African Union

African Development
Bank GroupMDG REPORTLESSONS LEARNED IN IMPLEMENTING THE MDGSASSESSING PROGRESS IN AFRICA TOWARD
THE MILLENNIUM DEVELOPMENT GOALSAfrican Union

African Development
Bank Group

Empowered lives.
Resilient nations.

MDG REPORTLESSONS LEARNED IN IMPLEMENTING THE MDGSASSESSING PROGRESS IN AFRICA TOWARD
THE MILLENNIUM DEVELOPMENT GOALSOrdering information
To order copies of MDG Report 2015: Assessing Progress in Africa toward the Millennium Development Goals, please contact:
Publications
Economic Commission for Africa
P.O. Box 3001
Addis Ababa, Ethiopia
Tel: +251 11 544-9900
Fax: +251 11 551-4416
E-mail: ecainfo@uneca.org
Web: www.uneca.org© United Nations Economic Commission for Africa, African Union, African Development Bank and United Nations Development
Programme, 2015
Addis Ababa, Ethiopia
All rights reservedFirst printing September 2015
ISBN: 978-99944-61-73-8
eISBN: 978-99944-62-73-5
Material in this publication may be freely quoted or reprinted. Acknowledgement is requested, together with a copy of the
publication.
Designed and printed by the ECA Documents Publishing Unit. ISO 14001:2004 certified.
Cover photo: © J. Swanepoel, thinkstock.com

Table of Contents
Foreword......................................................................................................................................... vii
Acknowledgements........................................................................................................................ix
A note on methodology.................................................................................................................xi
Acronyms and abbreviations...................................................................................................... xii
Executive Summary..................................................................................................................... xiii
Section I: Tracking progress.......................................................................................................... 1
MDG 1: Eradicate extreme hunger and poverty.................................................................................................................. 1
MDG 2: Achieve universal primary education........................................................................................................................ 9
MDG 3: Promote Gender Equality and Empower Women..........................................................................................15
MDG 4: Reduce child mortality................................................................................................................................................... 25
MDG 5: Improve maternal health................................................................................................................................................27
MDG 6: Combat HIV/AIDS, malaria and other diseases..................................................................................................39
MDG 7: Ensure environmental sustainability........................................................................................................................45
MDG 8: Develop a global partnership for development..............................................................................................51

SECTION II: Lessons learned from the implementation of the Millennium
Development Goals...................................................................................................................... 61
Section III: Conclusions and policy perspectives.................................................................... 79
Annex 1: Official list of MDG indicators..................................................................................... 84
References...................................................................................................................................... 87

Lessons learned in implementing the MDGs

iii

List of Figures
Figure 1.1
Figure 1.2
Figure 1.3
Figure 1.4
Figure 1.5
Figure 1.6
Figure 1.7
Figure 2.1
Figure 2.2
Figure 2.3
Figure 2.4
Figure 3.1
Figure 3.2
Figure 3.3
Figure 3.4
Figure 3.5
Figure 3.6
Figure 3.7
Figure 3.8
Figure 3.9
Figure 4.1
Figure 5.1
Figure 5.2
Figure 5.3
Figure 5.4
Figure 5.5
Figure 5.6
Figure 6.1
Figure 6.2
Figure 6.3
Figure 6.4
Figure 7.1
Figure 7.2
Figure 7.3
Figure 7.4
Figure 8.1
Figure 8.2
Figure 8.3
Figure 8.4
Figure 8.5
Figure 8.6
Figure 8.7
iv

Proportion of the population living below $1.25 purchasing power parity per day........................ 2
Poverty reduction in 30 African countries.................................................................................................................. 3
Poverty gap ratio (per cent)................................................................................................................................................ 4
Growth rate of GDP per person employed (per cent)........................................................................................ 5
Regional breakdown of unemployment, 2013........................................................................................................ 6
Regional breakdown of vulnerable employment................................................................................................. 7
Proportion of the population below minimum level of dietary energy consumption.................. 7
Trends in primary school enrolment, 1990, 2000 and 2012...........................................................................10
Trends in primary education completion rate, 2000 and 2012....................................................................12
Youth literacy trend, 2000 and 2012.............................................................................................................................13
Youth literacy by region and gender, 2012..............................................................................................................14
Ratio of girls to boys in primary, secondary and tertiary education in Africa, before
and after 2012............................................................................................................................................................................17
Ratio of girls to boys in primary, secondary and tertiary education,
West Africa...................................................................................................................................................................................17
African countries reaching parity in primary enrolment.................................................................................18
Countries with sufficient and insufficient data of women in wage employment in the
non-agricultural sector in Africa.....................................................................................................................................19
Share of women in wage employment in the non-agricultural sector.................................................21
Regional breakdown of vulnerable employment.............................................................................................. 22
Proportion of Seats held by Women in in national parliaments, 2000 and 2014(per cent), per region........................................................................................................................................................... 23
Seats held by women in national parliaments (per cent).............................................................................. 23
African countries with more than 30 per cent of seats held by women in national parliaments.....24
Under-five mortality rates by region, 1990, 2012 and 2015 target............................................................. 25
Progress in reducing the maternal mortality ratio, 1990-2013....................................................................29
Proportion of births attended by skilled health personnel (per cent)....................................................30
Contraceptive prevalence rate, any method (per cent)...................................................................................32
Current condom use among married girls and women 15-49 years (five highest Africancountries) (per cent)...............................................................................................................................................................33
Antenatal care coverage, at least four visits (per cent)......................................................................................36
Unmet need for family planning, total (%)...............................................................................................................37
Estimated HIV prevalence among individuals 15-49 years of age (%).................................................... 40
Number of AIDS-related deaths, all ages (million).............................................................................................. 40
Tuberculosis prevalence, incidence and death rate, 1990-2012...................................................................43
Tuberculosis detection rate and treatment success under Directly Observed Treatment
Shortcourse (DOTS), 1995-2012...................................................................................................................................... 44
Consumption of ozone-depleting substances (1,000 metric tonnes).....................................................47
Protected terrestrial and marine areas, 1990, 2000 and 2012....................................................................... 48
Access to improved sanitation by region (per centof the population), 2012......................................49
Proportion of urban population living in slum areas, 2000 and 2012 (%).............................................50
DAC ODA as a percentage of GNI, by country, in 1990, 2000 and 2014..................................................53
ODA from DAC countries in constant 2012 US$ million, 2004-2013..........................................................55
ODA to African LLDCs, as a percentage of their GNI, in 1990, 2000 and 2012....................................56
ODA to African SIDSs, as a percentage of their GNI, in 1990, 2000 and 2012......................................57
Inflows of external finance, 2010–2015 ($ billion).................................................................................................58
Growth of number of mobile-subscriptions, 1995-2013................................................................................. 60
Growth of mobile-cellular subscriptions per 100 inhabitants, 2000-2013............................................ 60

