MDG Report 2013

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Empowered lives.

Resilient nations.

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Copyright 2013

By the United Nations Development ProgrammeAlick Nkhata RoadP.O. Box 31966Lusaka, 10101Zambia

All rights reserved. No part o this publication may be reproduced, stored in a retrieval system or transmitted in any ormor by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission rom the UnitedNations Development Programme.

Editor: Camilla Hebo Buus

Photos: Georgina Smith or UN Communications Group/2012, Except MDG 8 photo (UNDP/Shutterstock/2013)

Printed By New Horizon Printing Press, Lusaka, Zambia.

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Empowered lives.

Resilient nations.

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MDG Progress Report 2013

Indicator

MDG 1:

EradicateExtremePoverty andHunger

MDG 2:

AchieveUniversalPrimaryEducation

MDG 3:

PromoteGenderEquality

MDG 4:

ReduceChildMortality

Goal

Target 1.A: Halve, between 1990 and

2015, the proportion o people living

in extreme poverty

Target 1.B: Achieve ull and produc-

tive employment and decent work

or all, including women and young

people

Target 1.C: Halve, between 1990 and

2015, the proportion o people who

suer rom hunger

Target 2.A: Ensure that by 2015, chil-

dren everywhere, boys and girls alike,

will be able to complete a ull course

o primary schooling

Target 3.A:Eliminate gender disparity in primary

and secondary education, preerably

by 2005, and in all levels o education

no later than 2015

Target 4.A: Reduce by two-thirds,

between 1990 and 2015, the under-

ve mortality rate

Proportion o population

in extreme poverty (%)

Poverty Gap Ratio (%)

Gini Coecient

Employment to population ratio

Proportion o employed people

living below the poverty line (%)

Prevalence o underweight

children U-5 (%)

Primary school net

enrolment rate (%)

Pupils reaching Grade 7 (%)

Literacy rates:

15-24-year-olds (%)

Ratio o girls to boysin primary education

Ratio o girls to boys

in secondary education

Ratio o girls to boys

in tertiary education

Ratio o literate women to men

15-24-year-olds

Share o women

in wage employment (%)

Proportion o seats held by

women in parliament (%)

U-5 mortality rate

(deaths per 1,000 live births)

Inant mortality rate


One-year-olds

immunized against measles (%)

Target

Status at a Glance

To help direct theocus, this report di-vides the MDG targetsinto three categories:

Targets whichhave been or willbe met by 2015

Targets whichrequires acceler-ated interventions

to be met

Targets whichwill not be metwithout signi-cant reorms andinvestments

2

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42.3 (2010)1

28.0 (2010)2

0.65 (2010)3

86.9 (2010)4

66.4 (2006)5

13.3 (2010)6

93.7 (2010)7

90.9 (2010)8

89 (2010)9

0.99 (2010)10

0.89 (2010)11

0.75 (2010)12

0.87 (2010)13

0.36 (2010)14

11 (2012)15

138 (2010)16

76 (2010)17

94 (2010)18

Status at a Glance

2015 Target Will Target be Achieved under the Present Trend?Current Data

3

29

31.1

0.34

12.5

100

100

100

1

1

1

1

30

63.6

35.7

100

Signicant reorms and investments needed

Yes


Yes

Acceleration required



Yes



Yes





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4

Indicator

MDG 5:

ImproveMaternalHealth

MDG 6:

CombatHIV&AIDS,Malaria andother Diseases

MDG 7:

EnsureEnvironmentalSustainability

MDG 8:

Develop aGlobalPartnership forDevelopment

Goal

Target 5.A: Reduce by three-quar-

ters, between 1990 and 2015, the

maternal mortality ratio

Target 6.A: Have halted, by 2015,

and begun to reverse the spread o

HIV&AIDS

Target 6.B: Achieve, by 2010,

universal access to treatment or

HIV&AIDS or all those who need it

Target 6.C: Have halted, by 2015,

and begun to reverse, the incidence

o malaria and other major diseases

Target 7.A: Integrate the principles

o sustainable development into

country policies and programmes

and reverse the loss o environmen-

tal resources

Target 7.C: Halve, by 2015, the pro-portion o the population without

sustainable access to sae drinking

water and basic sanitation

Target 8.A: Develop urther an

open, rule-based, predictable, non-

discriminatory trading and nancial

system

Target 8.B: Address the special

needs o the least developed

countries

Target 8.F: In cooperation with

the private sector, make available

the benets o new technologies,

especially ICT

Maternal mortality ratio


Proportion o births attended by skilled

health personnel (%)

HIV prevalence rate (%)

Proportion o 15-24-year-olds with

comprehensive, correct knowledge o

HIV&AIDS (%)

Ratio o school attendance o orphans to

non-orphans 10-14-year-olds (%)

Proportion o population with advanced

HIV inection with access to ARVs (%)

New malaria cases per 1,000 population

Malaria atality rate per 1,000

population

Households with ITNs (%)

Land covered by orests (%)

Land protected to maintain biological

diversity (%)

Carbon dioxide emissions per capita (MT

per capita)

Proportion o population using solid uels

(%)

Proportion o population without accessto an improved water source (%)

Proportion o population without access

to improved sanitation acilities (%)

Ocial development assistance

($ millions)

Foreign direct investment ($ millions)

Access to markets in developed countries

Debt sustainability (% o GDP)

