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  • 1. THE MILLENNIUM DEVELOPMENT AUTHORITYBACKGROUNDGhana, a tropical country on the west coast of Africa, is divided into ten administrativeRegions and 170 decentralized districts. The country has an estimated population of about23.4Million (GSS, 2009) with a population density varying from 897 per km2 in Greater AccraRegion to 31 per km2 in the Northern Region. Life expectancy is estimated at 56 years for menand 57 years for women, while adult literacy rate (age 15 and above) stands at 65%. Thegovernment is a presidential democracy with an elected parliament and independent judiciary.The principal religions are Christianity, Islam and Traditional African. Ghanas economy has adominant agricultural sector (small scale peasant farming) absorbing 55.8% (GLSS 5) of the adultlabour force, a small capital intensive mining sector and a growing informal sector (Small tradersand artisans, technicians and businessmen). Since independence, Ghana has made major progressin the attainment and consolidation of growth. However, a number of questions arise as to how toaccelerate equitable growth and sustainable human development towards the attainment of amiddle income country status by 2015.INTRODUCTION: the seven hundred and second act of the parliament of the republic ofGhana entitled the millennium development authority act, 2006.AN ACT to establish the Millennium Development Authority to oversee and manage theimplementation of the Ghana Programme under the Millennium Challenge Account for thesustainable reduction of poverty through growth as contained in the agreement between theGovernment of Ghana and the Millennium Challenge Corporation acting for and on behalf of theGovernment of the United States of America and to provide for related matters. Date of assent:23rd March, 2006. Enacted by, the president and parliament.The Millennium Development Authority establishment of Millennium Development act,2006.1. There is established by this Act the Millennium Development Authority.2. The authority is a body corporate with perpetual succession and a common seal and may sueand be sued in its corporate name.3The Authority may for the discharge of its functions under this Act acquire and hold movable orimmovable property and may enter into a contract or other transaction.4. Where there is any hindrance to the acquisition of property under subsection (3) the propertymay be acquired for the Authority under the States Lands Act, 1962 (Act125) or the StateProperty and Contract Act 1960 (C.A.6).The Millennium Development Authority was enacted by the president of the Republic of Ghanaand Parliament of Ghana through act 702, on 23rd March, 2006. An amendment to act 702, herebycalled act 709 was assented on 20th July, 2006.The objectives of the Authority are in three folds: 1. To oversee and manage the implementation of the Ghana Programme under the Millennium Challenge Account of the United States Government for sustainable reduction of poverty through growth as contained in the Compact. 2. To secure the proper and effective utilization of the Millennium Development Fund granted to Ghana under the Compact. 3. To oversee and manage the national development programmes of similar nature funded by the Government of Ghana, Development partner or by both.FUNCTIONS OF THE AUTHORITYFor the purpose of achieving its objectives the authority shall
  • 2. - Take necessary steps to ensure the reduction of poverty through modernization of agriculture. - Implement measures that ensure active participation by the private sector in national development including access to financial resources. - Provide as determined by the Board and within the terms of the Compact, infrastructure facilities including, schools, healthcare, water, sanitation and electricity. - Establish an account, reporting and auditing arrangement that is transparent and conforms to the best international practices. - Perform functions that may be required by subsequent investments made by the Millennium Challenge Corporation, the Government and other Development partners. - Put In place a mechanism by which there is exchange of information to and from the public on the activities of the Authority. - The targeted group(s) of the policyTHE TARGETED GROUP(S) OF THE POLICYThe United Nations Millennium Declaration, adopted by the world’s leaders at the MillenniumSummit of the United Nations in 2000, captured the aspirations of theInternational community for the new century. It spoke of a world united by common values andstriving with renewed determination to achieve peace and decent standards of living for everyman, woman and child. Derived from this Millennium Declaration are eight MillenniumDevelopment Goals aimed at transforming the face of global development cooperation.The MDGs aim to eradicate extreme poverty and hunger, achieve universal primaryeducation, promote gender equality and empower women, reduce child mortality improvematernal health, combat HIV/AIDS, malaria and other diseases, ensure environmentalsustainability, and develop global partnerships for development. Ghana in September 2000committed to tracking these eight time-bound MDGs and associated indicators. Progress towardsthe attainment of the MDGs has been reported annually in many national documents includingthe Annual Progress Report of the Growth and Poverty Reduction Strategy (GPRS II). In additionspecial MDG reports are prepared in biennial basis which examines trends in the attainment ofthe goals, supportive environment, challenges, and resource needs for the achievement of thegoals. So far three such reports have been prepared in 2002, 2004 and 2006 by NDPC withsupport from UNDP, Ghana.The Millennium Development Goals and TargetsGoal 1 Eradicate extreme poverty and hungerTarget 1: Halve, between 1990 and 2015, the proportion of people whoseincome is less than one dollar a dayTarget 2: Halve, between 1990 and 2015, the proportion of people who sufferfrom hungerGoal 2 Achieve universal primary educationTarget 3: Ensure that, by 2015, children everywhere, boys and girls alike, willbe able to complete a full course of primary schoolingGoal 3 Promote gender equality and empower womenTarget 4: Eliminate gender disparity in primary and secondary education,preferably by 2005, and in all levels of education no later than 2015Goal 4 Reduce child mortalityTarget 5: Reduce by two thirds, between 1990 and 2015, the under-fivemortality rate
  • 3. Goal 5 Improve maternal healthTarget 6: Reduce by three quarters, between 1990 and 2015, the maternalmortality ratioGoal 6 Combat HIV/AIDS, malaria and other diseasesTarget 7: Have halted by 2015 and begun to reverse the spread of HIV/AIDSTarget 8: Have halted by 2015 and begun to reverse the incidence of malariaand other major diseasesGoal 7 Ensure environmental sustainabilityTarget 9: Integrate the principles of sustainable development into countrypolicies and programmes and reverse the loss of environmentalresourcesTarget 10: Halve, by 2015, the proportion of people without sustainable accessto safe drinking water and basic sanitationTarget 11: By 2020, to have achieved a significant improvement in the lives ofat least 1 million slum dwellersGoal 8 Develop a global partnership for developmentTarget 12: Develop further an open, rule-based, predictable, non-discriminatorytrading and financial system.Includes a commitment to good governance, development andpoverty reduction – both nationally and internationallyTarget 13: Address the special needs of the least developed countries.Includes: tariff and quota-free access for least developed countries’exports; enhanced programme of debt relief for heavily indebtedpoor countries (HIPC) and cancellation of official bilateral debt; andmore generous ODA for countries committed to poverty reductionTarget 14: Address the special needs of landlocked developing countries andsmall island developing States (through the Programme of Actionfor the Sustainable Development of Small Island Developing Statesand the outcome of the twenty-second special session of theGeneral Assembly)Target 15: Deal comprehensively with the debt problems of developingcountries through national and international measures in order tomake debt sustainable in the long termTarget 16: In cooperation with developing countries, develop and implementstrategies for decent and productive work for youthTarget 17: In cooperation with pharmaceutical companies, provide access toaffordable essential drugs in developing countriesTarget 18: In cooperation with the private sector, make available the benefitsof new technologies, especially information and communication.PROGRESS TOWARDS THE ACHIEVEMENT OF THE MDGsGOAL 1: ERADICATE EXTREME POVERTY AND HUNGERTarget 1A: Halve the proportion of those in extreme poverty, 1990-2015 STATUS AND TRENDGhana is the first country in Sub-Saharan Africa to have achieved the target of halving theproportion of population in extreme poverty as at 2006, well ahead of the target date.
  • 4. However, with the global economic crisis and the rising food prices, it can be deducedthat the decline in poverty between 2006 and 2008, if any, could be minimal. The overallpoverty rate has declined substantially over the past two decades from 51.7% in 1991/92 to28.5% in 2005/2006, indicating that the target could be achieved well ahead of the 2015 targetof 26%. Similarly, the proportion of the population living below the extreme poverty linedeclined from 36.5% to 18.2% over the same period against the 2015 target of 19%. and 7 depictmovements towards the target of halving the proportion of people living inoverall and extreme poverty.The decline in poverty had occurred due to the significant improvements in economic growthover the past decade with accompanied sound social and economic policies on povertyreduction as spelt out in the GPRS II. These include the capitation grant, school feedingprogramme and the Livelihoods Empowerment against Poverty Programme (LEAP). _Theseprogrammers are intended to help reduce the levels of food insecurity, malnutrition andpoverty in the targeted communities. The increasing growth rates have also been accompaniedby increases in per capita income over time. Real GDP growth averaged 4.3% during theperiod 1998-2002 and since then exceeded 5% to a high of 7.3% in 2008. Available dataindicates that per capita GDP increased from US$402.23 to US$712.25 between 2003 and2008.However, despite the significant decline in poverty at the national level, regional,occupational and gender disparities exist. Some regions did not record improvements inpoverty, particularly the three Northern regions where high levels of poverty persist. Over70% of people whose incomes are below the poverty line can be found in the Savannah areas.Undoubtedly, the observed growth has not been more equitably distributed. Though povertyincidence has declined at the national level, there remains a large proportion of the populationliving below the poverty line. For instance, between 1991/92 and 1998/99 the decline inpoverty was unevenly distributed with poverty reductions concentrated in Greater Accra andforest localities, while in the others, rural and urban poverty fell moderately except in theurban savannah (GSS, 2007). The trend changed between the period 1998/1999 and2005/2006 when all the regions recorded marked improvements except Greater Accra and theUpper West which experienced worsening trend. The proportion of rural population livingbelow the poverty line also declined substantially. Food crop farmers remain the poorestoccupational group, while the situation of women has not significantly changed (GSS, 2008).Poverty Disparities at the District LevelUsing the District Poverty profile developed by the NDPC and GTZ in 2004, it was evidentthat poverty at the districts also varied. It ranges from severe poverty areas to least poor areas.Agona Swedru and Aboso in the Agona district as well as Towoboase and Abbankrom in theMfantsiman District (all in the Central region) are some of the relatively well endowedcommunities whereas Essikado No.1 and No. 2 (Western Region), and Nkwantanan inAjumako Enyan Essien District are in the poorest areas. Least poor communities includeAmaful and Dwukwa; Ajumako and Kyebi (Eastern Region); Mankessim and Saltpond.Awutu Efutu Senya district has a wide stretch of areas that have been demarcated as “highpoor enclaves”. These include communities such as Akomatom, Kofikum, Amowi, Kofi Ntowand Bosomabena.In the Northern region, Aaba, Nandom and Kunkwa are communities found in severe povertyareas in the West Mamprusi District. Tangni and Zankung in East Gonja District and Sakpeand Yagbogu in Yendi District are also least endowed. KEY FACTORS CONTRIBUTING TO THE PROGRESSHigh GDP growth rate supported by increased foreign investment outlays, governmentdevelopment expenditures and debt relief accounts for the decline in poverty. The growth
  • 5. rates have been supported by increases in the government’s poverty-related expenditure as aResult of debt relief from the HIPC initiative and the MDRI. The expenses financed by HIPCand the MDRI as well as foreign investment outlays accounted for 37% of total expenditure.Development expenditure has increased from 0.63% of GDP in 2002 to 5.83% of GDP in2008.The key factors that have contributed to the decline in poverty include:• High real GDP growth rate over the decade, growing by 5.1% between 2000 and 2006and averaged 6.8% between 2007 and 2008. With sustained growth, the progress inreducing poverty and hunger is expected to be maintained;• Political and macroeconomic stability have contributed to improving the investmentclimate;• Policy initiatives such as the establishment of the Savannah Accelerated DevelopmentAuthority (SADA) are expected to address inequality between North and South and inthe process improve gains on MDG 1;• Targeted social intervention programmers such as the Livelihood EmpowermentAgainst Poverty (LEAP), Capitation Grant, and the Ghana School Feeding and othersupplementary programmes;• Small-scale programmes in agriculture, industry and mining, rural energy, microcredit, employment generation, and specific nutrition improvement programmes.These programmes have helped reduce the levels of food insecurity, malnutrition andpoverty in the targeted communities. Ghana being highly decentralized in terms ofpublic administration, the coordination of all these programmes are done atMetropolitan, Municipal and District Assembly levels with the policy direction fromthe various sector ministries;• Commercialization of agriculture through financing, irrigation for rice, mango, andcotton farming in the north and improved land administration to promote large scaleagriculture;• Rising private savings and investment levels;• The introduction of the Microfinance and Small Loans Scheme (MASLOC) bygovernment;• Improved harmonization, coordination and volume of aid flows, especially under theMulti-Donor Budget Support (MDBS);• High cocoa and gold prices on the international market;• Increases in the demand for services as a result of CAN 2008 and other internationalconferences; and• Improved infrastructure especially road networks with the proportion of roadsmaintained or rehabilitated increasing from 65.4% in 2007 to 76.0% in 2008.KEY CHALLENGESAlthough it is acknowledged that, poverty levels have declined, inequality betweenregions, districts and within districts still remains. The following challenges must thereforebe addressed:Dependence on Primary Products and limited diversification: The country continues todepend on primary products such as cocoa and gold with limited diversification or processing.Although the non-traditional exports sector is being promoted, there has not been any majorshift towards the exports of these products. Besides, there is the concern that the discovery ofoil in commercial quantities will aggravate the situation unless oil revenue is used totransform selected productive infrastructure and productive sectors including agriculture.Vulnerability to Internal and Global Shocks: The country is highly vulnerable to externalshocks such as commodity prices and demand, oil price increases, aid flows to mention but afew. The global economic and financial crisis coupled with the rising food prices led to
  • 6. macroeconomic challenges which affected poverty reduction effort. Thus, such dependenceexposes the country to external shocks with its socio-economic implications. Internal shockssuch as droughts, floods, bush fires, etc. affect agricultural output with repercussions oninflation and other sectors of the economy.Low Domestic Resource Mobilization and Over-dependence on Aid: _Compared to manyAfrican countries, Ghana’s savings rate remains low. Savings as a proportion of GDP was5.4% in 1990 and increased to 7.8% in 2006. For a country to achieve sustained acceleratedgrowth, it must save at least 20% of its GDP and invest an equally higher amount. However,the low savings meant continuous dependence on foreign aid.Business climate: Although improving, the business climate is still weak thus holding backGhanaian firms from investing, hiring workers, and becoming productive. The typicalconstraints are related to electricity and access to finance by small and medium-sizeenterprises. RESOURCE REQUIREMENTSGhana’s development agenda as contained in the GPRS II has been focused on growth andpoverty reduction with the MDGs being adopted as the minimum requirements forsocioeconomicdevelopment. It has been estimated that the total resources needed to implement theGPRS II over the period 2006-2009 is US$8.06 billion. The greater proportions of these fundsare to be allocated towards the implementation of the MDGs related programmes and projects.So far US$6,395.11 million budgetary resources in services and investments have beenexpended on the GPRS II implementation between 2006 and 2008. In order to achieve thetarget of halving the proportion of people below the poverty line by 2015, the MillenniumProject 2004 puts the annual investment expenditure at about US$1.9 million over the period2005-2015 for the attainment of the MDGs with a per capita investment of US$80. Totalpoverty reduction expenditures increased from GH¢1,050.77 million in 2007(US$1,083.26million) to GH¢1,584.28 million (US$1,320.23 million) in 2008.Target 1C: Halve the proportion of people who suffer from extreme hunger by 2015 STATUS AND TRENDSReducing hunger requires sufficient physical supplies of food, access to adequate foodsupplies by household through their own production, the market or other sources, and theappropriate utilization of those food supplies to meet the dietary needs of individuals. Ghanais generally food secure in terms of production and availability for human consumption.Improvements in agricultural productivity and expansion in area under cultivation haveimpacted positively on annual output of the major staples. Total domestic production of majorstaples has seen an increase from 21,044,000 mt in 2006 to 24,097,000 mt in 2008. Productionavailable for human consumption and estimated national consumption showed foodsufficiency for all relevant commodities all year round in spite of the global food crisis in2008. Total production available for human consumption was estimated at 18,688,000 mt,while estimated national consumption was determined to be 9,892,000 mt. The per capitaproduction for all major crops except cocoyam showed an increase in 2008. Both legumes andcereals increased from 20.5 kg to 27.8 kg and 70.2 kg to 92.8 kg respectively from 2007 to2008, while that for roots and tubers increased from 856.0 kg to 910.1 kg.The number of districts facing chronic food production deficits has seen continuous reductionfrom 22 in 2005 to 15 in 2006, and reduced further to 12 in 2008. These achievements weremade possible as a result of numerous programmes and interventions implemented bygovernment, including fertilizer subsidy, the expanded maize and rice programmes whichsupported farmers with agricultural inputs (i.e. fertilizer, improved seed), ploughing andlabour cost.
