The social Situation in 1995 and Policy Challenges

63. The over-arching objective of this review of the trends in demography, education, health, employment and the refugee situation in Africa is to once again highlight the critical needs for African countries to restructure and reorientate their policies towards enhanced social development in consonance with the goal of poverty reduction. Absolute poverty in sub-Saharan Africa has been on the increase for many years. With estimates indicating that the number of poor people has been increasing by 8 to 9 million annually, almost half the population of sub-Saharan Africa will be living below the poverty line by the year 2000.

A. Unsustainable population trends

64. The population in ECA member States, according to median variant of the United Nations estimates, was about 728 million in mid-1995, expected to reach 832 million by the year 2000 (table II.1). At the current annual growth rate of 2.9 per cent, the population would double in approximately 24 years. Under the high growth scenario, the population is projected to reach a staggering 1,456 million by the year 2020 on account of high fertility. The policy to mitigate the rate of growth would have to target reductions in fertility while further upgrading and expanding health services qualitatively and quantitatively. Table II.1: African population, by subregion, 1990-2000:

Medium variant

SubregionsPopulation (1000s)
Eastern Africa227107261292
Middle Africa8232695577
Northern Africa160582178443
Southern Africa4739653004
Western Africa210663243280

Source: World Population Prospects, Population Division, Department for Economic and Social Information and Policy Analysis, United Nations, New York, 1995.

1. Alarmingly high fertility levels 65. The issue of high fertility in Africa and its critical relation to maternal and child health, poverty and sustainable development has been seriously addressed in a number of fora. The most recent of these include the third African Population Conference, held in Dakar, Senegal, in December 1992 and the International Conference on Population and Development (ICPD) held in Cairo, Egypt, in September 1994. Following these important milestones, ECA organized in Abidjan, Côte d'Ivoire, an Experts and NGOs Workshop on the implementation of the Dakar/NGOR Declaration and the ICPD Programme of Action in 1995, in the framework of the Joint OAU/ECA/ADB Secretariat and in cooperation with the International Planned Parenthood Federation (IPPF) and the United Nations Population Fund (UNFPA). An important con-sequence of these conferences is the increasing number of ECA member States (26 in 1995 and possibly 29(1) in 1996) adopting specific population policies, including the reduction of fertility.

66. However, the total fertility rate for the region, especially in sub-Saharan Africa, is still comparatively high. Except for North Africa, which has a total fertility rate (TFR) of 4.7, total fertility rates in the region range from 6.2 to 6.9. Among other factors, high fertility levels have a negative impact on maternal mortality and on infant and child mortality and morbidity rates. Recently, contraceptive prevalence rates have increased, lead-ing to slightly declining TFRs. However, contracep-tive prevalence rates have remained extremely low in Africa relative to other world regions. For instance, ECA data indicate that "With regard to current use of any modern contraceptive method, rates are above 30 per cent in eight countries, namely Algeria (43 per cent), Botswana (32 per cent), Egypt (45 per cent), Mauritius (49 per cent), Morocco (36 per cent), South Africa (48 per cent), Tunisia (40 per cent) and Zimbabwe (36 per cent). These are followed by Kenya (27 per cent) and Namibia (26 per cent). In the remaining countries, the rates are between 10 and 13 per cent in two countries, between 5 and 9 per cent in six countries and below 5 per cent in 10 countries.(2) 2. Challenge of high dependency burden

67. As a result of high population increase, the dependency ratio in Africa is the highest in the world. The population of children aged 0-14 years constitutes almost 50 per cent of the total population. Africa's high dependency burden at 92 per cent compares unfavourably with 68 per cent in Latin America, 61 per cent in Asia, 51 per cent in North America and 50 per cent in Europe. An inevitable concomitant of a heavily youthful, non-productive population in Africa is the undue pressure exerted on already overstretched social infrastructure and facilities, especially in the health, education and housing sectors.

68. The rapid increase in population and rural-urban migration also ensures that the demand for urban shelter and services expands more rapidly than their supply, leading to rising prices for urban land and housing and unprecedented squatting. The average density of occupation of dwelling rooms in Africa is estimated at 2.23 persons, with 40 to 85 per cent of the inhabitants living in slums and informal settlements, typified by poor sanitation, inadequate water and poor water quality, and inadequate garbage disposal. Much of the stock of buildings and infrastructure for human settlements in Africa is old and in a state of disrepair and therefore unsuited for current use without rehabilitation or rebuilding.

B. The health situation

1. Deteriorating institutional and physical infrastructure

69. The health sector continues to bear a disproportionate burden of the ongoing socio-economic crisis. In many countries, the exodus of doctors, nurses and technicians, compounded by declining or stagnating public expenditure on health, have culminated in a virtual collapse of the health infrastructure. For instance, the average expenditure on the health sector in sub-Saharan Africa rarely exceeds about 5.0 per cent of GDP. Because the health policies of most member States are yet to be grounded in preventive and primary health care, a large proportion of public expenditure on health, sometimes as high as 60 per cent, goes towards curative services in a few teaching hospitals. At the current level of Africa's economic development, focusing on primary health care is the only viable strategy for achieving health for all in the foreseeable future. For over a decade, the WHO Africa Regional Office has been exhorting African countries to rethink their health policies and reverse the concentration of the meagre health services in a few urban areas. The district and community focus in health care provision which underpins the WHO/Africa Regional Office framework for health policy development and for achieving health for all by the year 2000 is yet to receive universal endorsement in Africa.