Assessing Progress in Africa toward the Millennium Development Goals, 2015

List of Tables
Table 3.1
Table 5.1
Table 5.2
Table 5.3
Table 5.4
Table 5.5
Table 5.6
Table 6.1
Table 6.2
Table 7.1
Table 7.2
Table 7.3
Table 8.1
Table 8.2

Sectoral distribution of employed persons, by region and gender, 2004-2007 (per cent).........20
Global comparisons on maternal mortality ratio (maternal deaths per 100,000 live births,
women aged 15-49)..............................................................................................................................................................28
Global proportion of births attended by skilled health personnel(per cent)......................................................................................................................................................................................29
Global contraceptive prevalence rates among women aged 15 - 49 years, married or inunion, using any method of contraception (per cent).....................................................................................31
Live births per 1,000 adolescent girls aged 15 - 19.............................................................................................33
Country performance on adolescent births per 1,000 women................................................................. 34
Global unmet need for family planning among married or women in union aged
15-49 (%).......................................................................................................................................................................................35
HIV incidence rates in subregions of Africa............................................................................................................ 40
Malaria cases and death rates, 2000 and 2013.......................................................................................................42
Proportion of land area covered by forest (%).......................................................................................................45
Carbon dioxide (CO2) emissions (metric tonnes of CO2 per capita)......................................................... 46
Use of improved drinking water sources, 2012......................................................................................................49
Growth in merchandise trade by region, 2012-2013...........................................................................................52
Mobile-cellular subscriptions per 100 inhabitants, by regions.....................................................................59

List of boxes
Box 8.1.

Mauritius and MDG 8............................................................................................................................................................70

Lessons learned in implementing the MDGsv

Foreword
2015 is a watershed year for global development
discourse. It marks the winding down of the MDGs,
and also the confluence of events which will
shape the global development agenda for years
to come: the recently concluded Sendai Third
UN World Conference on Disaster Risk Reduction;
the Third International Conference on Financing
for Development; the upcoming United Nations
summit for the adoption of the post 2015 development agenda in September; and the United
Nations Climate Change Conference (COP 21) inDecember.
These landmark events are ushering in new global
agendas and defining their means of implementation.
The MDGs have helped focus the efforts of governments and development partners on pressing
issues in human development. The Goals haveunderscored the power of communication in
galvanizing global action and resources arounda core set of development objectives, and establishing the role which global partnerships canplay. Indeed, global initiatives such as the Global
Fund to Fight AIDS, Tuberculosis, and Malaria; theGlobal Vaccination Alliance (GAVI); and Education for All (EFA) have had a measurable impact
on combating diseases specified in MDG 6, andfacilitating immunisation and primary school
enrolment respectively.
As the MDG era comes to an end and the newdevelopment agenda is launched, it is timely
to reflect on the lessons learned from the MDG
experience to inform our next steps. It is in thiscontext that this year’s Africa MDG progress report
is written.
An important lesson from the MDG experience isthat initial conditions influence the pace of progress a country can make on global development
agendas. Thus it is not surprising that Africa as awhole will not achieve all the MDGs by 2015. Nevertheless, substantial progress has been achieved

on a number of goals and targets. Significant
achievements in increasing women’s representation in national parliaments, reducing infant andHIV-related deaths, and enrolling more children
in primary schools owe a lot to the effort andcommitment of African people and their governments to meet the Goals. The often uncelebrated
achievements of countries which have made significant progress without meeting MDG targets
also deserve special recognition.
This year’s report highlights innovative policies
and progammes which countries have adopted
to accelerate progress on the MDGs, such as
the deployment of community members as
health workers, Niger’s Ecole des Maris (Schoolfor Husbands) initiative, and the establishmentof community-run and -funded schools. It is ourhope that publicizing such success stories will
not only help document policy innovations for
SDG implementation, but also keep the focus on
the unfinished business of the MDGs as countries
and the global community make the transition to
implementation of the post-2015 Development
Agenda.
The report demonstrates that sustaining andadvancing beyond the gains made under the
MDGs require new approaches which embrace
all three dimensions of sustainability – the environmental, economic and social. Progress under
the SDGs will be assessed not only by the results
achieved, but also by considering how they wereachieved. Method will assume greater relevancein the post-2015 development paradigm.
The Ebola crisis has reminded us how quickly
progress can unravel when health systems are
not resilient to shocks. It has underlined theimportance of complementing targeted healthinterventions with integrated approaches whichstrengthen healthcare systems overall. Tackling all
three dimensions of sustainability will require rigorous development planning approaches underpinned by strengthened capacities, integrated
Lessons learned in implementing the MDGsvii

approaches to the continent’s development challenges, and access to reliable and quality data.
The MDG experience exposed the data challenges facing national statistical systems andunderscored the importance of strengthening
statistical and analytical capacities. The datarequirements for tracking SDG progress will begreater than those for the MDGs, reflecting the
SDGs’ broader scope and the emphasis on disaggregation of data. Confronting this challenge will
require strengthened human and financial capacities, together with new approaches and methodologies for harnessing the wealth of information
which can be obtained from ‘big data’.

The accumulated knowledge and experience
gained under the MDGs positioned the international community well for crafting an ambitious,
yet achievable, successor agenda. The level ofambition reflected in the new agenda must now
be matched by its means of implementation. We
trust that the findings of this report will add to thebody of knowledge on the MDGs from the African
regional perspective, and inform the approaches
which Member States adopt in their transition
from the MDGs to the SDGs.

