‘Policy verses Action’
Population Growth and its’ Influence to the
Efforts Made to Improve the Health, Education and
Nutrition Situation in Ethiopia
Africa Facing Major challenges:
Population growth and development impact on poverty
By
Tirsit Grishaw
13, September 2010, Berlin
Outline of the presentation
 Background information about Ethiopia

Health, Education and Nutrition situation in Ethiopia
 Policies/strategies that have direct impact on the health
education, and nutrition situation in Ethiopia
- PASDEP (Plan for Accelerated and Sustained
Development to End Poverty)
- The 20 year Sector Development Programs (SDP)
- Population policy in Ethiopia

Limitations/Challenges

Conclusion
Background information about Ethiopia
________________________________________________________
Geographic and demographic tips
 10th largest country in Africa covering 1,104,300 sq kilometers
 Ethiopia is the 2nd populous country form sub Saharan Africa
with a total population 73.9 Million (2007
census)
 The pyramidal age structure of the population has remained
predominantly young with 44% under the age 15 years.
 According to the 2005 DHS birth per women declined to 5.4.
compared to 6.4 in 1990 (2007 Census)
Cont’

Ethiopia’s economy depends heavily on the agricultural sector. Agriculture
accounts for 83.4% of the labor force. over 45% of the Gross Domestic
Product (GDP) and 80% of exports.

The regular droughts combined with poor cultivation practices, make
Ethiopia’s economy very vulnerable to climatic changes.

Real GDP growth registered from 2003 – 2005 is 5%. Recent data shows
that Ethiopia have registered double digit economic growth of 11.8%.

Compared to the 7% annual growth target that would be required to meet
the MDGs the above figures marks a significant progress.

Ethiopia is one of the 189 member states that adopted the Millennium
Declaration in 2000.
Health, Education and Nutrition
situation in Ethiopia
Health
 The major health problems of the country remain largely preventable
communicable diseases and nutritional disorders.
 High rate of Morbidity and Mortality
Life expectancy 53.4 for male and 55.4 for female
Infant Mortality Rate (IMR) of 77/1000
Under five mortality rate 123/1000 (more than 90% of the child death is due to
Pneumonia, diarrhea, malaria neonatal problems and malnutrition and HIV/AIDs )
-
Maternal Mortality Rate (MMR) 673/100,000
(Obstructed/prolonged labor
(13%), ruptured uterus (12%) Eclampsia (11%), malaria (9%) complication form abortion (6%).
Shortage of skilled midwives, weak referral system and lack of equipment and under financing of the
service)
Source (Health sector development program IV (2010/11-2014/15), DHS (2005)
Cont’
 Ethiopia has the largest number of people living with HIV in the world
after South Africa and Nigeria (CAFOD/Trocaire, 2006)
 The total number of People living with HIV/AIDs ever started on ART
has increased substantially and reached 150,136 (2008).
 1,005 HIV/AIDs Care Treatment sties established as result of the
Millennium AIDS campaign.
 Number of facilities PMTCT and ART has increased to 719 and 353
respectively in 2008.
Cont’
Nutrition
 Nutritional disorder are the main causes of morbidity and mortality.
 Protein-energy malnutrition and micronutrient deficiencies such as
vitamin A, Iron and Iodine are the major problems.
 During the implementation of HSDP III 90% of children 6-59 months
have got access for nutritional screening every three months at Health
post level.
 47 percent of children under –five in Ethiopia were stunted (DHS 2005)
Cont’
 27 percent of all women of childbearing age were found to
suffer from chronic energy deficiency (DHS 2005)
 In addition to food insecurity, Other factors such as
improper feeding practices, poor child and maternal care
practices, as well as social and traditional factors
contribute to malnutrition.
Cont’
Education
 Gross Enrolment ratio at primary school in 2008 is 96.7% (Girls 91
%, boys 102.4%).
 Net Enrolment ratio in 2008 reached 84.4%.
 In 2008 the number of primary schools in the country reached 23,235.
Out of 1,992 primary schools constructed in 2008, 80% are
constructed in rural areas with improved awareness of the community
towards girls education.
 Aiming at addressing the education need of pastoral and semi-pastoral
areas special programs such as Alternative Basic Education Centers(
ABECs) established.
Policies/strategies that affect the Health,
Education and Nutrition situation in Ethiopia