70. In many countries, an overwhelming majority of health workers, sometimes as many as 90 per cent of doctors, nurses and other essential health workers, are concentrated in a few urban areas. Rural communities are also disadvantaged vis-à-vis institutional and infrastractural facilities. For example, more than 50 per cent of the African population do not have access to modern health facilities and 30 per cent have no access to safe drinking water and sanitation. In many cases, over 60 per cent of people in the rural areas have no access to these facilities. High levels of maternal, child and infant mortality and low rates of immunization are symptomatic of the gross neglect of Africa's rural communities. As can be seen from table II.2, the rural sector is seriously disadvantaged in the provision of health and health-related services. There are significant variations also in the provision of these services as between subregions and countries within the same subregion. Studies indicate that the few modern health centres that do exist are too far apart and poorly equipped to justify the enormous costs to patients, both in terms of time and money involved. Table II.2: Some health indicators in selected African countries (in percentage)

CountryPopulation with access to safe water


Population with adequate sanitation


Population with access to health services


Fully immunized

1-year-old children



Source: Extracted from UNICEF, State of the World's Children, 1995 and 1996.

* Tuberculosis

** Diptheria

2. Slow progress with preventive and community health care

71. Failure to implement preventive health care (PHC), with its emphasis on community health, has had profound ramifications on Africa's long-term development prospects. For instance, lack of basic sanitation and safe drinking water, which is integral to PHC, is responsible for diarrhoeal diseases which are among the leading causes of death among children under five years of age. Diarrhoeal diseases can easily be con-trolled by the provision of safe water and sanitation and through increased availability and use of relatively cheap oral rehydration therapy or salts (ORT/ORS). Recent data indicate ORT use rate in sub-Saharan Africa to be about 57 per cent, compared to the WHO recommended use rate of 80 per cent by the year 2000. However, with assistance from the United Nations Children's Fund (UNICEF), considerable progress has been made in recent years in African countries in the use of oral rehydration therapy. Sixteen countries in Africa have lifted use rate by 30 percentage points or more over the last decade.(3) Between 1987 to 1993, regional oral rehydration therapy use rate ranged from 10 per cent in Mali to 90 per cent in Zambia. In addition, public health education in various forms can considerably reduce such major impediments to health as malaria, sexually transmitted diseases (STDs) and severe malnutrition which contributes enormously to acute respiratory infections - the leading cause of death among African children.

3. Inadequate and lagging immunization programmes

72. In the African region, immunization against major killer diseases is below the target set by WHO for the mid-1990s. This is particularly the case in rural communities and in countries facing serious financial crisis and economic recession, or those mired in internecine wars and civil strife. Immunization in Africa, especially against the major childhood diseases, is significantly below the global average. Large outbreaks of diphtheria and measles continue to afflict children who otherwise could have been protected through early immunization programmes. Immunization ramifies into many aspects of child health. For instance, immuni-zation against measles and pertussis contribute significantly towards the containment of acute respiratory infections, especially pneumonia, which is the single biggest killer of children.

4. Containing the HIV/AIDS pandemic is a priority

73. Globally, the spread of HIV/AIDS continues to be rapid with an estimated 5,000 individuals being infected daily.(4) Despite weak epidemiological surveillance and serious under-reporting, WHO data indicates that HIV/AIDS is increasing at an alarming rate in Africa. Thus, most of these new infections are occurring in Africa where at least one million persons are being infected annually and the projected numbers for the year 2000 are 20 million.(5) Within sub-Saharan Africa, HIV infection is unevenly distributed across geo-graphic areas, age groups and socio-economic classes. The percentage of the population infected with HIV ranges from less than 1 per cent across most of the continent to more than 25-30 per cent in certain cities in Eastern, Southern and Central Africa. The most seriously affected countries are those roughly clustered around Lake Victoria. They include Burundi, Central African Republic, the Congo, Kenya, Malawi, Rwanda, the Tanzania, Uganda and Zaire. Table II.3 indicates that by June 1995 there were 270,667 AIDS cases reported to WHO/AFRO by country area offices. Of these cases, Kenya accounted for 20.9 per cent, Côte d'Ivoire 9.3 per cent, Malawi 13.9 per cent, the Tanzania 17.0 per cent, Uganda 17.0 per cent, Zaire 9.7 per cent, Zambia 11.0 per cent and Zimbabwe 14.2 per cent. Previously, HIV/AIDS had not been a serious problem in the West African subregion, however, table II.3 indicates that HIV/AIDS is becoming a major health problem in Côte d'Ivoire and Ghana. This clearly indicates the need for vigilance and surveillance in countries that are still relatively free of the pandemic.