Nkosazana Clarice Dlamini Zuma
Carlos Lopes
Chairperson,
United Nations UnderAfrican Union
Secretary-General andCommission
Executive Secretaryof ECA

viii

Akinwumi A. Adesina
President,
African Development
Bank Group

Assessing Progress in Africa toward the Millennium Development Goals, 2015

Helen Clark
Administrator,
United Nations
Development
ProgrammeAcknowledgementsT

his report is a joint product of the African
Union Commission (AUC), the Economic
Commission for Africa (ECA) of the United
Nations, the African Development Bank (AfDB) andthe United Nations Development Programme-Regional Bureau for Africa (UNDP-RBA).
It was prepared by a core team which was led
by Bartholomew Armah, Chief, Renewal of Planning Section, Macroeconomic Policy Division,
ECA; Dossina Yeo, Acting Head, Statistics Division,
Economic Affairs Department, AUC; Bilal Kedir
Nejmudin, Principal Health Economist, Health
Division, Human Development Department, AfDB;
Mohamed Gueye, Principal Education Analyst,
Education Division, Human Development Department, AfDB; and Eunice Kamwendo, Strategic
Advisor, Strategy and Analysis team, UNDP-RBA.
The team also included Selamawit Mussie (AUC),
Habaasa Gilbert (ECA/AUC), Janet Byaruhanga(AUC), Nougbodohoue Samson Bel-Aube (AUC),
Mama Keita (ECA), Aissatou Gueye (ECA), Deniz
Kellecioglu (ECA), Seung Jin Baek (ECA), Judith
Ameso (ECA), Maimouna Hama Natama (ECA),
Stanley Kamara (UNDP), El Hadji Fall (UNDP), Sallem Berhane (UNDP) and James Neuhaus (UNDP),
with technical inputs from Yemesrach Workie(UNDP), Glenda Gallardo Zelaya (UNDP), Fatou
Leigh (UNDP), Frederick Mugisha (UNDP), Wilmot
Reeves (UNDP), Fitsum G. Abraha (UNDP), James
Wakiaga (UNDP), Rogers Dhliwayo (UNDP), Amarakoon Bandara (UNDP), Becaye Diarra (UNDP),
Celestin Tsassa (UNDP), Ginette Mondongou
Camara (UNDP), Ahmadou MBoup (UNDP) and
Khady Ba Faye (UNDP).
The work was carried out under the supervisionof Dr. René N’Guettia Kouassi, Director, Economic
Affairs Department, AUC; Dr. Adam B. Elhiraika,
Director, Macroeconomic Policy Division, ECA;
Dr. Agnes Soucat, Director, Human Development
Department, AfDB; and Dr. Ayodele Odusola,
Chief Economist and Head of Strategy and Analysis Team, UNDP-RBA.

Guidance to the team was provided by Dr.
Anthony Mothae Maruping, Commissioner for
Economic Affairs, AUC; Abdalla Hamdok, Deputy
Executive Secretary, ECA; Steve Kayizzi-Mugerwa,
Acting Chief Economist and Vice President, AfDB;
and Abdoulaye Mar Dieye Assistant Administrator
and Director, UNDP-RBA. The report was prepared
under the general direction of AUC Chairperson
Dr. Nkosazana Dlamini Zuma, the United Nations
Under-Secretary-General and ECA Executive Secretary Dr. Carlos Lopes, AfDB President Dr. Donald
Kaberuka and United Nations Development Programme (UNDP) Administrator Helen Clark.
The team undertook wide-ranging consultations
with stakeholders and African policymakers forthis report, from conceptualization to the final
draft. These consultations included an expert
group meeting to review and validate the draft
Africa MDG report 2015 in Algiers, held on 3 and
4 May 2015. The participants were MDG focal
persons from 51 African countries as well as
representatives from civil society organizations
and United Nations agencies. The experts andcountries they represented at the meeting were:Merzak Belhimeur and Lakehal Amal (Algeria); Ana
Machado and Marcelino Pinto (Angola), Alastaire
Alinsato and Adechian Colawole (Benin); Massie
Joyce Masego, Malepa Moffat and Seitiso Patrick (Botswana); Silga Maxime and Guene Herve
Jean-Louis (Burkina Faso); Marie Jeannine Hashazinka (Burundi); Okouda Barnabé and Yangam
Emmanuel (Cameroon); Hamida Ahmat El-Hadj(Chad); Djaafar Abdouroihamane and Massoundi
Miradji (Comoros); Bassissila Théophile Séraphin(Congo); Ibrahima Ba, Kouakou N’Goran, Sangare
Moustapha, Toha Félix and Toure Abdoul Karim(Côte d’Ivoire); Koyange Roger, Katumba Danieland Bomboko Francesca (Democratic Republicof the Congo); Ahmed Abdallah Hasana (Djibouti); Ahmed Abdallah Soltan (Egypt); Ndong
Bisa Cristobal (Equatorial Guinea); Bereded Fitsum
Arega and Eshete Tilahun Woldeyes (Ethiopia);
Ibouili Maganga Joseph (Gabon); Mohammed
L. Janneh and Kinteh Ibrahima M.B.S (Gambia);
Lessons learned in implementing the MDGs

ix

Adjei-Fosu Kwaku (Ghana); Baldé José Augusto
Braima (Guinea-Bissau), Mwangi Michael (Kenya);Lineo Mamonaheng Mokitimi (Lesotho); Musah
Bobby E. and Yussuf M. Sarnoh (Liberia); Rambolanome Sahondra Manana and Ratolojanahary
Mamy (Madagascar); Mzonde Rodwell (Malawi);
Doumbia Moriba (Mali); Tourad Dahmed Khalihena and Mohamed Abderrahmane Moine Teyeb(Mauritania); Chandranee Rughoobur (Mauritius);
Charrouk Jilali (Morocco); Macia Agonias Antonio
and Mutombene Alfredo Savador (Mozambique);Hangula Mary-Tuyeni, Neema Isak and Libertina
Kakwali Kautwima (Namibia); Kamil Halimatou
Amadou and Omar Maiga Alkassoum (Niger);
Adelokiki Olufunfe Titilayo (Nigeria); Yahiaoui
Lamine and Burra Sidgaum Hnini (Sahrawi); Niang
Assane (Senegal); Helena Isabell De Letourdis andThomas Marie-Angele (Seychelles); Momoh Morie(Sierra Leone); Mohamed Sheikh Abdirahman(Somalia); Lehohla Pali Jobo, Booysen Desmondx