  • 7. Food access continued to improve with additional weekly food distribution points, bettermobility of commodities and relatively good access road network. The number of food accesspoints increased by 188 nation-wide in 2008, representing an increase of 8.44% over 2007level. The average weekly/daily number of food distribution points per district is 13 with theminimum number of food distribution points per district at 7 and maximum at 31. Ashantiregion recorded the highest number (96) of food distribution points, while Upper East regionrecorded the minimum number (2) of food distribution points per district. The number ofdistricts facing difficulty in accessing food markets also reduced from 14 in 2005 to 13 in2007 and further to 10 in 2008.These improvements in food availability have significantly contributed to the decline inmalnutrition, especially with respect to the proportion of children under five years who areunderweight and prevalence of wasting.The upward trends with respect to the prevalence of children suffering from wasting andstunting that characterized the late nineties continued to be reversed in 2008. The incidence ofwasting has declined from a peak level of 11.4% in 1993 to 5.3% in 2008, while theoccurrence of underweight has declined from about 31% in 1988 to 13.9% in 2008, therebyachieving the MDG 1, target 2 of reducing by half the proportion of children under-five whoare underweight.Even though the proportion of children aged 0-35 months, suffering from stunting, reducedfurther from 29.9% in 2003 to 28% in 2008 after rising successively from 26% in 1993 to30.5% in 1998, extra effort is required in order to achieve the target of this indicatorThis progress notwithstanding, nutritional challenges still exist among some socioeconomicgroups and geographical areas. The proportion of children with stunted growth inthe Eastern, Upper East and Northern regions were estimated to be 38%, 36% and 32%respectively in 2008, compared to national average of 28% (MOH, 2008a). The proportion ofchildren with wasting was estimated to be highest in the three northern regions, while thecases of underweight children was highest in the Upper East, Northern and Central regions inthat order (Figure 9). In the Upper West region, malnutrition is prevalent in Jirapa-Lambusieclosely followed by Wa West. In Accra and Kumasi metropolitan areas, stunting accounts for10%, wasting was 5% and one in every 10 children is underweight (MOH, 2008). It was alsofound that while underweight is more prevalent in female children in the Northern region andalso in Accra and Kumasi, the reverse was the case in Upper East and Central regions.In 2008, malnutrition was found to be associated with the mother’s education. Childrenwhose mothers have some form of education were less likely to be malnourished thanthose whose mothers have little or no education. A higher proportion of children aged 12-23 months are underweight and wasted compared to children who are younger and olderowing to weaning which exposes them to contamination of food, water and from theenvironment. KEY FACTORS CONTRIBUTING TO THE PROGRESSSome of the policy measures that are responsible for the decline in the malnutrition rates inGhana include:• Prioritizing implementation of a community-based health and nutrition servicespackage for children under the age of two and for pregnant and lactating women;• Introduction and scaling-up of community management of severe acute malnutrition(CMAM) and improved inpatient care of severe acute malnourished cases. CMAMstarted in June 2007 as a pilot project by Ghana Health Service with support fromUNICEF, following a national orientation workshop to train senior health managersand clinicians on CMAM. The project is on-going. Development partners such asUNICEF are providing anthropometric equipment and logistics. Health workers fromselected districts have been trained in CMAM as part of the pilot initiative. Currently
  • 8. there are steps to mainstream the project into the national health system for countrywidescaling-up;• Implementing a government subsidy on fertilizers for small-holder farmers is expectedto provide a boost to agriculture;• A National Plan for Action for Food and Nutrition, a micronutrient deficiency controlprogramme, and related programmes aimed at promoting vitamin A supplementationof pregnant women and lactating mothers;• Programmes to promote early breastfeeding, family planning, de-worming of childrenand reducing micronutrient deficiency. Child welfare clinics have been set up tomonitor children suffering from malnutrition;• Establishment of National Health Insurance Scheme (NHIS) to rescue and cater forpoor and vulnerable groups in the society who cannot afford quality health care,nutritional health care and nutritional services;• The Medium Term Agricultural Development Programme 1991-2000, Food andAgricultural Sector Development Policy (MOFA, 2000) and other measures aimed atmodernizing agriculture under the GPRS I & II were intended to raise the level of foodsecurity in the country; and• Establishment of the School Feeding Programme in order to help reduce the level ofmalnutrition amongst school children.KEY CHALLENGESIn general, Ghana does not have food security problem as suggested by the data on nationalper capita production of key staples, however pockets of chronic food deficit exist in selecteddistricts. The Comprehensive Food Security and Vulnerability Analysis (CFSVA) undertakenby the Ministry of Food and Agriculture in 2008 suggests that about 5% of the households inselected regions including Northern, Upper East, Upper West, Western and Greater AccraRegions are food insecure and an additional 9% are vulnerable to food insecurity. It alsoshows that in a normal year, poor households face food insecurity during 3 to 4 months whilethey may face food insecurity for 6 to 8 months in a bad year. In this regard, the challengesthat need to be tackled comprises of reducing seasonal variations in food production,particularly in “famine prone” areas, and improving cross-sectoral collaboration inimplementation of nutrition programmes. Others are as follows:• It has been observed that, the districts that have food production deficits also havedifficulty in accessing food markets during periods of food shortages. Programmesthat are targeted at reducing food production deficits can go a long way to address thefood security problems of households;• Even though Ghana is generally food secure in terms of production and availability forhuman consumption, it is still bedevilled with nutritional challenges, especially amongchildren. The major indicators of malnutrition in children (i.e. stunting, wasting andunderweight) are above the international threshold. Ghana is on track in achieving thisMDGs target, although differences exist among socio-economic groups andgeographical areas. Lack of education on the required combination of food items in therural areas could account for this undesirable situation. A number of food-basednutrition related training and technologies may be required in the following areas:Protein Energy Malnutrition (PEM), Micronutrients (Vitamin A, Iron and Iodine),Food fortification demonstration, and nutrient conservation demonstrations in foodpreparation. Such training should involve men since they are the decision makers interms of the types of crops to cultivate for household consumption. Effort should bemade to mainstream gender into the food based nutrition and security programme;• Ghana’s aggregate productivity is improving but the level remain below Mauritius and
  • 9. Botswana (the most productive African economies), and far behind the rapidlygrowing Asian countries. With irrigation almost non-existent, Ghana depends largelyon rain-fed agriculture. Recently, productivity has begun to increase but the use ofmodern agricultural techniques remains limited;• Relatively low levels of productivity emanating from the application of traditionalmethods of farming have often led to stagnating levels of kilogram-yield per personfor the various foodstuffs;• Related to the above are the low application of fertilizers and the use of irrigationfarming methods;• Spatial and Gender Disparities persists: A large number of women and children sufferfrom high protein energy malnutrition and micronutrients deficiency. This is partlydue to cultural practices where adults, particularly males take a greater share of proteinat the expense of women and children;• High global food prices in addition to those of domestic key staples will likely impactthe nutrition status of vulnerable populations; and• Population growth rates and family sizes continue to affect the poor’s ability toadequately feed their families.RESOURCE REQUIREMENTSIn order to achieve the target of halving the proportion of people who suffer from extremehunger by 2015, the Millennium Project in 2004 put the annual investment expenditure atabout US$117.00 million over the period 2005-2015.GOAL 2: ACHIEVE UNIVERSAL PRIMARY EDUCATIONTarget 2A: Ensure that, by 2015, children everywhere, boys and girls alike, will be ableto complete a full course of primary schoolingSTATUS AND TRENDSSignificant improvements have been made particularly in the areas of basic school enrolment.The key policy objectives in this sector in 2007 and 2008 were to increase access to, andparticipation in education and training, with greater emphasis on gender and geographicalequity; improve the quality of basic education; and enhance the delivery of education services.Progress towards the attainment of these broad objectives has been recorded in the 2007 and2008 APRs of GPRS II. Indicators on Gross Enrolment Ratio; Net Enrolment Rate;Survival/Completion Rates and Gender Parity Index were used to assess progress towards theattainment of these policy objectives.Gross Enrolment Ratio (GER): The GER is an indicator of participation in theeducational system and it measures the number of pupils/students at a given level ofschooling, regardless of age, as a proportion of the number of children in the relevantage group. There have been persistent increases in the GER all levels of basic schoolsbetween 1991 and 2008. At the kindergarten (KG) level, GER has increased from 55.6% in1991 to 89.9% in 2008, while at the Primary level GER has increased from 74% in 1991 to95.20% in 2008. On the other hand, GER has increased from 70.2% in 1991 to 78.80% in2008 at the Junior High School level. With exception of Junior High School level, increases inGER has been significant across primary and KG .At the KG level, remarkable success has been achieved exceeding the 2015 target by 24.9% in2008. This compares to an increase of 10.7% over the 2006 target following the integration ofKG education into basic schools throughout the country. The Upper West and Upper EastRegions registered the most significant increase in the GER for the period 1998 – 2008, forprimary level, while Ashanti and Volta regions recorded the least in improvements in GERover the same period . The GER in the deprived districts has also improvedsignificantly especially at the KG level, increasing from 78.1% in 2006/07 to 87.5% in
  • 10. 2007/08.Net Enrolment Ratio (NER): The NER indicates the number of appropriately aged pupilsenrolled in school as proportion of total number of children in the relevant age groups. Similar tothe GER, successive increases were recorded in the NER at the primary level and also across thecountry from 69.2% in 2005/06 and further to 83.7% in 2007/08. Thecase was, however, different at the Junior High School level with NER increasing from 52.4% in2006/07 to 53.4% in 2007/08 indicating a slow progress in relation to the 2015 target of 58.4%.Male NER has always been higher than the female NER at all levels. The NER in the depriveddistricts also increased significantly from 74.51% in 2006/07 to 77.9% in 2007/08 atthe primary level and 41.6% to 43.8% at the Junior High School level during the same period.Survival Rate: Survival rate measures the proportion of pupils/students who stay andcomplete school after enrolment. Survival rate at the primary level recorded a downward trendfrom 83.2% in 2003/04 to 75.6% in 2005/06, but subsequently recovered to 88.0% in 2007/08slightly below the 2015 target of 100% . At the Junior High School (JHS) level,survival rate declined from 86% in 2003/04 to 64.9% in 2006/07 but has begun to increase to67.7% in 2007/08, thereby lacking behind the MDG target of 100% by 2015. Survival rateamong female pupils has been lower than the male pupils at both the primary and JHS levels.While survival rate has increased from 85.1% in 2003/04 to 88.9% in 2007/08 among malepupils at the primary school level, it has increased from 81.1% to only 82.4% among femalepupils over the same period. On the other hand, while survival rate among male pupil at theJHS level declined from 88% in 2003/04 to 72.4% in 2007/08, it declined from 83.7% in2003/04 to 62.9% in 2007/08 among the female pupil at the same level.Pupil-Teacher Ratio (PTR): The PTR is used as one of the proxies for measuring the qualityof education. With a PTR ranging from 1:34 to 1: 35.7 over the period 2003-2006, as a resultof the increases in enrolment over the year, the 2006 target of 1:34.1 was missed at theprimary level. However, the situation improved in 2007 and 2008 with PTR of 1:34 and1:34.1 respectively, meeting the 2015 target of 1:35 (Table 2). Some progress has also beenmade at the deprived regions (Northern, Upper East and Upper West). The situation is similarin the JHS level with significant success over the 2015 target of 1:25.Access to Education at the District Level: Access to educational facilities, especially inrural areas is crucial for the attainment of this target. According to the NDPC/GTZ DistrictPoverty Profiling and Mapping Reports within the Bawku East District in the Upper EastRegion, most of the communities are deprived of access to educational facilities. Only thedistrict capital has all the educational facilities ranging from nursery to tertiary level and Deganear Bawku has facilities only up to the secondary level. Few communities have facilities up tothe Junior High level whereas most towns like Waadiga, Powia, Zambala, Kpalugu have none. Inthe Central Region, only the district capitals like Winneba in the Awutu Efutu Senya district hasall the educational facilities ranging from Kindergarten to Tertiary level. On the other hand, mostof the communities like Bosomabena, Bentum, Darkoyaw, Kofi Ntow, Asem, Kofikum, andAdwinhuhia are deprived of any of these facilities. Educational facilities in West MamprusiDistrict in the Northern Region range from pre-school to secondary and vocational levels. Onlythe district capital, Walewale has access to all the educational facilities and Walugu has up tosecondary level. Prima, Nayoku, Nabari, Zuawlugu among others have only primary school whileSakori, Nyabuyiri, Aaba and Wuyima have none of these facilities. KEY FACTORS CONTRIBUTING TO THE PROGRESSSeveral policy measures have accounted for the appreciable improvement in the rate ofenrolment in the basic school. In 2008, quite a number of policy interventions were carried out toreinforce the attainment of universal primary education; chiefly among them are theconstruction/rehabilitation of classrooms, strengthening the capitation grant initiative andexpanding coverage of the school feeding programme. Others included enforcing laws thatsupport the implementation of Free Compulsory Universal Basic Education (FCUBE)
  • 11. expanding non-formal education in partnership with community groups, NGOs and privateproviders, and developing a national policy on distance learning. Distance learning is not newin Ghana but its significance has changed since 1982 when a number of distance learninginitiatives started. Since then, this mode of learning has remained an important component ofGhana’s education system. The Education Act 2008, Act 778 guarantees that whereappropriate at each level of education, distance learning should be provided. In the currentstrategic plan for the Ministry of Education, distance learning is viewed as a possiblecomplement to regular tertiary programmes which require many years of study leave. Withdistance learning being widely accepted, it provides opportunity to those in frontline servicessuch as teachers to upgrade their professional and academic skills without leaving theclassrooms.The main activities implemented include the following:• The government disbursed a total amount of GH¢15 million as payment of CapitationGrant to pupils in all public schools in addition to subsidizing the conduct of BasicEducation Certificate Examination (BECE) amounting to over GH¢4 million.• The School Feeding Programme was expanded to cover 596,089 pupils nationwide upfrom 408,989 in 2007 to help ease the burden on parents. There has also beenincreasing international interest in supporting the school feeding programme.• About, 230 classroom blocks and 147 three-Unit classroom blocks under the SchoolUnder Trees Project were completed and furnished at the cost of GH¢10 million.• In order to reduce the regional imbalance in teacher supply and improve oneducational quality, incentive packages including bicycles were given to teachers indeprived schools. Also, the quota system of postings was enforced with greaterconsideration given to deprived districts.• Non-formal literacy programmes continued to receive support with the recruitmentand deployment of 1,822 facilitators.• Funds were made available to expand and equip science laboratories in tertiaryinstitutions in order to ensure that the government’s policy of 60:40 enrolment ratio infavour of science education is achieved.KEY CHALLENGESDespite the efforts made, some major challenges that remain include:• Challenge of Teacher posting and retention: It is observed that the governmentspends about 25% of its entire budget on teachers (including salary, paid study leave,sponsored distance education, etc.) to overcome shortage of teachers. However, in2008, the Ministry of Education indicated that the distribution of teachers is highlyskewed to the disadvantage of the deprived areas. This may be attributed to poorconditions of service including poor remuneration which might have hamperedretention of the right type of teachers especially, in the rural areas. This situation cansignificantly reduce the possibility of achieving universal basic education by 2015.• Decline in quality of education: Learning achievements are low because bothstudents and teachers spend more time away from school. Rather, much time is spenton private jobs, funeral, festivals, etc.• Inadequate Infrastructure: Insufficient number of school buildings to accommodatethe growing population of pupils, especially after the introduction of the capitationgrant and the school feeding programme have affected education delivery in thecountry..• Low level of teacher commitment: Poor conditions of service coupled with lowmotivation factors, availability of teaching and learning materials, etc. havecontributed to undermine the quality of education.• Low accountability to parents and students: There is no mechanism to monitor and
  • 12. evaluate teachers and thus ensure that they are always in the classroom and teachingaccording to what is expected of them.• Falling quality of Science and Technology education is falling: The quality ofScience and Technology education is falling and has affected students’ interest in thediscipline. Thus, the government’s 60:40 ratio of Science to Humanities at the tertiarylevel will be difficult to achieve if this challenge is not immediately addressed.• High cost of education especially at the tertiary level: Government expenditureincidence analysis has revealed that the poor tend to be marginalized at the secondaryand tertiary level due to the high costs involved. Nonetheless, the implementation ofthe capitation grant and the school feeding programme has reduced the cost burden ofbasic school education to parents as compared to tertiary education. RESOURCE REQUIREMENTSAccording to the Ghana Education Service, about US$260.1 million would be requiredannually to attain the MDG targets. To embark on the implementation of the GPRS II, it wasprojected that an amount of US$1.5 billion would be needed to finance the entire educationrelated goals. In 2006, total education expenditure amounted to GH¢907.481million(US$986.39 million), of which about 52% was allocated to Basic Education. This increased toGH¢832.087 million (US$857.82 million) in 2007 (of which 52% was allocated to BasicEducation), and then to GH¢1,546.348 million (US$1,288.6 million) in 2008 (of which 48%was allocated to Basic Education).GOAL 3: PROMOTE GENDER EQUALITY AND EMPOWER WOMENTarget 3A: Eliminate gender disparity in primary and secondary education preferablyby 2005 and in all levels of education no later than 2015STATUS AND TRENDSEfforts have been made with respect to promoting gender equality and women empowerment.Gender Parity Index and proportion of seats held by women in national parliament are themainindicators being tracked.Gender Parity Index (GPI): The GPI is the ratio of boys to girls’ enrolment, with the balance ofparity being one (1.00). Active implementation of activities to promote girls’ education hashelped to eliminate barriers to enrolment and encouraged participation and attendance. The trendindicates that, the GPI at the primary level has increased from0.93 in 2003/04 to 0.96 in 2006/07.The index however remained at 0.96 in 2007/08. From Figure 10, the 2015 target of ensuringgender parity especially at the primary school level can be attained.At the Junior High School level, it decreased marginally from a peak of 0.93 in 2005/06 to0.92 in 2007/08 as presented in theThe GPI decreased marginally at the kindergarten. At the primary school level it was stablewhilst it increased from 91.0% in 2006/07 to 92.0% in 2008/09 for the Junior High Schoollevel. At the regional level, the GPI seems to be encouraging compared to the aggregatedfigures. The GPI for primary school level in the Central Region is 1.0 which signifies thatthere is no difference in school enrolment between boys and girls whereas GPI for secondaryschool is 0.92. The GPI for primary in the Upper West Region is, 1.02 indicating that moregirls attend school than boys while that for Junior High School is 1.00 (MOH, 2008b). Inaddition, there were no differences for the GPI for primary school in Accra and Kumasimetropolitan areas, with 1.00 and 0.99 respectively. At the secondary school level, the GPI of0.88 and 0.80 shows that girls are more disadvantaged in the two metropolitans.Women Participation in Decision Making: Proportion of seats held by women in nationalParliament is one of the indicators used to track the goal of promoting gender equality andempower women.The progress towards increasing the number of women in public life suffered a setback with
  • 13. the reduction of the number of women elected into Parliament during the 2008 elections. Thenumber of women MPs fell from 25 to 20 reducing the proportion to below 10%. This putsGhana under the international average of 13%. Specific affirmative action programmes arerequired to reverse this trend. Furthermore, looking at the proportion of women inadministrative and political leadership a declining trend is observed (Table 4).Table 4: Women in Key Political and Administrative PositionsPOSITION TOTAL (2008) % FEMALE TOTAL (2009) % FEMALEKEY FACTORS CONTRIBUTING TO THE PROGRESSA number of activities aimed at promoting gender parity include the following:• Scholarship schemes for needy girls• Provision of food rations for females• Rehabilitation of senior secondary school facilities including the construction offemale dormitories to encourage female participation at that level• Provision of stationery, uniforms and protective clothing to needy pupils especiallygirls to improve gender parity at the basic school level• Construction of gender-friendly toilet facilities in schools• Provision of take-home ration for girls in Northern, Upper East and Upper WestRegions and• District assemblies and local and international development partners, continued toprovide school uniforms, school bags, shoes for school, exercise books and otherschool supplies for girls. KEY CHALLENGESPromotion of gender equality and women empowerment face a number of challenges. At thenational level, the government is confronted with the challenge of:• Primary GPI appearing to be stagnated over the past two years,• Geographical imbalances in the Junior High School GPI which require additionalresources to undertake targeted interventions in difficult areas and to roll out packagesfor other less difficult but still vulnerable areas to attract and retain girls in school• Slow increases in female enrolment at the Senior High School level• Introducing suitable strategies that focus on bringing about a transformation inattitudes, values and cultural practices• According to the African Peer Review Mechanism (APRM), although gendermainstreaming processes are in place, the implementation challenges have not led tosignificant outcomes. Thus, although the ratios show improvement, more needs to bedone to ensure gender parity• Challenges facing girl-child education include socio-cultural practices such as earlymarriages, customary fostering, gender socialization, female ritual servitude (Trokosi)and puberty rites. RESOURCE REQUIREMENTTo ensure gender equality, an annual investment spending of US$9.6 million was allocated inthe GPRS II, whereas under the Millennium Project an annual investment spending of aboutUS$51 million was estimated over the period 2005-2015.GOAL 4: REDUCE CHILD MORTALITYTarget 4A: Reduce by two-thirds between 1990 and 2015 the Under-five Mortality RateSTATUS AND TRENDSUnder-five mortality rate which has shown worrying trends since 1998 has now begunregistering improvements. After declining successively from 122 deaths per 1,000 live birthsin 1990 to 98 deaths per 1,000 live births in 1998, the under-5 mortality rate appears to hasstagnated at 111 deaths per 1,000 live births during the period of 2003 and 2006 (Figure 12).
  • 14. The 2008 GDHS reported an appreciable decline in under-five mortality rate to 80 per 1,000live births, representing about 28% decline.The regions with significant reduction in under-five mortality rate between 1998 and 2008,are Upper East Region (reduction of up to 77.6 per 1000 live births), Western, Brong Ahafoand Volta Regions (up to 52.7 per 1000 live births reduction), while those that recorded theleast improvement over the same period, are Ashanti (increased by 1.8 per 1000 live births),Eastern, Greater Accra and Upper West (reduced by up to 13.3 per 1000 live births only). Sofar Upper East, Western, Brong Ahafo and Volta Regions are on track to achieving the MDGon under-five mortality, while the rest are off-track.On the other hand, infant mortality rate (IMR) which increased from 57 per 1000 live birthsbetween 1994 and 1998 to 64 from between 1998 and 2003, has also declined to 50 per 1000live births by 2008. Immunization of under 1 year old against measles improved from a low of61% in 1998 to 90.2% in 2008. Similarly the regions with the significant reduction in IMRbetween 1998 and 2008 are Brong Ahafo Region (up to 40.3 per 1000); and 24.6 per 1000 inWestern, Upper East and Volta Regions, while Ashanti, Eastern and Upper West Regionsexperienced worse IMR between 1998 and 2008, registering a decline of less than 15.5 per1000 live births.Other important indicators on child survival including measles vaccination coverage also showedpositive progress. The proportion of children aged 12-23 months who received measles vaccinehas increased from 83% in 2003 to 90% in 2008. Measles vaccine coverageneeds to be above 90% to stop transmission. Although evidence shows that there hasbeen significant reduction in both infant and under-five mortality rates in recent times, it isunlikely that the 2015 target of reducing the child mortality rates will be achieved unless there isan effort to scale-up and sustain the recent child survival interventions which have brought aboutthe current improvement in these indicators. To significantly improve the child survival indicatorswhich for the longest period showed stagnation and had not responded to the many interventions,Ghana has launched a new Child Health Policy and Child Health Strategy which outlines the keyinterventions to be scaled up along the continuum of care and focuses on improving access to,quality of, and demand for essential services. The strategy also includes recent new technologiessuch as low osmolarity ORS and zinc for the management of diarrhoea, and introduction of newvaccines such as 2nd dose measles vaccine, pneumococcal vaccine and rotavirus vaccine throughthe national EPI programme.KEY FACTORS CONTRIBUTING TO THE PROGRESSThe improvement in under-five mortality and infant mortality rates have resulted from policies,strategies and a number of interventions that have been put in place over the years.Key among them are as follows:• Child Health Policy and Strategy in place• Infant and Young Child Feeding Strategy• Prevention of Mother-to-Child Transmission (PMTCT) policy and strategy• De-coupling children from their parents for NHIS coverage• Developing guidelines for neonatal care• Establishment of at least one fully operational and furnished hospital in every districtto deal with complications from maternal health delivery• Result-oriented strategies for under-five, maternal health care and malnutrition• Increased access to health services under the national health insurance scheme• High vaccination coverage• increased use of ITNs.• Continuous advocacy to District Assemblies and DHMTs to devote more resources to maternal and child health;
  • 15. • Sustaining the Expanded Programme on Immunization (EPI) and reaching every district• Expansion of community-based health service delivery;• Using integrated campaigns to improve coverage of key child survival interventionse.g. vaccination, vitamin A, de-worming, growth monitoring, birth registration andITN distribution and hang-up; and• Development of guidelines for neonatal care as well as management of malaria,pneumonia and diarrhoea in the community.KEY CHALLENGESKey challenges that beset the target of reducing under-five mortality in Ghana include:• Socio-economic and socio-cultural factors - low female literacy rate; low level ofwomen’s empowerment (in some parts of the country men make decisions abouthousehold healthcare choices and practices, including decisions about the healthcarepractices of their wives or female partners);• The inability to sustain the funds used to support programmes under EPI whichrequires enormous donor support;• Funding – more innovation is required in the use of existing resources, in addition tosustaining resource mobilization and allocation to the child health programme.• Inadequate human resources and skills within the health system to improve on the poorquality of care;• Need to improve coverage of some key interventions e.g. Integrated Management ofNeonatal and Childhood illnesses (IMNCIs), skilled deliveries, and postnatal care;• Less awareness on the use of non-medical preventive health care;• In order to give more up-to-date data analysis of child mortality in the country, the ongoingmortality and morbidity data collection needs to be conducted at all levels toprovide complete and reliable information on child health;• Inadequate national data to provide complete and reliable information on child health.• Inadequate human resources within the health system to improve on the poor qualityof care; and• Poor health-seeking behaviours. RESOURCE REQUIREMENTAccording to the Ghana Macroeconomics and Health Initiative report, about US$620 millionis required as investment towards reducing under-five mortality by two-third by 2015. Healthexpenditure increased from GH¢348.283 million (US$ 378. 568 million) in 2006, of which56.9% was allocated to primary health care to GH¢583.991 million (US$486.659 million) in2008 of which 49% was allocated to primary health care.GOAL 5: IMPROVE MATERNAL HEALTHTarget 5A: Reduce by three-quarters, between 1990 and 2015 the maternal mortalityratio STATUS AND TRENDSResult from the Ghana Maternal Mortality Survey of 2008 showed a slow decline of maternaldeaths from 503 per 100,000 live births in 2005 to 451 per 100,000 live births in 2008, which isan average estimate for the seven-year period preceding the 2008 survey . This trend is supportedby institutional data which suggest that maternal deaths per 100,000 live birth has declined from224/100,000 in 2007 to 201/100,000 in 2008, after an increased from 187/100,000 in 2004 to197/100,000 in 2006. However, if the current trends continue, maternal mortality will reduce toonly 340 per 100,000 by 2015, and it will be unlikely for Ghana to meet the MDG target of 185per 100,000 by 2015 unless steps are taken to accelerate the pace of maternal health interventions.At the regional level, institutional maternal mortality ratio has decreased by up to 195.2/100,000in Central and Upper East regions; 141/100,000 in Northern and Western Regions; 120.1/100,000