Table II.3: AIDS cases reported to WHO by country/area based on

reports received through 30 June 1995.

Côte d'Ivoire1465540156566025236

Source: WHO Africa Regional Office, Brazzaville, Congo, 1995.

74. The HIV/AIDS scourge is now one of the leading causes of death among adults in a number of African countries. In countries severely affected by the pandemic, studies indicate that up to half of all hospital beds may be occupied by HIV/AIDS patients. Also, the pandemic is significantly associated with the upsurge of tuberculosis. Recent data by WHO indicates that in some communities, the incidence of TB in HIV seropositive patients may be as high as 90 per cent. Tuberculosis is the leading killer among com-municable diseases, but, as contended by WHO, the main obstacle to TB control is the lack of political will. Relatively inexpensive cure is readily available but not being widely used.(6) Political will is also critically needed to arrest the spread of STDs which are also heavily implicated in the spread of HIV. Currently, WHO estimates indicate that there are 65 million cases of STDs in sub-Saharan Africa. The risk of trans-mission and acquisition of HIV is five-twenty fold in the presence of STDs.(7)

75. In the absence of a cure, strategies have largely focused on changing human behaviour and attitudes. Emphasis on rural communities and urban households highlights the need for communication and action pro-grammes which attempt to raise the consciousness of women, promote knowledge among youth, especially young girls, who are disproportionably vulnerable, and teach skills required to enforce the knowledge which has been disseminated. In some communities, there is a widespread belief that young girls, particularly those who are still virgins, are better sex partners since they are free of HIV infection. Long-distance truck drivers are known to seek very young girls for sex because of their presumed innocence.

76. Information campaigns have been successful in a number of countries which have increased the level of awareness regarding transmission routes, the need to alter sexual behaviour and reduce unprotected sexual contact. These include Madagascar, Rwanda and Zimbabwe. In Rwanda, out-of-school youth show evidence of reduction in risk-taking and positive changes in gender relations. In several countries, including Uganda and Zambia, the stigma attached to HIV/AIDS has been substantially reduced.(8) Governments are collaborating with community leaders, musicians, NGOs and international organizations in media campaigns. Thus in Zaire, pre- and post-campaign surveys in 1991 revealed a five-fold increase in condom use.(9) In the numerous mobilization programmes, various communication models have been developed including peer education, outreach communication, community initiative models and school clubs. The peer education approach has been one of the most successful.

C. Challenges to African education

1. Less public spending in the face of more needs

77. The crisis in African education has intensified. Rapid population growth rates and severe cut-backs in public expenditure often in connection with debt rescheduling and economic restructuring, among other factors, have culminated in a near collapse of the educational infrastructure. Table II.4 shows public expenditure on education in sub-Saharan Africa to be the lowest in the world. The most severe cuts on education have been made in capital and recurrent expenditures for new construction, supplies, furniture, equipment for science laboratories and for repair and maintenance. In the light of the continuing socio-economic crisis, rehabilitation of decaying educational institutions has become daunting for most countries. Moreover, the public expenditure for all levels is disproportionately skewed in favour of higher education but that has not rescued this level of education from decaying infrastructure, low pay and poor working conditions, flight of teachers and industrial disputes that have kept classrooms and laboratories closed for months, if not years. On the other hand, data from many African countries indicate that at the primary level, there is practically no funding from central government except for teachers' salaries and allowances. In addition, the surge in unit costs is not accompanied by a marked improvement in the quality of education as a result of devaluation and rising inflation rate. Consequently, the contribution which education is expected to make to Africa's recovery and socio-economic development is clearly not yet on the horizon.

Table II.4: Public expenditure on education, 1980-1992

RegionsUS$ (billions)Percentage of GNP
Sub-Saharan Africa15.811.315.
Arab States18.023.624.726.
Latin America/Caribbean34.228.947.
Eastern Asia/Oceania16.020.131.841.
Southern Asia12.814.735.860.

Source: UNESCO, World Education Report, 1995.

2. Declining primary level enrolment

78. Even though the total enrolment of students at all levels has been on the increase, gross enrolment ratios at the primary level, as indicated in table II.5, have steadily declined from 76.0 in the mid-1980s to 74.3 per cent in 1992 and is further estimated to decline to 71.3 per cent by the year 2000. Persistent crisis at the first level is exemplified by declining standards culminating in high rates of attrition and repetition of classes, over-crowding, lack of basic teaching materials and low morale among teachers. The crisis is further exacerbated by parents' lack of confidence in the educational system due to the rising cost of educa-tion which is not accompanied by an increase in formal employment opportunities. Due to a myriad of cul-tural factors, girls have borne a more disproportionate burden of the ongoing crisis than boys. The continu-ing educational crisis at the primary level is particularly serious for Africa's long-term socio-economic development, considering that the highest rates of return to education are usually at the primary school level. Studies demonstrate unequivocally the positive relationship between sound primary education and such diverse spheres as human capital development, life expectancy, agricultural productivity, nutrition, fertility levels, income generation and child health. Education of girls at this level is even more important for sustainable development. "Poor primary schools often compromise the foundation for education. Their products are poorly prepared for secondary and tertiary education, and ill-equipped for lifelong learning."(10)

Table II.5: Past, present and projected enrolment

at the primary level

YearGross enrolment ratioTotal number of pupils

(in millions)


Source: UNESCO, Report on the State of Education in Africa, "Education Strategies for the 1990s: Orientations and Achievements", UNESCO, Breda, 1995.