Reginald, Ngwenya Jackia Lucky and Mphahlele
Morore Benjamin (South Africa); Mojwok Charles
Chol (South Sudan); Abdalla Wisal (Sudan);Fakudze Robert Nkosingiphile (Swaziland); Waniko Kokou and Abdoulaye Nouroudine (Togo);
Saidi Hedi, Nadia Touihri and Mejri Abdelwahed(Tunisia); Rutaro Thomas and Mbuga Donald(Uganda); Katunzi Tumaini and Mashavu Khamis
Omar (United Republic of Tanzania); Mpokosa
Esnart Constance Phiri and Nkombo Nchimunya(Zambia); and Mungate Taizivei and Mkwakwami
Godfrey (Zimbabwe).
The report benefitted from editorial, translation,
graphic design, printing, media and communications and secretarial support from Ferdos Issa,
Charles Ndungu, Azeb Moguesse, George Kokebe,
Barbara Hall, Adla Kosseim and Melanie Guedenet.

Assessing Progress in Africa toward the Millennium Development Goals, 2015

A note on methodologyT

his year’s report, entitled “Assessing Progressin Africa towards the Millennium Development Goals”, uses the latest updated andharmonized data from the United Nations Statistics Division (UNSD), the official data repository forassessing progress towards the Millennium Development Goals (MDGs). It also uses complementary data from United Nations agencies, including
the World Bank, and from statistical databases of
the Organisation for Economic Co-operation andDevelopment (OECD). The main reason for using
international sources is that they collect and provide accurate and comparable data on MDG indicators across Africa. The irregularity of surveys andcensuses, ages, definitions and methozone-depleting substances for producing the indicators
might explain the lag between the reporting year
and the data years. Another irregularity is the paucity of data, especially for recent years and fromsome countries that persistently fail to produce
and submit data sets.
In order to mitigate such shortcomings, United
Nations agencies regularly compile data fromcountries using standardized questionnaires or
through other agreed on mechanisms. Submitted
questionnaires are then validated through a peer
review process based on the data collection andprocessing methozone-depleting substances.
The agencies provide estimates, update data, fill indata gaps by estimating missing values, and makeadjustments if needed to ensure cross-country
comparability. OECD is the premier source forrecent aid flows, which are based on a standard
methodology and agreed on definitions to ensurecomparability of data among donors and recipients. These United Nations agencies and OECD
provide harmonized and comparable sources ofdata for producing MDG reports at the continentlevel. However, this report uses some country-level
national data and information on some MDGs toenrich its analysis. Such data are generally utilized
inside specific boxes in the report.
Over the last few years, African countries havetaken commendable steps, with the support ofinternationals organizations, to obtain data for
tracking MDG progress. The African Union Commission (AUC), the United Nations Economic Commission for Africa (ECA) and the African Development Bank (AfDB) have developed programmesthat respond to data challenges and that improve
African countries’ statistical capacity, such as: theAfrica Symposium for Statistics Development, anadvocacy framework for censuses; the African
Charter on Statistics, a framework for coordinating
statistics activities in the continent; the Strategy
for the Harmonization of Statistics in Africa, which
provides guidance on harmonizing statistics; anda new initiative on civil registration and vital statistics. Since 2009, the three institutions have set
up a joint mechanism for continental data collection and validation in order to produce an Africa
statistical yearbook. These initiatives will scale up
the availability of data for tracking future development progress. In fact, the four pan-African
institutions behind this report have launched theconcept of data revolution in Africa. A large number of Member States have also recognized theutmost importance of data because they inform
development outcomes, which are in turn associated with implemented policies and changed
circumstances. Data also serve as a foundation
for accountability, investment decisions, research,and many other fields.

Lessons learned in implementing the MDGsxi

Acronyms and abbreviations
AfDB		AUC		DAC		DOTS 		
ECA		
EFA		
FAO		
GNI		
GPI		
HIPC		
ILO		
IMF		
LDC		
LLDC		
MDG		
MMR		
NGO		
ODA		
OECD		
SIDS		UNAIDS		
UNDP		
UNDP–RBAUNESCOUNICEF		
UNFPA		UN-Habitat
UN-OHRLLS		UNSD		
WHO		
WTO		

xii

African Development Bank
African Union Commission
Development Assistance Committee
Directly observed treatment, short-course
Economic Commission for Africa
Education for All
Food and Agricultural Organization of the United Nations
Gross national income
Gender Parity Index
Heavily indebted poor countries
International Labour Organization
International Monetary Fund
Least developed country
Landlocked developing country
Millennium Development Goal
Maternal mortality ratio
Non-governmental organization
Official development assistance
Organisation for Economic Co-operation and Development
Small Island and Developing States
Joint United Nations Programme on HIV/AIDS
United Nations Development Programme
United Nations Development Programme–Regional Bureau for Africa
United Nations Educational, Scientific and Cultural Organization
United Nations Children’s Fund
United Nations Population Fund
United Nations Human Settlements Programme
United Nations Office of the High Representative for the Least Developed Countries,
Landlocked Developing Countries and Small Island Developing States
United Nations Statistics Division
World Health Organization
World Trade Organization

Assessing Progress in Africa toward the Millennium Development Goals, 2015

Executive SummaryAfrica has made considerable progress
towards achieving the Millennium Development Goals despite challenging initialconditions. The baseline figures for Africa on
most Millennium Development Goal indicators
were relatively low compared to other regions.
Nevertheless the continent has achieved impressive gains, including in placing more children in
primary school, bridging the gender gap in primary enrolment, increasing the representationof women in national parliaments, reducing childand maternal deaths and reducing the prevalenceof HIV/AIDS. These achievements underscore theimportant role that national commitment, supported by global partnership, can play in realizing
development objectives. The highlights of Africa’s
performance on the MDGs are discussed below.