  • 16. in Volta and Eastern Regions; and 59.7/100,000 in Upper West, Brong Ahafo and Ashantiregions between 1992 and 2008. The only region where institutional maternal mortality rateworsened over the same period is Greater Accra.A number of initiatives have so far been implemented to positively affect maternal healthoutcomes including increased production of midwives through direct midwifery training(24.6% increase in enrollment), two new midwifery training schools opened in Tamale andTarkwa and the implementation of free maternal health services, which is still ongoing.Antenatal care from health professional (i.e. nurse, doctor, midwife or community healthofficer) increased from 82% in 1988 to 95% in 2008. While women in urban areas receivemore antenatal care from health professionals than their rural counterparts, the regionalfigures present a different scenario. The proportion of mothers in urban areas who receivedantenatal care from professionals in the health care service was 98% as against 94% for theirrural counterparts. Majority of women across all the regions received antenatal care fromhealth professionals ranging from 96% to 98%, with the exception of women in Volta andCentral regions who are less likely to receive antenatal care estimated at 91% and 92%respectively.The result from the Ghana Maternal Health Survey, 2008 identified haemorrhage as thelargest single cause of maternal deaths (24%), while 14% of deaths of women within thereproductive age are due to maternal causes. Abortion,miscarriage and obstructed labour were also cited as causes of maternal death.Lack of information on signs of pregnancy complications and access to basic laboratoryservices, particularly in the Northern and Upper West regions, affect the quality of antenatalcare. In the Northern and Upper West regions, only access to urine testing and blood testingrespectively. These are against 90% access to these services at the national level deliveries thatwere assist from 40% in 1988 to 59% in 2008. In the Northern region, Greater Accra region islikely to be delivered in a health facility. Professional assistance at birth for women in urban areaswas found to be twice more likely to rural areas (MOH, 2008a). The available data showed thatover 40% of women did not deliver in a health facility because some of them thought it wasunnecessary to do so, while others cited lack of money; accessibility problems like distance to ahealth facility, transportation problems, not knowing where to go main reasons. Others hadproblems with the services rendered at the health facility including long waiting, the non-availability of a female doctor and inconvenient service hours.KEY FACTORS CONTRIBUTING TO THE PROGRESSIn order to address the high levels of maternal deaths, some interventions that have been put inplace include Safe-Motherhood Initiative, Ghana VAST Survival Programme, PreventionMaternal Mortality Programme (PMMP), Making Pregnancy Safer Initiative, Prevention andreceive hypertensive sepsis, and Management of Safe Abortion Programme, IntermittentPreventive Treatment (IPT), Maternal and Neonatal Health Programme and Roll Back MalariaProgramme.Most of the interventions that have been pursued to curb high incidence of maternal mortalityover the years are similar to those for under-five mortality. The additional policies, strategiesand interventions that have been pursued to curb high incidence of maternal mortalityrecorded over the years include the following:• Reproductive health strategy• Road Map for Accelerating the Attainment of the MDGs related to Maternal andNewborn Health in Ghana• Standards and Protocols for Prevention and Management of Unsafe Abortion:Comprehensive Abortion Care Services• Wheel for Improving Access to Quality Care in Family Planning: Medical Eligibility
  • 17. Criteria (MEC) for Contraceptive Use Road Map for Repositioning Family Planning• Declaring maternal mortality a national emergency in 2008 and a programme of freehealth care for pregnant women including deliveries through the national healthinsurance scheme• Strengthening of Community Health Planning Services (CHPS) to facilitate theprovision of maternal health services; and expansion of community-based health servicedelivery• At the districts level, the range of approaches that are used to increase superviseddelivery, includes targeting pregnant women for NHIS registration, raising communityawareness through CHPS zones, Community Health Officers outreach education andmobilization of community leaders, among others• Continuous education to traditional maternal health service providers to ensurepreventable maternal deaths• On-going process of making maternal death a notifiable event backed by legislation;• Decline in guinea worm cases, and improved TB treatment• Establishment of the steps aimed at revising the guidelines for the conduct of maternaldeath audits and for establishing a system of Confidential Enquiry into maternal deathhave began. KEY CHALLENGESMost of the key challenges and bottlenecks identified for MDG 4 are also relevant to MDG 5.The additional ones include:• Unavailable data set on maternal health care for systematic investigation into maternalhealth• Anti-retroviral for children with HIV is low (14%)• Barriers to access to critical health services by families and communities• Well-structured plans and procedures to check and assess where maternal healthprogrammes are absent• Inadequate financial capabilities of mothers to meet their treatment and drug needs Poor access to health care providers, caused by long distance to the health facility, andthe fact that women have to take transport (1out of 4 women) on a single visit• Low female literacy rate, low level of women’s empowerment, poor health-seekingbehaviours among the poor• Low rate of setting up health facilities with maternal health care services, particularlyin the rural areas (about 34.8% of women in rural areas complain of distance to healthcare facility as against 16.4% for urban areas)• Human resource constraints and poor quality of care continue to blight maternal healthcare provision• Socio-economic and socio-cultural factors such as low female literacy rate; low levelof women’s empowerment in some parts of the country where men make decisionsabout household healthcare choices and practices on behalf of their spouses• Inadequate data on maternal health care for systematic investigation (monitoring andevaluation) into maternal health• Absence of well-structured plans and procedures to check and assess efficacy.The determinants of maternal mortality are classified as direct, indirect and underlyingfactors. The principal direct determinants are pregnancy/labour related complications; indirectdeterminants are pre-existing disease(s) that appear during pregnancy (not related to directobstetric determinants) but are aggravated by the physiological effects of pregnancy; andunderlying determinants include social, cultural, health systems, and economic factors. Allthese have profound effects on maternal mortality. For instance, unavailability of family
  • 18. planning services and post-natal care in health facilities have been identified as majorconstraints to the progress towards reducing maternal mortality (MOH/GHS, 2003).3.2 National efforts to reverse the trend in MDG 4 & 5To address the challenges of the health sector, specifically the problem of low coverage ofsupervised deliveries and high institutional maternal mortality rate among others, maternalmortality was declared a national emergency in 2008 and a programme of free health care forpregnant women, including deliveries through the National Health insurance Scheme, hasbeen implemented since July 2008. In addition, other measures including inter-sectoralactions, repositioning of family planning and training, and repositioning of reproductive andchild health staff, have been introduced. The Reproductive Health Strategic Plan for 2007 –2011 and the Roadmap for Accelerated Attainment of the MDGs is also being implemented.Discussions are on-going about whether to include family planning in the NHIS package ofservices.RESOURCE REQUIREMENTAccording to the Ghana Macroeconomics and Health Initiative report, resource requirementof US$790 million for the period 2002-2015 is needed to achieve the MDG of reducingmaternal mortality by three-quarters.GOAL 6: COMBAT HIV/AIDS, MALARIA AND OTHER DISEASESTarget 6A: Halt by the 2015 and reverse the spread of HIV/AIDSSTATUS AND TRENDSThe HIV prevalence rate had fallen from 3.2% in2006 to 2.2% in 2008 but has currentlyincreased to 2.9% in 2009. Given this trend, Ghana has to sustain the efforts in order to meet thetarget of halting and reversing the spread of HIV/AIDS by 2015.Available data show that the national prevalence rate of HIV/AIDS has slowed down afterpeaking at 3.6% in 2003 and gradually declining to3.2% in 2006. Althoughthe prevalence rate fell further to an all-time low of 2.2% in 2008, it later increased to 2.9 in2009.Recent estimates show that the number of adults infected with HIV has increased to250,829 in 2008 from 247,534 in 2007. Females are the most infected accounting for 147,958 outof the 250,829 people infected. The number of new infected adults also increased from 21,310 in2007 to 21,619 in 2008 out of which 12,198 and 12,544 were females respectively. A majorconcern is the high prevalence rate amongst pregnant women. Annual deaths as a result of thedisease however dropped to 17,244 in 2008 from 18,396 in 2007, though females still account forthe largest portion. The age groups 24-29 continue to record the highest prevalence rate althoughthis declined from 4.2% in 2006 to 3.0% in 2008.On the whole, the year 2008 marks significant progress from the previous year across all theage groups. Some measures have been taken and it is important that the country scales up itsactivities aimed at reversing the trend.At the regional level, the Northern region recorded the least HIV prevalence (1.1%) while theEastern region recorded the highest rate (4.2%) in 2008 with Dangbe West (Manya Kroboincluding Agomanya and Somanya, etc.) recording the highest in the region. Greater Accra,Eastern and Ashanti regions recorded prevalence rate of 3%. Moreover, HIV prevalence in theurban areas was higher than in rural areas. The mean prevalence in the urban areas wasestimated at 2.6%, while that of the rural areas was 2.3%. The median prevalence rate, on theother hand, was 2.6% for the urban areas and 2.1% for the rural areas. Agomanya recorded thehighest urban prevalence rate of 8.0%, while Tamale recorded the lowest urban prevalence rate of1.2%. In the rural areas, the highest prevalence was in Fanteakwa with 4.6% as against 0.0% inNorth Tongo.HIV Prevalence among pregnant women increased from 1.9% in 2008 to 2.6% in 2009. Allthe ten regions recorded an increase except the Eastern region where prevalence rate remainedunchanged.
  • 19. KEY FACTORS CONTRIBUTING TO THE PROGRESSVarious bodies and institutions in the country and elsewhere have supported the government’sfight against HIV/AIDS pandemic in Ghana. These include the Government of Ghana, MDAs,MMDAs, the Global Fund (to Fight AIDS, Tuberculosis and Malaria), multilateral partners suchas the World Bank and other bilateral partners, NGOs and CSOs. Practicing safe sex, especiallyamong the most vulnerable, reducing mother-to-child transmission, promoting voluntarycounseling and testing, and increasing use of Anti-retroviral Therapy (ART) for Persons Livingwith HIV/AIDS (PLWHAs) are some of the measures being undertaken by all stakeholders toreduce the spread of the disease.Specific initiatives that have taken place to address the prevalence of HIV/AIDS since 2008are as follows:• Training of 75 health care workers from district level facilities in the management ofHIV and AIDS• Monitoring, supervision and supporting sites providing ART services and also assessingpotential sites for ART accreditation• Providing nutritional support for PLHIVs/AIDS• Strengthening referrals and collaboration between facilities and communities to increaseART uptake and adherence• Support to the most-at-risk-population (MARP)• Coordinated District Response Initiative to HIV• The launch of the Know Your Status campaign that has taken HIV counselling andtesting to the doorsteps of people at the community level• Training of over 1000 health care workers from facilities across the country in themanagement of HIV and AIDS• A successful Round 8 application to the Global Fund to increase funding for HIVprevention activitiesKEY CHALLENGESThere are many challenges facing the fight against HIV/AIDS, but the key ones include:• Stigma and discrimination against people living with HIV/AIDS is quite high, coupledwith misconceptions about the disease• High levels of sero-discordance and consensual unions or marriages• The lack of efficient monitoring and accountability on spending on HIV/AIDS -relatedprogrammes• The absence of a vibrant unit under the Ghana AIDS Commission to coordinate nationalresponse• Gender issues are vital in tackling the HIV/AIDS epidemic especially in cases wherewomen are powerless in relation to their counterparts due to poor economicempowerment and negative social norms which subject them to the will of their partners• Human resource constraints• Weak coordination of the national response RESOURCE REQUIREMENTTo be able to sustain the fight against HIV/AIDS and achieve the MDG 6 target of halting andreversing the spread of HIV/AIDS by 2015, the Ghana Macroeconomics and Health Initiativereport puts the resource requirement at about US$976 million over the period 2002-2015. STATUS AND TRENDS OF MALARIAMalaria remains an immense public health concern especially for the government. It is regardedas a leading cause of mortality and morbidity particularly among pregnant women and childrenunder-five years, consequently a leading cause of miscarriage and low birth weight.that about 30% to 40% out of which 900,000 are children under admissions of children below agefive and pregnant women, respectively, are cases of malaria(MOH, 2008a).
  • 20. The campaign on the use of ITNs, which was geared to mortality and morbidity by 25% by 2008,has received appreciable attention over the years especially for children less than five years.2002 to a peak of 55.3% in 2007. H under ITNs declined significantly to 40.5% in 2008.Similarly, ITN use among pregnant women has been encouraging until 2008 where it declineddrastically to 30.2% from a peak of 52.5% in the 2007.According to the High Impact RapidDelivery (region had the highest proportion of households with at least one mosquito net (6055% are ITN. In Upper East, 58% had at least one mosquito net (of which 53% ITN) and 40% (ofwhich 38% ITN) in the Central region. The situation is years who sleep in ITNs. Upper East hadthe highest in the Northern and Central regions respectively. It is also found that ITN use ishigher in the rural areas than in the urban areas in all the three regions.KEY FACTORS CONTRIBUTING TO THE PROGRESSGovernment’s initiative directed towards the prevention, control and treatment of malaria inthe country has varied over time. These consist of:• The Abuja Declaration on Roll Back Malaria in Africa which aimed to achieve 60%coverage of malaria interventions by the year 2005 with focus on pregnant women andchildren under-five years• Recent government commitment to review national health insurance scheme with aview to reducing inefficiencies, improving claim management and expanding servicesto the poorest• The National Malaria Control Programme (NMCP) intended to promote the use andavailability of ITNs through public-private sector partnership.• Malaria prevention and control through clinical trials of indigenous medicines,distribution of insecticide treated nets, indoor residual spraying and scaling up biolarviciding• In addition, new measures that were introduced to enhance the preventive measuresinclude:9 Promoting chemoprophylaxis for pregnant women and improving environmentalsanitation.9 An Anti-Malaria Drug Policy known as Artesunate-Amodiaquine to cater for thetreatment of uncomplicated malaria across the country. This policy was laterrevised to include two alternative ACT drugs known as Artemether-Lumefantrineand Dihydroartemisinin-Piperaquine for those who remain hypertensive toArtesunate-Amodiaquine . KEY CHALLENGESThe government of Ghana, on its part, has dedicated resources and devised strategies allgeared towards the control and prevention of malaria in the country. Nonetheless, malaria relatedfatality ratios still remain high. The major challenges facing the government despite all its effortsinclude:• The lack of proper waste disposal system in the country and poor drainage systems inthe cities which ensures that stagnant waters are always collected across the city• Poor sanitation habits by many city dwellers• Due to inadequate supply, the poor has limited access to ITNs• Limited finance to scale-up malaria control programmes• Duplication and wastage of resources especially by key implementation agencies dueto lack of coordinationRESOURCE REQUIREMENTThe Ghana Macroeconomics and Health Initiative report estimates investment requirementsaimed at attaining this target at about US$788 million over the period 2002-2015, of which anestimated amount equivalent to 0.45% of GDP over the same period is needed.
  • 21. GOAL 7: ENSURE ENVIRONMENTAL SUSTAINABILITYTarget 7A: Integrate the principles of sustainable development into country policies andprogrammes and reverse loss of environment resources by 2015 STATUS AND TRENDSGhana’s forest remains an important asset for ensuring sustainable development especially inpoor communities where farming and other activities that require intensive use of landdominates. Although current data is unavailable, it has been estimated that Ghana’s forestcover has declined from 32.7% to 24.2% between 1990 and 2005. In 1990, the forest coverwas estimated at 7,448,000 hectares, and this has declined at an average rate of 1.8% perannum to 5,517,000 hectares in 2005. The rate of decline of Ghana’s forests is alarming and it isimportant to accelerate the rate of reforestation efforts. Ghana is not on course to achieveMDG 7 target 7A in full partly because the forest cover is continuously depleting, and theconsequence on global warming is likely to be very high.Several factors, including livelihood activities explain why the country’s forest is beingdepleted at such an alarming rate. Population pressures, poor sanitation and solid wastemanagement, low level of investment in water and sanitation delivery, air and water pollution,forest depletion, land degradation, climate change and fast growing unplanned expansion of citiespose major health, water, sanitation, and environmental concerns.Human activities such as logging, fuel production and farming have become the very causesof forest loss. In the case of logging, much of it is done illegally and often done with littleconsideration for the environmental damages it causes. Also, when matured trees are cut fortimber and other uses, they are hardly replaced. Although several number of timber companiesare required to replant trees, they are hardly ever monitored to ensure strict compliance becausethe institutions mandated to do so are under-staffed and poorly resourced. The illegal loggers whoare popularly known as Chain Saw operators fell rare tree species and young trees, therebyworsening the already precarious situation.Farming methods in Ghana have not seen any significant transformation for a long time. Mostfarmers still practice slash and burn methods while the use of crude and obsolete farmingimplements remain. These activities eventually, contribute to climate change and otherYear Forest Cover(Hectares)environmental effects. Bad farming practices expose the top layer of the soil, the slash andburn release environmental gases besides the pollution of rivers and the destruction of otherwater bodies.A great deal of the mining activities in Ghana takes place in forest areas thereby affecting theenvironment significantly. It is not common to find the forests are reclaimed, particularlyamong the small scale miners, after mining activities have been halted and the necessarymineral deposits extracted. In many cases, the land and water sources are never recovered as aresult of severe pollution from chemicals used in mining.KEY FACTORS CONTRIBUTING TO THE PROGRESSIn a bid to arrest the degradation of the environment and regain loss of the forest cover,measures that have taken place involve the following:• The Government of Ghana and its Development Partners initiated a Natural Resourcesand Environmental Governance (NREG) support mechanism with prioritized activitiesand time-bound targets in order to reverse the persistent trend of high environmentaldegradation in a coordinated and sustainable manner;• To increase the nation’s forest cover, Forestry Services Division surveyed anddemarcated 1,440 hectares under the Community Forest Management Project (CFMP)and 178 hectares under FSD model plantation programme. Under the HIPC PlantationProgramme 1,127 hectares were surveyed and demarcated in 2008. In addition, 1,405hectares were prepared and 752,000 seedlings were delivered for planting. Also the
  • 22. programme accomplished the establishment of 26,600 hectares of plantation forest. Ithas facilitated the establishment of 15,000 hectares of plantations in off-reserve forestsunder its CFMP, whiles 3,000 hectares under its Urban Component were planted. Theprogramme also supplied 4,000,000 seedlings to the Greening Ghana Project;• The Voluntary Partnership Agreement (VPA) was initialed between the Governmentof Ghana and the European Union;• Ghana’s Readiness Project Idea Note (R-PIN) among other country proposals forreducing emissions from deforestation and degradation (REDD) under the World BankForest Carbon Partnership Facility (FCPF) was reviewed;• The mining sector continued to strengthen internal controls in adherence to theadministrative directives by the Kimberly Process Certification Scheme (KPCS). Incompliance with the directives, the diamond sub-sector continued with theidentification of artisanal diamond mining sites with the view to registering them andcapturing their production. As at the end of December 2008, 5,000 small scalediamond miners have been registered;• The EPA issued 800 environmental permits to stakeholders across the various sectorsof the economy including the activities of mining companies all aimed at protectingthe environment including the forest;• The Town and Country Planning Department provided financial support for Land UseManagement Projects in Kasoa (Central Region), Asankragwa (Western Region) andEjisu (Ashanti Region); and• Land Use Enforcement programmes being implemented. KEY CHALLENGESThe rate at which the nation is losing its natural resources owing to human activities raisesconcern about the sustainability of these resources. Among other things, the following are themajor obstacles that need to be addressed:• Low institutional capacity for environmental management;• Low awareness on the effects of human activities on the environment; and• Limited resources (human and financial) to implement reforestation and otherenvironmental management programmes. RESOURCE REQUIREMENTEnvironmental degradation poses severe costs on the country’s resources, accounting for atleast 7% of GDP in 2008. However estimates by Economic Sector Work (ESW) on NationalResource Management and Growth, and the Country Environmental Analysis (CEA, 2007),suggest a declining trend in the years ahead as a result of the massive reforestation programmeand other complementary conservation measures implemented by the Government of Ghana.Target 7C: Halve by 2015, the proportion of persons without sustainable access to safedrinking water and basic sanitationSTATUS AND TRENDS OF DISEASESThe prevention of diseases especially water-borne diseases like guinea worm infectionsrequires improved access to clean potable water for both rural and urban households. Theproportion of the population with access to improved drinking water, according to the WHO/UNICEF Joint Monitoring Programme (JMP), is an indicator expressed as the percentage ofpeople using improved sustainable drinking water sources or delivery points. Examples ofsuch sources or delivery points are outlined as follows:• Household connection • Unprotected well• Borehole • Unprotected spring• Protected dug well • Bucket• Protected spring • Rivers or ponds• Public standpipe • Vendor-provided water
  • 23. • Tanker truck water• Bottled (& sachet) waterAvailable data indicates that the proportion of the Ghanaian population that uses improveddrinking water has increased significantly from 56% in 1990 to 83.8% in 2008 .Similarly the proportion of the urban population with access to improved drinking water hasincreased from 86% in 1990 to 93% in 2008, while that for rural population increased from39% in 1990 to 76.6% in 2008.Under the MDG 7 target 7C, the proportion of Ghanaians without access to improved watersources, is expected to reduce from 44% in 1990 to 22% in 2015. With the trend abovesignificant progress appear to has been made in achieving this target. The proportion ofpopulation without access to improved water sources has decreased from 44% in 1990 to16.2% in 2008. This implies that Ghana is on track to achieving the MDGs target of reducingby half the proportion of the population without access to improved water sources well aheadof the 2015 target date .In 2008, Upper West has the highest percentage (87%) of households with access to improvedsource of drinking water compared to Northern (62%), Upper East (82%) and Central (79%)regions (MOH, 2008a). It is observed that the use of improved water sources is higher forwealthiest households (90%) than for the poorest households.In all the regions, boreholes constitute the major improved source; followed by public taps/stand pipes, and only a few households have pipe-borne water in their dwellings.Rivers/streams/lakes, etc. make up the largest proportion of unimproved sources in theNorthern region while unprotected wells form the largest in the Upper East and Centralregions. In Accra and Kumasi metropolitan areas, 95% of households have access to improvedsource of drinking water; those with pipe-borne water in their dwelling places constitute 48% and38% use sachet or bottled water as their major source of drinking water.Nadawli District registered the highest percentage of households with access to improvedsource of drinking water (98%) compared to Wa West District which recorded the lowestpercentage (64%) in the Upper West region. Access to water facilities in Bawku East Districtin the Upper East region is mainly in the form of boreholes. Communities that have oneborehole include Kwatia, Zariboku and Gagbiri. Others such as Potwia, Kugasego Bugri, andWaadiga have none. In West Mamprusi district in the Northern region, water facilities includeborehole, dam, well, and pipe-borne. Communities that lack any of these facilities include Tia-Noba, Wabukugiri, Salbuga, Kpagtusi, Siisi and Guriba. Lack of water facilities is very severe inthe Awutu Efutu Senya. District in the central region with facilities ranging from borehole, well,and stream to pipe borne located in few communities. The communities that lack these facilitiesinclude Dankwa,Akufful, Krodua, Bentum Darkoyaw, Bosomabena, Kofi Ntow and Mangoase. KEY FACTORS CONTRIBUTING TO THE PROGRESSIn 2008, increased investments in the construction and rehabilitation of water facilities in bothrural and urban areas were carried out by government. Some of these include:• Construction of 1,838 new water points and 15 new pipe systems;• Government Water Expansion Projects to improve water supply in Greater Accra,Central, Ashanti and Northern regions;• Government fully subsidising the provision of safe water in guinea worm endemicareas; and• HIPC funds have also been directed towards the provision of safe water tocomplement the regular budget flows and have provided for 382 boreholes (themajority fitted with hand pumps) in guinea worm endemic areas.• Expansion in access to potable water supply in guinea worm endemic areas andincreased funding from districts to improve sanitation.KEY CHALLENGES
  • 24. A number of challenges which have been identified include:• Inadequate infrastructure especially energy, water and sanitation. World Bankestimated that Ghana spends approximately 3-4% of GDP per year less than requiredto address the most critical infrastructure gaps in electricity, water and sanitation, andto a lesser extent, ICT and rural roads. The medium-term shortfall in infrastructurefinancing is approximately 5-6% of GDP. The power crisis is costing the country anestimated 1% of GDP per year, and “silent crisis” in water and sanitation is deemed tothreaten not only economic activity but also public health;• Competition between the CWSA and the private sector for technical expertise;• Inadequate finances required to undertake and maintain huge water projects;• Perennial water problems continue to plague both the rural and urban communities;and• Substantial regional variations in access to safe water still exist.RESOURCE REQUIREMENTTwo separate scenarios, namely, the base and the ideal scenarios, have been proposed by theGhana Macroeconomics and Health Initiative Report (2008) all aimed to facilitate theachievement of this target. The base scenario is estimated at about US$732 million over theperiod 2002-2015. The ideal scenario’s estimate is about US$850 million for the same period.On annual basis, an amount of about US$179 million has been estimated by the MillenniumProject as resource requirement for the period 2002-2015.An improved sanitation facility is defined by WHO/UNICEF Joint Monitoring Platform(JMP), as one that hygienically separates human excreta from human contact. By thisdefinition, only users of improved sanitation facilities are considered as having access tosanitation on condition that the facility is not shared by multiple households. Examples ofsanitation facilities in the improved and unimproved categories are outlined as follows:• Flush or pour-flush to piped sewer system, piped sewer system and pit latrine• Flush or pour-flush to elsewhere• Ventilated improved pit latrine (VIP) • Pit latrine without slab or open pit• Composting toilet • Bucket• Hanging toilet or hanging latrine• No facilities/bush/field (opendefecation)Available user-based data from the Ghana Demographic and Health Survey (GDHS) showsthat national coverage for improved sanitation has increased from 4% in 1993 to 12.4% in2008 (Figure 19). Among urban populations, improved sanitation coverage has increased from10% in 1993 to 17.8% in 2008, while the rural populations with access to improved sanitation hasincreased from 1% to 8.2% between 1993 and 2008. The proportion of rural population withaccess to improved sanitation has increased by 6% between 2003 and 2008 compared to anincrease of 3% for the proportion of urban population with access to improved sanitation duringthe same period.On the other hand, open defecation has declined marginally from 24.4% in 2006 to 23.1% in2008. This includes defecation into drains, fields, streams, bush and the beaches. With currentpopulation estimates for Ghana being about 23.4 million (2008), this implies that about 5.4million people practice open defecation. The practice is also more widespread in the Northern,Upper West and Upper East Regions.At the regional level, access to improved sanitation facilities varied considerably in 2008. Theproportion of population in the Greater Accra and Eastern regions who has access to improvedsanitation was above the national average of 12.4%, while those in the Western and Centralregions were close to national average (Figure 20). The rest of the regions including Ashanti andBrong Ahafo regions recorded less than the national average. Large proportion of the population
  • 25. in the three northern regions (i.e. Northern, Upper East and Upper West) are less likely to haveaccess to improved sanitation facilities as an average of 4% of the population have accessed toimproved sanitation facilities (not shared) compared to 25% in the Greater Accra and 15% in theEastern regions.Another dimension of access to improved sanitation is the wide urban and rural differenceseven within region. Maps 7 and 8 show that the proportion of urban population without access toimproved sanitation in Northern region has decreased by 50%, while the proportion of ruralpopulation in the Northern, Upper West, and Upper East regions who have no access to improvedsanitation has increased by about 6%. This puts the rural areas of the three northern regions farbehind the MDG 7 target of reducing by half the proportion of the population without access toimproved sanitation.The regions where significant progress is being made towards achieving the MDG 7 target ofreducing by half the proportion of the rural population without access to improved sanitationare Ashanti, Eastern and Central.Even though Ghana has made progress in reducing the proportion of the population withoutaccess to improved sanitation, the target may not be achieved by 2015 if the current trendscontinue. At the current trend, the proportion of the population with access to improvedsanitation will reach 21.2% by 2015 instead of 52%, while the proportion of urban populationwith access to improved sanitation will be 23.4% instead of 55% by 2015. In the rural areas,only 20.6% would have access to improved sanitation instead of 50.5%. The gap between thepresent national coverage on improved sanitation of 12.4% and the 52% target by 2015indicates that there must be approximately five times increase in coverage to be able toachieve the set target. KEY FACTORS CONTRIBUTING TO THE PROGRESSA number of interventions to help improve environmental sanitation and waste managementin both rural and urban areas in Ghana were carried out by government. Some of theseinclude:• Collection of baseline data on environmental sanitation in the entire metropolitan,municipal and district assemblies in 2008, which is currently being processed.• Preparation of a draft national Environmental Sanitation Strategy and Action Plans(NESSAPS) and District Environmental Sanitation and Action Plans (DESSAPS) in2008.• Introduction of Sanitation Guards under the National Youth Employment Porgrammeto assist Environmental Health Officers in intensifying education and enforcingsanitation laws.• Under the second Urban Environmental Sanitation Project, construction of additionalstorm drainage and community infrastructure upgrading in major towns and citiesincluding Accra and Kumasi was initiated in 2008. In addition, about 900 households,schools and public sanitation facilities were completed under the sanitation componentof the project.• Providing training in supervisory management for Environmental Health Offices andWaste Management staff in the districts.• MMDAs making effort to get rid of the use of pan latrines in every community by2010 after which individuals and households using pan latrines will face prosecution.KEY CHALLENGESA number of challenges have been identified and these include:• Inability to effectively monitor environmental sanitation due to the unavailability ofaccurate and timely data on sanitation.• Access to improved sanitation was more prevalent in urban than rural areas.