Plan for Accelerated and Sustained Development to End Poverty
(PASDEP)
Main development objective of the Ethiopian government is poverty
eradication
- Hence the objective of the PASDEP is to define the nation’s overall
strategy for development for five years.
- This document is strategic guiding framework for the five-year period
2005/06-2009/10
- PASDEP represent the second phase of the Poverty Reduction
Strategy program (PRSP) process which has begun under the
Sustainable Development and Poverty Reduction Program (SDPRP)
Important strategic direction of the PASDEP
PASDEP carries forward important strategic directions pursued under
the sustainable development and poverty Reduction program
(SDPRP)
Cont’
 In addition to Important strategic direction of SDPRP i.e
infrastructure and human development, rural development,
food security and capacity building, PASDEP embodies
some bold new direction that include;
-
greater commercialization of agriculture
enhancing private sector development
Industry
Urban development and
Scaling up of efforts to achieve the Millennium
Development Goals *** (MDGs)
Cont’
Selected MDGs indicators synchronized with PASDEP Targets and process
(2007/08)
MD
Gs
Component
Selected
Target
Base line
(2004/0520
Outturn
(2005/06)
Progress
(2007/08
PASDEP
Target
2009/10
Goal 1
Eradicate extreme
poverty and
hunger
GDP growth
rate
10.6
0.6
11.6
7.3 (period
average)
% of People
under poverty
line
39
36.6
32.6
29.2
% of people
who are below
food poverty
line
38
35.6
31.5
27.6
Goal 2
Achieve universal
primary education
GER
(1-8 in%)
79.8
91.3
96.7
109.7
Goal 4
Reduce child
mortality
Child mortality
140/1000
123/1,000
123/1,000
85/1000
Goal 5
Improve maternal
health
Maternal
mortality
871/100,000
673/100,000
673/100,000
600/100,000
Source UNDP, 2010
Sector Development programs
 The Ethiopian Government adopted 20 years sector
development program which mainly include education,
health and food –security strategies.
 The three sector development programs mainly Health
Sector Development Program (HSDP), and Education
Sector Development Program (ESDP) have been
implemented since 1997/98.
 Health sector reform, Human resource development and
health facility construction and expansion are major
achievements of HSDP.
Cont’
Facility
HSDP I (1996/7)
HSDP II (2003/4)
HSDP III (2009/10)
Health Posts
76
2,899
14,416
Health centers
412
519
2,689
Hospitals
87
126
195
Human resources to population
Specialists
1:103,098
1:91,698
1:78,921
General
practitioners
1:54,385
1:58,203
1:68,635
Nurses
1:5,613
1:4,980
1:3,928
Midwives
1:77,981
1:55,782
1:57,374
HEW
-
1:23,775
1:2,335
Source HSDP III
Cont’
 Education reforms based on ESDP are intended to achieve universal
primary enrolment by 2015.
 ESDP III major objective is to provide demand driven skilled human
labor to the economy through improving the quality of education,
increasing access to educational opportunities with enhanced equity,
equality and relevance.
 The ESDP provides a sector-wide policy and implementation
framework for educational development. One of its main purpose is to
coordinate government and donor inputs in the education sector.
 Both HSDP and ESDP III spanning for the years 2005/06-2009/10 are
under implementation.
Cont’
The national Nutrition Strategy
 Emanated as result of the implementation of HSDP.
 The National Nutrition strategy aims at ensuring optimum nutrition for
all citizen with main priorities and focus on pregnant and lactating
women, infants and children under-five years of age, people living with
HIV/AIDs, Food in secured house hold, and displaced population
groups.
 To address the problem of food security, the government established
rural development extension strategies and related programs.
 Nutrition has also been made part and parcel of the Health extension
program.
The national Population Policy of Ethiopia
The national Population Policy of Ethiopia

The national population policy of Ethiopia has been prepared by taking in to
consideration the interrelationship between demographic factors on the one
hand and developmental variables on the other.