Fixed telephones per 100 people

Mobile phones per 100 people

Target

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Status at a Glance

5

483 (2010)19

46.5 (2007)20

14.3 (2007)21

48 (2007)22

92 (2009)23

79 (2007)24

330 (2010)25

34 (2010)26

64.3 (2010)27

49.9 (2010)28

41 (2007)29

17.4 (2007)30

82.9 (2010)31

36.9 (2010)32

67.3 (2010)33

480.16 (2011)34

1729.3 (2010)35

11.6 (2011)36

0.8 (2011)37

62.5(2011)38

2015 Target Will Target be Achieved under the Present Trend?Current Data


Yes

Yes

Yes





162.3

< 15.6

100

80

255

11

25.5

13

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Table o Contents

2 Status at a Glance6 Table o Contents

8 Foreword

9 Acronyms

10 Executive Summary

13 A Cautionary Note on Data

16 MDG 1 End Poverty and Hunger

22 MDG 2 Universal Education

26 MDG 3 Gender Equality

30 MDG 4 Child Health

34 MDG 5 Maternal Health

38 MDG 6 Combat HIV&AIDS and Malaria

44 MDG 7 Environmental Sustainability

52 MDG 8 Global Partnership

56 Conclusion

60 Notes

16 Table 1: Progress in MDG 1 Indicators (Poverty)

18 Table 2: Progress in MDG 1 Indicator (Hunger)

22 Table 3: Progress in MDG 2 Indicators (Universal education)

26 Table 4: Progress in MDG 3 Indicators (Gender equality)

27 Table 5: Ratio o Women to Men in Tertiary Education by Institution

30 Table 6: Progress in MDG 4 Indicators (Child health)

34 Table 7: Progress in MDG 5 Indicators (Maternal health)

38 Table 8: Progress in MDG 6 Indicators (HIV&AIDS)

40 Table 9: Progress in MDG 6 Indicators (Malaria)

44 Table 10: Progress in MDG 7 Indicators (Environment)

46 Table 11: Progress in MDG 7 Indicators (Water and sanitation)

52 Table 12: Ocial Development Assistance to Zambia (2006-2010)

TABLES

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Table o f Contents

16 Figure 1: Population in Extreme Poverty

16 Figure 2: Poverty Gap Ratio (depth o poverty)

17 Figure 3: Extreme Poverty by Province (2010)18 Figure 4: Underweight Children under Five

18 Figure 5: Underweight by Province (2010)

22 Figure 6: Primary School Net Enrolment

22 Figure 7: Pupils Reaching Grade 7

23 Figure 8: Literacy Rates (15-24-year-olds)

23 Figure 9: Completion Rates Grades 9 and 12

26 Figure 10: Ratio o Girls to Boys in Primary, Secondary and Tertiary Schools

26 Figure 11: Ratio o Girls to Boys in Primary School by Province

30 Figure 12: U-5 Mortality Rate

30 Figure 13: Inant Mortality Rate

30 Figure 14: One-Year-Olds Measles Immunized

31 Figure 15: Full Immunization Coverage by Province (2008-2010)

34 Figure 16: Maternal Mortality Ratio

34 Figure 17: Births Attended by Skilled Personnel

35 Figure 18: Supervised Deliveries by Province (average 2008-2010)

38 Figure 19: HIV Prevalence Rate

38 Figure 20: Universal Treatment

39 Figure 21: HIV Prevalence by Province 2007 (2001/02)

39 Figure 22: New HIV Inections among Adults ( 15 years)

39 Figure 23: Adults ( 15 years) who have Received VCT, and Know Their Results

39 Figure 24: Mothers Needing and Accessing PMTCT

40 Figure 25: New Malaria Cases

40 Figure 26: Households with ITNs

41 Figure 27: Malaria Incidence by Province

44 Figure 28: Land Covered by Forest

44 Figure 29: Use o Solid Fuels

44 Figure 30: Land Protected or Biodiversity

45 Figure 31: Main Sources o Energy or Cooking (2010)46 Figure 32: Access to Improved Water

46 Figure 33: Access to Improved Sanitation

47 Figure 34: Access to improved Water by Province (2006 and 2010)

47 Figure 35: Proportion o Population using Pit Latrines and Flush Toilets by Province

53 Figure 36: FDI into Zambia (2000-2011)

53 Figure 37: Direct Employment Created by FDI by Sector

54 Figure 38: Phone and Internet Connectivity

FIGURES

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Foreword

The 2013 Millennium Development Goals (MDGs) Report or Zambia tracks achievements on the 8goals and 39 indicators in the context o the countrys development. The report is an essential toolor Zambias leaders, citizens and partners or reviewing the progress o national policies and pro-grammes that address each o the 8 goals. In some o the areas, as highlighted in the report, we seesignicant achievements. In others, progress remains slow.

By emphasizing triggers or acceleration, government and UNDP, as co-authors o the report, exam-ine what has been tried and tested. This includes looking at lessons learnt or what could light a reunder relevant policies and institutions in order to either increase the momentum or get back ontrack towards achieving the targets by 2015.

For those targets that have been reached, we have moved the bar up by looking at the next set ochallenges. For example, while it is highly commendable that the target or primary school enrol-ment is close to being met, no country can develop on primary education alone. Zambia now has

to improve access, quality, relevance and completion o secondary and tertiary education. Similarly,the country has reduced its HIV prevalence rate to below the target, and did so by 2007. Yet, anotherchallenge is the rate o new HIV inections. This report is thereore not limited to global targets only,but sets new targets according to Zambias realities in response to the national commitment andimpetus to go even urther.

Concerns remain in those areas where Zambia is not on track to achieve its MDG targets. In a countryendowed with natural resources, the outlook or MDG 7 (environmental sustainability) is worryingdue to the degradation o land, orests, water and wildlie. Similarly, or MDG 1 (reducing povertyand hunger): Zambia has grown economically at an average o 6.5 percent or the past six years, yetcannot show a signicant reduction in poverty, inequality and malnutrition in the rural and peri-urban areas most in need o this. Accordingly, national priorities and policies will have to be resetand institutions realigned to gain ground in these areas.

Given the relatively short time remaining, the private sector and civil society will have to play aneven greater role in supporting the acceleration initiative, as well as providing eedback on govern-ments eorts towards achieving the MDGs by 2015.

We wish to thank all those who contributed to this report, by providing data, substantiation andcomments to help us tighten the analysis, including government partners, particularly the Minis-try o Finances Monitoring and Evaluation Department and the Central Statistical Oce; the manyreaders across government ministries and NGOs; and the UN agencies, particularly WHO, UNICEF,UNFPA, UNAIDS and ILO. We look orward to this report being actively used in the national develop-ment dialogue and policy-making process.

Honourable Alexander Chikwanda, MPMinister o Finance

Kanni WignarajaUnited Nations Resident Coordinator/

UNDP Resident Representative

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Foreword Acronyms

Acronyms

AIDS Acquired Immune Deciency SyndromeART Antiretroviral Therapy

ARVs Antiretrovirals

CFCs Chlorouorocarbons

CSO Central Statistical Oce

FDI Foreign Direct Investment

FISP Farmers Input Support Programme

GDP Gross Domestic Product

GNI Gross National Income

HIV Human Immunodeciency Virus

ICT Inormation and Communications TechnologyIMF International Monetary Fund

IRS Indoor Residual Spraying

ITNs Insecticide-Treated Mosquito Nets

LCMS Living Conditions Monitoring Survey

MDG Millennium Development Goal

MDGR Millennium Development Goals Report

MOE Ministry o Education

MOH Ministry o Health

MT Metric Tons

ODP Ozone Depletion PotentialOECD Organization or Economic Cooperation and Development

ODA Ocial Development Agency

PAGE Programme or the Advancement o Girls Education

PMTCT Prevention o Mother to Child Transmission

PPP Purchasing Power Parity

REDD Reducing Emissions rom Deorestation and Forest Degradation

SADC Southern Arican Development Community

SIM (Cellular Phone) Subscriber Identity Module

SNDP Sixth National Development Plan

TB TuberculosisTEVETA Technical Education, Vocational and Entrepreneurship Training Authority

U-5 Under 5 years o age

UN United Nations

UNDP United Nations Development Programme

UNGASS United Nations General Assembly

UNICEF United Nations Childrens Fund

UNESCO United Nations Educational, Scientic and Cultural Organization

VCT Voluntary Counselling and Testing

WHO World Health Organization

WTO World Trade OrganizationZDHS Zambia Demographic and Health Survey

ZICTA Zambia Inormation and Communications Technology Authority

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Executive Summary

The 2013 Millennium Development Goals Re-port or Zambia provides an opportunity or the

country to reect upon and assess its progress

towards achieving the eight Millennium Devel-

opment Goals (MDGs). With the 2015 deadline

approaching, Zambias progress on many o the

MDG targets is encouraging. Nonetheless, the

country is still conronted by challenges that

hold back key policy and institutional reorms,

and consequently the overall pace o implemen-

tation. Issues o policy direction and consistency,

as well as institutional capacities to deliver, must

thereore underpin eorts to both accelerate

and widen progress.

In this regard, particular attention must be paid

to lessons learnt as well as interventions re-

quired to ast-track the attainment o the MDGs

in Zambia. This years report has thereore iden-

tied selected triggers or acceleration that will

help gain ground as well as sustain progress

achieved so ar or the MDGs. These triggers

have been identied based on available data

and trend analysis, a review o ongoing nationalpolicies and programmes, and lessons learnt at

both national and global level.

It is important to point out that many targets

have seen movement in the right direction.

Gains have been made or HIV and TB preva-

lence, underweight children, and gender equal-

ity in primary school. In some areas, however,

the pace o improvement has been slow. Yet

with political commitment and the right policy

and investment choices, the pace can be accel-

erated dramatically beore 2015. Other targets

have seen some reversal, including those or im-

proved sanitation, some areas o environmental

sustainability, and gender equality in political

representation. Here, there is a need or special

measures.

Finally, MDG targets per se do not take into con-

sideration some o the underlying causes o lack

o progress. These causal actors, which drive

poverty, inequality, unsustainability and non-

inclusive development, are the cornerstoneso the United Nations Millennium Declaration,

which set out the oundation or the MDGs. I

these actors are not addressed, achieving the

MDG targets becomes a hollow victory.

MDG 1:Extreme poverty is decreasing

but at a very slow pace

Extreme poverty has reduced rom 58 percent

in 1991 to 42.3 percent in 2010. However, Zam-

bia is still ar rom reaching the MDG goal o 29

percent by 2015. Yet, the past twenty years have

seen improvements, and the depth o poverty

in urban areas has diminished: Copperbelt Prov-

ince has already reached its MDG target, and Lu-

saka Province is very close to doing the same. In

contrast, the rural provinces o Luapula, Western,

Eastern and Northern remain very distant rom

their goals. Deliberate eorts to bring these out-

lying provinces back on track will be needed.

Zambia, with a Gini coecient o 0.65, is among

the most unequal countries o the world today.

Specic attention to these growing disparities

must be high on the agenda o policy makers.

MDG 2:

Universal primary education

is within reachZambia has made steady progress on primary

school enrolment, which has increased rom 80

percent in 1990 to 93 7 percent in 2010. The im-

provement can be linked to the boost in primary

education inrastructure and the introduction

o ree education. Similarly, progress has been

made in improving primary school completion

rates. The proportion o pupils reaching Grade

7 has increased rom 64 percent in 1990 to 90.9

percent in 2010. Disaggregation by sex shows

that the improvement was higher or girls. How-

ever, concerns remain on the quality o educa-

tion received, as well as the enrolment and com-

pletion rates in secondary school subsequently.

MDG 3:

Gender equalityand the empowerment o women

require special measures

The good news is that Zambia is on track to

achieve gender parity in primary school enrol-

ment as well as in literacy among 15-24-year-

olds.The Programme or Advancement o Girls

Education introduced in 1994 has provided

eective advocacy and support in this regard.