Poverty is falling, albeit slow,
with a real risk of reversals fromshocksAfrica excluding North Africa reduced poverty
levels from 56.5 per cent in 1990 to 48.4 percent in 2010, a 14 per cent reduction, well below
the MDG target of 28.25 per cent. Efforts at thecountry level vary, however, with some countries
reducing poverty rates much faster than others.
The greatest reduction was in the Gambia with a
32 per cent reduction, followed by Burkina Faso,
Niger, Swaziland, Ethiopia, Uganda and Malawi.
Poverty declined in 24 out of 30 African countries
with available data, and increased in the remaining 6 countries. Additionally, growth has neither
been robust nor sufficient enough to sustain poverty reduction efforts. Many countries, particularly
in Africa excluding North Africa are dependent on
primary commodities and susceptible to shocks
that tend to disrupt development gains. Early
estimates on the socioeconomic impact of theoutuberculosisreak of Ebola virus disease alone
indicate extensive losses in livelihoozone-depleting substances, which have already pushed many
households back into poverty and destitution in
the most affected countries.

Africa’s productivity, as measured
by output per person employed,
is on the rise
Globally, almost all regions doubled their annual
growth rate of gross domestic product (GDP) perperson employed since 2001. Developing regions
as a group more than doubled their GDP growthrate per person employed from 1.4 per cent in2001 to 3.2 per cent in 2013, with strong growth
rates registered in Asia (2.6 per cent in 2013), followed by Africa excluding North Africa (1.4 percent in 2013). On balance, Africa excluding North
Africa has made the most effort in increasing its
GDP growth rate per person, an increase of 0.6
basis points, compared with Asia’s 0.4 basis points.
By contrast, North Africa experienced negative
growth from its strong growth of 2 per cent in2001 to 0.5 by 2013, due largely to the lingering
effects of the mass revolutions and unrest thathave swept through the subregion and the Middle East since 2010.

Africa’s growth has been
relatively strong but not rapid
or inclusive enough to create
adequate decent employment
opportunities
Africa’s GDP growth has remained positive since2001, averaging at least 5 per cent above theglobal average of 3 per cent. Extractive industries,
particularly minerals, oil and gas have accounted
for the largest share of Africa’s growth. This has
led to improvements in some areas, but thesehave not been sufficient or inclusive enough toprovide decent job opportunities for the majorityof the labour force. Indeed, the employment topopulation ratio has declined on average from57.7 per cent in 2005 to 44.4 per cent in 2012.
Unemployment rates are in the double digits
in some subregions, but these are masked, insome cases, by high levels of informality. Southern Africa had the highest unemployment rates
in 2013 (21.6 per cent), followed by North Africa(13.2 per cent), Central Africa (8.5 per cent), andEast Africa (7.9 per cent), whereas West Africa had
Lessons learned in implementing the MDGs

xiii

the lowest unemployment rates (6.9 per cent).
Youth and female unemployment are persistently
higher than male unemployment rates in all
regions. Responding to the youth unemployment
challenge is vital if Africa is to derive a dividend
from the youth bulge. Owing to a lack of decent
jobs, most of the population in Africa is engaged
in vulnerable employment, which is largely concentrated in the informal sector.

Disasters and persistent conflictare obstructing the path to foodsecurity
The overall net change in the proportion of persons whose food intake falls below the minimum
level of dietary requirements in Africa between
2012 and 2013 is zero. Africa excluding North
Africa remains the most food-deficient of all
regions of the world, with 25 per cent of its population having faced hunger and malnutrition
during the 2011-2013 period, a modest 8 per centimprovement from the level experienced during
the 1990-1992 period. Persistent conflicts in Central Africa and unfavourable weather conditions
such as droughts and flooding in the Sahel, theHorn of Africa and Southern Africa continue toexert pressure on food security and nutrition. In
addition, the Ebola outuberculosisreak in Guinea,
Liberia and Sierra Leone has increased food inflation in the three countries and the subregion,
threatening to push many people below the minimum level of dietary energy consumption.

Africa is close to the universal
primary education enrolment
targetSince 2000, most African countries have shown
accelerated progress in expanding access tobasic education. In 2012, Algeria, Benin, Cabo
Verde, Cameroon, Congo, Mauritius, Rwanda,
South Africa, Tunisia and Zambia recorded a net
enrolment rate of over 90 per cent. Overall, mostAfrican countries have made significant progress
as a result of policy reforms using participatory
approaches, improved service delivery and governance. Progress has been slower in meeting theneeds of the hardest-to-reach categories suchas out-of-school youth, children with disabilities,
xiv

children living in conflict-affected States, nomadic
people and some ethnic minorities.

Improving primary education
completion rates remains achallenge
There is steady progress in achieving primary
completion for all, but one third of pupils whostart grade 1 will likely not reach the last gradeof primary education. With a 67 per cent primary
completion rate, Africa is still far from the achieving primary completion rates for all by 2015. Barely
20 per cent of African countries reached the target in 2012. Between 2000 and 2012, some countries, for example, Ghana, Morocco, Rwanda andthe United Republic of Tanzania, registered fast
progress, while others stagnated or experienced
severe declines. Regression is largely attributed
to conflict, political unrest, or poor educational
quality and limited capacity of schools to absorb
all pupils.

High primary enrolment rates areboosting youth literacy
The youth literacy rate for the population aged
15-24 years has improved in Africa as a result of
the increased access to universal primary education observed since 2000. In 2012, only Niger,
Chad and Côte d’Ivoire recorded youth literacy
rates below 50 per cent. Over 58.8 per cent ofAfrican countries have achieved at least a 75 percent youth literacy rate. The performance of Algeria, Botswana, Equatorial Guinea, Libya, South
Africa, Swaziland and Tunisia has been exemplarywith youth literacy rates above 95 per cent.

Improvements in girls’ enrolment
and achieving gender parity
Gender parity in primary education has increasedin most regions of the world, with several countries
adopting universal primary education policies andimplementing gender-responsive interventions
that have helped increase girls’ enrolment substantially over the years. Within Africa, West Africa
is the most improved subregion, followed by
North Africa. In terms of reaching parity at all levels of education, Southern Africa has continued toregister a strong performance, followed by North
Africa, which has reached parity in all levels except

Assessing Progress in Africa toward the Millennium Development Goals, 2015

Executive summary

for primary education and has made exceptional
progress in tertiary education. East Africa is making steady progress from its relatively poor initialconditions, and although it is yet to reach the target at all levels, it has made significant progressin closing the gender gap in tertiary education.
Central Africa, however, trails all regions in making
progress towards this target.

with Rwanda registering the highest percentageof women in its national parliament, followed bySouthern, Central, West, and finally, North Africa.
Legislated or voluntary quotas have had a positive
impact on the share of women in national parliaments, as observed in most countries that were
the first to adopt such policies in Southern andEast Africa in the early 1990s.