3. Middle and high level education also at crossroads

79. The problems of middle level education in secondary, grammar, teacher training and vocational and technical education are too vast to be adequately treated here. However, this level which should provide the foundation for the building of the middle classes and a modernizing economy also remains in a state of serious crisis with inadequate places and deteriorating quality. Box 3


Thirty-six million girls in sub-Saharan Africa are out of school and those who gain access are poorly served. Even when the same number of girls and boys enrol in first grade, by fourth grade, 50 per cent of the female students would have dropped out. Sixty-four per cent leave school before they have acquired full literacy. By the end of the primary school cycle, the completion rate for girls is only 34 per cent. At secondary and tertiary levels, the discrepancies between boys' and girls' education increase radically. Only 10 per cent of girls as compared to 36 per cent of boys attend secondary school. Four times as many boys as girls continue to tertiary level. Four years of additional schooling for girls can increase agricultural production by 8 to 9 per cent. One year of additional schooling for girls can reduce infant mortality rates by approximately 6 per 1000.

Source: Girls and African Education, Federation of African Women Educationist (FAWE), Nairobi, Kenya, 1995; Educating Girls and Women in Africa, Pan-African Conference on the Education of Girls, Ouagadougou, Burkina Faso, 1993.

80. Higher education in most African countries faces unprecedented crisis and calls for special attention from policy makers. A number of factors seem to have considerably exacerbated the situation. The most salient of these are, inter alia, incessant currency devaluations and high rates of inflation which reduce the already low salaries of teachers to well below subsistence levels; political interference in the operation of universities, including the appointment of principal officers and professors; frequent and prolonged closures of universities;(11) student boycotts of classes or strikes by lecturers and professors; lack of equipment and teaching materials; etc. These factors, compounded by political instability, translate into a continuous exodus of university teachers to foreign countries in search of better remuneration and working conditions, and this in turn leads to a further decline in the quality of higher education in particular, and education in general.

4. Number of adult illiterates on the increase

81. Non-formal education and literacy programmes have not grown fast enough to compensate for the shortfalls in the formal educational system. Although literacy ratios have risen, as can be seen from table II.6, the number of absolutely illiterate adults in the region is still increasing rapidly and is projected to reach 146.8 million by the year 2000. Non-enrolment and high attrition rates due to poverty and increasing cost of education at the primary level account largely for the rising illiteracy in the region. Available information indicates that the percentage of literacy is highest in Eastern and Southern Africa, followed by Central Africa and lowest in West Africa. The ratio is higher for males than for females with West Africa and North Africa exhibiting the lowest percentages.

Table II.6: Estimated adult literacy rates (percentages)*, 1980-2000

Sub-Saharan Africa40.251.829.256.866.647.362.070.953.3
Arab States40.855.026.256.668.444.261.572.250.1
Latin America/Caribbean79.782.177.586.687.785.588.289.087.4
Eastern Asia/Oceania69.380.458.083.690.676.386.892.880.6
Southern Asia39.152.824.550.262.936.653.766.040.7

Source: UNESCO, World Education Report, 1995. The population data utilized are those of the United Nations Population Division database (1994 revision).

Notes: M = Male; F = Female

* Percentage of literate adults in the population aged 15 years and over.

D. Employment and unemployment

1. Inadequate job and work opportunities

82. The 1995 World Summit for Social Development reiterated the inseparable link between poverty reduction and employment, stating, inter alia, that: "Productive work and employment are central elements of development... Sustained economic growth and sustainable development as well as the expansion of pro-ductive employment should go hand in hand. Full and adequately and appropriately remunerated employ-ment is an effective method of combating poverty and promoting social integration".(12) Creating enough jobs and productive employment to break the vicious cycle of poverty remains one of Africa's most daunting development challenges. The region's economies have not achieved enough employment creation or enough labour absorption capacity to keep pace with population growth, urbanization and the rising expectations of their citizens.