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Executive Summary

However, accelerated intervention is requiredi gender parity is to be achieved in secondary

and tertiary education. In addition, the country

has moved backwards on womens participation

in government in both local councils (6 percent)

and parliament (11 percent). Zambia will have to

introduce special measures to even come close

to the MDG target o 30 percent women in par-

liament or the AU/SADC target o 50 percent.

MDG 4:

Child mortality remains highChild mortality has declined by almost 30 per-

cent since 1992, but is still unacceptable high.

The mortality rate o children under ve dropped

rom 190.7 deaths per 1,000 live births in 1992

to 137.6 per 1000 live births in 2010. Similarly,

the mortality rate or inants (death beore rst

birthday) reduced rom 107.2 deaths per 1,000

live births in 1992 to 76.2 deaths per 1,000 live

births in 2010. Progress in reducing child mortal-

ity has been brought about by increases in im-

munization coverage, exclusive breast-eeding,vitamin and mineral supplementation, and ma-

laria prevention and treatment. These and other

interventions must be sustained and acceler-

ated i this goal is to be met by 2015.

MDG 5:

Improving maternal healthrequires renewed emphasis

Thirty-eight mothers die each month due to

complications o pregnancy or childbirth. Al-

though maternal mortality in Zambia has been

alling, the decline is insucient to reach the

2015 target o 162.3 deaths per 100,000 live

births. The number o women dying during

pregnancy and childbirth has decreased rom

649 per 100,000 live births in 1997 to 483 in

2010. Interventions that have been successul,

and need to be scaled up, include improved use

o contraception or birth spacing, prevention o

early marriages, improved reerral systems and

provision o and access to emergency obstetric

care, and the deployment o more trained mid-wives and birth attendants. Investing in moth-

ers education and nutritional status has a direct

impact on the health and well-being o children

and households.

MDGs Explained

The Millennium Development Goals are

based on the Millennium Declaration,

signed by 189 countries - including

147 heads o State and Government -

in September 2000, and rom urther

agreement by member states at the

2005 World Summit.

To assess progress on the commitment

made in the Millennium Declaration

over the period rom 1990 to 2015,

relevant targets and indicators were

agreed upon. The goals and their targets

are interrelated and should be seen as

a whole. They represent a partnership

between the developed countries and

the developing countries to create

an environment - at the national and

global levels alike - which is conducive

to development and the elimination o

poverty.1

The ocial list o MDG indicators can

be ound on http://mdgs.un.org/unsd/

mdg/host.aspx?Content=indicators/o-

ciallist.htm.

Kindly note that certain targets and

indicators are not included in this report

due to unavailability o data in Zambia.

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MDG 6:Gains on HIV&AIDS, malaria

and other major diseasesmust not be lost

The number o Zambians inected with HIV

has dropped to 14.3 percent o the population.

Zambia has thereore already achieved and sur-

passed the MDG target or HIV prevalence o

15.6 percent. However, prevalence rates in Lu-

saka, Copperbelt, Southern and Western Prov-

inces remain higher than 14.3 percent. This is

o particular concern in Lusaka due to its high

population. In addition, HIV incidence (new in-

ections) remains high throughout Zambia, and

is alarmingly on the rise among young people.

Thereore, the ocus must be redirected to pre-

vention, including intensiying prevention o

mother-to-child transmission, male circumci-

sion, voluntary counselling and testing, and ART

as a preventative measure. The act that HIV in-

cidence is consistently higher in women than in

men demonstrates that the underlying causes

o income and gender inequality need to be ad-

dressed as well. Concerns are also raised withregards to the sustainability o the response,

as cooperating partners und approximately 87

percent o HIV&AIDS interventions.39 The move

to a sustainable model o domestic nancing or

HIV&AIDS is a necessary national priority.

Zambia made signicant gains in malaria con-

trol and prevention up until 2009. However, the

drop-o in resources in the health sector has re-

sulted in a reversal o these gains in recent years.

With malaria, one cannot take a time-out. Given

the weather patterns and eco-systems in Zam-

bia, continuous attention is required to combat

malaria. The malaria atality rate is o particular

concern in this regard, as it remains over three

times the target. Today, three children die every

day o malaria. The distribution and eective use

o ITNs and indoor residual spraying must con-

tinue.

While there has been a concerted eort to treat

TB and other inectious diseases, o growing

concern in Zambia today is non-communicable

diseases. Mortality and loss o productivity due

to heart disease, diabetes and hypertension are

on the rise, and constitute the next big health

challenge the country aces.

MDG 7:Gaining lost ground

on environmental sustainability

Land covered by orests in Zambia reduced rom

59.8 percent in 1990 to 49.9 percent in 2010. This

decline stems rom over-exploitation through

logging or wood uel and encroachment or

agriculture and settlements. There have been

recent eorts to stem this tide, including a na-

tional tree planting campaign and a temporary

ban on timber export, as well as integrated land

use assessment and reclassication o protected

areas. These eorts will help regenerate both

ora and auna and protect the eco-systems and

biodiversity under threat in Zambia. As it takes

time or trees and species to mature, this is a leg-

acy or generations to come, and this MDG will

underpin the issue o sustainability or a post-

2015 vision or Zambia.

Zambia has observed improvements in the pro-

vision o clean water: The proportion o the pop-

ulation without access to an improved water

source has decreased rom 51 percent in 1990 to36.9 percent in 2010.

However, the proportion o the population with-

out access to improved sanitation acilities is not

getting any better. On the contrary, it worsened

rom 26 percent in 1991 to 67.3 percent in 2010.

Zambia is thereore well o track to achieve the

MDG target o 13 percent by 2015. This disturb-

ing trend is partly explained by the increase

in inormal human settlements without basic

sanitation acilities, the high cost o sanitation

inrastructure and the low returns to these in-

vestments or the private sector, especially in ru-

ral areas, partly by a methodology change. The

need or public engagement and state action

in this area is o paramount importance. Mas-

sive sanitation inrastructure investments and

social campaigns on healthy sanitary behaviour

can turn around this trend. Poor sanitation is the

breeding ground or day-to-day ill health, low

productivity and large epidemics that destroy

communities.

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Executive Summary

MDG 8:An evolving global partnershipor development

as Zambia transitionsto a middle-income country

Zambia has implemented reorms since the

1990s that have seen the development o a airly

open, rule-based, predictable and non-discrim-

inatory trading and nancial system. These re-

orms have among other things seen the coun-

try obtain debt relie. This coupled with a global

rise in copper prices has increased the countrysscal space.

Zambia has also graduated rom a low-income

to a lower middle-income country, which means

the country now has less access to concessional

lending and overseas development assistance.

The latter is thereore expected to remain below

5 percent o GDP in the remaining years to 2015.

Instead, Zambia is turning more and more to in-

ternational nancial markets.

In addition, the country has succeeded in at-

tracting increasing inows o oreign direct in-

vestment (FDI), peaking at $1.73 billion in 2010,

although inows have allen since then. Most o

the FDI in 2010 went into the mining sector, and

copper remains the main source o export earn-

ings, accounting or about 65 percent o total

exports. Yet, non-traditional exports are grow-

ing as well. In act, Zambias external trade has

grown extensively since the early 1990s in re-

sponse to globalization, with many more prod-

ucts being exported today.

A Cautionary Note on Data

This report has to the extent possible

used ocial national data provided by

the Central Statistical Oce. However,

when necessary, and in order to provide

a more complete picture o develop-

ments, it has included data rom other

sources as well.

The report demonstrates that i Zambia

improved its collection o timely data

along with the consistency o data

collection and compilation methodolo-

gies, it would enable policy design and

implementation as well as the accurate

monitoring o MDG progress. For many

indicators, there is a lack o consensus

amongst state actors on the methodolo-

gies used. For instance, there are three

dierent data sets on the production o

copper, provided by the Central Statisti-

cal Oce, the Bank o Zambia, and the

Ministry o Mines, Energy and Water

Development.

Old data does not acilitate timely and

relevant policy-making and implemen-

tation, and can provide an outdated and

at times irrelevant story. It thereore te-

naciously advocates or timely, publicly

available and robust data, disaggregat-

ed to the extent possible. This data mustbe made available in the public domain

or more people to access and engage

on it. In doing so, the public would be

allowed to contribute their voice to the

policy choices made to accelerate prog-

ress on the MDGs or Zambia.

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End Poverty and Hunger

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0

10

20

30

40

50

60

70

80

90

100

1990 1995 2000 2005 2010 2015

Percentage

Poverty gap ratio Target

0

10

20

30

40

50

60

70

80

90

100

1990 1995 2000 2005 2010 2015

Percentage

Extreme poverty Target

Target 1.A

Halve, between 1990 and 2015, the proportion of people living in extreme poverty

Indicators

Proportion of population living in extreme poverty (percent)

Poverty Gap Ratio (incidence x depth of poverty) (percent)

Table 1: Progress in Indicators

16


Eradicate extreme poverty and hunger

Status

Extreme Poverty: The current pace o povertyreduction in Zambia is too slow or the country

to achieve MDG target 1.A. The proportion o

people living in extreme poverty has decreased

rom 58 percent in 1991 to 42.3 percent in 2010.