  • 26. • Significant regional differences in access to improved sanitation continue to exist, withthe three northern regions having the lowest proportions of households with access toimproved sanitation facilities. Even within regions wide disparities exist betweenurban and rural population. In the three northern regions, lack of access to improvedsanitation was more prevalent in the rural population than in the urban population; and• Population pressures, poor sanitation and solid waste management, low level ofinvestment in sanitation delivery, and fast unplanned expansion of cities pose majorchallenges for the full attainment of the MDG 7 target 7C. RESOURCE REQUIREMENTCurrent estimates from Environmental Health and Sanitation Directorate (EHSD) of theMinistry of Local Government and Rural Development indicates that Ghana requires aboutUS$1.5 billion within the next five years in order to attain the MDG in Sanitation by 2015.This means that Ghana will require a capital investment of about US$300 million on anannual basis to be able to attain the MDG 7 target for improved sanitation.Target 7D: By 2020, to have achieved a significant improvement in the lives of at least100million slum dwellers STATUS AND TRENDSHousing is one of the most important basic needs in every society. Improved housingpromotes socio-economic development and brings about social cohesion. The right toadequate housing is intricately linked to the enjoyment of other human rights like security ofperson, education and health. Though the provisions of the Fundamental Human Rights andFreedoms entrenched in the 1992 Constitution of the Republic of Ghana does not expresslyprotect the right to adequate housing, it nevertheless guarantees the right to own propertyalone or in association with others, the right of non-interference with the privacy of one’shome as well as protection from the deprivation of one’s property. To track progress in access toimproved housing, the above two indicators have been adopted by Ghana.The proportion of the population with access to secure housing:The rapid increases in population and urbanization, and the inability of the housing deliverysystem to meet the growing effective demand over the years has created strains in the existinghousing stock and infrastructure, especially in the urban areas. This has resulted inovercrowding and development of slums in many places. Available estimates show that urbanpopulation has increased from 28.9% in 1970 to 43.8% in 2000. On the other handpopulation with access to secure housing has stagnated at about 12% over the past five yearsand if the trend continues, the proportion with access to secure housing will increase by only6% by 2020. This means that significant proportion of urban population will remain withoutaccess to secure housing.The proportion of urban population living in slums:A slum household is defined as a group of individuals living under the same roof lacking oneor more of the following conditions: (i)access to improved water; (ii) access to improved sanitation;(iii) sufficient-living area; (iv) durability of housing; and (v) security of tenure .The informal nature of these settlements hamper the availability of basic facilities andas a result, households in these areas spend significant amounts of time and resources toaccess these facilities, especially improved water and sanitation, at inflated prices.Slum development has become a feature of the urban environment in Ghana. Available statisticsfrom the 2000 population and housing census shows that, out of 3.88 million dwelling unitsrecorded in 2000 in Ghana, less than 50% were classified as houses, while the
  • 27. remaining were dwelling units constructed with poor quality mud bricks and earth, mostly withthatched roof and poor floor construction materials. In addition, 74,000 kiosks and containershoused several hundred thousand people and a large number of people in urbanareas sleep on pavements, walkways and on streets. This phenomenon has been attributed in part,to increasing urbanization, accompanied by high rural urban migration. In 1990, the total numberof people living in slums in Ghana was estimated at 4.1million, and increased to 4.99 million in2001 and then to 5.5 million people in 2008. In Greater Accra alone it is estimated that nearlyone-third of the population live in slums. In terms of its share of the total population, theproportion of people living in slums in Ghana has declinedconsistently from 27.2% in 1990 to about 19.6% in 2008 (Figure 21). However, in terms of itsshare of the urban population, the proportion of people living in slums in Ghana showed adeclined from 80.4% in 1990 to about 45.4% in 2005. It is important to note that the decliningpattern observed has been attributed, in part, to the change in the definition of adequatesanitation. In 2005, only a proportion of households using pit latrines were considered slumhouseholds, whereas in 1990 and 2001, all households using pit latrines were counted as slumhouseholds. If the current pattern continues, a significant proportion (about 14%) of thepopulation will still be living in slum areas by 2020.KEY FACTORS CONTRIBUTING TO THE PROGRESSIn line with government’s commitment to providing affordable and decent housing for allGhanaians and also ensuring the upgrading of slum areas, policy measures implemented in2008 include:• Government initiated the review of the national housing policy in 2008 for a morerealistic and responsive framework, which will deal with low-cost housing. Also thepreparation of a comprehensive shelter policy with the ultimate goal of providingadequate, decent and affordable housing which is accessible and sustainable withinfrastructural facilities to satisfy the needs of Ghanaians was initiated;• The National Land Policy provides a comprehensive framework for dealing with landconstraints and providing the legislative and institutional framework for landmanagement and administration in the country, taking into account the provisions ofthe 1992 Constitution on private property ownership, compulsory land acquisition,public lands, and stool and skin lands management. However Government of Ghanaunder the Land Administration Project (LAP) initiated a programme in 2005 to reformand build capacity for comprehensive improvement in the land administration system.Under the programme, it is envisaged that the current problems associated with landacquisition and ownership, including cumbersome land registration process andmultiple sales of land, will be eliminated;• About 8,787.01 acres of land in Accra and other Regional and District Capitals wereacquired by government as land banks for the National Housing Programme;• The Government initiated project to construct 100,000 housing units for the middleand low-income groups over a ten year period, through Public-Private-Partnershipscontinued in 2008. Work is ongoing at 6 sites in 5 regions of Ghana, namelyBorteyman-Nungua in Accra, Kpone near Tema, Asokore-Mampong near Kumasi,Koforidua, Tamale and Wa;• In line with its commitment to sustainable urban development, Government signed anMOU with UN-Habitat to facilitate collaboration between both parties with regard tourban development. Under the MOU, Ghana has been selected as one of four countriesto undertake the Slum Upgrading Facility (SUF) pilot project, which is currently at itsimplementation stage. SUF works with local actors to make slum upgrading projects“bankable”, by way of its attractiveness to commercial banks, property developers,housing finance institutions, service providers, micro-finance institutions and utility
  • 28. companies. The project is now being undertaken in three locations, namely; Tema,Sekondi-Takoradi, and Ashaiman Municipalities. The Tema and Ashaiman MunicipalSettlement Upgrading Strategy and associated Settlement Upgrading Fund has beenfully established with a multi-stakeholder board meeting regularly held to advise onproject direction and lead in negotiations for the urban poor/slum dwellers;• A forum to provide opportunity for stakeholders to share experiences on how bestgovernments can support the private sector and domestic financial services industry toinvest in affordable housing, was organized by Government of Ghana and UNHABITATin 2008. KEY CHALLENGESA number of challenges identified include:• The inability of housing delivery system to meet effective demand over the years hascreated strain on the existing housing stock and infrastructure, especially in urbanareas. The housing needs of urban inhabitants are often restricted to sub-standardstructures and unsanitary environments in squatter and slum settlements;• The upsurge in rural-urban migration, limited supply of land, and regulatoryframeworks that are not addressing the needs of the urban poor has exacerbated thephenomenon of slum creation;• The market for land in Ghana continued to be highly unorganized. Information aboutwho owns what piece of land is not readily available and the legal and administrativesystems for transferring title are very cumbersome. These features have seriousrepercussions on housing supply. Property transactions are slow and costly, andfinancial institutions are unwilling to extend credit to property holders without cleartitle deed. RESOURCE REQUIREMENTThe 2000 Population and Housing Census estimated the total number of households in Ghanato be about 3.7 million, and was growing at an average rate of 2% per annum. At this rate,about 2.3 million new households are expected to be generated and sheltered by 2025. Thecurrent estimate indicates that the country’s housing deficit is in excess of 800,000 units,while the housing supply growth is about 35% of the total annual requirements of 100,000units per annum. This poses an enormous challenge for the country in order to meet the MDG7 target of achieving a significant improvement in the lives of proportion of the populationliving in slums and those with access to secure housing.GOAL 8: DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENTTarget 8D: Deal comprehensively with LDC debt and make debt sustainable in the longrun STATUS AND TRENDSThere has been increasing global interest to promote development in LDCs including Ghana.Building partnerships for development and resource mobilization for development isfundamental in achieving this goal. It calls for dealing comprehensively with the debtproblem.Over the past two decades Ghana has been receiving external financial support (both loansand grants) of about 40% of budget for projects and programmes annually. This translates intoannual average inflow of about US$560 million over the period 1990 – 2000 and aboutUS$1,050 million for the period 2001-2008. Loan inflows have dominated external receipts,except in 2003, the inception of the Multi-Donor Budget Support (MDBS) programme, whengrants recorded US$798.98million against loans of about US$487.31 million.By 1990, Ghana’s external debt was estimated to be about US$2.8 billion, of which 67.9%was multilateral, 28.6% was official bilateral and 7.1% was commercial debt (Table 9). The
  • 29. external debt almost doubled to about US$4.6 billion by 1995 and rose to US$5.5 billion by1998 and further to US$6.01 billion by 2000.The worsening terms of trade in 1999, characterized by falling prices of Ghana’s two mainexports (gold and cocoa) and rising prices of crude oil led to a sharp depreciation of the cediagainst the major trading currencies and subsequently raised the value of external obligations,resulting in a build-up of both domestic and external debt.A Debt Sustainability Analysis (DSA) conducted in 2000, showed Ghana’s external debt asunsustainable, recording NPV of debt to budget revenue of about 571% and NPV of debt toexports of about 157% . The public debt to GDP ratio stood at about 181% of GDP withdomestic debt component of 28.9% of GDP. Public debt servicing accounted for 32% and39% of total government expenditure in 1999 and 2000 respectively.In view of the above developments, Ghana opted for the Enhanced Highly Indebted PoorCountry Initiative (E-HIPC) in 2001, aimed at reducing external debt and releasing resourcesto pursue poverty-reducing programmes.In 2004, public debt dropped to US$8.345 billion from US$9.09 billion in 2003 as a result ofdebt cancellation at the Completion Point of the HIPC Initiative (Table 10). The public debtreduced further to US$5.31 billion in 2006 due to the Multilateral Debt Relief Initiative(MDRI) which resulted in a cancellation of about US$4.2 billion debt owed to multilateralinstitutions.The public debt increased again in 2007 to US$7.41 billion and further to US$8.07 billion in2008. About 70% of the rise in public debt from the 2006 position was accounted for in theexternal debt stock, underpinned by Eurobond of US$750 million issued in 2007 andincreased foreign inflows.Domestic debt had been growing steadily from the 2001 position of US$1.4 billion. By theend of 2005, it rose to US$1.997 billion and sharply to US$3.1 billion by end 2006. The sharprise is mainly attributed to the floatation of more indexed medium term instruments especially the2-year Fixed Treasury Notes, 3-year Fixed Rate Bond and the 5-year GOG Bond.Domestic Debt stock rose further to US$3.82 billion in 2007 and again to about US$ 4.85billion by end of 2008.In terms of debt sustainability, Ghana’s debt stock has declined consistently from about181.7% of GDP in 2000 to about 41.2% in 2006 with both external and domestic debtfollowing a similar trend during the same period (Figure 22). However, in 2007, the publicdebt to GDP ratio begun to rise, reaching 55.2% in 2008, and exceeding the 50% threshold ofdebt sustainability. Subsequently, interest payments on external and domestic debt also begunto increase from GH¢98 million (US$101 million) and GH¢253 million (US$260.82 million)in 2007 to GH¢197 million (US$164.17 million) and GH¢482 million (US$ 401.67 million)in 2008. As a percentage of export of goods and services, the external debt servicing declinedfrom 7.8% in 1990 to 3.2% in 2006, and has since increased to 4.2% in 2008 (Table 11). Thisdevelopment certainly threaten the macroeconomic stability and growth that have beenachieved in the past few years. KEY FACTORS CONTRIBUTING TO THE PROGRESSTwo major policy initiatives introduced by government to deal comprehensively with thedomestic debt burden and create the fiscal space for investment in poverty reduction are theuse of 20% of HIPC funds to service the domestic debt, and the development of medium- andlong-term instruments to restructure the external debt. In 2008, government’s debt strategy toshift from heavy reliance on short term domestic financing to longer term maturity bondsopen to non-resident investors was not successful due to the commodity crisis which resultedin high inflation. This generated strong preference for short term instruments by domesticinvestors coupled with the financial crunch which discouraged the reopening and issuance ofnew medium term securities to non-resident investors.The main factors contributing to the progress so far include:
  • 30. • Improved fiscal resource mobilization: The government has endeavoured to implementsome policy measures seeking to improve upon its fiscal stance. These include measuresaimed at enhancing revenue collection;• In 2008, the government undertook a Debt Management Performance Assessment(DeMPA) to appraise Ghana’s debt management operations;• In order to assess the relative costs and risks of various debt management strategies, amedium term debt sustainability analysis was carried out which identified desirable debtcompositions and corresponding financing strategies consistent with maintaining debt atsustainable levels.• The government intensified its dealings with its Development Partners (DPs) with theintention to increase the total aid portfolio earmarked for Ghana.• A draft Aid Policy for Ghana has been developed with the aim of coordinating aidadministration and management in Ghana. KEY CHALLENGESThe challenges include:• Shortages in foreign currency inflows due to inadequate export revenues vis-à-visunlimited and expensive import demand that face the economy especially in the case ofrising crude oil prices on the international market;• Debt sustainability continues to pose a challenge to country despite prudent measures toensure proper fiscal management of resources and spending;• Over-reliance on donor support could pose severe financial gaps in the face ofunfavourable external shock such as the global financial and economic crisis that stifledthe flow of aid and other donor support; and• Changes in the international economic environment and the need for effective andefficient debt management in current debt management operations.STATUS AND TRENDSFirst pledged 40 years ago in a 1970 General Assembly Resolution (Box 7), the worldsgovernments agreed to commit 0.7% of rich-countries Gross National Product (GNP) toOfficial Development Assistance (ODA). This target was affirmed in many internationalagreements over the years, including the March 2002 International Conference on Financingfor Development in Monterrey, Mexico and at the World Summit on SustainableDevelopment held in Johannesburg later that year. At the summit of the leaders of the G8countries(UK, USA, France, Germany, Japan, Russia, Italy and Canada) at Gleneagles, Scotlandin July 2005, the G8 promised to increase aid to developing countries by US$50 billion annuallyby 2010, which was only half of the UN estimate to reach the Millennium Development Goals.The UN Millennium Projects analysis indicated that 0.7% of the rich world GNI could provideenough resources to meet Millennium Development Goals, but developed countries must followthrough on commitments and begin increasing ODA volumes. The UN Millennium Projectscosting shows that a comprehensive package to meet the Millennium Development Goals wouldcost about $75-$150 US per person per year over the period, and that less than half of this wouldneed to be financed by ODA. To achieve the Goals, aid from industrialized countries should riseto 0.44% of the industrialized nations GNP in 2006 and reach 0.54% of GNP by 2015- less thanthe global target 0.7% of GNP reaffirmed by world leaders at the Monterrey conference onfinancing development in 2002. If one includes the other essential investment needs that are notdirectly related to the Millennium Development Goals, such as protecting global fisheries andmanaging geo-strategic and humanitarian crises, global aid will need to rise to 0.7%. If donorcountries reached the 0.7% ODA target, they could generate the additional funding that will beneeded for developing countries to achieve the Millennium Development Goals.An analysis of ODA inflows to Ghana shows that aid inflows has increased from US$ 578.96million in 2001 in nominal terms to US$1,433.23 million in 2008, constituting an average
  • 31. annual increment of about 23% during the period (Figure 23). Project aid constitutes the bulk(about 64%) of ODA portfolio in Ghana, increasing steadily during the period, whereasprogramme aid has virtually stagnated over the period 2004 and 2007 (Figure 24). Generalbudget support, for instance, has increased by only 46% (constituting an average annualincrease of about 8%) over the period 2001 and 2008. The relative levels of both types of aid,in spite of the different trends, remained relatively higher than the levels recorded in thesecond half of the nineties. The improvement in General Budget Support (GBS) fromUS$85.07 in 2002 to US$378.37 in 2008 has been largely attributed to the introduction of theMulti-Donor Budgetary Support (MDBS) mechanism in 2003 which allows donors tocontribute to a common basket to support the national budget. The MDBS which currentlyconstitute about 30% of donor inflows in Ghana, has improved commitment and predictability ofaid inflows.In real terms, however, ODA inflows has stagnated between 2002 and 2008, after increasingfrom 6% of GDP in 1999 to 15% of GDP in 2001 (Figure 25). The average annual ODAinflows to Ghana as a percentage of GDP during the period 2002 and 2008 was estimated at8.7%, while that for the period 1999 – 2001 stood at 10%. Programme aid as a percentage oftotal ODA has remained below 50% between 2003 and 2008, after increasing from 30% in1999 to 58% in 2002. The average annual programme aid as a percentage of total ODA wasestimated at 38% between 2003 and 2008, while that for the period 1999 – 2002 stood at 42%.This implies ODA portfolio in Ghana continued to be dominated by project aid which isusually off-budget, and lends itself to non-use of country systems, creation of parallel systemfor its management and excessive rigidity in its administration.KEY FACTORS CONTRIBUTING TO THE PROGRESSThe main factors contributing to the progress so far include:• Political stability and improved democratic governance including strengthening ofParliament, protecting of rights under rule of law, ensuring public safety and security,empowering women and vulnerable groups, and improving domestic accountability,has led to growing confidence of development partners in the country systems. Since2003, the country has introduced new rules governing procurement and competitivebidding systems (Public Procurement Act 663), accountability (Internal Audit AgencyAct, 2003 (Act 658), and efficient utilization of resources (Financial AdministrationAct, 2003 (Act 654). Furthermore, Parliament through the Public Accounts Committeecontinue to exercise its statutory oversight control over the budgetary process byholding public hearings on the Auditor General’s report on the use of public funds.The essence is to ensure accountability of public officers in the use of public funds,reduce duplication, transaction costs, and misdirected aid as well as to make thecountry’s and donor aid resource utilization more effective and efficient.• Improved partnership between government and development partners based on theParis Declaration: The period between 1983 and 1999 was characterized bydisproportionate power imbalance in aid administration in Ghana, with large numberof agencies, a high proportion of bilateral aid, high proportion of project andinvestment aid, and high proportion of technical assistance. The government begun totransform government-development partner relations into mechanisms or importantforum for policy dialogue on strategic reforms and allow international partners tocommit resources to measurable results. The partnership has evolved through regularsector dialogues, Consultative Group (CG) meetings and country review missions. Aspart of the process of deepening the government-donor partnership, regular meetings
  • 32. have been introduced at the sectoral levels by the government to dialogue withSectoral Partner Groups (SPGs). These meetings, usually led by government agencies,are structured to identify and prioritise focal areas which require support from specificdevelopment partners. Overall, improved government-donor partnership has facilitateda shift from activity-based to results-oriented approach to aid delivery andmanagement, and has contributed positively to changing the aid architecture in Ghana.• The ownership of development process and alignment of donor resource towardsimplementation of the development policy framework: Ownership of the developmentprocess as characterized by a country’s ability to exercise effective leadership over itsdevelopment policies and strategies is critical to achieving development results and iscentral to the Paris Declaration. In acknowledgement of this fact, Ghana has since2003 prepared two medium term national development policy frameworks, namelyGhana Poverty Reduction Strategy (GPRS I) and the Growth and Poverty ReductionStrategy (GPRS II), which have provided the basis for donor coordination andalignment. Sector and local governments derive their respective medium-termdevelopment plans from them, and also monitor the progress made in achieving sectorand district development targets. This process has enabled the government to deepenthe ownership of the development process as well as the coordination of donorassistance towards implementation of the development policy framework.• Improvement in public financial management: The improved public financialmanagement increases the confidence of Development Partners in the use of thecountry’s systems. Though some weaknesses exist in the rules, systems and capacityof users in the public sector, improvements have been observed in:- budget execution and control,- timely external auditing of the accounts of the consolidated fund,- broadening of budget coverage to include more information on internallygenerated funds and external grants (including HIPC and MDRI grants), and-external audit reports being produced in a more timely fashion with theAnnual Report by the Accountant General being submitted to Parliamentwithin 12 months of the closing of the accounts.Cash Management System aimed at providing frequent and up to date monitoring ofrevenues, expenditures and cash balances has been instituted. This system provides thegovernment with an early warning system to guide the implementation and monitoringof the budget to ensure that, the programmed budget deficit was not exceeded. Inaddition, an outstanding claims and payments framework has been instituted toidentify the level of claims on Government in order to improve the management ofthese claims and reduce the stock of arrears for Government. KEY CHALLENGESA major weakness in aid administration in Ghana is the absence of a Comprehensiveframework guidelines and targets to facilitate effective aid delivery. The participatory processtowards formulating a National Aid Policy, currently in progress, is expected to address thisweakness. The goal of the Comprehensive National Aid Policy is a well documented andcountry owned set of codes as an instrument for formalizing GOG/DP partnership,incorporating a strong commitment to the key elements of the Paris Declaration on Aideffectiveness. The broad consensus emerging from the consultative process towardsformulating a Ghana Aid Policy includes addressing issues linked to the following broadobjectives:• Ensure Value for Money through the reduction of untied aid (including food andtechnical assistance by 100% by the year 2010;• Setting of concessionality/grant element floors in aid inflows with a clearly defined