83. The labour force in Africa is growing at about 3 per cent per annum while productive employment lags behind at 2 per cent annually. According to the 1995 African Employment Report,(13) unemployment in the early 1990s was estimated at 20.0 per cent for the urban areas. The number of urban unemployed has been growing at the rate of 10.0 per cent annually and was estimated to have reached a staggering 18.6 million in 1994. To arrest this trend, it is argued that the economies of the region will have to grow at a rate of about 5 to 6 per cent per annum in order to meet the employment needs of fresh entrants into the labour force and to reduce the number of poor people in the region.(14)

84. The unemployment problem remains critical in Africa. High levels of unemployment, particularly among educated people including university graduates, is alarmingly high in a number of African countries. The implications of large numbers of unemployed educated youth and university graduates are serious for Africa's social and political stability. Youth unemployment rates are about three to four times higher than for older workers, rising to some 40-50 per cent in some countries. Among women it is two to three times higher than among men, partly through gender biases, but also because about 60 per cent of African women over 15 are illiterate, compared to 40 per cent of men. It should be noted, however, that Africa's unemploy-ment figures do not fully reflect the actual situation. Given the small size of the formal sector, unemploy-ment figures mask many other related situations such as underemployment and under-utilization of skills, the size and capacity of the informal sector as well as the millions of women and girls engaged in hidden, non-accounted productive work in households, family enterprises and in farms.

2. Saturation of the informal sector sponge

85. The urban informal sector in Africa, despite low wages and low productivity, now accounts for about 60 per cent of urban employment and has to be recognized as the most significant structural change in African economies. The sector's capacity to absorb unemployed labour is demonstrated by the fact that in sub-Saharan Africa, informal sectors created 6 million jobs between 1980 and 1986, compared with 500,000 created in the formal sector over the same period.(15) The general policy towards this sector, therefore, should be to remove administrative, fiscal and other obstacles to its growth and to facilitate its employment creation functions with access to training, credit and advisory services, productive inputs and improved pro-duction technology. Financial resources and investment in skills and infrastructure are urgently needed.

E. The refugee problem

Slow progress with repatriation and resettlement

86. The number of refugees and displaced persons in Africa remains extremely high. About 7 million are directly categorized as refugees in Africa. This does not include many internally displaced persons forced to flee their homes but were not registered in camps or with any institutions or persons who have privately sought asylum in other countries. As can be seen from the table II.7, 12 countries in Africa are responsible for over 6 million refugees, most of them from Eastern Africa. Office of the United Nations High Commissioner for Refugees (UNHCR)(16)estimates indicate that of the 27,418,000 who come under UNHCR concern, 11,816,000 are in Africa. This is in comparison to 5,018,300 for Asia, 1,876,400 for Europe, 109,000 for Latin America, 681,400 for North America and 51,200 for Oceania.

87. The primary causes of this phenomenal wave of human displacement are political (ethnic conflicts, civil wars), drought and famine. The latter is responsible for large-scale displacement of persons now termed environmental refugees.

Table II.7: Origin and location of major refugee populations in Africa

Country of originMain countries of asylumTotal
RwandaZaire, Tanzania, Burundi2 257 000
LiberiaCôte d'Ivoire, Guinea794 200
SomaliaEthiopia, Kenya546 000
EritreaSudan422 400
SudanUganda, Zaire398 600
BurundiTanzania, Zaire389 200
AngolaZaire, Zambia283 900
Sierra LeoneGuinea, Liberia275 100
MozambiqueSouth Africa234 500
ChadSudan211 900
EthiopiaSudan188 100
MaliMauritania, Algeria,Burkina Faso172 700

Source: UNHCR by Numbers 1995, United Nations High Commission for Refugees, January 1995. 88. Rapid and early repatriation of refugees to countries of origin is the only sustainable solution to the African refugee problem. Towards this end, there have been a number of positive developments, for example, the recent agreement between Togo and UNHCR for the voluntary repatriation of Togolese citizens and the relative political stability in northern Mali and the Niger which is facilitating the return of Touareg refugees. In addition, in 1995 alone, 48,087 Eritrean refugees were repatriated from the Sudan, 31,617 Ethiopian refugees were repatriated from Djibouti while many others registered for repatriation from Kenya to Ethiopia. The repatriation of 24,535 Mozambican refugees from Zimbabwe completed the repatriation operation of all Mozambican refugees from Zimbabwe. The repatriation of Mozambican refugees from six neighbouring countries has considerably lightened the current refugee burden on these countries and on the donor community. With regard to Rwanda, 39,634 Rwandan refugees were repatriated from Burundi, 13,060 from the Tanzania, and 99,753 from Uganda and 85,988 from Zaire, in 1995. Peace in Angola should lead also to the return of more than 300,000 refugees and hundreds of thousands of displaced people, just as the 1995 Abuja peace agreement between the Liberian factions should, if sustained, hasten the process of voluntary repatriation.