Uneven gains in the share ofwomen in wage employment in
the non-agricultural sector

Impressive progress in reducing
child mortality

Historically, in the agricultural sector in Africa,
labour participation is generally high and almost
the same for men and women. However, in theservices sector, the participation of women ishigher than that of men. For example, over the
2004-2007 period in Southern Africa, female
and male labour force participation was 70 and
49 per cent, respectively. In the industrial sector,
during the same period, however, female labour
force participation was lower than that of men, at
11 per cent against 20 per cent. Furthermore, Africa’s growth has had a limited impact on the welfare of women and youth, and several constraints
perpetuate significant gender gaps in women’s
participation in gainful employment in the formal
sector. In order to enhance the productive capacities and economic empowerment of women
together with skills development geared towards
the formal sectors, it is imperative to remove barriers such as access to inputs, land, credit, capitaland technology.

Africa is leading the way inwomen’s representation innational parliaments
The global average for women’s representationin national parliaments has risen steadily, from
14 per cent in 2000 to 22 per cent in 2014. Africa
has made the most progress on this target, withan increase of the share of women in national
parliaments by at least 15 per cent over thesame period, followed by Latin America and the
Caribbean (11 per cent increase), Asia (9.8 percent increase) and developed regions (9 percent increase). There are significant differences,
however, within the African regions and acrosscountries. East Africa continues to lead the way,

Overall, African countries have made substantial
progress towards achieving MDG 4 (Reduce childmortality). Indeed, 99 of 188 countries, including
43 in Africa, excluding North Africa, observed
more significant decreases in child mortality during the 2000-2013 period than during the 19902000 period. Continent-wide, the U5MR reduced
from 146 deaths per 1,000 live births in 1990 to
65 deaths in 2012, i.e. a 55.5 per cent reduction
against the target of a two-thirds reduction. In
addition, the infant mortality rate fell from 90
deaths per 1,000 live births in 1990 to 54 deaths
per 1,000 live births in 2014, an average decline of
40 per cent. Nevertheless, many African countries
have demonstrated either slow progress or stagnating neonatal mortality rates. The situation isworse for the large rural populations of Africa thathave poor access to and utilization of maternal
and newborn health services. For these populations, social protection mechanisms are needed
to improve access to high-impact interventions.

Challenges abound in maternal
health despite tremendous
progress
Africa has made progress in improving maternal
health, although only Cabo Verde, Equatorial
Guinea, Eritrea and Rwanda have reduced theirmaternal mortality ratio by more than 75 per centbetween 1990 and 2013, hence meeting MDG 5(Improve maternal health). Africa still remains theregion with the highest maternal mortality ratio
compared to the rest of the world, registering 289
maternal deaths per 100,000 live births comparedto the global average of 210 maternal deaths per
100,000 live births in 2013. Africa is also grapplingwith low proportions of births attended by skilled
health personnel, low contraceptive prevalence
Lessons learned in implementing the MDGs

xv

Executive summary

rates, high adolescent birth rates, limited antenatal care coverage, and high unmet need forfamily planning, all of which are contributing toa high maternal mortality ratio in the continent.
Other challenges include difficulty in measuring
maternal deaths according to the recommended
World Health Organization (WHO) definition, andpoor auditing and registration of the causes andnumber of maternal deaths, which affect accurate
reporting and monitoring of progress on MDG 5.

Downward trend in HIV/AIDS,
malaria and tuberculosis
Efforts to combat HIV/AIDS, malaria and tuberculosis in Africa have yielded impressive results since1990 and are placing the continent on a solid path
to reversing the spread of these diseases. Indeed,a downward trend is observed in the incidence,prevalence and death rates associated with HIV/
AIDS, malaria and tuberculosis, especially since
2000. The efforts to combat these diseases havebeen largely through: the adoption of WHO
recommended programmes and interventions,such as Directly Observed Treatment Shortcourse(DOTS) for tuberculosis; the use of insecticide
treated nets and artemisinin-based combination
therapies for malaria; and the use of condoms
and antiretroviral therapy for HIV/AIDS. These
initiatives demonstrate the high level of politicalcommitment to combating these diseases. Notwithstanding the progress being made, Africa
accounts for more than half of all cases and death
rates of HIV/AIDS, malaria and tuberculosis.

Africa’s progress onenvironmental targets exceeds
global performance
Carbon dioxide emissions per capita were highest
in developed regions and lowest in Africa excluding North Africa in 2010. However, rising carbon
dioxide emissions in a few African countries andslower progress in other regions of the world raise
concern about future trends. Over the 1990-2010
period, only 16 African countries reduced theircarbon dioxide emissions, while 38 increased
them.

developing regions, and 100 per cent in developed regions between 1986 and 2012. In effect,
most African countries are on the right track interms of reducing the consumption of these substances. Nonetheless, six countries experienced
an increase in their consumption between 2000
and 2012. The proportion of protected terrestrial
and marine areas increased in all regions of theworld; in 2012, globally, 14 per cent of terrestrial and marine areas were protected. In Africa
excluding North Africa, protected area coverageincreased from 10.7 to 15.2 per cent between 1990
and 2012. More African countries are registering
improvements in the proportion of protected
terrestrial and marine areas; by 2012, a total of 32
African countries had reached the target of protecting at least 10 per cent of their territorial andmarine areas compared to 19 countries in 1990.

Access to safe drinking water andsanitation is improving slowly,
but progress remains skewed
towards urban areas
Almost a quarter of the current African population(24 per cent) have gained access to an improved
drinking water source since 2000, which is thelowest globally. Furthermore, only 16 per centof the population has access to piped drinking
water, which is also the lowest in the world. There
are wide rural-urban disparities in access to safe
drinking water that tend to pull down national
aggregate figures in some countries. The weak initial conditions (low 1990 baseline), combined withhigh population growth relative to the rest of theworld exacerbate the challenge of meeting thetarget in Africa. Similarly, the proportion of people
with access to improved sanitation has increased
only moderately in Africa excluding North Africa,
from 24 per cent in 1990 to 30 per cent in 2012.
This is in stark contrast to North Africa, where it
increased from 72 to 91 per cent, and developing
regions, from 36 to 57 per cent during the same
period. The rural-urban divide and the poor situation of slum dwellers further compound this slow
progress.