  • 33. link of such facilities to a national debt policy;• Ensure strong elements of multi-year and in-year predictability of aid delivery and ameasure of flexibility in contingency provisions required to address shocks andemergency priorities of GoG;• A rolling medium term programme and results-based aid expenditure plan linked tothe Medium Term Expenditure Frameworks;• Encourage DPs to identify and explicitly put targets on relative preference for budgetsupport on one hand and sectoral and pooled funds on the other;• Reduce the levels of donor conditionalities which tend to undermine countryownership and exacerbate unpredictability;• Reduce the requirement for counterpart funds, multiple PIUs and pre-shipmentregimes;• Increase the capacity to use Ghana-led studies, analysis and reports;• Switch from the payment modality of re-imbursements to accountable cash advances;and• Observe a national mission-free period in the calendarTHE IMPORTANCE OR EFFECT OF MILLENIUM DEELOPMENT AUTHORITY TOECONOMY OF GHANAThe programme focuses on measurable. There are guided principles intended to ensure that thegrant assistance provided to Ghana, delivers a difference to the lives of the people in theintervention zones and therefore a growth to the economy.On this front excellent progresses were made in the various targeted areas; AGRICULTURE PROJECTThe Agriculture Project aims to enhance the productivity and profitability of staples and highvalue cash crops and to improve delivery of business and technical service that support theexpansion of commercial agriculture among 1,200 Farmer-Based organization(FBOS)FBOS who are the immediate beneficiaries of the Programme, are groups of eligible farmers orinput suppliers selling to such famers; or output processors buying from the farmers.The Agriculture Project will therefore directly touch 1200 FBOs or a maximum of 60,000individual farmers, a s FBOs have 50 members each.CDFO:- Under the Commercial Development of Farmers-based Organizations (CDFO)Programme, the poor rural farmers are assisted to confidently participate in local andinternational markets. This is done through investment worth US$214 million that will:- Diversify , intensify or expand agriculture practices and outputs;And also enables FBOs to become better organized through training.It also improve the quality of their product which will add value to primary products, throughprocessing. It also provide FBOs with access to Credit.It reduces the cost of transportation of agriculture produce.And provide a range of rural service, including marketing and financial services. Training of Farmers: over47, 000 farmers have received free technical and business skillstraining delivered by specialist technical training service providers draw from both public andprivate sector institutions. Every trained farmer have received and worked with $230 worth ofinput as Starter Park. This innovation arrangement has yield result and there are success stories totell on the excellent intermediation of Value-Chain Associations and growing exportopportunities. Irrigation Development: the current plan to irrigate 4,000 hectares of land to enable year-round farming by FBOs. It is for this reason that they have completed feasibility studies on anumber of large and small irrigation dams spread across the three zones. I.e. four (4) in the
  • 34. Northern Area, VIZ; - Nasia, Botanga, Golinga, and Ligba; two (2) in the Southern Zone, viz:-Kpogn Left Bank and Kpandu-Torkor and four in the Afram Basin Zone, viz: Amate, Dedeso,Kotoso and Sata. Out of these scheme six of them which have been considered feasibility haverehabilitate to irrigate 4000 hectares of farm lands to enable all year round farming by FBOs.These include Kpogn Left Bank, Botanga, Golinga, Amate and DedesoIn addition to this, other small Irrigation Schemes will be undertaking in the following areas:-Northern Zone: - Arigu, Wala and Janga SchemesAfram Basin Zone: - Adawso and Kotoso SchemesThis achievement and lessons has guided to replicate the process fully in the Northern Zone andpartially in the Afram Basin Zone .As part of this intervention, the programmers has provided the use of the Land Registry Divisionof the Land Commission, modern survey equipment and accessories and purpose-built andfurnished Offices to support the initiative in all three Zones. The first of these offices wascommissioned for use in Winneba .Through the capacity building sub-activity of the land project, MiDA has trained middle levelStaff of the Lands Commission in Land Administration and Land Law. This activity is alsointended to assist in changing the mindset of the Public Servant in the delivery of LandRegistration Services.Backlog of Land Cases: - In furtherance of this Activity, MiDA is currently working with thejudicial service and has already funded and completed a review of the backlog of Land Casespending in court all over the country. We with this, essential IT infrastructure is been provided toassist in complete rehabilitation and modernization of ten (10) circuit court across the country.These Selected Land Courts will handle and clear the backlog and any new Land Cases. theimplementing Entity Agreement with the Judicial Service supports this.Agriculture Business Centres:- Ready markets guarantee and motive production and enhancethe productivity of resources. To assist with markets for the produce of smallholder farmers,MiDA has funded the construction of sixteen private-sectors managed Agribusiness centers,(mainly small-scale grain storage facilities),spread across the three Zones as follows: Seven(7) inthe Northern Zone, four in the Southern Zone and five in the Afram Basin Zone. These will serveas buying Centres for a selected food crops, in particular grains. It will also help meet the creditneeds of farmers in the catchment area of these facilities. These Centres will be for use in the firstquarter of 2011.In addition, it is intended to locate a number of storage facilities close to farming Communities toallow for initial storage prior to sales to Business Centres Safeguarding the Quality of FarmProduce/Inputs .The quality of inputs and the end produce intended for both the local and exportmarket is of essence to our Program. For this reason, MiDA has sponsored various consultationson behalf of the Plant Protection and Regulatory Service Division (PPRSD) of MOFA that willensure an increase in the Public Sectors capacity to meet the International Plant ProtectionStandards. What is left now is the outdated Plants, Pests and Diseases Act, Act 307 of 1965.TRANSPORTATION PROJECT Transportation linkages has been improved to the FBO Communities and to reducetransportation costs and the cost of doing business, the program covers a significant number ofvital roads connections across the three Zones. Our interventions, estimated at US$6.8 millioninclude: Feeder Roads:- We have selected for upgrading works , over 356 kms of Feeder Roadsacross the Northern and Southern Zones, already spread out as 110.5kms in the North, 144kms inthe Eastern and Central Districts, 101.5kms In the District in the Volta Region These roads willbe finished to mainly bituminous surfaces and when completed will increase agricultutral activityand productivity , contribute to food security and facilitate access to domestic and international
  • 35. market to critical social services. Other donor supports were in agreement to rehabilitate morefeeder roads. N1 Highway: - Besides the rehabilitation/construction of Feeder Roads, the program hasalso upgraded the14.1km National Highway, the Tetteh Quarshie Interchange to Mallam.Highway. This6-lane dual carriageway, which includes interchange at Dimple junction mallamjunction when completed, has reduced the bottlenecks in accessing the International Airport andthe Port of Tema with farm produce and support Ghana’s horticulture export base beyond the7,000 hectares.This program which has been on the drawing board since 1965 is now ongoing. For ease ofconstruction, the road corridor has been split into two and contracted out of Messrs China Wujugroup , Lot 1(6.0km) and Messrs Monaz, Serra and Fortunato-Empreiteiros,S.A. (MSF) ofPortugal for Lot 2(8.1km). The entire project estimated at US$25.9 million will be completedbefore the end of 2011. Trunk Roads: - Also in progress in the construction of the 75.1 km Agogo-Dome Trunkroad. This vital road segment valued at US$25.9 million will enhance access to the excellentinvestment potential of the Afram Plains, from Agogo in the Ashanti region; and will supportsignificant growth in commercial agriculture and access to social services. Ferry Services:-the final leg of the Transportation Infrastructure Development Project isthe improvement to the Lake Volta Ferry Services. A US$9.484 MILLION contract has beenawarded to Messrs Arab Contractors of Egypt for the extensive rehabilitation of over the 40years-old floating dock lying at Akosombo and the construction of double ended ferries to connectAdawso on the southern shore to Ekye Amanfrom on the Northern shore of Volta riverThis intervention will enhance the Volta lake transport company construction repair andmaintenance capabilities for ferries. These ferries will offer reliable easier and speedier access tofarmlands in the Afram Basin and will save farmers and all ferry users, a lot of valuable time andmoney.Solicitation for the rehabilitation of ferry terminals and the, construction of new and enlargedlanding stages to increase ferry and vehicle handling capacities will be launched this month.Finally as submerged trees have the potential to cause accidents on lake, a contract for extractionof tree stumps from the crossing route between Adawso and Ekye Amanfrom, to eliminatenavigation and safety hazards has been negotiated with the Volta River Authority and work willbe completed before the ferries are commissioned.RURAL SERVICES DEVELOPMENT PROJECT, as you all know the poor farmers lives under deplorable conditions in their communities. If theymust continue to play a meaningful role in the country’s agricultural sector, then status quo mustchange. The rural service development project component was included in the program to servethis purpose. The farmer, his family and workers must be happy in their farming community.Unfortunately, it is these farmers in the rural areas who have poor access to basic communityservices like portable water ,sanitation, schools at all levels and electricity for economic use.These shortcomings of rural services constrain the productivity of the people and have made itdifficult to attract or retain the youth, entrepreneurs and skilled workers in the rural areas. Thishas in turn affect Ghana’s abilities to realize the full potential of its abundant agriculturalresources and to achieve speedy and sustainable growth of the industry.the rural service development project, with a budget of US$73.43million, addresses theseproblems in a coordinate fashion. Three activities are been implemented to strengthen the ruralinstitutions that provides complementary services to the agricultural services. The sub-project ofthe community services activity is currently at various levels of commission.COMMUNITY SERVICESSchools: - in total 435 educational facilities made of 2, 3 &6-units classroomblocks,kindergartens
  • 36. , teacher’s accommodations sanitation facilities, etc. will construct under the program. To date,under the phase 1(a) and 1(b) of the school rehabilitation project, 60 of these schools have beencompleted in fourteen Districts. The rest which have been spread over the three (3) zones andcontracted out to 32 contractors will be completed and handed over the assemblies before theyear-end 2011. It is important to add that all the school will be provided with complete sets offurniture for the teachers and pupils. The United States Agency for International Development(USAID) and the International Foundation for Education and Self Help (IFESH) are alreadysupporting the training of 260 community Teachers to teach in the 65 schools rehabilitated underphase 1A and 1B.Ghana has made significant improvements particularly in the areas of basicschool enrolment and the country is on the achieving both the gross and net enrolment targets of100% by 2015.At the kindergarten(kg) level, gross enrolment ratio (GER) has increased from55.6% in 1991to 89.9% in 2008,while at the primary level GER has increased from 74% in 1991to 95.20% in2008. At the junior high school level however, there has been marginal increase inGER from 70.2% in 1991 to 78.80% in 2008. The upper west and Upper East regions registeredthe most significant increase in GER for the period 1998 to 2008, for primary level while Ashantiand Volta Regions recorded the least in improvement in GER over the same period.Similar to the GER, the Net Enrolment Ratio (NER) recorded increase in the NER at the primarylevel and across the country from 69.2% in 2005/06 and further to 83.7% in 2007/08. The washowever different at the junior level with NER increase from 52.4% in 2006/07 to only 53.4% in2007/08 indicating a slow progress in relation to the 2015 target of 58.4% Male NER has alwaysbeen higher than the female NER at all levels. Male NER in the deprive district also increasefrom 74.51% in 2006/07 to 77.9% in 2007/08 at primary level during the same period and 41.6%to 43.8% at the junior high school level during the same period. Despite the increase GER andNER survival rate at the primary level declined from 83.2% in 2003/04 to 75.6% in 2005/06 eventhough it recovered to88.0% in 2007/08. At the JHS level survival rate also declined from 86% in2003/04 to 64.9% in 2006/07 but begun to increase to 67.7% in 2007/08. Survival rate amongfemale pupils has been lower than the male pupils in the primary school level and JHS levels.While survival rate increase from 85.1% in 2003/04 to 88.9% in 2007/08 among male pupils atthe school level, it increased from 81.1% to only 82.4% among female pupils over same period.At the JHS level, between 2003/2004 and 2007/08, survive rate among male pupil decline from88% to 72.4% in 2007/08 and from 83.7%t to 62.9% in 2007/08 among the female pupil.Water:-contract has been awarded to13 small towns water systems 6-pipe extensions designs forextension for tamale water system from the Dulund Head Works in Tolon Kumbungu, throughSavelugu-Nanton to the Tamale Metropolis, a distance of 67km has been completed. As part ofthe process leading to finalization of the Designs and Tender Documents, presentation of thegenerals’ design works and consideration to major stakeholders including participating agenciessuch as GWCL, CWSA and WD, is schedule to take place in Tamale on the 13th of May 2011.Civil will commence I September and this will bring treated portable water to farmingElectricity: MiDA is engaged in consultations with the ministry of energy extend an estimated230km of power to processing plants, nucleus farms and Agribusiness Centre’s spread across allthe three zones for domestic as well as economic use, i.e. for food processing and irrigation etc.this program will also install 12 transformers to boost power supplying to deserving communities.These contracts were awarded in May and physical construction of these activities has
  • 37. commenced subsequently. With goal three, efforts have been made with respect to promotinggender equality and women empowerment. Trends show that Ghana is on track in achieving thetargets of gender parity especially at the Primary and Junior High school (JHS) levels althoughprimary level parity has stagnated at 0.96 since 2006/07, while the parity at the JHS increasedslightly from 0.91 in 2006/07 to 0.92 in 2007/08. On the other hand the parity at the KG declinedslightly from 0.99 in 2006/07 to 0.98 in 2007/08.The progress towards increasing the number of women in public life suffered a setback with thereduction of the number of women elected in Parliament during the 2008 election. The proportionof seats held by women I Parliament in 2009 was 8.7 %( 20). This was a drop from 10.0% (25) in2006.There has been significant reduction in both infant and under-five mortality rates with respect toGoal four. The under-five mortality rate declined from 111 per 1000 live birth in 2003 to80per1000 live births in 2008. However, Ghana I unlikely to meet to meet the 2015 target ofreducing the child mortality rates to 53 deaths per 1000 live birth unless coverage of effectivechild survival interventions is increased. Infant mortality rate dropped from 64 per 1000 livebirths in 2003 to 50 per 1000 live birth in 2008. Neonatal mortality rate also has been seen adecreased from 43 per 1000 live births in 2003 to 30 per 1000 live birth in 2008. The proportionof children aged 12-23 months who received measles vaccine increased from 83% in 2003 90%in 2008 showing an improvement of the coverage of one of the key child survival interventions(Ministry of Health (MOH), 2008 ad GHS, 2003)Goal 5: Maternal mortality rate captured by survey and institutional data has shown animprovement over the past 20 years.However, the pace has been slow. Between 1990 and 2005, maternal mortality rates reduced from740 per 100,000 live to 503 per 100,000 live births and then to 451 deaths per 100,000 live birthin 2008. This trend is also supported by institution data which suggests that maternal deathsper100, 000 live births have declined from 224/100,000 in 2007 to 201/100,000 in 2008. This wasafter an increase from 137/100,000 in 2004 to 197/100,000 in 2006. If the current trends continue,maternal mortality will be reduced to only 340per 100,000 by 2015 instead of the MDG target of185 per 100,000 by 2015. Unless extreme efforts are made by all stakeholders, Ghana is unlikelyto meet the target. 14% of deaths of women within the reproductive age are due to material causesand identified hemorrhage (24%) as the largest single cause of maternal deaths; abortion was thesecond single largest cause of death, accounting for 15%. Hypertensive disorder, sepsis, andobstructed labor were also cited as causes of maternal death.Antenatal care from health professional increased from 82% in 1988 to 95% in 2008. Theproportion of women who received two or more tetanus injection during last pregnancy increasedfrom 50% in 2003 to 56% in 200t8. Assistance is skilled providers during childbirth increasedfrom 43% in 2003 to 59% in 2008.Goal 6: The HIV prevalence rate slowed down after peaking at 3.6% in 2003. It then declined to3.2% in 2006 and further dropped to 2.2%in 2008 but increased to 2.9% in 2009. Given thistrend, Ghana has to sustain the efforts in order to meet the target of halting ad reversing thespread of HIV/AIDS by 2015. The report notes that females are the most infected accounting for147,958 out of the 250,829 .The prevalence rate is high amongst pregnant women. Annual deathsas a result of HIV/AIDS however dropped to 17,244 in 2008 from 18,396 in 2007, thoughfemales still account for largest portion The age groups 24-29 years also recorded the highestprevalence rate although this declined from 4.2% in 2006 to 3.0% in 2008.HIV prevalence rate ishighest in the Eastern region recording 4.2% in 2008 as against 1.1% in the Northern regionThe use of Insecticide Treated Nets (ITN) increased successively. from 3.3% in 2002 to a peak of33.3%2007. However, the proportion of children under five years sleeping under ITNs declined
  • 38. significant to 40.5% in 2008. Similarly, ITN use among pregnant women has been encouraginguntil 2008 where it declined drastically to 30.2% from a peak of 52.5% in 2007.Ensuring Environment SustainabilityGoal 7: Ghana is to o course to achieve MDG 7 in full. Even though Ghana is on achieving thetarget on halving the proportion without access to safe water, critical challenges exist in achievingthe target of reversing the loss of environment resources, reducing the proportion of peoplewithout access to improved sanitation, and achieving significant improvement in the lives ofpeople living in slum areas.Ghana’s forest cover has declined from 32.7% to 24.2% between 1990 and 2005. In 1990, theforest cover was estimated at 7,448,000 hectares, and this has depleted at an average rate of 1.8%.The proportion of Ghanaian population that uses improved drinking water has increasedsignificantly from 56% in 1990 to 83.8% in 2008. The proportion of Ghanaians without access toimproved water sources was thus reduced from 44% in 1990 to 16.2% in 2008. Ghana istherefore said to be on track in achieving the target 0f 22% ahead of 2015 target.Even though national coverage for improved sanitation has increased from 4% in 1993 to 12.4%in 2008, reducing the proportion of the population without access to improved sanitation willreach 21.2% by 2015 instead of 52%, while the proportion urban population with access toimproved sanitation will be 23.4% instead of 55% by 2015. In the rural areas, only 20.6% wouldhave access to improved sanitation instead of 50.5%.In 1990, the total number of people living in slums in Ghana was estimated at 4.1million, andincreased to 4.99million in 2001 then to 5.5 million people in 2008. In terms of its share of thetotal population, the proportion of people living in slums in Ghana has declined consistently from272% in 1990 to about 19.6% in 2008.On the other hand, population with access to secure housing has stagnated at about 12% over thepast five years. By 2020 only 6% by would have access to secure housing will increase by only6% would have access to secure housing will increase by only 6% by 2020.In terms of Global Partnerships for developmentGoal 8, many developed countries have not met the 0.7% GNP target for aid, but aid inflows’ toGhana appear to have increased in nominal terms from US$578.96 million in 2001 toUS$1,433.23 million in 2008. However, the current concerns, is the level of increase in real termsand the quality of the aid the country receives. In real terms ODA inflows to Ghana has stagnatedat 8.7% of GDP between 2002 and 2008, after initial rise from 6% of GDP in 1999 to 15% ofGDP in 2001. The portfolio of aid inflows continued to be dominated by project aid whichconstitutes more than 60% of ODA in flows. The negative and effect of the domestic energycrisis I 2006, as well as the global financial oil and food crisis begun showing on the public debtposition of Ghana. Ghana’s public debt as a percentage of GDP has increased from 41.4% in2006 to 55.2% in 2008, thereby approaching the unsustainable levels.UNDP is partnering with the Ghana Government to ensure that national priorities with theMillennium Development Goals. The Growth poverty Reduction strategy all (GPRS) is themedium term national strategy that guides Ghana’s efforts to reach the MDGs.UNDP is supporting and building the capacity of the Nation Development Planning Commissionin order to strengthen the GPRS all as the national framework to reach the MDGs and all nationalobjectives.UNDP is active in creating the platform for MDG promote the localization of the MDGs, at thecommunity level. To assist in monitory Ghana’s progress circulation of national MDG Reports.