This took 19 years. In addition, the pace has

slowed down in recent years. Extreme poverty

has reduced by only 0 5 percentage points in

the 4 years rom 2006 to 2010. Yet, it will have to

decline by 13.3 percentage points in the 5 years

rom 2010 and 2015 to attain the MDG target.

Specic accelerators are thereore required in

the orm o policy changes and targeted rural

investments.

Extreme poverty in Zambia is concentrated in

rural areas. In act it is our times higher in ru-

ral areas (57.7 percent) than in urban ones (13.1

percent). Typical rural provinces such as Luapula

(64.9 percent), Western (64.0 percent) and East-

ern (58 7 percent) are thereore the worst a-

ected (see Figure 3). Rural poverty is due to lim-

ited access to physical and social inrastructures,

such as roads, electricity and medical acilities,which impede development.

Whereas rural areas still have to travel 17.2 per-

centage points between 2010 and 2015 to reach

National

Rural

Urban

NationalRural

Urban

1996

5379

44

51.3

55.6

37.9

2004

5353

34

53

56

42

2006

5167

20

34

45

13

2015 Target

29.040.5

16.0

31.1

34.8

23.2

1991

5881

32

62.2

69.7

46.4

1993

6184

24

1998

5871

36

2002

4652

32

Proportion of population living in extreme poverty %

Poverty Gap Ratio incidence x depth of poverty %

2010

42.357.7

13.1

28.0

37.9

9.3

Will target 1.A be

achieved under the

present trend?

Significant reforms

and investments

required

Figure 1:Population in Extreme Poverty

Figure 2: Poverty Gap Ratio (depth o poverty)

Although the propor-tion o Zambian living in

extreme poverty has de-

clinedin the past decade,

the proportion o rural

Zambians in extreme

poverty has increased.

Sources: CSO Poverty Trends Report 1996-2006 and LCMS 2010

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-10

0

10

20

30

40

50

60

70

National

Urban

Rural

Copperbelt

Lusaka

Central

Southern

Northwestern

Northern

Eastern

Western

Luapula

Percentage

Extreme poverty (2010) Distance to target

17

MDG 1 End Poverty and Hunger

The top 10% o Zambi-

ans share more than hal

o total national income.

The bottom 60% share

less than 14% o total

income (LCMS 2010).

Figure 3: Extreme Poverty by Province (2010)

Target achieved

the MDG target, urban areas have, on average,

attained it. Urban provinces such as Lusaka (11.5

percent) and Copperbelt (18.3 percent) record-

ed the lowest rates o extreme poverty in 2010

(see Figure 3). This is because Zambias strong

economic growth has been concentrated to an

expansion o industrial and service sector activi-

ties in urban areas primarily. In act, over 80 per-cent o Zambias real GDP in 2010 was generated

in urban areas, according to the Central Statisti-

cal Oce. These trends suggest that in the past

decade poverty has mainly reduced through mi-

gration rom the economically depressed, rural

areas to the low-cost peri-urban areas closer to

the economic opportunities in the cities.

Poverty Gap Ratio: This indicator shows how

ar below the poverty line the poor are. The wid-

er the poverty gap ratio, the more the resources

required or poverty reduction programmes.

Zambia has reached its goal or the poverty

gap ratio, although this disguises dierences

between urban and rural areas, as the latter is

still to reach its goal (see Table 1). As poverty re-

mains deeper and wider in rural provinces such

as Western, Luapula, Eastern and Northern Prov-

inces, these areas need targeted poverty reduc-

tion programmes.

Obstacles to Poverty Reduction

Higher poverty amongst emale-headedhouseholds: Poverty aficts men and women

dierently. In 2010, extreme poverty was higher

in emale-headed (60.4 percent) than male-

headed (57.1 percent) households.40 The loss o

a male spouse, typically via death or divorce, re-

sults in less labour capacity and income, which

makes emale-headed households vulnerable to

poverty and ood insecurity.

Low labour productivity in particular in ag-

riculture, which provides work or most people

in rural areas, has negative implications or in-

clusive growth. Despite the sector absorbing

around two-thirds o the labour orce, it only

accounts or 6.7 percent o Zambias real GDP.41

Lack o reliable electricity, coupled with the act

that electricity access is very low and unequal,

urther exacerbates the problem o low produc-

tivity. According to the 2010 Living Conditions

Monitoring Survey, only 22 percent o Zambian

households are connected to electricity.

High population growth rate: Zambia has one

o the astest growing populations in sub-Saha-

ran Arica. The growth rate reached 2.8 percent

per annum during 2000-2010, up rom 2.4 per-

cent during 1990-2000. This has not been ac-

companied by the requisite social and economic

development planning and investment, in eect

weakening the link between economic growth

and poverty reduction. A rapidly growing pop-

ulation puts pressure on public expenditure,

thereby straining vital public services, particu-

larly education and health. Matching population

growth with appropriate planning is undamen-

tal to raising the low quality o Zambias human

capital and to speed up poverty reduction.

Low growth elasticity: The signicant eco-

nomic growth rate over the last decade has not

translated into poverty reduction because o the

low growth elasticity o poverty in Zambia. The

absolute value o elasticity was less than 1.0 dur-

ing 2000-2007.42 This means there is a weak con-nection between growth sectors o the Zambian

economy and those which employ the poor.

Wide income inequality: The responsiveness

o poverty to economic growth is weakened by

income inequality, which reduces the growth

gains that accrue to the poor. Zambias Gini co-

ecient, which measures income inequality, has

worsened, rom 0.60 in 2006 to 0.65 in 2010, and

mostly in rural areas. Most economic activities

are concentrated in urban areas, while the resto the country is airly underdeveloped and de-

pendent on subsistence arming. Thus, econom-

ic growth must be accompanied by progressive

redistribution o income in avour o the poor.

Source: LCMS 2010

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0

10

20

30

40

50

60

70

80

90

100

1990 1995 2000 2005 2010 2015

Percentage

Underweight U-5 children Target

-4

0

4

8

12

16

20

National

Urban

Rural

Western

Lusaka

Luapula

Northern

Eastern

Northwestern

Central

Southerm

Copperbelt

Pe

rcentage

Underweight U-5 children (2010)

Distance to target

18


Target 1.C

Halve, between 1990 and 2015, the proportion o people who suer rom hunger

Indicator

Prevalence o underweight children under ive years o age (percent)

Table 2: Progress in Indicator

Will target 1.C be

achieved under the

present trend?

Accelerationrequired

Figure 4:Underweight Children under FiveStatusUnderweight children: The proportion o un-

derweight children under ve years o age de-

clined rom 25.1 percent in 1992 to 13.3 percent

in 2010, with both rural and urban areas record-

ing signicant improvements. In act, in rural

areas, the 2015 target has been reached, while

in urban areas, a urther reduction o just 0.4

percentage points is required. MDG target 1.C is

thereore likely to be met. According to the 2010

Living Conditions Monitoring Survey, only three

provinces (Copperbelt, Southern and Central)have not yet met the target on underweight U-5

children (see Figure 5), which calls or urther

investments in child nutrition programmes in

these provinces. In addition, the incidence o

stunting (caused by chronic malnutrition) de-

clined rom 54.2 percent in 2006 to 46.7 percent

in 2010.43These improvements are mainly due to

government intensiying programmes or breast

eeding, nutritional supplements and immuni-

zation during this period.

Nutrition: There is a direct correlation between

nutritional levels o the population, especially

among young women and children, and ood

prices (ood ination). Poor people spend most

o their income on ood and have little capacity

to adapt to rising prices. To cope, they limit their

consumption o more nutritious but expensive

oods. In Zambia, the annual ood ination rate

decreased rom 180 percent in 1992 to -0.2 per-

cent in 2006. In the same period, the proportion

o underweight children almost halved, rom

25.1 percent in 1992 to 13.3 percent in 2006.

National

Rural

Urban

1996

25

27

19

2004

20

22

16

2007

14.6

15.3

12.8

2015 Target

12.5

14.5

10.4

1992

25.1

29.0

20.8

2002

28.1

30.1

23.4

2010*

13.3

14.2

10.8

Prevalence of underweight U-5 children %

Figure 5: Underweight by Province (2010)

Zambia is an exporter

o oodstus, including

maize, yet almost hal

o Zambian children are

stunted in growth.