Consumption of ozone-depleting substances
declined by 94 per cent in Africa, 86 per cent inxvi

Assessing Progress in Africa toward the Millennium Development Goals, 2015

Executive summary

North Africa maintains thelowest slum prevalence amongdeveloping regions
The proportion of people living in slum conditions in urban areas was highest in Africa excluding North Africa (62 per cent). The lowest slum
prevalence is observed in North Africa, with a levelof 13 per cent. From 2000 to 2012, the share ofurban residents in the developing world living inslums declined from 39 to 33 per cent. Globally,
the MDG target of significantly improving the
lives of at least 100 million slum dwellers by 2020
has been attained, 10 years in advance.

Wide gap between trade and ODA
commitments and delivery
The Ninth Ministerial Conference of the World Trade
Organization, held in Bali, Indonesia, in December
2013, revitalized the Doha Development Agenda
with the Bali Package, which covered trade facilitation and agriculture, and developed and least
developed countries. However, new forms ofprotectionism through a proliferation of non-tariff barriers are prejudicial to Africa’s trade. This isreflected in the share of Africa’s exports in global
merchandise exports, which declined from 3.5 percent in 2012 to 3.3 per cent in 2013, comparedwith 4.9 per cent in the 1970s. Meanwhile, official
development assistance (ODA) from the States
members of the Development Assistance Committee (DAC) of the Organisation for Economic
Co-operation and Development (OECD) declined
0.5 per cent in real terms between 2013 and 2014.
In nominal terms it was virtually unchanged –$135.2 billion in 2013 as against $135.1 billion in
2014. Of particular concern is the fact that ODA
to least developed countries, landlocked developing countries, and small island developing States
declined 16 per cent in real terms compared to2013, pushing donors further from the targets.
On average, DAC countries delivered 0.29 percent of the group’s gross national income (GNI)
as ODA, which is unchanged relative to 2013 andbelow the United Nations target of 0.7 per cent.
On a positive note, 5 of the 28 DAC countries (i.e.
Denmark, Luxembourg, Norway, Sweden andUnited Kingdom) continue to exceed the 0.7 percent target. The United Arab Emirates, a country
that is not a member of DAC, posted the highest

ODA/GNI ratio of 1.17 per cent in 2014. Beyond
shortfalls in commitments, there are also concerns about the quality of ODA since substantial
amounts stay in donor countries, while some ODA
reaching recipient countries is associated with little or even negative development impact.

Debt sustainability is a growing
concern
Total foreign debt has been higher than 30 per
cent of GDP in Africa since 2010 and is expected
to rise to 37.1 per cent of GDP in 2015. Net foreign
debt as a share of GDP is projected to be only
1 per cent of GDP in 2015; it has been negative
since 2006 owing to high international reserves
in oil-exporting economies. Mineral-rich and oil
importing countries have positive net foreigndebt, and some extreme cases have very highratios, raising issues of debt sustainability. Moreover, Africa’s long-term debt sustainability remains achallenge for the post-completion point of heavily
indebted poor countries, due mainly to the structural problems of these countries and inadequate
debt management capacity. With completion of
the Heavily Indebted Poor Countries Initiative,
the rising concern about debt sustainability raises
the more basic issue of how to ensure a fair debt
workout mechanism to address future sovereign
debt crises.

Notable progress in technology
indicators
Notable progress can be observed in Africa in thetechnology indicators, to different degrees. Fixed
telephone subscriptions per 100 inhabitants
peaked in 2009, averaging 4.17 from 1.44 in 1990.
Thereafter, it has steadily declined to 3.60 in 2013.
This is closely related to fast growth of populations and mobile telephone subscriptions. Mobile
telephone subscriptions have indeed grown massively in Africa from only four African countries
registering mobile-cellular subscriptions in 1990,
to all African countries having mobile subscriptions in 2013. Subscriptions averaged 80.20 per
100 inhabitants, with 15 African countries registering over 100 subscriptions per 100 inhabitants.
In 2013, at 11.1 per cent, mobile subscriptions in
Africa continue to grow and surpass the global
average of 6.3. Africans have been able to utilize
Lessons learned in implementing the MDGs

xvii

Executive summary

mobile phone technology in a number of innovative ways that have changed their lives in banking,activism, education, entertainment, disaster management, agriculture and health. In Africa, 14.7
out of 100 inhabitants use Internet, which is much
lower than the world average of 43.7. However,during the 2004-2013 period, the average annual
growth of Internet users per 100 inhabitants wasmuch faster in Africa (21.7 per cent) than the global
average (10.2 per cent). If the current growth rates
are maintained over the coming years, Africa as awhole may reach the global rates.

•

Policymakers must be mindful of the utility
and sustainability of their investments. Investments in brick and mortar such as schools andhospitals can be sustainable and useful only ifthey are matched by complementary investments in recurrent expenditure on teachingmaterials, equipment and skilled health professionals.

•

Sustainability requires addressing the root
causes, not the symptoms of underdevelopment. Donor support is more likely to resultin sustainable development if it focuses on
giving Africa a “helping hand” rather than a“handout”. The MDG focus on outcomes suchas poverty reduction without particular attention to the pathway or enablers required toachieve them is ultimately unsustainable. Critical areas of priority should include: supporting Africa’s agenda for structural transformation; strengthening capacities in development
planning, domestic resource mobilization andpublic expenditure management; strengthening cooperation in stemming illicit outflows;
returning stolen assets; supporting technology, innovation and science; promoting fairtrade; strengthening trade facilitation; andfacilitating good governance.

•

Global development agendas are likely to
succeed if they are underpinned by a credibleand committed means of implementationthat takes into account both financial andnon-financial resources. The lack of thesemeans rendered the implementation of the
MDGs vulnerable to resource shortfalls.

•

Given the interrelatedness of the goals,
focusing on development interventions thathave the greatest knock-on effects heightens
impact.

•There are effective and often low-cost impact
interventions that can drive progress on the
MDGs. More importantly, these interventions
must be focused on populations that are vulnerable or most at risk, which include womenand girls, the extremely poor and rural dwellers, among others.