  • 39. Assessments made as a primary step in the programmes clearly showed the need to step up thecampaign for MDGs I Ghana, in order to increase awareness levels among policy makers and thepopulation. PROBLEMS CONFRONTING THE IMPLEMENTATION OF THE MILLENNIUMDEVELOPMENT GOALSWhile in rural areas, where poor roads, few ambulances, inadequate schools andcom m u nications shortfalls compoun d problems brought on by a shortage of trained staff. Ineducation, such capacity constraints can increase dropout rates, especially in rural areas, ifteacher quality suffers while staff turnover increases. This cycle makes it even more difficultto explain the importance of education to groups with little experience with schooling. Manyconstraints and bottlenecks.Structural shortfalls: Unresponsive institutions and poor implementation have slowedprogress by constraining econo mic growth and hampering basic service delivery. They havealso created sharp disparities between rural and urban areas and between women and men.In many instances, these limitations led to clear disparities in MDG progress, even asecono mic growth and appropriate policy pushed indicators forward at the national level.Some countries indicate that growth has been accompanied with increasing incomeinequality among regions (usually with rural areas lagging behind urban areas), by genderand among ethnic groups (especially for those groups living in remote areas). This threatenswake and is likely to continue slowing econo mic growth in many countries for some timeunless targeted investments are made to improve their education and health. Greaterpopulation mobility, for example, spurred by econo mic growth, can facilitate the spread ofthe HIV/AIDS,is reinforcingkey element for reducing poverty, yetnimble and sustainableJob creation another the need of long-term vigilance, partly because of thedependence on a limited range of export products, neglect of agricultural sector, and thefinancial crisis, many people in many countries are une m ployed or work in the informalLack of capacity: Capacity shortages, including the quality and quantity of personnel, arethe largest obstacle to service delivery in many countries. Programmes often suffer from alack of personnel in health, education, environmental management or administration skills.Countries, for example, report that attempts to decentralize health care service can bestymied by resources: Lack of financesare unable hindered the country as they workInadequate local administrators who has also to plan and implement effectivetowards meeting the MDGs. Particularly in the wake of the global food and financial crises,many national budgets are straining to maintain the status quo and to avoid reversingprogress already achieved towards reaching the Millenniu m targets. In recent years, officialdevelopment assistance, a significant part of the national budgets has been threatened,leaving many countries scrambling to meet their com mit ments. Many countries are trying towork around such financial constraints by improving the efficiency of aid-fundedprogrammes, for example by finding ways to coordinate and integrate efforts targetingMany Country Reports cite the need for greater support from developed countries over thenext five years if they are to achieve the MDGs. Along with the burden of the debt serviceand repayments, government revenues have been compro mised by the global econo micand financial crisis. Many countries saw a significant decline in exports, foreign remittancesand official development assistance in the Country Reports is the impact of social and andSocial attitudes: A recurring theme from the wake of the crisis. Regional cooperationcultural attitudes that shape the de man d for MDG services, and thus on reaching the MDGs.Culture plays an obvious role for example in shaping attitudes toward gender equality.Violence against women encouraged by legacy gender roles and the traditional econo micdependency of wo men in many areas create gender disparities across a range of otherissues, notably HIV/AIDS. Growth, poverty reduction, health outcomes and educationalopportunities are all missed when women are not empowered to make their own decisions
  • 40. Social attitudes can also directly impede efforts to achieve other MDGs. Cultural obstaclescan take the against people living with HIV and those most at risk of HIV (such as sexDiscriminationform of stigma and discrimination against many other marginalized groups. workers,men who have sex with men, intravenous drug users and migrants) impedes progress against HIV-Inadequate infrastructure: For many countries, infrastructure shortfalls also blockimprovements needed to reach the MDGs. In particular, unimproved roads or othertransportation links prevent countries from delivering health care and education services andprevent farmers and others in remote areas from bringing their products to market. Withoutquestion, larger countries face particular difficulties in building appropriate infrastructure toVulnerable groups: While disparities in poverty levels between men and women and betweenurban and rural inhabitants are cited in many Country Reports, some also mention challengeslinked to specific vulnerable groups. Persons with disabilities, orphans and the elderly,particularly women, have had difficulties fighting against poverty. Even among the poor, thesegroups can be marginalized and overlooked in efforts to reduce poverty.Poor data and monitoring mechanisms: Across some MDG sectors and some CountryReports, the theme of poor data and monitoring recurs. National statistical systems often sufferfrom weak institutional capacity and human resource constraints. When data is available, it istoo often incomplete, incomparable across surveys or lacking in important detail, such asdisaggregation by sex. These informational and capacity constraints impede appropriateplanning, policy actions and service policy andand as a result create gapsoutcomes.major constraint to making informed delivery, monitoring gender-equitable and disparities. TheSeveral countries report that the indicator for biodiversity is lagging, partly because themetrics are less specific, but also because few have in place the means to measure progress.Institutions with limited resources often lack the capacity to manage and monitor environmentalresources, handle vital data, such as information on hazardous chemicals, or both. Severalcountries, however, have recently begun developing information post-conflict situationspreserveConflicts and disaster-related challenges: Conflicts and systems to monitor and pose aserious challenge to achieving MDG targets by leaving countries with barely functioningnational institutions, hobbled infrastructure and a traumatized population. Around the globe,conflict, armed violence and disaster hold back or even reverse progress toward the MDGs. Inmany countries, the costs of policing crime, treating the consequences of violence and subsidizinglost income now exceed the sum total of national investments in education and health. Countriessuffering high levels of armed violence, conflict and insecurity are farthest from reaching MDGimpede achievement of the MDGs by undermining growth, job opportunities and the delivery ofsocial and emerging challenges: Many MDG Country Reports cite the food crisis, globalNew crisis and climate change as having significantly complicated the road to achieving theMDGs. Often, the effects of these multiple shocks were intertwined, for example weak exportmarkets linked to the financial crisis made it more difficult for countries to afford food imports,which have remained more expensive than recent levels despite a slight weakening of markets. Insome cases, progress has been slowed and even reversed. When possible, countries have respondedand has occasionally come at the expense of other development programmes.Without doubt, the MDGs will not be reached if efforts across the board are not accelerated.But the successes shown in the most recent MDG Country Reports offer justified hope that,through application of the lessons learned over the past decade, these development targets canbe reached. The path to success is not a mystery. Achievements follow when appropriateresources and partnerships are conjoined with good policy, the right programmes and commitment.Well-established interventions have brought success when partners work together to create theroadblocks. Cultural obstacles can be overcome when leaders talk openly about the neededchanges and when oppressed groups arehighlight the difficulties in reaching the MDGs, they alsoWhile the Country Reports certainly empowered with the necessary tools.offer inspiration. Almost a third of the Country Reports examined for this synthesis states thatthe countries will probably meet at least half of the eight MDGs, while another third statesthat they still have the potential to meet half of the MDGs. Three countries report in their selfAfter ten years of hard work, now is the time to celebrate the successes of countries around theglobe and to embrace the lessons they have shown us. The obstacles to achieving the Millennium
  • 41. THE WAY FORWARDProgress on the goals of the health-related MDGs is mostly very slow in the African Region.Countries and their development partners should increase resources significantly and explorenew and innovative ways to ensure progress.Countries should allocate at least 15% of public expenditure to the health sector as set out inthe 2001 Abuja Declaration.10 In addition, they need to strengthen existing structures andmechanisms for sustainable, effective and efficient mobilization and utilization of internal andexternal resources. Countries can strengthen health systems by fully implementing the 2008Ouagadougou Declaration on Primary Health Care and Health Systems in Africa to ensure betteraccess to, and quality of, health services; a strong health workforce; an effective healthinformation system; equitable access to essential medical products, vaccines and technologies; afunctioning health financing system; and a robust leadership and governance structure. It isnecessary for countries to increase their attention to areas where progress has been limited,particularly to improve maternal health, by providing sufficient financing to strengthen maternaland other reproductive health services. Both countries and partners should build internationalpartnerships, sustain the gains achieved and scale up interventions to achieve the necessaryreductions in under-five mortality as well as combat HIV/AIDS, malaria and tuberculosis.Countries should strengthen leadership and institutional capacity within ministries of health,especially in macroeconomic analysis and strategic planning and budgeting. There is a need toincrease dialogue between health and oversight ministries such as finance and planning.National efforts should follow the “Three Ones” principle of one national plan, onecoordination mechanism and one monitoring and evaluation plan while striving to achieve theMDGs. Countries can improve the monitoring of progress towards the MDGs in collaborationwith all stakeholders and international partners by:(a) Improving the frequency, quality and efficiency of national health surveys;(b) strengthening birth and death registration;(c) improving the availability of demographic data by completing the 2010census round;(d) improving surveillance and service statistics;(e) enhancing monitoring of health systems strengthening; and(f) strengthening the analysis, evaluation and use of data for decision-making.11Unless current trends are drastically changed, most countries of the African Region areunlikely to achieve any of the health or health-related MDGs. However, progress is possible ifMember States work with development partners to devote more resources, strengthen healthsystems, including the data sources for monitoring MDG progress, and improve access to proveninterventions. The Regional Committee is requested to take note of this progress report andencourage countries to adopt the proposed actions as the way forward for reaching the targetsof the millennium development goals.OTHER COUNTRY REPORTS, DRIVES AND CONSTRAINS TO THE PROGRESS OF MDGSThe MDG Country Reports included in the Synthesis Report paint a dynamic picture of countriesworking toward fulfilling the promises made ten years ago. Countries began their journeytoward meeting the MDGs from a wide range of starting positions. Some were favoured with richnatural resources and other assets that allowed them to take part in a global economy thatwas buoyant until late 2008. For some of these countries, resources that could have liftedmillions out of poverty, instead served as divisive assets that sparked violent conflicts that havein some cases lasted decades. Some had the national commitment to move forward as a matter ofdomestic development strategy. Others, of course, faced clear obstacles to pushing ahead. Land-locked or small-island nations had to work harder to find a place in a dynamic global economy,for instance. Still others were in crisis or post-crisis situations and were left with barelyfunctioning national institutions, hobbled infrastructure and a traumatized population.Yet, from this mosaic, progress toward reaching the MDG goals is clearly shown. Of the 34MDG Country Reports analyzed for this Synthesis Report, ten report that they will probablymeet at least half of the MDG targets, while 11 others report that they can potentially meet at
  • 42. least half of them. Together, these groups represent almost two thirds of the countries in thesynthesis. In addition, three report in their self-assessment report that they have reached orwere about to reach at least one of the targets. Only one country reports that it is unlikely tomeet any of the MDGs by 2015.Examining each goal in sequence creates a clear picture of progress from this mosaic.MDG 1: Eradicate extreme poverty and hungerMDG 1 focuses on efforts to reduce the number of people living in extreme poverty, generallydefined as living on less than $1.25 per day, to assure that able adults have jobs and to improvenutritional standards.Data collected from the Country Reports often do not capture the full impact of the globalfinancial crisis since they generally reflect the situation in 2009 or even 2008. Reduced globalconsumption, for instance, was a primary factor that led to reduced jobs and incomes indeveloping countries, but the impact was delayed as the chain of events worked through theglobal markets. Many countries expressed grave concerns over the effect in their CountryReports. The number of unemployed youth is expected to increase dramatically, leaving themmore vulnerable to conflict and insecurity and threatening progress toward MDG achievement.The Central African Republic, for example, which is at risk of missing all of the MDG 1 targetsnotes, “The recent international financial crisis has made a huge impact at a time in thedynamics of the struggle against poverty. It undermines the significant progress made over thelast three years.Success toward meeting MDG 1 has many faces. In this section, the report examines the influenceof economic growth and how it can benefit all people. Despite the adage that “a rising tide liftsall boats,” experience shows that carefully crafted pro-poor development policies are needed tomake sure the surge indeed helps everyone. In addition, the report looks at how policies thattarget employment disparities, and programmes to modernize agricultural production have shownbenefits.Economic growthEconomic growth has been a prime catalyst toward eradicating poverty, reducing hunger andcreating productive employment. An expanding economy can offer more and better-paying jobsand with pro-poor development strategies, increased income can reach all strata of society.Many countries credit the buoyant global economy in the first years of the 21st century andparticularly high world prices for oil, minerals and other commodities with rising nationalincomes. But while national average incomes have risen, countries are struggling to ensureinclusive growth. Often, the benefits are not reaching the poorest segments of the population,usually in rural areas. In Botswana, for instance, where the diamond trade fuelled one of theworld’s strongest economicgrowth rates until the economic and financial crisis, the County Report notes, “In spite ofsustained overall economic growth, growth has been slow in the bottom income groups.Unemployment remains high, especially in the rural areas. The poor people who are inemployment mainly occupy low-paying jobs because of their education and skills.”But some countries have been able to narrow the gap between high- and low-income segments,helping ensure that the benefits of growth are more evenly distributed. Ethiopia, for example,has for years achieved a very low score on the Gini Coefficient, a common metric for measuringincome disparity. While poverty rates remain high, the rural poverty rate of 39 percent is onlyslightly higher than the urban rate, 35 percent. Growth and the nature of growth (whether it ispro-poor or not) has the most significant impact on reducing absolute poverty,” the EthiopiaCountry Report states, adding that it is on track to meeting the poverty goal by 2015.A key element to maintaining equality in Ethiopia has been the country’s agriculturaldevelopment led industrialization strategy, which focuses on modernizing the country’ssubsistence-level and inefficient agricultural production system. The strategy guided anintegrated effort that included improved vocational training for farmers, better landmanagement and more secure rights, market-based initiatives, targeted interventions in areasprone to flooding or with non-productive land, expansion of arable land, improved inputs such asbetter seeds and decentralized authority bolstered by better training, staffing and equipment fordistrict offices. By 2006, Ghana had already halved the proportion of people living in extremepoverty. The success was helped by foreign direct investment in the country and high globalcocoa and gold prices, but a vital aspect was an innovative approach that integratedprogrammes that included food transfers, employment initiatives and agricultural investments.Political security and developmentprogrammes carefully targeted to create inclusive growth were essential factors. However,Ghana’s Country Report also notes that, beneath this national success, some disparities remain,for instance with high levels of poverty in the northern regions. As part of its effort to correctthese disparities, Ghana is trying to diversify its economy away from gold and cocoa bypromoting non-traditional exports.Beyond the challenge of narrowing income gaps, particularly as national economies grow, manynations have had to contend with health problems that have taken people out of the productivemainstream and made them dependent on socials services. HIV/AIDS, in particular, has had adevastating impact on sub-Saharan Africa. Beyond the tragic human toll, the health challengeshave also slowed economic growth in many countries. The Lesotho Country Report explains, “The(HIV/AIDS) epidemic is concentrated in the productive age group, often the breadwinners. Itcommonly undermines the ability of individuals and households to feed and care for themselves,while eroding the capacity of communities and institutions to provide basic services and supportthe people in need.” In addition, women and girls are often taken out of education and productivework to care for the sick.Employment
  • 43. Several Country Reports, including Mauritania, indicate that growth in modern industries,particularly the mineral and oil sectors, is creating very few job opportunities. In the Republicof Congo, for example, economic growth relies heavily on the oil and mining sectors, but they arepoorly integrated with the rest of the economy and so have not led to the creation of a broaderrange of jobs. Also, creating jobs for unskilled labour is especially difficult, hindering effortsto disperse the benefits of economic growth more evenly. In the Central African Republic, loweducation, particularly among women and young people, is the main impediment to employment.The Country Report states that youth unemployment is more than twice the national averageand there is a strong mismatch between the skills offered by workers and the skills needed byemployers.But even as education levels improve, jobs may still be hard to find, particularly in socialsciences, leading to frustration and disappointment among young workers. In at least onecountry, Botswana, hundreds of students graduate each year who cannot find jobs. TheKyrgyzstan Country Report adds that inadequate vocational and technical training contributesto the unemployment among youth. “Job opportunities that are created, especially for ruralyouth, do not meet existing requirements in terms of remuneration, career prospects, laboursafety and the protection of rights of labour migrants,” the Country Report states. Countriesare tackling this problem through pro-poor job creation programmes, often focusing onopportunities for women, as well as targeted training in vocational and technical skills forlow-income households. The Kyrgyz government, with the support from internationalorganizations such as the Asian Development Bank, is implementing the “Second EducationProject,” which aims to help the general education system adapt to the requirements of themodern market economy, to increase coverage of education and to improve progress among pupilsin poor region.Nevertheless, disparities in employment patterns remain. In Syria, despite the estimated 250,000new entrants into the labour market annually, the percentage of employed youth from the agegroup 15-24 fell from 30.8 percent in 2001 to 22.2 percent in 2007 and then to 20.4 percent in2008. Employed women represented 6.2 percent of the number of employed men in 2001, but fellto 2.4 percent in 2008. Countries in conflict or post-conflict situations also face exceptionalhurdles. Disparities such as these could create situations that are prone to unrest. In Uruguay,the MDG Country Report notes that formalizing relations between employees and employers hashelped the country post significant employment gains that have reached into the countryside. In2005, the country expanded the use of wage boards to ease interactions between workers,employers and the government. These included wage boards for rural and domestic workers, twofields that historically had not been covered by formal labour relations.The Country Report indicates that the proportion of workers covered by wage boards rose from25 percent in 2005 to 100 percent at the time of the report. “The reinstatement of collectivebargaining contributed to the achievement of a higher number of registered workers, real wagegrowth and an increase in the number of jobs, estimated at about 160,000,” the Country Reportgoes on. “The trend in terms of formalization of labour relations suggests that it is feasible toreach the [MDG 1] goal by 2015.”NutritionMDG 1 also encompasses improved nutritional standards and, especially with the sharp rises inthe price of rice, wheat, corn and other food staples in 2007 and 2008, food security became apressing issue for many countries. In land-locked Burkina Faso, where the price of food staplesrose by as much as 44 percent in one year, “households had to restructure their budgets,spending more on food and less on other categories, such as health and education,” the CountryReport states. “Such coping strategies in the crisis as household incomes stayed unchangedwere detrimental to health and nutrition.” Acute malnutrition in Benin Because of thealarming state of nutrition of children under five in Benin, especially in the north,the government, supported by its partners, including UNICEF, began efforts to detect acutemalnutrition at early ages. Mass screening campaigns have been launched since June 2007throughout Alibori, where one of ten children under five was malnourished. Under theinitiative, all households are visited once a year for regular screening. In addition, theprogrammes increase community awareness of malnutrition and its management. In 2007,nearly 90,000 children under five received active screening. The detection of malnutritionhas been gradually integrated into the routine health system to ensure sustainability.Many countries have shown progress, however, by promoting micro-level solutions. Theseprogrammes often rest on the fundamentals of promoting good nutrition, for example byencouraging breastfeeding. The Country Report from Senegal notes that the government hasbegun the second phase of a nutritional programme that resulted in more mothers exclusivelybreastfeeding their babies, as well as other measures that increased calorie and protein intakeand improved monitoring of children’s health status. Backyard food production has also beenhelpful in meeting MDG nutritional targets and food security. In Lesotho, where the prevalenceof underweight children has been dropping since about 2000, the government has worked withvarious organizations to promote small vegetable patches and fruit orchards by offering seeds,saplings and building materials. In particular, the country encourages keyhole gardens, whichare small raised plots with layers of organic material that retain moisture better thantraditional beds in dry conditions.The integration of anti-poverty and nutritional programmes into a national agenda and thelaunching of initiatives that span several targets have emerged from the various MDG Country
  • 44. Repor t s as cl ear success f act or s. In Per u, t he Count r y Repor t descr ibes a coor dinat ed ef f or tam ong nat ional and l ocal gover nm s, int er nat ional or ganizat ions and civil societ y t hat entpushed pr ogr ess t owar d bet t er nut r it ion and heal t h. A s par t of t he init iat ive, 20 r egionalgover nm s, 638 m ent unicipal gover nm s and var ious ot her off icial and pr ivat e par t ies wor ked entt oget her t o com bat m nut r it ion. Ef f or t s incl uded pr ogr am es t ar get ing wom al m en’s l it er acy,pr enat al car e, heal t hy l if est yl es and heal t h car e f or wom and chil dr en. In addit ion, l essons on enhousehol d hygiene, ir r igat ion and anim husbandr y l ed t o nut r it ional and heal t h im ovem s. al pr entIn Egypt , t he gover nm int r oduced pl ast ic r at ion car ds, r epl acing l ess dur abl e and l ess secur e entpaper ones, t o hel p ensur e t hat f ood aid is get t ing t o t he r ight f am ies. In addit ion, t hese car ds ilar eexpect ed t o evol ve int o ‘f am y car ds’ t hat woul d ease access t o ot her gover nm ser vices such il entas educat ion, heal t h car e and pensions. In Niger , t he MDG Count r y Repor t descr ibes how an int er -agency ef f or t has accel er at ed pr ogr ess in t he Mar adi r egion, t he count r y’s poor est . Theinit iat ive was pl anned t hr ough incl usive consul t at ion am r el evant st akehol der s nat ional and ongr egional off icial s, t echnical and f inancial par t ner s and l ocal r ecipient s, am ot her s t o cr eat e onga pr ogr am e t hat st r ives t o im ove f ood secur it y and incom ease access t o basic m pr e,ser vices, dam popul at ion gr owt h and incr ease capacit ies of l ocal gover nm s. pen ent MDG 2: Achieve universal primary educationMDG 2 focuses on educat ion. Im oved educat ional oppor t unit ies, especial l y st ar t ing wit h t he prear l iest year s, opens t he door s t o bet t er incom and advanced agr icul t ur al pr oduct ivit y, hel ps ecom bat har m ul l egacy views of gender r ol es, al l ows peopl e t o m f ake sm t er choices arsur r ounding heal t h r isks and behavior s and of f er s a br oader view of t he envir onm and gl obal enteconom MDG 2 cent er s on univer sal access t o a f ul l cour se of pr im y educat ion. y. arDelivering educationBr inging univer sal pr im y educat ion t o a popul at ion r el ies ver y m ar uch on secur ing enought eacher s, f acil it ies, t ext books and t he ot her r equisit es of school ing. But success can cr eat eaddit ional chal l enges. In Ghana, t he MDG Count r y Repor t obser ves t hat one bot t l eneck it f acesis an “ insuf f icient num of school buil dings t o accom odat e t he gr owing popul at ion of pupil s, ber mespecial l y af t er t he int r oduct ion of capit al izat ion gr ant s and school f eeding pr ogr am es.” mGhana and ot her count r ies al so r epor t t hat , even when a count r y’s st ock of qual if ied t eacher s issuf f icient ( and in som cases m e t han t he num of j obs avail abl e) , t he st aff ing of r ur al e or berschool s, wher e posit ions ar e seen as l ess at t r act ive t han ur ban ones, r em ains a pr obl em “ The .dist r ibut ion of t eacher s is highl y skewed t o t he disadvant age of t he depr ived ar eas,” t he GhanaCount r y Repor t cont inues. The Maur it ania Count r y Repor t adds t hat l ow pay for t eacher s al soencour ages t hem t o shun r ur al post ing. “ The l evel of com pensat ion encour ages t eacher s t o st ayin Nouakchot t or in l ar ge ur ban cent r es wher e t hey can have com em ar y pl entgainf ul em oym ( t eaching in pr ivat e school s or hom or business) ,” t he r epor t st at es. pl ent eGhana is wor king t o cor r ect t his dispar it y in par t by of f er ing cr eat ive incent ive packages, whichincl ude bicycl es for t eacher s assigned t o post s consider ed l ess at t r act ive and gr eat er dil igence inenf or cing it s quot a syst em on t eaching assignm s, t he Count r y Repor t indicat es. In addit ion, t he entcount r y has expanded it s dist ance l ear ning pr ogr am e so t hat it can, am m ong ot her obj ect ives,al l ow t eacher s t o r eceive addit ional t r aining wit hout l eaving t heir cl assr oom A l ong wit h a s.l ack of wil l ing t eacher s, r ur al dispar it ies in pr im y school enr ol m ar e al so a r esul t of ar entm at or y cul t ur es in som count r ies, such as t he past or al ist s in Et hiopia, who m cont inuousl y igr e ovein sear ch of wat er and past ur es f or t heir l ivest ock. The Et hiopian gover nm hopes t o r each entm e of t hese m at or y com unit ies t hr ough it s m e school s pr ogr am e. In t his init iat ive, t he or igr m obil mcom unit y sel ect s a t eaching candidat e who is t hen t r ained and t r avel s wit h t he gr oup, of f er ing mcour sewor k t o t he young in t heir m her t ongue when t he oppor t unit y ar ises. Sim ar ef f or t s ar e ot ilbeing t r ied in Kenya and el sewher e. Many MDG Count r y Repor t s r aised concer ns about t eacherqual it y. For exam e, as pr im y educat ion becom m pl ar es andat or y, t he dem and for t eacher s r ises,l eaving gover nm s wit h t he unpl easant choice bet ween incr easing st udent - t eacher r at ios or enthir ing l ess- qual if ied t eacher s, at l east unt il a l ar ger suppl y of cer t if ied educat or s gr aduat es.“ A second chal l enge [f ol l owing r egional dispar it ies] r el at es t o t he t r ade- of f s bet ween t hesubst ant ial success in r aising t he l evel of enr ol m and t he qual it y of educat ion,” t he Et hiopia entCount r y Repor t obser ves. To com t his t r end, Et hiopia is wor king t o im ove t he st andar ds of bat pron- t he- j ob t r aining and sum er pr ogr am es for t eacher s, as wel l as cont inuing eff or t s t o m mr educe st udent - t eacher and st udent - t ext book r at ios. Inadequat el y t r ained t eacher s, ones who ar epoor l y paid and t hose at t ending t o t oo m any chil dr en al l del iver l ower qual it y educat ion. Factors impeding teaching quality: skewed teacher distribution that favours urban areas,insufficient classrooms and materials, low accountability of teachers to parents and children,no system to monitor and evaluate teachers, and low teacher commitment and motivation.Access to resources is a recurring issue. In some cases, like Nepal, more than 90 percent ofthe national education budget goes to teacher salaries and recurrent costs, leaving little forinvestment in books, laboratories and general building improvements, like proper sanitationfacilities for teachers and students.Building schoolsDistance to schools can be a significant barrier to achieving universal enrolment. In manycountries, programmes to bring schools closer to students have markedly increasedenrolment. Nepal, for example, has made considerable investment to ensure that more than90 percent of the student population is within 30 minutes from a school. In Botswana,officials cut the maximum distance to a school from ten miles to five.In noting that Burkina Faso is making strides toward universal education, the Country Reportcites among its efforts a focus on public-private partnerships, which has helped increase the