Sources: ZDHS 1992, 2001-2002, 2006 and 2007, LCMS 1996, 2004, 2006 and 2010

Target achieved

Source: LCMS 2010

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MDG 1 End Poverty and Hunger

Despite Zambias impressive macroeconomic perormanceover the last decade, it has had little impact on extreme pover-

ty, as acknowledged by the countrys Sixth National Develop-

ment Plan (2011-2015). Ensuring that economic growth is ac-

companied by rapid poverty reduction is thereore a key ocus

o both government and its development partners. As extreme

poverty and inequality is particularly pronounced in rural ar-

eas, the analysis below ocuses on how to accelerate reduction

o poverty and inequality in rural Zambia, largely drawing on

international experiences outlined in the global MDG Report

2012: Assessing Progress in Arica toward the Millennium De-

velopment Goals.

Rural areas have suered chronic lack o investment in inra-

structure and services both hard (roads, energy and ICT) and

sot (skills, health and markets). Specic policies to promote in-

clusive growth, with a particular ocus on agriculture and the in-

ormal sector, have the potential to improve the growth elastic-

ity o poverty. Countries such as China, Brazil and Ethiopia have

succeeded in reducing rural poverty through implementing a

wide range o pro-poor programmes to improve agricultural

technologies, expand agricultural extension services, commer-

cialize smallholder agriculture, develop rural inrastructure and

to enhance access to social protection especially through pro-grammes or productive saety nets and provision o credit.

Policies to mitigate and sustainably manage high population

growth and to promote social protection are also vital. Global

evidence suggests that successul national employment strate-

gies, which expand the number o jobs and labour productivity

in growth sectors, have ocused on widening access to credit,

machinery and other equipment to acilitate value-addition pro-

duction, on easing the business environment, boosting physical

and institutional inrastructure, and on improving working con-

ditions. The large increase in the minimum wage in Zambia in

2012 will work towards minimizing inequality in the ormal sec-

tor. However, 90 percent o the workorce is in the inormal sec-

tor.44 Thereore, it is key to implement policies and instruments

that target the inormal sector and the non-working poor.

Food security requires short- and long-term strategies and in-

terventions. In the short term, these should ocus on improv-

ing nutritional outcomes, or example by linking comprehen-

sive national nutritional programmes to health services, on

promoting home visits by health workers, and on acilitating

distribution o therapeutic ood supplements to vulnerable

groups, especially children and women. Long-term interven-tions, which recognize and respond to the impact o climate

change through the promotion o sustainable agricultural

practices, should be institutionalized. These should, amongst

other things, promote better use o ertilizer and wider accessto drought and disease-resistant seed. Encouraging all-season

arming and easier access to market and insurance inormation

via mobile phone technologies are other long-term interven-

tions to consider.

Learning rom both the Zambian experience, as well as what

has worked globally, the primary accelerators suggested to re-

duce extreme poverty and hunger in Zambia are as ollows:

Promote long-term planning o and investment in sus-(1)

tainable energy and equitable access to energy, espe-

cially amongst the poor. On-grid rural electrication e-

orts could be supplemented by o-grid interventions

such as mini-hydro, natural gas and solar energy, where

cost-eective and available. Such interventions can be

implemented within a short period to avoid beneciaries

having to wait or the power grid to be extended to rural

areas, which oten are costly to reach and maintain.

Allow or greater private sector participation in the maize(2)

market, to promote agricultural diversication, and hence

more income opportunities or the rural poor.

Review the Farmers Input Support Programme in a trans-(3)parent manner to assess its direct benets to small-scale

armers and poor households. I correctly targeted, this

input subsidy programme could potentially have a more

immediate impact on hunger and income deprivation

among the poorest rural households, especially i it was

combined with cash transers.

Ensure access to cheaper credit and insurance, skills up-(4)

grading and appropriate technology to enable scale-up

and improvement o small-scale agricultural and labour

productivity.

Intensiy investments in rural and peri-urban economic(5)

and social inrastructure, with priority given to eeder

roads, secondary schools, clinics, water and sanitation.

Provide public transportation that connects rural com-(6)

munities to markets, to enable cheaper transportation o

goods and services, and hence cheaper ood or poorer

households.

Implement legislative and regulatory instruments that(7)

will promote the introduction o protein- and vitamin-rich

oods into the staple diet, and teach young mothers to

optimize provision and preparation o low-cost nutritionaloods or inants and children.

MDG 1 TRIGGERS FOR ACCELERATION: Combating poverty and hunger in rural areas

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Universal Education

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0

10

20

30

40

50

60

70

80

90

100

1990 1995 2000 2005 2010 2015

Percentage

Primary school net enrolment Target

0

10

20

30

40

50

6070

80

90

100

1990 1995 2000 2005 2010 2015

Percentage

Pupils reaching Grade 7 Target

Target 2.A

Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a

ull course o primary schooling

Indicators

Net enrolment in primary schools (percent)

Proportion of pupils reaching Grade 7 (percent)

Literacy rates for 15-24-year-olds (percent)


22


Achieve universal primary education

Will target 2.A be

achieved under the

present trend?

Acceleration

required

Total

Girls

Boys

Total

Girls

Boys

2001

76.6

75.3

77.8

2004

85.1

84.6

85.6

82

75

95

70

66

75

2005

95.6

95.8

95.3

81

73

88

2015 Target

100

100

100

100

100

100

100

100

100

1990

80

69

71

64

57

71

74.9

71.2

78.9

2000

71.1

69.6

72.7

7066

75

2002

77.7

76.4

78.8

2003

81.3

82.4

81.3

73

66

80

75

70

75

Primary school net enrolment %

Pupils reaching Grade 7 %

2006

97

98

96

83

79

91

Literacy rates for 15-24-year-olds %

2009

102 *

104.6*

103.6*

91.7

87.7

98.7

2010

93.7#

93.9#

93.1#

90.9

89.6

90.8

88.7

86.5

91.2

Total

Girls

Boys

* Enrolment rates cannot exceed 100 percent, however these gures are based on demographic data, which does not include

actors such as migration within Zambia. # Enrolment rates or 2010 are based on the actual size o the population according tothe 2010 census, while enrolment rates or 2001-2009 are based on population projections in the 2000 census.

Figure 6:Primary School Net Enrolment Figure 7:Pupils Reaching Grade 7

Status

Primary school net enrolment: Zambia hasmade steady progress on primary school enrol-

ment, which has increased rom 80 percent in

1990 to 93.7 percent in 2010. The improvement

is linked to several actors such as development

o education inrastructure and introduction o

ree education.

Grade 7 completion:45 Zambia has also made

progress in boosting primary school completion

rates. The proportion o pupils reaching Grade

Almost all children

in Zambia complete

primary school, but less

than 40% pass their nalexams in secondary

school and only 19% o

girls do so (MOE).

Sources: MOE, except literacy rates (1990, 2000 and 2010) rom CSO census reports

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0

10

20

30

40

50

60

70

80

90

100

1990 1995 2000 2005 2010 2015

Percentag

e

Literacy rates (15-24-year-olds) Target

23

MDG 2 Universal Education

Figure 8:Literacy Rates (15-24-year-olds)7 has increased rom 64 percent in 1990 to 90.9

percent in 2010. Disaggregation by sex shows

that the improvement in the same period was

higher or girls (32.6 percentage points) than or

boys (19.8 percentage points). This was partly

on account o the Programme or Advancement

o Girls Education and the re-entry policy. The

latter may by now be showing a positive, albeit

minor, impact.

Similarly, the completion rate or Grade 9 (basic

school) increased rom 35.3 percent in 2002 to

53.2 percent in 2010 (see Figure 9), while that or

Grade 12 (secondary school) increased rom 14.4

percent in 2002 to 31.7 percent in 2010. In both

instances, the completion rate has improved ast-

er or girls than or boys. In act, girls have over-taken boys in completing basic school. However,

this says little about the quality o this education

and its ability to make graduates t or work.

Both Grades 9 and 12 have low pass rates.

Youth literacy: National youth literacy has im-

proved rom 74.9 percent in 1990 to 88.7 per-

cent in 2010. It has increased aster or girls, by

15.3 percentage points in the same period, than

or boys, by 12.3 percentage points. (see Table 3).

Illiteracy presents a real challenge to the attain-

ment o MDG target 2.A, and to the overall issue

o addressing the transition to employment and

increasing labour productivity. A ocus on unc-

tional literacy or young adults is required, with-

out which vocational and technical training and

skills upgrading eorts are undermined.

MDG 2 TRIGGERS FOR ACCELERATION:Moving to secondary school and literacy targets

By improving its primary school enrolment and completion, Zambia has en-

countered a new challenge: How to ensure that its primary education is o

a quality high enough or pupils to progress through secondary education.

In addition, the country is aced with the issue o equal access or girls and

boys at secondary and tertiary levels o education.