F. Policy framework for social development in Africa

1. What to target and how?

89. The crisis in the social sector remains severe in most ECA member States despite the modest economic recovery that is taking hold on the continent. There is little inter-sectoral coordination and co-operation among the various social sector institutions, and between them and the economic ministries, whether at the formulation or implementation stage. Instead, what obtains for now are inappropriate social development policies oriented towards the urban enclaves and lack of bottom-up approaches with emphasis on decentralization, self-reliance and community/grass-root involvement. A serious and sustained policy commitment to social development and greater coherence in social policy in Africa is urgently needed. It must incorporate adequately the formulation and implementation of social development policies, especially as they pertain to such issues as population, poverty reduction and sustainable human development, basic health, education, the pursuit of productive full employment for all and the integration of women in the development process. Such a holistic orientation and integrated approach to development must ineluctably conceive of social development as an integral and important component of sustainable and long-term socio-economic transformation. Besides, it needs to address the often-neglected issues of excessive rural-urban migration, food insecurity, high levels of unemployment and poverty. The provision of universal and com-pulsory basic education must be on the top of the social policy agenda, and so must be the provision of basic primary health care. The question of maternal and child health and family planning needs also to be addressed as it ramifies into such other areas as child and maternal health. Sustainable poverty reduction is inseparably linked to the issues of democratization and popular participation, which are today the most pressing issues on the African development agenda.

2. Achieving basic health for all is an imperative

90. Achieving basic health for all is thus imperative for poverty reduction and sustainable development. Policies are urgently needed to address the major obstacles to the provision of basic health services in Africa, in particular the predilection towards curative health care provision. To do so, integrated and coherent health policies must be grounded in the principles of primary health care and WHO/AFRO's African Health Development Framework which underlines the goals of health for all by the year 2000.

91. In consonance with the Bamako Initiative and Saitama Declaration, ECA member States must inten-sify efforts to develop strategies for health care financing community participation and mobilization for health care provision and extensive training for community health workers and the establishment of district health committees. The establishment of critical drug lists and cost- recovery mechanisms are essential components of sustainable preventive and community health care. Government expenditure in the health sector must be restructured in favour of preventive and community health care, paying particular attention to the rural and urban poor. Some of the areas needing urgent attention are maternal and child health services, especially immunization and family planning programmes, public health education, nutrition, sanitation and provision of safe drinking water, the containment of HIV/AIDS, sexually transmitted diseases and tuberculosis, promo-tion of healthy lifestyles and stable and safe environment. Under the Special Initiative for Africa, significant expansion of Africa's primary health facilities is projected over a 10-year period, under the theme, "New hope for the upcoming generation". With reduced military expenditure by national governments, more funding could be channelled to the sector. Negotiated "debt for health" swaps and debt cancellations can also enable African Governments to carry out extensive health sector reforms for primary health provision.

92. Declared a global emergency by WHO since 1993, the recrudescence of tuberculosis and its threat to public health in Africa is magnified by the high incidence of HIV/AIDS-related infections. Treatment, which is cheap and effective when available, must be linked to the treatment, containment and prevention of STDs and HIV/AIDS. Public health messages which warn people against casual sex with multiple partners, unprotected by condoms, should also include TB as a disease to guard against. Ministries of health, family planning and reproductive health agencies and centres must, with the assistance of United Nations agencies and NGOs, use the communication media, pharmacies and other health structures to issue information and ensure availability of good quality condoms, as well as the appropriate treatment for HIV/AIDS and AIDS-related tuberculosis.

3. Greater linkages between education and the world of work

93. The World Conference on Education for All argued for the provision of basic education for all by the year 2000, as the world's most important development priority. Provision of basic education is con-strained by a number of obstacles however. For example, while the total cost of achieving universal primary education for all in Africa during the period 1990-2000 is estimated at no less than $US26 billion, Africa's per capita expenditure on education remains at $US28 compared to $US49 in other developing countries. The allocation of resources earmarked for education is usually to the advantage of second level and tertiary education rather than to basic primary education and literacy, a situation which should be rapidly reversed.

94. The financing of education also needs radical changes in resource allocation to ensure justice and equity between rural and urban areas and between male/female education. In this regard, innovative methods of education cost management are urgently required. Cost recovery and fee-sharing is one strategy used to augment state educational expenditures by transferring part of the education cost to beneficiaries. However, one of the short comings of this strategy is the reduced access to education of low-income populations. To overcome this problem requires, among other things, that partnerships between local communities, students/-parents associations, employers associations, trade unions, development partner organizations, religious bodies and NGOs be strengthened for increased resource mobilization for education in rural areas.

95. In many African countries, educational and training policies are currently in need of in-depth rethinking and revision, given that in some cases, high school leavers and even university graduates cannot find wage employment, some times for several years. They are increasingly caught in a situation of long-term structural incongruence between human resources development and socio-economic development. Science and mathematics education have received greater emphasis in the curriculum in recent decades, but they are still largely taught theoretically, while instruction in technical subjects and productive technology is seriously deficient. Teacher training colleges need also to be strengthened. Technical training in trades, crafts and engineering fields such as construction and civil engineering and mechanical engineering create self-employment opportunities and raise the level of productivity in the informal and small-scale formal sectors. Agricultural science and practice also need emphasizing, since agriculture is still the largest employer and the basis of rural development and agro-industry.