  • 45. country’s available classroom space by almost eight percent a year between 2000 and 2007.The country has also institutionalized the concept of free universal primary educationthrough changes in national legislation and has distributed free textbooks and other suppliesDropout ratesMany MDG Country Reports noted problematic dropout rates for primary and secondaryschools. Families are often discouraged from sending their children to primary schools bylong distances to the schools (often more than five kilometers), discomfort in sendingchildren to boarding schools at a young age, language barriers, the need for help duringplanting and harvesting seasons, a migratory lifestyle or unaffordable costs, whether forschool fees, uniforms or other expenses. Often, the reasons for students leaving school areclosely tied to the local economy and culture, as well as health challenges. The LesothoCountry Report observes that boys tend to drop out earlier than girls. “In Lesotho, the normhas been that boys from a young age tend to herd livestock and then migrate to take upwork in the South African mining industry,” the Country Report indicates. Early marriage andpregnancy are also strong reasons that girls is evidence that parents are more likely to keepThe Rwanda Country Report states, “There drop out of secondary school in many countries.their children in school if they will be able to continue into the secondary phase. Theintroduction by the government of free basic education, enabling all children to attendschool until the end of the junior secondary phase, may have a positive impact on primarybe low, and many countries struggle to clarify the benefit of education, especially to parentswho never attended school. In Benin, ‘Mothers’ Clubs,’ which started as a local initiative in2004 and are led by the communities themselves, increase the awareness of parents byexplaining the need for schooling through public meetings and home visits, with specialattention paid to the education of girls. These clubs serve as an interface between parentsand schools. They also identify and register school-age children, again with a particular focuson girls. Moreover, the clubs identify children without birth certificates and assist children indifficult circumstances by giving them school uniforms and supplies. The clubs are alsoadvocates for vulnerable children to authorities, managers and social promotion centres andmonitor the progress of children. A National Federation of the ‘Mothers’ Clubs’ was createdin 2009. Other countries have created demand for primary education by introducing orexpanding preschool programmes and through grants, food programmes and other effortsGender disparitiesGender inequality is also a pressing concern for governments as they work to createuniversal enrolment in primary school and often further into secondary school. Generally, agreater proportion of boys than girls attends and completes a full course of formaleducation. Egypt and Lesotho are among the exceptions, with girls more likely to completeprimary school than boys. The MDG Country Report from Egypt attributes this to the successof the Girls Education Initiative, which was launched in 2003 and led to the creation of‘female-friendly’ schools where Grade re petition evidence Several Country Reports, includingthe Republic of Congo, indicate that there may be a link between dropout rates and graderepetition. “Families might view repetition imposed on their child as if they are not successfuland do not benefit from attending school,” the Republic of Congo Report states.“Repetitioninvites parents to remove their child from school. These negative impacts of repetition areEducation has wide-ranging effects throughout society and links directly to poverty-reductionefforts. Poverty levels are lower among families in which the head of the household has hadsome education than in those where the head of the household has no education. In Serbia,the poverty level was three times the national average in households that were headed bysomeone with no education. Education is also directly related to improved health. In Syria in2008, 77 percent of the mothers who had a child who died prematurely were illiterate orhad not finished primary school. Educated mothers are also much more likely to have theirchildren immunized. Countries should watch the adult literacy indicator to ensure that effortsto increase enrolment and keep children in school truly produce a better-educated
  • 46. MDG 3: Promote gender equality and empower womenFrom the Country Reports, governments have approached the issue of gender equalityfrom many directions. Among the critical steps the report looks at in this is legal reform thatcreates a national framework establishing the principles of gender equality. In addition, itexamines measures focused on placing woman in elected posts, improving their educationalLegal empowermentFor many countries, major steps made toward gender equality have included drafting anappropriate legal framework and building representation of women on the nationallegislations that create those laws. The principles of gender equality have been written intothe constitutions of some countries, but individual laws have often had to be changed orrepealed altogether to reflect adequately the principles of gender equality set out in theCommittee on the Elimination of Discrimination Against Women (CEDAW) and reflected inMDG 3. In many countries, legislation dealing with inheritance rights, land rights, assetownership, access to credit and protection from violence, has beenempowerment of womenthat resources must focus on strategies to facilitate the legal scrutinized and revised toenvisaged in legislation. This includes mechanisms to enhance access to justice for womento know, assert and protect their rights. In those countries affected by HIV/AIDS, armedconflict, and poverty resulting in a sharp rise in widowhood and subsequent girl- and female-The Mauritania Country Report, for example, notes that the low socio-economic status ofwomen is preventing their access to information and their capacity to claim their rights.“National or international legal provisions are poorly implemented due to the lack ofresources, capacity and willingness of decision makers,” the report explains. “There are veryfew opportunities for women to assert their rights, including lack of childcare and accessibleGovernmentCountries are also working to increase the proportion of women in national parliaments orlegislative bodies. In Burundi, for example, constitutional provisions mandate that womenoccupy at least 30 percent of the senior legislative and executive posts in government, butthe Country Report adds, “According to the current situation the road ahead is still long toachieve this objective. Indeed, although women represent 51.1 percent of the populationand are an important production force in a national economy based on agriculture, theyremain relatively marginalized due to cultural constraints that limit their full emancipation.And despite the guarantees stipulated in the Constitution, it should be noted that womenremain poorly represented in decision-making.” Burundi and others are tackling theseproblems continued gender disparities and lack of awareness partly through programmesthat incorporate these issues into the overall national strategy of poverty reduction anddevelopment. In Rwanda, constitutional change followed vigorous lobbying by women’sOther countries are helping women create networks and offering other services to helpthem enter the public sphere. Botswana, for example, held a series of workshops aroundthe country to assist aspiring female politicians in areas such as assertiveness and navigatingin a male-dominated environment. The country also initiated an awareness campaign thatadvocated female representatives in local and central governments, which the CountryReport cites as a contributing factor to the election of three women to mayoral positions inEducationAccess to education, through primary school and beyond, is also a critical factor in creatinggender equality and, as more countries adopt the principle of universal primary educationthe focus is beginning to shift toward preventing girls from dropping out. “The mainchallenge is the ability to keep girls in school once enrolled, including up to secondary leveland higher,” explains the MDG Country Report from Niger. “This requires improvements inproductivity among poor households to enable them to reduce the opportunity cost ofsending girls to school. Thus, this issue covers the whole challenge of reducing poverty.” InGhana, where the MDG Country Report puts it on track to fulfilling MDG 3, the country hasinitiated“Active efforts that make of activitiesinto promoteattractive option for girls. Amonghome. some implementation remaining school an girls’ education has helped toeliminate barriers to enrolment and encouraged participation and attendance,” the CountryReport states. Data from the Country Reports show that Ethiopia, Ghana, Mozambique and
  • 47. bringing it above 0.90. But school completion rates for girls remain a challenge, especially inlater years. In Nepal, for instance, the median age for marriage is 17 years for girls, leadingto high dropout rates. Targeted scholarship programmes for girls, school meals and oil-for-HealthEfforts to promote healthy lifestyles and disease prevention, detailed in later sections, arealso necessary to create an environment in which women and men have equalopportunities. Women and girls generally spend many hours a day doing households choressuch as getting water and fuel or caring for children. In addition, HIV/AIDS has The Girls’Empowerment Programme in Rwanda With few role models, low expectations by teachersand others and a stereotyped perception that these are ‘boys’ subjects,’ girls in Rwanda oftenperform poorly in these subjects at the secondary school level. To change this, the Girls’Empowerment Programme was piloted at the Kigali Institute of Science and Technology in2006 and aims to increase girls’ access to degrees in science, mathematics and engineering.The small-scale programme has enabled about 100 young women whose grades narrowlydisqualified them from acceptance to these programmes to attend the institute to pursuescience, mathematics or engineering degrees. Later evaluation showed that women whograduated from the programme and went on to study at the institute did extremely well. Theprogramme forward. Countries reported that girls are often taken out of school to supportthe household when members are stricken with HIV/AIDS or some other critical healthproblem. In addition, control over their own health options, which often starts with“Low utilization of existing health services by women is an obstacle to their enjoyment ofreproductive rights, [and] increased vulnerability of women to sexually transmitted infectionsand HIV/AIDS is also a major challenge,” warns the Country Report from Ethiopia, whichechoes other Country Reports when it observes, “In a country like Ethiopia the notion ofEmploymentLegacy institutions and attitudes also prevent women from finding salaried employment innonagricultural jobs. In many countries, unemployment among women can be twice as highor more as that among men. And while even in the developed markets earning powerbetween the genders still favours men, the gap widens substantially in less-developedmarkets. In Egypt, for example, the unemployment rate among women was 23 percent in2009, more than four times the rate among men, the Country Report indicates, and it haddoubled since 1984. The trend highlights one of the emerging issues cited in the EgyptCountry Report: “The vulnerability of women in the global financial and economic crisisCoordinated by several government agencies, including the Ministry of Investment, theprogramme recognizes companies that are publically committed to internal effortspromoting gender equality in hiring, wages, and promotions. The certification is valid for twoyears, after which participating companies must undergo a renewal audit to continue therecognition. Pay differences between the women and men are also common. In Ukraine, thegender gap in income level is significant, with the Ukraine Country Report stating that theaverage income of women was 65.2 percent that of men. In Nepal, men earn about 45national budget in Nepal addresses gender imbalances, either directly or indirectly.Violence against womenIn many countries, violence against women (VAW) remains a serious impediment towardachieving gender equality. Without fundamental protections against physical and mentalharm, progress toward equal social, economic and political rights is nearly impossible. InMorocco, the government included as part of its national strategy a plank to tackle violenceagainst women. The Country Report notes the need for “a societal awareness andsensitization approach to influence and change behaviour in this area”. Together withinstitutions and civil society, the government is organizing annual social mobilizationcampaigns to raise awareness. In Papua New Guinea, about two thirds of all married womensuffer violence inflicted by their husbands. The country’s Law Reform Commission notes that67 percent of rural men believe that it is acceptable for a husband to hit his wife. The
  • 48. Botswana and Mozambique, for example, recently passed laws to protect women fromviolence, including domestic violence. Ghana already has a constitutional ban on gender-based discrimination, but has also enacted legislation to protect men and women fromdomestic violence. Some countries have moved toward laudable implementation of theselaws through training of police (Togo) and the creation of domestic violence victim supportThe multi-sectoral Tamkine programme in Morocco fights violence based on gender andseeks to empower women and girls. The initiative includes several projects, such as anational survey on the prevalence of violence based on gender, a survey on men’s andwomen’s daily activities, a review of the country’s penal code (which led to the amendmentsin articles related to discrimination) and a review of the law on domestic violence againstDataWhile the presence of gender disparities is beyond dispute, many countries report difficultiesin assessing the breadth of these gaps. Poor data and monitoring systems make it difficult tomeasure the progress of programmes designed to close these gaps. In many cases, nationaldata is not disaggregated by sex and, when data is available there is often insufficientinformation to determine whether changes in the numbers are the result of a programme’s“If the current national statistical system allows conducting of gender analysis of data onpolitical representation, economic pro-activeness and employment, income capacity ofpopulation, then obtaining reliable data on displays of indirect discrimination in the labourmarket, intra-family distribution of power and resources, family violence or illegal labourmigration will be possible through conducting special studies,” the report continues. Theabsence of such data complicates the country’s ability to monitor regularly gender indicatorsand to assess the progress toward gender equality. To counter this obstacle, countries haveintegrated gender issues into other programmes such as education and health care. Amongother benefits, such mainstreaming helps create gender awareness in a broader swath ofdata-collection efforts. Indeed, integration ofof women to a country’s stock of assets. Theeffectively adding the muscles and minds gender equality issues with a diverse range ofCentral African Republic, working to lift itself from a post-crisis environment, notes in itsCountry Report, “With the many problems facing women in the Central African Republic,their resolution requires all actors (the government, civil society, the private sector andcommunities) to child mortality, and MDG 5: Improve maternal health of equality and MDG 4: Reduce show ingenuity and creativity to meet the challengeMDG 4 and MDG 5 are the first two of three Millennium Goals that focus on health issues.Because the health issues along the spectrum ranging from pre-natal care to childhoodimmunization are intertwined and often affect the well-being of both mother and child, thereport analyses the findings from the MDG Country Reports on these two targets together.The objective of MDG 4 is to improve the standard of children’s health, and the report looksclosely in particular at infants and children under five years of age, as well as the extent ofmeasles immunization. The lens shifts to focus on maternal health in MDG 5, where thetargets are to reduce maternal mortality by three quarters by 2015, compared to 1990levels, and achieve universal access to reproductive health services. Analyzing progresstoward these targets includes indicators such as teen pregnancies, proportion of birthsWell-known interventionsInterventions to improve overall health care standards are generally well known. Forexample, the Kenya MDG Country Report notes that attaining childhood health targets “isdependent on scientifically proven interventions, such as prenatal care, essential obstetricand newborn care, immunization, use of insecticide treated nets, breastfeeding, vitamin Asupplementation and appropriate management of common childhood illness, including oralnetwork. In Egypt, which is on track to reach the MDG target on under-five mortality andadvances in maternal health are also generally on track, the Country Report reflects fearsexpressed in other reports, stating, “The impact of the global interrelated financial and
  • 49. child health, can be reflected in the possible reduction in the national budget allocated forhealth care. Any cuts would end in underinvestment in training, weak incentives andinsufficient equipment and supplies for obstetric care. This is also coupled with reducedinternational financial assistance repeatedly spurred rapid progress towardhealth andtheImmunization programmes have to the country, especially for maternal achieving familyMillennium child and maternal health targets. In the Occupied Palestinian Territories, forinstance, the percentage of children immunized against measles increased from 49 percentin 1996 to 96.8 percent in 2006.CapacityPrenatal and postnatal care are necessary to promote a healthy pregnancy, delivery andinfancy. In Papua New Guinea, the proportion of mothers attending antenatal clinics fellfrom 68 percent to 60 percent from 1995 to 2008, while the proportion of births attendedCountries that have found ways to reach mothers and newborns with skilled medical staff,however, have shown progress. In Botswana, 84 percent of the population lives within fivekilometers of a health facility and 95 percent lives with eight kilometres, which helped cutinfant mortality by one half. Such effective service delivery was achieved throughpartnerships with the private sector, civil society and international parties, which togetherdirectly offered services and financing. Many countries have expanded facilities for prenataland postnatal care, but haveprofessionals increased from 82by a shortage of qualitypercent“Antenatal care from health found themselves constrained percent in 1988 to 95 healthin 2008. However, lack of information on signs of pregnancy complications and access tobasic laboratory services, particularly in the Northern and Upper West regions, affect thequality of antenatal care. In the Northern and Upper West regions, only 6 in 10 pregnantwomen and 2 in 3 have access to urine testing and blood testing, respectively. These arerituals associated with a woman’s life cycle. Rather than excluding these women from themodern health care system, the Egyptian government has recruited from among the day asin Upper Egypt and provided training in modern midwifery. The programme had beeninstrumental in advancing toward the government’s goal of having sufficient nurses orReproductive health and family planningThe Yemen Country Report states that one third of the total maternal mortalities are amongwomen aged 20 years or less. Teenage pregnancies put both the mother and child at risk ofmortality. The Niger Country Report adds that an important constraint to improved maternalhealth is also related to behaviours such as infrequent use of contraceptives, which results inpregnancies that are too close together, or low participation of women in decision makingwithin the marriage. The scarcity of goods and services for reproductive health care is achallenge for countries trying to improve family planning, as Country Reports from theDemocratic Republic of the Congo, Mauritania and Mozambique note. And the KyrgyzstanCountry Report cites as another constraint that “the awareness of the population of familypregnancies and, consequently, unsafe abortions. Several Country Reports indicate thatcontraception use is increasing, although progress is slow in some countries. In Mauritania,access to contraception has been hampered by opposition from some religious groups, theunavailability of contraceptives and the low technical capacity of providers. In Burundi,medical staff increased efforts to educate and sensitize women to use contraceptivemethods. The Country Report states, “This development would also result in outreach effortsand local communication and the availability of more modern contraceptive methods inhealth facilities.” In Ethiopia, 90 percent of the country’s health care facilities carried stockedat least three contraceptive methods. The most commonly available methods in bothhospitals and health centres were injectables, combined oral contraceptives and maleAwarenessAlong with working on the supply side of health care, many Country Reports record theneed to sensitize people, especially those with little education, about when to seek medicalassistance. According to several Country Reports, the mother’s level of education is inverselyrelated to the risk of death to both mother and child. The Rwanda Country Report states,“There are substantial differences between the mortality rates for the children of women
  • 50. fathers will identify symptoms and seek help through national awareness campaigns.Ghana, for instance, declared maternal mortality a national emergency in 2008, offering aGovernment coordinationIntegration of services is also a recurring theme as countries address the challenges of MDG4 and MDG 5. A counter example from the Lesotho Country Report helps explain the needfor integration. “Services for children are not integrated with health services for mothers,” thereport indicates. “This means that available resources to improve the health for both childand mother are not efficiently used. There is also an urgent need to mobilize resources andstrengthen partnerships for maternal and child health services to operationalise fully theThe combining of maternal and childhood health care initiatives with programmes targetingthe HIV/AIDS epidemic has been an important facet of integrated services. Especially in Sub-Saharan African, the close connection among HIV/AIDS, maternal health and early childhoodhealth makes integration of these programmes vital. In Botswana, the Country Reportrecounts that 58 percent of the deaths of children under five years of age can be directlyattributed to HIV/AIDS. The Country Report adds that the government is working to integrateHIV/AIDS and other health programmes, for example by supplying free antiretroviralmedicines to all infected children under two years of age. In addition, noting that HIV/AIDSprogrammes have overshadowed maternal health efforts, the report states the governmentis also moving to integrate more closely initiatives on sexual and reproductive health,HIV/AIDS and family planning “to better tackle some challenges to maternal health.” TheMDG Country Report from Togo explains, “Taking into account the scarcity of resources,integration of interventions is an effective strategy for the achievement of the MDGs.” The MDG 6: Combat HIV/AIDS, malaria and other diseasesMDG 6 calls on countries to stop and reverse the spread of HIV/AIDS and to secure universalaccess to antiretroviral drugs for people living with HIV/AIDS by 2015. For many countriesfighting their way out of poverty, the ravages of HIV/AIDS represent not only a singularhealth crisis, but also the single greatest obstacle to economic growth and well-being. In2008, sub-Saharan Africa accounted for almost three quarters of the global deaths related toAIDS and for about two thirds of those infected with HIV worldwide. In Asia, about 6 millionhouseholds will sink into poverty between 2008 and 2015 as a result of the economicconsequences of AIDS, based on an estimate by the Commission on AIDS in Asia. Despitesignificantnational health insurance to treatment,Another successful health care interventionGhana ’s gains in universal access programme significant gaps remain for most countries.brought up in the Country Reports was a national health insurance programme launched inGhana. The programme was started in 2004 and costs most individuals about $8 per year; anational sales tax and a portion of social security contributions from those working in theformal sector finances the rest of the programme. Indications suggest that insured peopleare more likely to seek medical care when ill and their costs are much lower than those ofthe uninsured for example, $2 to deliver a child compared with $18. “These early findingsindicate that health insurance with high population coverage can broadly increase healthcare utilization and financial protection in sub-Saharan Africa,” the Ghana Country Reportconcludes, although challenges remain in increasing efficiencies, reducing waste andbroadening the programme’s accessibility to the poor malaria, tuberculosis and other deadlydiseases, striving to halt or reverse the spread of these diseases by 2015.Counter to the pattern of problems targeted by other MDGs, prevalence of HIV/AIDS tends tobe concentrated in cities where the urban lifestyle exposes residents to greater risks. In somecases in sub-Saharan Africa, the urban prevalence of HIV/AIDS can be up to four times thenational average, allowing governments to focus their HIV/AIDS interventions of cities. Incountries with the highest prevalence rates, however, the regional disparities are lesspronounced. In Lesotho, for example, which has the world’s third highest prevalence of HIV/AIDS, the Country Report notes that urban prevalence is 28 percent compared with 21