To urther improve the Grade 7 completion rate, government needs to(1)

secure greater balance between interventions that ocus on improving

educational access and gender parity in enrolment, on the one hand,

and those that address retention and completion rates, on the other.

Although the completion rate or Grade 12 has been improving rapidly(2)

since 2009, primarily due to major improvements in school inrastruc-

ture, it is still very low. Enhancing this will require massive investments

in the construction o secondary and post-secondary educational acili-

ties, and higher recurrent budgets or the provision o books, lab and

computer equipment.

Quantitative improvements in education outcomes, while necessary,(3)

are not sucient. Improved enrolment and progression rates should

be accompanied by quality teaching sta and upgraded school acili-

ties to improve the overall quality o education (including improvingthe dwindling pass rates). The commitment by government in its 2013

national budget to provide more resources or the educational sector,

including or the recruitment o more teachers and retention incentives

or those to serve in rural areas, is encouraging.

To address illiteracy, government must work with its stakeholders and(4)

partners, including civil society organizations, private sector, academia

and parent-teacher associations in pursuing policies and programmes

that improve youth literacy rates, especially or emales. Civil society has

experience in designing exible programmes or specic community

groups, lobbying or the interests o vulnerable populations and moni-toring perormance. The private sector has a particular interest in an edu-

cated workorce and must be encouraged to oer more apprenticeship

programmes, as well as workplace literacy and skills development.

Average class sizes in

Zambias schools have

increased rom 37 to

57 over the past two

decades (UNESCO).

Figure 9:Completion Rates Grades 9 and 12

Source: MOE Educational Statistical Bulletin 2010

0

10

20

30

40

50

60

2002 2004 2006 2008 2010

Percentage

Grade 9 total Grade 12 total

Grade 9 boys Grade 12 boys

Grade 9 girls Grade 12 gi rl s

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Gender Equality

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Target 3.A

Eliminate gender disparity in primary and secondary education, preerably by 2005, and

in all levels o education no later than 2015

Indicators

Ratio of girls to boys in primary, secondary and tertiary education

Ratio of literate women to men (15-24-year-olds)

Share of women in wage employment in non-agricultural sector (percent)

Proportion of seats held by women in parliament (percent)


26


Promote gender equality

Will target 3.A be

achieved under the

present trend?

Acceleration

required

StatusGender parity in education: The ratio o girls

to boys in primary education has increased rom0.90 in 1990 to 0.99 in 2010, which is very close

to the target o 1. In eect Zambia has attained

gender parity in primary school enrolment. The

Programme or Advancement o Girls Educa-

tion, introduced in 1994, and to a lesser degree

the re-entry policy, is considered a major driver

in this regard. Gender parity by province (see

Figure 11) shows that Lusaka and CopperbeltProvinces have attained equality in primary edu-

cation. Being urban provinces, they have a high

number o schools places, and are less suscepti-

ble to traditions working against girls getting an

education. Amongst the rural provinces, Eastern

Primary

Secondary

Tertiary

2000

0.70

12

2006

0.97

0.86

0.72

0.80

14

2007

0.96

0.89

0.77

0.80

14

2015 Target

1

1

1

1

30

1990

0.90

0.90

0.75

39

6.7 *

1995

0.72

10#

2004

0.95

2005

0.96

0.86

0.74

0.80

34

12

Ratio of girls to boys in education

Ratio of literate women to men 15-24-year-olds

2008

0.97

0.87

0.74

0.80

14

Share of women in wage employment in non-agricultural sector %

2009

0.96

0.88

0.74

0.80

14

2010

0.99

0.86

0.75

11.4^

Proportion of seats held by women in parliament %

* 1991, # 1997, ^ 2012

Figure 10:Ratio o Girls to Boysin Primary, Secondary and Tertiary Schools

Figure 11:Ratio o Girls to Boysin Primary School by Province

Zambia lags behind

other SADC countries on

women representation

in government. Only 18

o its 158 members o

parliament are women. Sources: MOE Educational Statistical Bulletin 2010 and Zambia MDGR 2011

Source: MOE

0

0.2

0.4

0.6

0.8

1

1.2

1.4

National

Northern

Southern

Luapula

Western

Central

Northwestern

Eastern

Copperbelt

Lusaka

Rat

ioo

fgirlstob

oys

2 00 5 2 01 0

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

1990 1995 2000 2005 2010 2015

Ratioo

fgirlstob

oys

Primary Secondary Tertiary Target

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MDG 3 Gender Equality

(0.99) had the best gender parity, while North-

ern (0.93) had the worst.

Gender parity in secondary education has, how-

ever, allen rom 0.92 in 1990 to 0.86 in 2010

(see Table 4), primarily driven by a high drop-out rate or girls. Girls are being socialized to

become wives, mothers and care-givers, which

results in more domestic responsibilities (chores

and care tasks), teenage pregnancies and early

marriages. Once in secondary school, girls are

also vulnerable to sexual harassment and vio-

lence and related diseases such as HIV&AIDS.

HIV&AIDS worsens gender-based dierences in

access to land and other productive resources

such as labour, technology, credit and water.

These gender dierences become more acute

when productive resources are eroded, making

emale- and youth-headed households the mostvulnerable o the rural poor. Zambia has a rela-

tively high percentage o households headed

by girls o school-going age.46 HIV&AIDS has no

age boundaries, and the loss o adult labour has

orced amilies to withdraw older children rom

school to take care o younger siblings and/or

help in ood production.

Gender parity in tertiary education has remained

almost unchanged rom 2005 (0.74 percent) to

2009 (0.75 percent). Many young women do not

enrol in colleges and university, or nd it di-

cult to continue attending classes ater gettingmarried or becoming pregnant. However, within

some tertiary institutions, such as the Univer-

sity o Zambia, great improvements have been

made (see Table 5). The obvious exception is the

Copperbelt University, which had a ratio o e-

males to males o 0.39 in 2011. This is likely to

be caused by this institution oering primarily

scientic and mathematical courses.

Women in parliament: Zambia has continued

to perorm poorly with respect to political rep-

resentation o women in government. Women

made up 52 percent o the voting block in the2011 general elections, yet they hold a low pro-

portion o seats in both local councils (6.3 per-

cent) and parliament (11.4 percent). In act, Zam-

bias representation o women in parliament is

one o the lowest in Arica; ar short o the MDG

target o 30 percent and the even more ambi-

tious target o 50 percent set by both the AU

and SADC (Zambia has signed the SADC Gender

Protocol or 50/50 representation). Experience

shows that countries, which have perormed

well on emale representation in politics, such as

Egypt, Rwanda, South Arica and Uganda, have

adopted legal rameworks that guarantee parlia-mentary seats or women.47 In addition, political

parties have a strong role to play in accelerating

gender inclusiveness in politics at local, regional

and national levels.

MDG 3 TRIGGERS FOR ACCELERATION:

Reaching or gender equalityin the economic, social and political spheres

Despite awareness-raising and other interventions to promote gender equal-

ity, Zambia has not ocused suciently on addressing the underlying causes

o womens economic, social and political marginalization. Waiting or the

pervasive cultural norms and discriminatory attitudes to change is a wait too

long. Zambia needs to actively advance policies and laws that reinorce gen-

der parity and equality in access to education, labour market, public services

and political representation. Many countries within the region and in other

parts o the world have shown that armative action initiatives are needed

to correct or age-old biases and behaviours in order to provide a level play-

ing eld or girls and boys, women and men. Specic triggers include the

ollowing:

A continued ocus on specic initiatives that target the educational(1)

needs o under-served and under-privileged girls (and boys) in order to

increase their educational access.

Promoting womens skills development to improve access to higher(2)

skilled and productive jobs, including in non-traditional work areas.

Provision o subsidized child care services, in particular made more eas-(3)

ily available to poorer women to enable them to participate in remu-

nerative economic activities.

Directly and aggressively address the issue o gender violence and early(4)

marriages through implementation o laws, advocacy and campaigns

that include traditional leadership, and through actual banning o hurt-

ul cultural practices.

A concerted eort to attain gender parity in secondary education would(5)

entail conronting the preerence to educate boys rather than girls and

practices such as early marriages. Extensive advocacy, household in-

centives, school bursaries and more girls hostel acilities would make

a dierence, as would continued eorts to reduce HIV prevalence and

incidence.

Minimum thresholds o male and emale representation throughout(6)the political cycle rom party lists to seats in parliament could be

introduced to incentivize the change and ensure greater gender parity

in political representation at all levels.