96. There is need for monitoring, evaluating and reporting on the implementation of educational policies along the lines of the resolutions of the World Conference on Education for All (WCEFA) at the national and regional levels. At the national level, a government focal point is required to monitor, evaluate and report on progress in the education sector. Grass-roots organizations will also have to be involved in the monitoring process. At the regional level, UNESCO, ECA, OAU and ADB should be responsible for reporting to the Conference of African Ministers of Education both on progress made and on setbacks to the implementation of basic education for all. Special attention must be paid to the quality of education so as to develop the appropriate human capacities and skills needed for sustained socio-economic development, including entrepreneurial education at all levels.


In Kenya, the employment promotion and maternal child health/family planning (MCH/FP) for women and youth in the Mathare Valley (Nairobi) is implemented by the National Council of Churches of Kenya (NCCK), a national umbrella organization for Christian churches, promoting social justice and development activities. It was initiated with UNFPA funding in 1988. The project encourages employment through credit, business skills seminars and vocational skills training. It also involves MCH/FP promotion through educational seminars supported by information, education and communication (IEC) materials and service delivery and counselling through a mobile clinic. In addition, the business skills and vocational training programmes integrate population and family planning education into their curricula. By the end of 1992, more than 2,000 individuals had received business training, 169 women had received credit, 60 youth had received vocational training, and more than 15,000 individuals had received MCH/FP services through the project.

Source: UNO, The Work of the United Nations System in Poverty Alleviation, United Nations Office at Geneva, Palais des Nations, 1995.

97. Comprehensive educational and manpower planning and policies for socio-economic development must address the very serious problem of brain drain, especially among highly trained professionals in such diverse fields as medicine and medical sciences, engineering and social sciences. These professionals are trained at a tremendous cost to Africa. Among the most salient factors accounting for brain drain are sharply declining wages and incomes, dividing economic opportunities and inhospitable working environment, social injustice and political stability. Halting significant outflow of highly skilled personnel and attracting those who have already left will require putting in place effective incentive structures: financial and tax incentives, opportunities for self-employment and private practice, especially for doctors and university teachers. The return home could further be cushioned with attractive remuneration packages: for example, job offers, housing allowances and car loans, affordable mortgages, duty-free exemptions and special customs status on entry of professional equipment and personal effects. The one good time is that the cost of all these incentives is relatively small compared to the cost of current and continued flight of highly skilled manpower.

4. Improvements in housing and the environment

98. Most African countries have experienced spontaneous and haphazard urban sprawl and are usually unable to keep infrastructure and services in harmony with population growth and rising expectations. Systematic urban development planning and maintenance is urgently needed to deal with large concentrations of people in a few capital cities at the expense of secondary cities and rural service centres. Policies are also needed to arrest the proliferation of shanty towns, peri-urban areas and urban slums and to halt urban decay in African major cities as old infrastructure deteriorates due to lack of maintenance and new planned investment, insufficient political and civic commitment and enormous population pressure.

99. Within the framework of an urban environment, sustainable human settlement presupposes, among other things, adequate shelter for all. Underpinning integrated human settlements planning is a need for political commitment, well-trained staff and strong local and national institutions for planning and managing human settlements, balanced land-use development within sectors and in both urban and rural areas. Given the unprecedented high rate of urbanization in Africa and the rising expectations and demand for basic services, effective human settlements management and development policies are urgently needed. These are among the major issues to be discussed during the forthcoming United Nations Conference on Human Settlements (Habitat II) in Istanbul, Turkey in June 1996.

100. African Governments will need to take advantage of the outcome of the Conference, which is expected to encourage governments and local authorities to build partnerships with urban dwellers to improve management of cities. Policies promoting well-managed and well-serviced urban centres maximize their mandate and capacity to function as growth poles and centres of economic productivity and social development. Cities not only offer significant economies of scale in production, employment, housing and services, they provide also the impetus for innovation and change.

101. Agenda 21 of United Nations Conference on Environment and Development's (UNCED) Rio Conference in 1992 discussed human settlements, environment and population policies and noted the need to mitigate rural/urban migration flows. Given the need for balanced spatial population distribution, governments were encouraged to achieve urban consolidation through small- and medium-sized urban centres and to promote rural industrialization through labour-intensive projects, job and agricultural training for women and youth and effective transport and communications.

102. The above-mentioned Experts and NGOs Workshop on the Implementation of the Dakar/Ngor Declaration and the ICPD Programme of Action stressed the importance of effective population policies and programmes at country level and highlighted such implementation constraints as the unrealistic targets set out in both documents without adequate regard for national financial and institutional capacities. It also stressed the need for countries to integrate population and human settlements planning into ongoing and future SAPs.

103. Financing and maintaining infrastructure for human settlements needs national and local budgetary allocation as well as affordable cost-recovery measures. If urban decay in Africa is to be halted, governments and city councils and managers need to upgrade standards, systems and equipment. Garbage disposal systems and provision and improvement of toilet facilities and basic sanitation, piped water systems that deliver clean water regularly, continuous electricity supplies, health and education services all require committed management and an integrated policy coordination.