The policy boldly emphasize the influence rapid population growth, young age
structure and uneven spatial distribution of population fuelled by high
continuing fertility have on the state of underdevelopment that characterize the
Ethiopian reality.

Ethiopian population policy therefore aims at pursuing the following major
objectives
close the gap between high population growth and low economic
productivity
Expediting economic and social development process through holistic
integrated development programs
Reducing the rate to urban migration
Cont’
- Maintaining/improving the carrying capacity of the environment.
- Raising the economic and social status of women by freeing them form the
restrictions and drudgeries of traditional life and making it possible for them to
participate productively in the community.
- Significantly improve the social and economic status of vulnerable groups.
Limitations/Challenges
General Challenges

Lack of coordination of all concerned bodies at national level towards achieving
the goals set.

Absence of accurate and up-to-date data on some targets and indicators

The attitude of crucial government officials (policy makers and implementers)
towards population growth, family planning and related issues.

Socio- cultural issues related to Nutrition, family size, and health seeking
behavior.
Cont’
Specific Challenges
Population growth/carrying capacity of the economy
 Ethiopia still gets almost 2 million people a year in a highly unfavorable
economic and environmental context.
 Despite the fact that the government announced 11 percent economic
growth, due to population growth and uneven distribution of wealth
economic and social indicators are declining to most of the populations.
 Majority of the population is economically inactive: Over half are too
young or too old to work
Cont’
Subsistence farming with low technological input
 The mainstay of the national economy (agricultural sector) is less
productive per capita today than it was 25 years ago.
 Agricultural out put and export income is still minimal and the country is
heavily dependent of foreign assistance.
 Arable land is overcrowded, over cultivated, and under –maintained.
Lack modern production techniques and over dependent on rainfall.
 Drought in Ethiopia which used to happen every 10-15 years in the
past are now almost permanent features due to more environmental
degradation and growth of population.
Cont’
Health and Education infrastructures not keeping pace with
population growth
 Various reports from CSOs and world bank affirms that at the current
pace achieving the child survival objective of MDG will be challenging.
 The MMR is still the highest when compared with other Sub-Saharan
African countries.
 Still only 50% of the population lives within five kilometers (one hour’s
walking distance) of a health facility.
 Unmeet need for contraceptive is 14 percent (government) 21 percent
(other sources)
 The ration of health professionals is still extremely low (Source: UNDP, WHO, UNICEF
and others)
Cont’
 Though gross enrolment rate increased all over the
country, There is significant drop out specially of girls and
this is not well detected and addressed.
 Unfortunately, improvements in coverage have been
accompanied by a sustained deterioration in educational
quality.
 Important polices such as agricultural policy, PASDEP and
even the millennium development projects in Ethiopia
have not focused on population despite its causal role.
Conclusion

As demonstrated above the root of Ethiopia’s challenge is its runaway
population growth. All efforts has to be made to assure sustainable
population growth in the country that will allow healthy and sustainable
economic growth.

Ethiopia’s demographic and developmental challenges are multifaceted and
needs multi- sectoral approaches that should be carried out in well
coordinated manner.

Government has to continue showing good commitment to the implementation
of its’ population policy designed in 1993.

Government has to work hard in sustaining already started initiatives with
regard to health, education and nutrition and look for mechanisms that could
ease the existing foreign aid dependency.

The issue of quality should get necessary attention in all sectoral development
programs.
Thank You