Total

TEVETAInstitutions

Educationcolleges

Universityof Zambia

CopperbeltUniversity

MulungushiUniversity

2003

0.79

1.04

0.29

0.24

2006

0.72

0.68

0.89

0.68

0.26

2007

0.77

0.69

0.96

0.69

0.46

1994

0.08

1995

0.36

0.18

2004

0.61

1.05

0.51

0.25

2005

0.74

0.59

1.27

0.60

0.25

2008

0.74

0.68

1.02

0.68

0.25

2009

0.74

0.81

0.90

0.76

0.32

0.60

2010

0.75

0.78

0.91

0.80

0.34

0.60

2011

0.75

0.80

0.80

0.83

0.39

0.50

2012

0.41

1.20

Table 5:Ratio o Women to Men in Tertiary Education by Institution

Source: MOE

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30/64

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31/64

Child Health

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0

10

20

30

40

50

60

70

80

90

100

1990 1995 2000 2005 2010 2015

Percentage

One-year-olds immunized against measles Target

0

20

40

60

80

100

120

1990 1995 2000 2005 2010 2015

Deathper1,0

00livebirths

Infant mortality rate Target

0

50

100

150

200

250

1990 1995 2000 2005 2010 2015

Deathsper1,0

0

0livebirths

U-5 mortality rate Target

Target 4.A

Reduce by two-thirds, between 1990 and 2015, the under-ve mortality rate

Indicators

Under-ve mortality rate (deaths per 1,000 live births)

Infant mortality rate (deaths per 1,000 live births)

Proportion of one-year-olds immunized against measles (percent)


30


Reduce child mortality

Figure 12:U-5 Mortality Rate Figure 13:Inant Mortality Rate

Status

Child mortality: The observed declines in child

mortality rates in Zambia are insucient to reach

MDG target 4.A. Under-ve mortality dropped

rom 190.7 deaths per 1,000 live births in 1992

to 137.6 deaths per 1,000 live births in 2010,

while inant mortality (death beore a childs rst

birthday) reduced rom 107.2 deaths per 1,000

live births in 1992 to 76.2 deaths per 1,000 live

births in 2010.

U-5 mortality rate deaths per 1000 live birthsInfant mortality rate deaths per 1,000 live births

One-year-olds immunized against measles %

2002

16895

84

2015 Target

63.635.7

100

1992

190.7107.2

77

1996

197109

86.5

2007

11970

84.9

2010

137.676.2

94

Will target 4.A be

achieved under the

present trend?

Significant reforms

and investments

required

Figure 14:One-Year-Olds Measles Immunized

Sources: Mortality rates rom CSO (1992-2007 rom ZDHS and 2010 rom LCMS) and immunization rom MOH

Child mortality has

declined by almost 30%

in the past two decades.

Yet, 1 in 8 children die

beore they turn 5 years.

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MDG 4 Child Health

Similarly, neonatal mortality (deaths during the

rst 28 days ater birth) has according to UNICEF

reduced rom 43 deaths per 1,000 live births in

1990 to 27 deaths in 2012.48

The leading causes o death among children

are complications arising during pregnancy

and birth, and later, respiratory inections, diar-

rhoeal diseases, malaria, measles and malnutri-

tion, oten in combination. Many countries have

thereore successully reduced child mortality

by implementing the Integrated Management

o Childhood Illness (IMCI) strategy, a holistic

approach to child health developed by UNICEF

and WHO. Zambia has also adopted IMCI, but its

child mortality rates suggest an urgent need to

revise its child health interventions. The countryneeds to improve the prevention and manage-

ment o diarrhoea, pneumonia, malaria and

HIV inection in children, including scaling up

o high-impact advocacy on the importance o

exclusive breasteeding and appropriate eed-

ing o young children as well as hygiene, hand-

washing and unsae drinking water.

Measles immunization: One eective interven-

tion has been the immunization against mea-

sles, with coverage growing rom 77 percent o

all one-year-olds in 1992 to 94 percent in 2010.

Measles are part o the ull immunization pack-

age in Zambia. Figure 15 shows that ull immu-

nization coverage has varied across provinces.

Generally, urban provinces (Lusaka and Copper-

belt) are in the lead, while remote rural provinc-

es such as Northwestern and Western have the

lowest coverage. Although there has been an

improvement in the availability o logistics, vac-

cines and cold chain storage, driven by ecient

interventions such as the Expanded Programmeon Immunization and the National Vaccine Cold

Store, some acilities still get cut o during the

rainy season. In addition, aggressive social mo-

bilization will have to correct or the worsening

turn-out or immunization in urban provinces.

Government is also supporting the introduction

and expansion o new vaccines into Zambia in-

cluding pneumococcal, rotavirus and measles

second dose vaccines, as well as other new vac-

cines in the uture.


Saving more children rom birth to fve years

Expand interventions that target the main causes o(1)

death in U-5 children as well as the most vulnerable

newborns, inants and children. This includes promot-

ing breast eeding and appropriate nutrition and en-

suring ull immunization coverage, especially against

measles. In this regard, the bi-annual Child Health Week

has shown good results, but more resources must be

put into outreach activities to ollow up on mothers de-

aulting on immunization programmes.

Empowering women and increasing awareness and(2)

education levels o young mothers will have a direct im-

pact on the lives, health and nutritional status o their

children.

Diarrhoea remains a dominant threat to the lives o(3)

inants and children in Zambia. Access to clean water

and improved sanitation acilities both in homes and

schools eectively addresses this threat.

Countries that have signicantly reduced neonatal(4)

deaths have ocused on having trained midwives at all

deliveries, increased pre-natal check-ups and nutrition-

al care, and maternity waiting homes near clinics to re-

duce travel distances, especially i complications set in.

Figure 15:Full Immunization Coverage by Province (2008-2010)(sorted by average)

Source: MOH Annual Health Statistical Bulletin 2010

0

25

50

75

100

125

150

National

Nortwestern

Western

Luapula

Northern

Southern

Eastern

Copperbelt

Central

Lusaka

Percentage

2008 2009 2010

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34/64

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35/64

Maternal Health

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36/64

Figure 16:Maternal Mortality Ratio

Target 5.A

Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio

Indicators

Maternal mortality ratio (deaths per 100,000 live births)

Proportion of births attended by skilled health personnel (percent)

Target 5.BAchieve, by 2015, universal access to reproductive health

Indicators

Contraceptive prevalence rate (any modern method) (percent)


34


Improve maternal health

Status

Maternal mortality: Although maternal mor-

tality has declined in Zambia, the magnitude

o the problem is still unacceptably high. Ac-

cording to the Ministry o Health, 38 women die

every month on average during pregnancy and

childbirth. The maternal mortality ratio has im-

proved rom 649 deaths per 100,000 live births

in 1996 to 483 deaths per 100,000 live births in

2010. This is a lot higher than the MDG target o

162.3 deaths per 100,000 live births by 2015.

Will target 5.A and 5.B

be achieved under the

present trend?

Significant reforms

and investments

required

Figure 17:Births Attended by Skilled Personnel

Maternal Mortality Ratio deaths per 100,000 live births

Births Attended by Skilled Personnel %

Contraceptive Prevalence Rate %

2002

729

43.4

18.6

2015 Target

162.3

1992

50.5

7.0

1996

649

11.2

2007

591.2

46.5

24.6

2010*

483

44*

38 women die everymonth in Zambia

during pregnancy and

childbirth

Sources: CSO, except *MOH

The major direct causes o maternal mortality in

Zambia are complications arising during preg-

nancy and birth, such as haemorrhage, septicae-

mia (blood inection), obstructed labour, hyper-

tensive conditions, as well as unsae abortions.

Zambia has sought to reduce maternal mortality

by ensuring universal access to amily planning,

skilled attendance at birth, and basic and com-

prehensive emergency obstetric care. However,

maternal mortality is rooted in gender inequal-

ity, which maniests itsel as poor education or

girls, early marriages, adolescent pregnancies

0

100

200

300

400

500

600

700

800

1990 1995 2000 2005 2010 2015

Deathsper100,0

00livebirths

Maternal mortality ratio Target

0

10

20

30

40

50

60

70

80

90

100

1990 1995 2000 2005 2010 2015

Percentage

Births attended by skilled personnel

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MDG 5 Maternal Health


A mothers health is a communitys wellbeing

Eorts to decrease maternal mortality cannot be undertaken

in isolation, as it is closely linked to other MDG indicators such

as mothers education, nutrition and diseases such as HIV&AIDS

and tuberculosis. An aggressive eort to reduce maternal mor-

tality should include eorts by government and its partners to:

Scale up long-term methods o(1) amily planning that areencouraged and supported by amilies, health acilities

and local communities.

Continue expanding and sustain basic and compre-(2)

hensive emergency obstetric care, including improved

reerral systems, or an immediate and direct impact on

mothers lives at child birth.

Improve(3) pre-service training o midwives and the capac-

ity o other health care providers in emergency obstetric

care, and acilitate the return o retired nurses to ll the

gap until trained midwives have been deployed.