5. Promoting earnest productive employment and sustainable livelihoods

104. Informal sector employment policy both in urban and rural areas needs far more emphasis for employment generation, since strategies aimed at it and at the unemployed may have more positive impact on the lives of the majority of the population and the critically poor. The United Nations System-wide Special Initiative on Africa urges promotion of employment-generating opportunities, particularly in the informal sector and sustainable livelihoods, particularly in environmentally marginal areas. In this regard, the Initiative supports building on local knowledge and community-based action, increased access to technology, skills development, entrepreneurial training and micro-credit and a participatory approach, especially in rural communities in arid and semi-arid environments.

105. Sustainable rural development policies geared to real local resources are part and parcel of policies to support productive employment and livelihoods. Governments have to create alternatives to out-migration from rural areas. Attention to land reform and access to land is one of the pre-conditions. Access of rural populations to water, electricity, transport and communications, schools and hospitals, recreational and other physical and social facilities is also crucial. To be effectively implemented, adequate decentralization of administrative systems is needed, along with budgetary responsibility at local, district and regional levels. There is need for governmental action to encourage establishment of new businesses, industrial units and income-generating projects in the rural areas. In improving the conditions in the rural areas, African socio-economic policy-makers can learn a great deal from the Asian newly industrialized countries (NICS). These countries have been successful in formulating and implementing policies to pave the way for social transformation through increased pace of small-scale industrial development which however required adequate rural/agricultural development to create effective demand. They promoted the transfer of agricultural underemployed workers to industry and heavy investment in labour-intensive employment in rural areas during the early stages of development. Investment was directed not only at agricultural productivity and expansion but at rural small-scale industrialization as well, with well coordinated movement into export-oriented production from the early phase of import-substitution industries. There was also planned and sustained political and budgetary commitment to human and physical capital development and investment in agricultural and agro-industrial research and development.

6. Mainstreaming gender issues into all sectors of development activities

106. Sustainable integration of women in development can only be achieved within the framework of gender relations and analysis vis-à-vis issues such as equity, equality and justice between men and women. Among the many recommendations emanating from the United Nations fourth World Conference on Women are five priority areas of focus for the next five years. These are poverty eradication, health, education, promoting women's human and legal rights and women's participation in decision-making.

107. In Africa, women are increasingly becoming the main income earners for a majority of households and the hub of development, particularly in agriculture where they play a key role in food production activities in addition to traditional domestic chores. Still, in many parts of Africa, cultural traits and taboos have continued to underpin the marginalization of women in the development process: low rate of participation of women in areas of education and labour force, women's lack of adequate access to health resources, their relatively high unemployment rate in the formal sector as compared to men as well as their lack of access to credit facilities for investment in self-employment generating activities. In addition, the issues of enhanced women's role in the decision-making process and human and legal rights are critically important, especially in relation to land tenure and poverty reduction. These are some of the constraints that still inhibit gender equality in the African region and it is to be hoped that genuine efforts will be made by African Governments and peoples and their development partners to enhance the status of women and to improve their participation in the development process within the framework of the Beijing Declaration and the Platform for Action.

1. D. Sala-Diakanda paper presented at a Seminar on "Fertility transitions and family planning in Africa", ONSEA ORSTON, Abidjan, 16-19 June 1995.

2. ECA, "Statistical compendium on contraceptive prevalence and practice in ECA member States", 1995, p. 12.

3. State of the World's Children, UNICEF, 1995.

4. WHO and UNDP, Women and AIDS: Agenda for Action, 1994.

5. Organization of African Unity: Tunis Declaration on AIDS and the Child in Africa, AHG/DECL.1(XXX), 1994.

6. WHO, "The work of WHO 1992-1993 Biennial Report of the Director General", p. 106.

7. Dr. Workneh Feleke, "The interrelationship between sexually transmitted diseases (STDs) and HIV/AIDS; paper presented at the Senior Policy Seminar on the Social Impact of HIV/AIDS in Households and Families in Africa", ECA, October 1995.

8. Op. cit.

9. Ibid.

10. UNESCO, Education for All: An Expanded Vision, Round-table Theme 11, World Conference on Education for All, Jomtien, Thailand, p.27.

11. According to UNESCO, since the early 1990s, universities have been closed in Kenya (1993-1994), Nigeria (1992-1993), the Congo (1994-1995) and Zimbabwe (1995), among others. UNESCO, op.cit., 1995.

12. World Summit for Social Development, United Nations, New York, 1995, p.79.

13. African Employment Report, International Labour organization, Regional Office for Africa, 1995.

14. World Bank, Adjustment in Africa: Reforms, Results and the Road Ahead, Oxford University Press, 1994, p.161 and ILO, Ibid; p.11.

15. African Employment Report, 1995.

16. UNHCR. United Nations High Commission for Refugees by Numbers, 1995, p.4.