  • 51. created enabling environments. In addition, the section looks into measures that countrieshave taken againstand other diseases. malaria, tuberculosisHIV preventionImproved education and awareness about HIV/AIDS are vital steps toward preventing newHIV infections and stopping its spread. In South Africa, President Jacob Zuma, despite acontroversial record, has raised awareness and helped remove the stigma associated withHIV testing by announcing the results of his own tests (negative) in 2010 and announcing acampaign to test 15 million South Africans over the next year. MDG Country Reports recountefforts that focus on a more grassroots level. The Occupied Palestinian Territories, forexample, have standardized and supported a set that had been sex education with past, inand prevention programmes to at-risk groups curriculum on neglected in the a focusparticular those in uniformed services, prisoners, migrant workers, herd boys, adolescents,Having multiple concurrent partners helps fuel the epidemic, and reducing the incidence ofsuch relationships is thus an important pillar of prevention strategies in hyper-endemiccountries. Botswana, the country with the second highest prevalence of HIV/AIDS, launcheda high-profile awareness campaign in 2009 targeting individuals with multiple concurrentpartners. As part of that campaign, “local theatre groups were trained to deliver a play thatdemonstrated how multiple concurrent partnerships spread HIV in an entertaining andvisually appealing way,” the Country Report notes. In addition, prominent musicians werebrought in to attract crowds to the performances, and, following the performance,community workers milled through the crowds to discuss prevention measures andwould change their behaviour as a result.” Botswana has also taken a leadership role inrolling out safe male circumcision, one of the newest tools in the HIV prevention arsenal.The country aims to circumcise safely 500,000 men over five years. Already, many healthcare providers have been trained in the procedure, and the government has promoted it toCondom use is another central pillar in preventing the spread of HIV. Unfortunately, rates ofcondom use are quite low in many countries. In Lesotho, for example, condom use amongthose with multiple concurrent partners is 51 percent among men and only 38 percentamong women. On the supply side, one of the bottlenecks cited was lack of logistics support,especially coordination in procurement among different national and international partners.A central aspect of many prevention programmes is stopping mother-to-child transmission ofHIV infection. Following good practice and making highly effective antiretroviral therapyavailable to pregnant women with HIV infections, Botswana has reached 94 percent ofpregnant women with HIV, reducing transmission rates to less than 4 percent and expectingthe rate to drop to below 1 percent by 2016 as availability of treatment becomes universal,the Country Report indicates. Part of the success is attributed to integrating HIV/AIDStreatment and counseling with antenatal clinics, as well as involving men and providingpsycho-social support. Monitoring and data collection are other facets of prevention,allowing governments to track trends in HIV infection and measure the effectiveness ofpolicy initiatives. The Lesotho Country Report recounts, for instance, that an analysis of themodes of transmission in the country has provided valuable evidence for the developmentand implementation of effective HIV/AIDS interventions. In Botswana, routine exercises togather data on HIV/AIDS, supported by a computerized data-input system at the clinic level,have fuelled some of the country’s successes against the disease. “Policy is directly informedby the growing amount of information gleaned from careful analysis of statisticalparticularly useful in countries like Swaziland where the family unit has broken down and alarge number of children are orphans or living with single parents and preventativemeasures among young adults. Unfortunately, monitoring of the HIV epidemic is typicallyweakest among thosedrug users. at-risk, such as sex workers, men who have sex withmen and intravenous groups mostHIV treatment
  • 52. MDG 6 also calls for universal availability of HIV/AIDS treatments and antiretroviral drugsthat can prolong the life of those infected with HIV and allow healthier lives. UNAIDSestimates that, in 2008, at least 4 million people had access to antiretroviral drugs in low-income and middle income countries.4 Although this is a significant improvement fromearlier in the decade, it suggests that only about 40 percent of those needing treatment haveaccess to antiretroviral drugs. A successful antiretroviral programme in Botswana hasbroughthighest in the world.” AIDS deaths in Botswana fell by 50 percent the Country Reportare the antiretroviral coverage to well over 90 percent in some areas, between 2003 and2007. The success in expanding treatment availability is mirrored with high rates ofadherence to treatment protocols (93 percent of people on antiretroviral treatment after 12months in 2010) and a low rate (4 percent) of secondary resistance developing. Yet, thesuccess of the programme and population increases mean that the number of people livingwith HIV will grow to more than 350,000 by 2021, with the number of people receivingantiretroviral treatments also increasing. “Lack of human resources is the number onechallenge faced by the HIV programme,” the Botswana Country Report avers. “The Ministryof Health requires an estimated 20 new clinics a year […], with the underlying concern thathave arisen,” it indicates. “These include sharply increased volumes at the health-centre level,where a registered nurse or nurse clinician is the only clinical provider on the centre staff.” Aspart of the solution, the government has approved the use of data clerks in health centres toreduce the paperwork burden on medically trained staff and allow them to focus more ontreatment. In addition, the Country Report continues, supervising medical officers have beenHIV care and supportIn addition to treatment, people living with HIV/AIDS also require care and support as theytry to maintain healthy and productive lives. According to the MDG Country Reports, manycountries have launched community-based efforts to help those living with HIV/AIDS handleLinked to community care and support is the need to create an enabling environment thatallows people to be tested and seek treatment without fear and, particularly for women, tobe empowered to make meaningful choices that affect their sexual and reproductive health.mustintravenous drug users legislation or institutional human rightsexample, undermineand also examine national that not only infringe on attitudes for but also toward high-riskefforts to combat the epidemic. Some countries have already made some headway on policyreforms to protect people living with HIV from discrimination. Countries that recently passedsuch laws include Botswana, the Democratic Republic of the Congo, Mozambique, Togo andUkraine. Often, the main challenges of implementation are two-fold: lack of awareness ofrights among individuals and lack of enforcement and implementation structures, includingministerial regulations. Progress can also come with setbacks, however. The sameMozambique law that dealt with a suite of human rights Country Reports routinely cite thestigma and discrimination attached to HIV/AIDS as a prime obstacle to prevention, treatmentand care and support. For example, the Ghana Country Report states, “Stigma anddiscrimination against persons living with HIV/AIDS is quite high, coupled withmisconceptions about the disease.” Changes in behaviour and norms within a communityFurthermore, the Mozambique law penalizes ‘vices against nature,’ which could be construedto mean consensual sex among same-sex partners. Togo also still has laws that make sexwork and men having sex with men crimes. Unfortunately, these countries are not outliers.An enabling community environment also empowers its women to take control of their ownchoices and actions. Among other disparities, the MDG Country Reports repeatedly note thatwomen have a higher rate of HIV prevalence than men. This is often rooted in uncheckedgender-based violence, women’s inabilities to assert control of their own sexual activities,including safer sex negotiations, and their economic exclusion, which leaves many womenwith few options for three times more likely to be living with HIV/AIDS than young men.”Young women are a livelihood beyond commercial or transactional sex. A stark illustrationWhile this is an extreme case, the powerlessness of women is echoed in many of the
  • 53. the primary tools used by countries to combat the prevalence of HIV/AIDS among womenand its root causes. Often, these efforts are coupled with other programmes targeted atimproving women’s health. In Ethiopia, for example, the Country Report notes that voluntarycounseling and testing for HIV/ AIDS have been incorporated into the country’s existingantenatal services and are available in are of the country’sto control malaria, tuberculosisIn addition to HIV/AIDS, many countries all also struggling hospitals and health centres.and other life-threatening diseases, including hepatitis and schistosomiasis. Many of thesediseases are closely linked to environmental issues, such as unsafe drinking water and poorsanitation,intervention against malaria is the distribution and use of insecticide-treated bedA proven and are exacerbated by the prevalence HIV infections. Malaria in particular is anets. Distribution efforts are often hindered by a lack of resources and logistical bottlenecks,though as several Country Reports noted. And while some Country Reports note that morethan one half of the targeted population has received treated bed nets, they add that theprogrammes will need to be accelerated if complete coverage is to be achieved by 2015.Resource shortages are hurting efforts to improve drinking water and sanitation facilities, aswell as procurement of direct observed treatment short course (DOTS), the common courseagainst tuberculosis. Integrated efforts that combine several interventions have been themost successful, based on the Country Reports. For example, Burundi states that it is tacklingmalaria through a programme that combines insecticide-treated nets (focusing on pregnantwomen and small children), spraying of housing and public buildings, testing and prompt MDG 7: Ensure environmental sustainabilityMDG 7 takes a longer-term view of national development and efforts to reduce poverty, toensure food security and to create the infrastructure needed to underpin social and healthcare advances. In doing so, it considers the protection of natural resources and an area’sbiodiversity. In addition, this Millennium Goal calls for significantly better access to safedrinking water and basic sanitation, as well as improved living conditions for people living inslums. The Country Reports show that, although there has been progress toward thesetargets, many countries are struggling with environmental sustainability. In addition, MDG 7has produced a wide range of ambiguity, with data often insufficient to allow assessment ofWhile developing countries generally have some history of addressing poverty, hunger andhealth issues, most are new to issues related to environmental protection. Until recently,these have been given a lower priority than more immediate demands. But heightenedglobal awareness of the value of natural resources whether clean air, pristine water, rich For example, evidence clearly shows that child mortality is disproportionately high amonghouseholds with poor access accounts for the majority of infant deaths in areas whereSanitation facilities. Diarrhea to safe water and improve people do not have access to improved water facilities. Access to modern energy services: Access to energy, especially in rural areas, is a recurring theme in some Country Reports interms of impeding the prospects for increases productive entrepreneurship, growth andaccelerated progress across the MDGs. In sub-Saharan Africa, for example, more than 75 lacks access to electricity. In South Asia, more than 50 percent of the rural population ormore than 300 million people lack access to electricity. The direct and indirect links betweenthe provision of energy and accelerated progress across the MDGs are increasingly evidentthrough some bold initiatives. In addition, nature conservation is one of the four pillars ofthe country’s “Gross National Happiness “development strategy. Systems in more than 2,163rural households, 4,700 toilet-attached biogas plants and 11,500 improved cooking stoves.The initiative has affected all MDGs, with particular benefits to women and girls. In BurkinaFaso, Ghana, Mali and Senegal, the adoption and provision of access to cleaner, morereliable fuels have created income generating opportunities, particularly for women. EasyData and monitoringMany countries are just initiating data collection and monitoring efforts, and some arefinding it difficult to allocate the proper resources. The Lesotho MDG Country Report
  • 54. challenge. Because of the nature of the task, detailed, time-consuming and costly studiesneed to be taken by qualified experts. The resource competition that exists within ministriesmay often favor projects that focus on improving the material circumstances of thepopulation over designedthatcapture data on the environment from various sources. fill theSystem, which is projects to are focused on gathering statistics.”In an attempt to “Whilethere are still gaps in the data and the quality is weak, the system itself is a majorimprovement and in coming years is expected that much more reliable data and informationwill be available,” according to the Country Report. The Country Report cautions, though,that a Country Reports note. The Lesotho Country the statistical analysis needed for themany shortage of human resources could impede Report recounts, “A large number ofseedlings are planted each year, but no system exists to determine the survival rate of thesetrees.” In many countries, farmers continue destructive slash-and-burn methods to clear landand governments have nothing in place to spot and stop this illegal practice. At the sametime, there is no system in many areas to ensure, for example, that mining companiesreclaim the land once it is no longer viable for their uses. Insufficient capacity is often behindthese problems in data collection, monitoring and other shortfalls in moving towardenvironmental sustainability. Country Reports note, for example, that efforts are oftenLand managementCountries are also finding that economic growth, generally desired as a factor in reducingpoverty and making other social gains, is putting significant pressure on natural resourcesand the environment. Increased private, commercial and industrial demand for water issparking shortages. Urbanization and the need for more arable land are drivingdeforestation in many countries. At the same time, external shocks effective legal system, tomore land for crops. Modern land management, guaranteed by an have crimped efforts isthe keystone to achieving the first two targets of MDG 7 (reversing the loss of environmentalresources and preserving biodiversity) and to resolving many of the resource-based conflictsthat accelerate environmental degradation. The MDG not take Report from Ethiopia explains,such as settlement and investment activities that do Country into account biodiversity, theabsence of a land use policy and land use plans as well as increasing amounts of toxicAs an initial step toward effective land use, many countries are requiring some companies toobtain environmental permits or produce an environmental impact statement before theybegin work on a project that could be detrimental. In Lesotho, for example, theEnvironmental Act of 2008 requires certain public and private projects to file anenvironmental impact assessment before beginning work. “This is an effort to ensure thethe 2008 Environment Bill was signed into law, many projects were already voluntarilysubmitting environmental impact assessments (EIAs).”Water managementWater management is also a critical issue linked to land-use management. On the one hand,governments face an urgent need to supply safe drinking water to a growing population,while, on the other hand, they need to create sanitation systems that safely treat or re-useNot surprisingly, many of the immediate improvements in providing safe water andimproved sanitation have focused on cities. Improvements in the countryside have beenslower. While noting that Lesotho is on track to meet the safe water target by 2015, theCountry Report adds a cautionary note relevant to many countries, stating, “Over this periodthe improvement in access to water has largely been concentrated in urban areas. Providingwater in rural areas presents a difficult technical challenge and the lower density ofsettlements means that further incremental improvements become progressively more costlyto achieve.” Basic sanitation improvements face similar disparities and obstacles. In BurkinaFaso, a system of water towers and pipes made safe water available to 1,300 villagers ataffordable prices, which had the added impact of radically reducing the workload of women.Nevertheless, there are some counterexamples. In Benin, for example, the infrastructuredevelopment focused on creating access to potable water proceeded without ensuringReforestationAnother aspect of MDG 7 is reforestation, which is linked to preserving biodiversity andcreating sustainable development. While many efforts remain in their infancy, the Country
  • 55. to drought was reduced through large-scale reforestation programmes supported by thetransfer of land ownership from the state to local communities. In another interestingprogramme, Egypt has combined wastewater management with reforestation. Under theprogramme, the government will ultimately use 2.4 billion cubic meters of treatedwastewater to irrigate desert lands for forestry. The Country Report indicates that 26,000feddans of land (roughly 27,000 acres) of desert land have already been cultivated under theprogramme. The target is to create 400,000 feddans of forest altogether. Urban conditionsCrowded, unsanitary urban living conditions are also targeted by the aspirations of MDG 7,Reports, Egypt and Ethiopia both cite programmes that are expected to encourage small-andMedium-sized enterprises and to support micro-lending in these areas. Additional effortsinclude community-based urban works programmes and the creation of low-cost housing. MDG 8: Develop a global partnership for developmentThe final Millennium Goal takes broader view of development that supports national effortsto achieve the other MDGs. Among a diverse set of targets within MDG 8 that range frominternet access to flows of official development assistance, one of the clear prioritiesencouraged by the Millennium Goal is integration with the global economy with equalopportunities through assistanceOfficial development market access, international cooperation, debt policies and fiscalIndividual Country Reports testify to the efforts national governments are making to becomemore self-reliant, although the continued need for official development assistance (ODA)remains clear. For Benin, the mobilization of ODA to finance the MDG financial gap, which isestimated at 12 percent of gross domestic product (GDP), is a major constraint. Niger’s andSwaziland’s Country Reports cite that ODA has been falling over the years. Liberia, on theother hand, continues to make marked progress in attracting significant donor support,which has allowed60 percent of the committed aid wasprogress in The Nepal Country2007/08, less than the country to make enormous disbursed.” good governance,Report suggests that some of the shortfall could be explained by mismatched fiscal yearsbetween donors and recipients and management capacity constraints, then continues that,more importantly, significant aid funds do not actually come through the government’sbudget, but rather via payments to consultants and purchases of donor home country goodsand services. Donors also tend to place compliance requirements for disbursement and tolean toward direct funding to meet their own agenda and to safeguard aid money, thereport continues. Most countries expect a decline of ODA in the coming years as developedcountries feel the impact of the global economic crisis, although initial data suggest aid hasactually increased.9 Under such uncertainty, countries find it difficult to hold theinternational community to their MDG commitments. Another challenge, mentioned in theSyria Country Report, is that conditions tied to ODA are placed on recipient countries. ForDonor coordinationWhile developing countries can take greater steps to integrate with the world economy, alack of donor coordination and cooperation is a significant obstacle to meeting the MDGs,especially for the least-developed countries. The DRC, for example, has a large number ofdonors supporting the country’s development programme, but wants to ensure that thefunds are could address this problem. A programme approach would avoid resources beingapproach distributed according to needs and skills, to reduce transaction costs and towasted by the need to coordinate simultaneously with multiple implementation agencies9 World Bank and International Monetary Fund (2010), Global Monitoring Report 2010: TheMDGs after the Crisis. many countries trade in raw material and manufactured goods hasTrade initiatives; forbeen the entry point into the global economy. Country Reports show that many countriesare struggling to create competitive, gender responsive exporstrategies that can sustain theirglobal trade activities. In an effort to expand its exports, for example, Egypt is pursuing freetrade agreements that would considering trade policies that would ensure that its products
  • 56. which triggered a drop in demand for its chief export diamonds. “The current economic crisisprovides, in some ways, a window on the future when diamond revenues will no longerform the mainstay of Botswana’s economy,” the Country Report explains. “The need todiversify the economy away from mineral wealth could hardly be mad more starkly.” Withno illusions about the challenges it faces, the Country Report concludes that Botswana needsto create a more diverse economy that provides jobs for a wide spectrum of people. TheSerbia Country Report adds that trade policies are buttressed by active regional and globalRegional alliancesRegional cooperation can also help countries steepen their growth trajectories and in turnaccelerate progress toward fulfilling the MDGs. Swaziland, for example, credits itsmembership in the Southern African Development Community (SADC) with reducing tradebarriers. “Following the launch of the SADC Free Trade Area in August 2008, member statesare currently in the process of fulfilling their obligations of tariff phase-downs in order toachieve the goal of having tariffs and import quotas phased out by 2012,” the CountryReport states, noting that plans to create a customs union could further improve thecountry’s economic competitiveness and offer opportunities for further development. HealthCOMPACT in Mali In Mali, the COMPACT on “increased efforts and resources for health to theachievement of MDGs” is a contract between the government and its partners to acceleratethe implementation of the health MDGs. It focuses on the predictability of aid and theprinciples of responsibility and accountability between the signatories. It aims to unite allefforts of government, civil society and bilateral and multilateral partners for more efficiencyin the implementation of the joint programme and will allow Mali to attain the health MDGsmore quickly. The COMPACT was developed by the government to ensure long-term,predictable resources in a single budget framework and alignment with nationalprocedures.Rwanda has increased partnerships with many countries, organizations andinstitutions. The Country Report explains that strengthening its positions within the EastAfrican Community (EAC) and Economic Community of the Great Lakes Countries (CEPGL) is apriority for forming development partnerships. By opening access to more markets, theseefforts will enable Rwanda to gain benefits and seize opportunities to increase trade. Fiscalmanagement Sound macroeconomic management is a continuing need among countriesanalyzed in this Synthesis Report. Many countries cited the need for better debtmanagement skills. In its Country Report, Ghana, for example, notes that the country madesignificant progress in reducing its debt through 2008, but these efforts were reversed underrenewed borrowing for non-productive projects. High inflation linked to increases incommodity prices and the global credit crunch also sabotaged Ghana’s attempt torestructure its debt portfolio with a greater weighting for long-term instruments. Along withthe burden of debt service and repayments, fiscal policy was also been hit by the direct andindirect effects of the global crises. Most countries report a significant decline in exports andofficial development assistance. Burkina Faso states, “Its sustainability of external debt couldGovernanceCountries must also tackle governance issues within their system. Inadequate governanceinvariably leads to ineffective use of available resources, for example through corruption andother leakages. The Central African Republic helped to restore the confidence of its aidpartners by “consolidating public finances and raising public servants’ and financialauthorities’ moral standards,” the Country Report states. As part of the programme, thegovernment established a new code of public procurement and an efficient instantAffordable drugs:Access to affordable drugs is also an aspect of MDG 8. High prices charged by drugscompanies have in the past kept needed drugs out of the reach of patients in poor countries.
  • 57. the population, while another 6 percent is covered by other insurance programmes. Onlyabout 11 percent of the population remains without access to essential medicines. Further,the Swaziland Country Report notes that the problems linked to the country’s centralized,inefficient and unresponsive health management systems are compounded by frequentshortages of quality medicine linked to procurement and distribution shortfalls. The CountryReport notes imbalances in distributing drugs between public and private clinics andCivil society ;many Country Reports document that civil society and the private sector playimportant roles in achieving the MDGs. In Burkina Faso, civil society and the private sectorare involved in school construction, while Country Reports from Botswana and the CentralAfrican Republic state that civil society played a positive role in the health sector, includinghelping reduce infant and maternal mortality. Also in the Central African Republic, non-government organizations (NGOs) were essential in mobilizing assistance for humanitarianemergencies and recovery efforts, for example in building basic sanitation services. The DRCCountry Report also mentions the important role of NGOs in humanitarian emergencies.During the war, many displaced people were not able to feed themselves without theassistance of NGOs and international aid, even as security concerns in some parts of thecountry hampered health care programmes. In Cambodia, where people are hurt by landmines and unexploded ordinance, civil society provides assistance through communitybased rehabilitation, emergency assistance, income generation activities, vocational trainingand social reintegration of persons with disabilities. And in Egypt, civil society adoptedvarious measures and mechanisms to decrease loss of biological diversity, particularly in theprotected areas. Several Country Reports, including those of Mauritania, Papua New Guinea,the Republic of Congo and Senegal, mention the important role that civil societyorganizations play in the fight against HIV/AIDS. In Mauritania, there are three NGOs thatcan do voluntary HIV testing. The Republic of Congo Country Report states that the fightagainst HIV/AIDS was accelerated, not only because the government provided moreresources, but also through greater commitments from civil society, including from peopleliving with the virus themselves, associations and NGOs. In Kyrgyzstan, civil societyimplements prophylactic programmes and provides support to drug addicts, HIV-infectedindividuals and sex workers Conclusion The world today is much different than it was in2000 when the Millennium Development Goals were first penned. At the turn of the century,the world economy was dynamic and a consensus was being formed to find ways to sharethe benefits of globalization more broadly. Over the next decade, cracks began showing inthe foundation. Soaring prices for food and fuel, the impact of climate change and, finally,the global financial crisis of 2008 pushed the pendulum to the opposite extreme, triggeringfears from the wealthiest nations to the poorest and inspiring reactionary debates onprotectionist policies and economic nationalism. Development goals that were alreadyinspirational became much harder to reach. But the efforts and the accomplishments of thepast decade cannot be ignored. While the MDGs may be more difficult to reach for manycountries, they remain within reach. Even conflict and post-conflict countries found theresolve and the capabilities to move forward in many of the MDGs. Without doubt, theMDGs will not be reached if efforts across the board are not accelerated. But the successes ReferencesUnited Nations/Department of Economic and Social Affairs UN/DESA Working PaperNo. 15 ST/ESA/2006/DWP/15 March 2006Ghana millennium development goals report,April,2010Adams, R, Cuecuecha, A. and Page, J. (2008), The impact of remittances on poverty and
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