main priorities and focus on pregnant and lactating women, infants and children under-five years of age, people living with women, infants and children under-five years of age, people living with HIV/AIDs, Food in secured house hold, and displaced population HIV/AIDs, Food in secured house hold, and displaced population groups.groups.

To address the problem of food security, the government established To address the problem of food security, the government established rural development extension strategies and related programs.rural development extension strategies and related programs.

Nutrition has also been made part and parcel of the Health extension Nutrition has also been made part and parcel of the Health extension program.program.

The national Population Policy of EthiopiaThe national Population Policy of Ethiopia

The national population policy of Ethiopia has been prepared by taking in to The national population policy of Ethiopia has been prepared by taking in to consideration the interrelationship between demographic factors on the one consideration the interrelationship between demographic factors on the one hand and developmental variables on the other.hand and developmental variables on the other.

The policy boldly emphasize the influence rapid population growth, young age The policy boldly emphasize the influence rapid population growth, young age structure and uneven spatial distribution of population fuelled by high structure and uneven spatial distribution of population fuelled by high continuing fertility have on the state of underdevelopment that characterize the continuing fertility have on the state of underdevelopment that characterize the Ethiopian reality.Ethiopian reality.

Ethiopian population policy therefore aims at pursuing the following major Ethiopian population policy therefore aims at pursuing the following major objectivesobjectives- - close the gap between high population growth and low economic close the gap between high population growth and low economic

productivityproductivity- - Expediting economic and social development process through holistic Expediting economic and social development process through holistic

integrated development programs integrated development programs - - Reducing the rate to urban migrationReducing the rate to urban migration

The national Population Policy of Ethiopia

Cont’Cont’- Maintaining/improving the carrying capacity of the environment. Maintaining/improving the carrying capacity of the environment.

- Raising the economic and social status of women by freeing them form the 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 restrictions and drudgeries of traditional life and making it possible for them to participate productively in the community.participate productively in the community.

- Significantly improve the social and economic status of vulnerable groups.- Significantly improve the social and economic status of vulnerable groups.

Limitations/ChallengesLimitations/Challenges General ChallengesGeneral Challenges

Lack of coordination of all concerned bodies at national level towards achieving Lack of coordination of all concerned bodies at national level towards achieving the goals set.the goals set.

Absence of accurate and up-to-date data on some targets and indicatorsAbsence of accurate and up-to-date data on some targets and indicators

The attitude of crucial government officials (policy makers and implementers) The attitude of crucial government officials (policy makers and implementers) towards population growth, family planning and related issues.towards population growth, family planning and related issues.

Socio- cultural issues related to Nutrition, family size, and health seeking Socio- cultural issues related to Nutrition, family size, and health seeking behavior. behavior.

Cont’Cont’Specific ChallengesSpecific Challenges

Population growth/carrying capacity of the economyPopulation growth/carrying capacity of the economy

Ethiopia still gets almost 2 million people a year in a highly unfavorable Ethiopia still gets almost 2 million people a year in a highly unfavorable economic and environmental context.economic and environmental context.

Despite the fact that the government announced 11 percent economic Despite the fact that the government announced 11 percent economic growth, due to population growth and uneven distribution of wealth growth, due to population growth and uneven distribution of wealth economic and social indicators are declining to most of the economic and social indicators are declining to most of the populations. populations.

Majority of the population is economically inactive: Over half are too Majority of the population is economically inactive: Over half are too young or too old to work young or too old to work

Cont’Cont’Subsistence farming with low technological inputSubsistence farming with low technological input

The mainstay of the national economy (agricultural sector) is less The mainstay of the national economy (agricultural sector) is less productive per capita today than it was 25 years ago.productive per capita today than it was 25 years ago.

Agricultural out put and export income is still minimal and the country is Agricultural out put and export income is still minimal and the country is heavily dependent of foreign assistance.heavily dependent of foreign assistance.

Arable land is overcrowded, over cultivated, and under –maintained. Arable land is overcrowded, over cultivated, and under –maintained. Lack modern production techniques and over dependent on rainfall.Lack modern production techniques and over dependent on rainfall.

Drought in Ethiopia which used to happen every 10-15 years in the Drought in Ethiopia which used to happen every 10-15 years in the past are now almost permanent features due to more environmental past are now almost permanent features due to more environmental degradation and growth of population. degradation and growth of population.

Cont’Cont’Health and Education infrastructures not keeping pace with Health and Education infrastructures not keeping pace with

population growthpopulation growth

Various reports from CSOs and world bank affirms that at the current Various reports from CSOs and world bank affirms that at the current pace achieving the child survival objective of MDG will be challenging.pace achieving the child survival objective of MDG will be challenging.

The MMR is still the highest when compared with other Sub-Saharan The MMR is still the highest when compared with other Sub-Saharan African countries.African countries.

Still only 50% of the population lives within five kilometers (one hour’s Still only 50% of the population lives within five kilometers (one hour’s walking distance) of a health facility.walking distance) of a health facility.

Unmeet need for contraceptive is 14 percent (government) 21 percent Unmeet need for contraceptive is 14 percent (government) 21 percent (other sources)(other sources)

The ration of health professionals is still extremely low (The ration of health professionals is still extremely low (Source: UNDP, WHO, Source: UNDP, WHO, UNICEF and others)UNICEF and others)

Cont’Cont’ Though gross enrolment rate increased all over the Though gross enrolment rate increased all over the

country, There is significant drop out specially of girls and country, There is significant drop out specially of girls and this is not well detected and addressed.this is not well detected and addressed.

Unfortunately, improvements in coverage have been Unfortunately, improvements in coverage have been accompanied by a sustained deterioration in educational accompanied by a sustained deterioration in educational quality.quality.

Important polices such as agricultural policy, PASDEP and Important polices such as agricultural policy, PASDEP and even the millennium development projects in Ethiopia even the millennium development projects in Ethiopia have not focused on population despite its causal role. have not focused on population despite its causal role.

ConclusionConclusion As demonstrated above the root of Ethiopia’s challenge is its runaway 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. All efforts has to be made to assure sustainable population growth in the country that will allow healthy and sustainable population growth in the country that will allow healthy and sustainable economic growth.economic growth.

Ethiopia’s demographic and developmental challenges are multifaceted and Ethiopia’s demographic and developmental challenges are multifaceted and needs multi- sectoral approaches that should be carried out in well needs multi- sectoral approaches that should be carried out in well coordinated manner.coordinated manner.

Government has to continue showing good commitment to the implementation Government has to continue showing good commitment to the implementation of its’ population policy designed in 1993.of its’ population policy designed in 1993.

Government has to work hard in sustaining already started initiatives with Government has to work hard in sustaining already started initiatives with regard to health, education and nutrition and look for mechanisms that could regard to health, education and nutrition and look for mechanisms that could ease the existing foreign aid dependency.ease the existing foreign aid dependency.

The issue of quality should get necessary attention in all sectoral development The issue of quality should get necessary attention in all sectoral development programs.programs.

Thank YouThank You