Continue sensitization o pregnant women, and their part-(4)

ners, on the importance o attending and seeking early

antenatal care. This includes scaling up sae motherhood

action groups to all districts to provide the needed sup-

port.

Construct(5) maternity waiting homes where there are

none, with priority given to districts with ew health cen-

tres, where expectant mothers travel long distances.

Reduce the high number o(6) unsae abortions, both by

preventing unplanned pregnancies, and by tackling bar-

riers that prevent women rom accessing sae services.Community interventions could increase awareness about

the moral and legal rights o women to access abortions

under certain circumstances.

Figure 18:Supervised Deliveries by Province (average 2008-2010)

Source: MOH Annual Health Statistical Bulletin 2010

and lack o access to sexual and reproductive

health inormation and services.

This is related to the problem o unsae abor-

tions. According to the University Teaching

Hospital, unsae abortions account or nearly

30 percent o all maternal deaths in Zambia,

with young women particularly at risk. Zambia

may have one o the most progressive abortion

laws in sub-Saharan Arica, but there are many

barriers to access sae services, including moral

prejudices against abortions, even amongst

healthcare providers. The result is that women,

and girls, go to great lengths to end pregnancies

in secret.

Assisted deliveries: This is one o the most criti-cal interventions or ensuring sae motherhood.

It hastens the timely delivery o emergency

obstetric care as well as newborn care when

lie-threatening complications arise. Figure 18

shows that supervised deliveries averaged over

60 percent over the period 2008 to 2010, which

partly explains the recent reduction in maternal

mortality. Several typically rural provinces such

as Northwestern, Eastern, Luapula and Northern

did well due to their high proportion o home

births assisted by trained traditional birth at-

tendants. As a temporary measure, traditional

birth attendants help to bridge the gap until

more midwives are trained.

The increase in rural health centres, which pro-

vide a hygienic environment or deliveries, has

had a positive impact on maternal health, as has

the increase in healthcare providers equipped

with in-service emergency and obstetric care

skills. Other actors include community sensiti-

zation on how institutional deliveries can save

both mothers and babies lives. Yet, many wom-en still deliver at home, especially poor women

in rural areas with little education. These women

also have ewer and lower-quality antenatal

care visits. On average, Lusaka and Copperbelt

Provinces had the highest proportions o institu-

tional deliveries (see Figure 18) due to an easier

access to health centres. Northern Province had

the lowest proportion o institutional deliveries.

0

10

20

30

40

50

60

70

80

90

100

Zambia

Northern

Southern

Western

Central

Luapula

Lusaka

Copperbelt

Eastern

Northwestern

Percent

age

Institutional deliveries

Home births assisted by trained Traditional Birth Attendant

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38/64

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39/64

HIV&AIDS and Malaria

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Target 6.A

Have halted, by 2015, and begun to reverse the spread o HIV&AIDS

Indicators

HIV prevalence rate (percent)

Proportion of 15-24-year-olds with comprehensive, correct knowledge of HIV&AIDS (percent)

Ratio of school attendance of orphans to non-orphans (10-14 years)

Target 6.BAchieve, by 2010, universal access to treatment or HIV&AIDS or all those who need it

Indicators

Proportion of population with advanced HIV infection with access to ARVs (percent)


38


Reverse the spread o HIV&AIDS,

malaria and other major diseases

Figure 19:HIV Prevalence Rate StatusHIV prevalence and incidence: Zambia is likely

to achieve the 2015 target or the HIV prevalence

rate, as it ell to 14 3 percent in 2007. Although

the national MDG target has been met, this masks

great dierences in HIV prevalence rates amongst

provinces (see Figure 21). Lusaka, Copperbeltand Central Provinces are all above 15.6 percent.

Thereore extra attention must be paid to prov-

inces with high prevalence.

However, ocus is increasingly shiting to reduc-

tion o new inections (the incidence rate). From

1990 to 2011, the rate o new inections more

than halved in the Zambian adult population (15

years and older), to 0.96 percent amongst males

and to 1.25 percent amongst emales (see Figure

22). The increase rom 1998 to 2002 was caused

by a range o actors, such as lack o awarenessand use o services, the window period o HIV

and scale-up o VCT. Although the incidence

rate amongst adults over 15 years o age is pro-

jected to continue alling rom 2011 to 2015, by

Will targets 6.A + 6.B

be achieved under the

present trend?

Yes

Figure 20:Universal Treatment

HIV prevalence rate %

Proportion of 15-24-year-olds with comprehensive,correct knowledge of HIV&AIDS %

Ratio of school attendance of orphansto non-orphans 10-14 years %

Proportion of population with advancedHIV infection on ART %

2002

15.6

31

79.1

2015 Target

15.6 or less

100

80

2000

71.8

2007

14.3

48

93

2009

40.2*

92*

2005

43.7*

23.5#

2008

74#

2011

77.6#

Sources: CSO, except *Zambia Sexual Behaviour Survey 2009 and #HIV&AIDS UNGASS Zambia Report 2012

HIV incidence has

stabilised in Zambia, yet

the absolute number

o new HIV inections

is increasing due to an

expanding population.

Large cities host a dispro-

portionate share o the

HIV epidemic in Arica,

and Zambia is no excep-

tion. HIV&AIDS is a major

health and social prob-

lem in large cities in the

orm o high prevalence

and associated need or

treatment and care.

0

5

10

15

20

25

30

1990 1995 2000 2005 2010 2015

Percentage

HIV prevalence rate Target

0

20

40

60

80

100

1990 1995 2000 2005 2010 2015

Percentage

Proportion of people wi th advanced HIV on ART

Target

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41/64

0

10

20

30

40

50

60

70

80

90

100

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Percentage

Numberofmothers

Mothers needing PMTCT

Mothers on PMTCT

Perc entage of mothers on PMTCT

0

500,000

1,000,000

1,500,000

2,000,000

2008 2010 2011

Numberofadults

Me n Wom en Total

0.0

0.5

1.0

1.5

2.0

2.5

3.0

1970

1975

1980

1985

1990

1995

2000

2005

2010

2015

Percentage

Men Women All adults

39

MDG 6 HIV&AIDS and Malaria

2.2 percent or men and 2.1 percent

or women, it is still much higher than

the death rate o 0.34 percent per year

amongst adults over 15 years o age.

A disease only wanes signicantly i

there are ewer new inections than

deaths rom the disease, and in the

case o Zambia this can only happen

once new inection rates are below 0.2

percent per annum.49

The key drivers o new inections in

Zambia are multiple and include con-

current sexual partners, low and incon-

sistent use o condoms, low rates o

medical male circumcision, poor cov-

erage o vulnerable and marginalized

groups such as sex workers, prisoners

and migrants, and mother-to-child

transmission.

Since the introduction o voluntary

medical male circumcision (VMMC) in

2007, over 167,000 VMMCs have been

perormed in Zambia, o which 89 per-

cent took place in 2010 and 2011.50

Yet, the VMMC programme has allen

short o its target o 150,000 circumci-

sions annually.

In this connection, it is encouraging

that the number o people accessing

Voluntary Counselling and Testing

(VCT) has been increasing steadily

over the years, rom 511,266 in 2008

to 1,772,043 in 2011. However, more

women than men are utilizing VCT

in Zambia (see Figure 23). Behaviour

change or men in a highly male-driv-

en culture remains a signicant chal-

lenge, as does the poor availability o

test kits.

Young people with knowledge o

HIV&AIDS: Comprehensive knowl-

edge o HIV&AIDS amongst young

people (15-24 years) is vital to improve

their health-seeking behaviour and

ability to access relevant health and

support services. The proportion o

young people with comprehensive

knowledge o HIV&AIDS has improved

rom 31 percent in 2002 to 40.2 percentin 2009. However, HIV prevalence re-

mains high amongst people with com-

prehensive knowledge o HIV&AIDS,51

suggesting that socio-economic and

gender inequalities as well as cultural

actors are important drivers o the

HIV epidemic. Research has indicated

that transactional sex (the exchange o

avours or sex) is common in Zambia,

even among young people.

School attendance o orphans: The

vulnerability o children orphaned by

the HIV&AIDS epidemic is immense, not

only to HIV inection, but also to pover-

ty, drugs and engaging in sex work and

other illegal activity. Eective mitigation

eorts include ensuring that they do no

end up on the streets and supporting

their education. The ratio o orphans to

non-orphans aged 10-14 years attend-

ing school has increased rom 71.8 per-

cent in 2000 to 92 percent in 2009, close

to the 2015 target o 100 percent.

Universal access to HIV&AIDS treat-

ment: With ree paediatric ARVs and an

adult ART p

Documents

MDG Report 2013