Lessons learned from MDG
implementation
The MDGs implementation process has generated
invaluable lessons that can inform policymaking
going forward. This is particularly important in
the context of the new development agendathat will build on several elements of the MDGs.
While sector-specific lessons can be drawn fromeach goal, there are some overarching lessons
that cut across various sectors and even into the
new areas that will be covered by the post-2015
development agenda.
••

Initial conditions are important in achieving
and accelerating progress on the MDGs. Differentiated approaches to supporting andevaluating progress are therefore imperative.
For countries close to achieving specifictargets, incremental progress may not be
as relevant as the quality of such progress.
Alternatively, for those countries and regionsthat are furthest from the target, the pace ofprogress relative to their baselines is a more
appropriate measure of performance.
Effective communication and follow-up are
critical for the success of global agendas. Even
though the commitments made by its signatories were not binding, the MDGs generated
some success. This positive outcome waspartly due to the effective communication andcontinual follow-up processes undertaken at
the national, regional and global levels, which
helped to sustain pressure on governments tofulfil their social compacts.

xviii

Assessing Progress in Africa toward the Millennium Development Goals, 2015

Section I: Tracking progress
MDG 1: Eradicate extreme
hunger and poverty

S

ignificant progress has been made globallytowards reducing poverty by half from the1990 levels, attributable in part to notableadvancements in economic growth and development globally, particularly in China. Strong
growth, decent jobs, increased productive capacities and the provision of social protection for themost vulnerable groups have accounted for mostof the reduction in poverty rates across the world.
There are regional variations, however, revealing
significant caveats to growth, reinforcing theinclusive growth notion and necessary conditions
for poverty reduction. In Africa, it still remains aserious challenge to reduce the region’s poverty
rates by half despite a positive GDP growth since2001, an average of at least 5 per cent above theglobal average of 3 per cent (AfDB, 2014).
Extractive industries in minerals, oil and gas
have accounted for the largest share of Africa’s
growth, which has led to improvements in someareas. However, this has not been sufficient ortransformational enough to effectively respondto challenges posed by shocks (commodity
prices, climate change, Ebola etc.), widespreadpoverty, rising inequalities, unemployment, theyouth bulge, unplanned urbanization and manyothers. Economies in Africa, in particular those in
the Southern, East, West and Central subregions,remain undiversified, in enclave sectors and heavily dependent on a few commodities. As a result,poverty has remained widespread despite: (i) adecline from 56.5 per cent in 1990 to 48.4 per centin 20101 for Africa excluding North Africa; (ii) relatively high levels of unemployment, particularly
for youth and women, with a large share of the
population engaged in vulnerable employment

1

Latest available data, estimates by the World Bank, April 2013.

with low productivity; (iii) the largest proportionof its population living below the minimum levelof dietary energy consumption out of all regions;and (iv) the relatively strong growth in West Africa
of around 6.7 per cent, followed by East Africa(6.2 per cent), Central Africa (3.7 per cent) and asignificant contraction in Southern Africa (3 percent) in 2014 alone (Ibid).
The focus on growth as a necessary condition forpoverty reduction provides important lessons as
the world transitions from the implementationof the MDGs to that of Sustainable Development
Goals . The type and sources of growth are important in order for development to be sustained overthe long term. The lack of structural transformationand economic diversification has limited poverty
reduction efforts in Africa, which remains increasingly vulnerable to shocks. In West Africa, theEbola outbreak is estimated to have significantly
reduced growth prospects in the three affected
countries (Guinea, Liberia and Sierra Leone) by atleast 2 to 3 per cent in the short to medium term
(UNDP, 2015b). At the same time, short-run shocks
such as the commodity price decline that is affecting commodity-dependent economies in Africa,
threaten to have precarious medium-run balanceof payments effects. Recurrent shocks, such as
flooding in southern Africa, severe droughts in the
Sahel and the Horn of Africa, instability in the Great
Lakes region, and sluggish growth in South Africa
owing to persistent industrial action continue tocloud the regional outlook and highlights Africa’s
vulnerabilities to shocks. Strengthening Africa’s
resilience to shocks will first require: a strengthening domestic and regional policies to respondand promote structural transformation and inclusive and job-rich growth; improvements in political and economic governance; enhancement
Lessons learned in implementing the MDGs

1

MDG 1: Eradicate extreme hunger and povertyof domestic/regional institutions and infrastructure; the empowerment of women and youth;
scaled-up action on climate change adaptation;effective health systems; resilience building andrecovery; and finishing the unfinished businessof the MDGs and the effective implementation of
the post-2015 Development Agenda.
Target 1.A: Halve, between 1990 and 2015,
the proportion of people whose income isless than $1.25 a day
Significant global progress has been made in
reducing poverty by half since 1990; however, theprogress is uneven across regions and countries(see figure1.1). While globally the target has been
met for developing regions, challenges remain at
subregional levels – with Africa excluding North
Africa and the Oceania regions lagging behind
the rest of the world in responding to the poverty challenge; between 1990 and 2010, poverty
rates declined by only 8.1 per cent and 7 per cent,respectively. Over the same period, Asia as a whole
has made the greatest improvements in poverty
reduction attributable in part to strong growthin China and India: East Asia, from 60.2 per centto 48.6 per cent, Southeast Asia, 45.4 to 31 per

cent, and Southern Asia, 51.5 to 21.8 per cent.
By contrast, the Caribbean subregion excluding
Latin America experienced a 4 per cent increase
from its 1990 poverty levels. It should be pointed
out the regions that have experienced rapid androbust growth per person employed are thosethat have made significant dents on poverty, thus
reinforcing the relationship between increased
productivity, jobs and poverty reduction.
Africa also lagged behind other regions in its
attempt to reduce the intensity of poverty; 2
between 1990 and 2010, it has only reduced itby 2 basis points between (from 13 per cent to11 per cent), while developing regions as a whole
reduced the intensity of poverty by at least 9 basis
points. Asia accounts for most of this reduction,
having reduced its poverty gap ratio from 11 percent in 1990 to 3 per cent in 2010. Hunger also
remains a challenge on the continent, especiallyfor Africa excluding North Africa, which has thehighest proportion of its population living below
the minimum level of dietary energy consumption
in the world, exceeding the developing regions’average. Progress has been made on this target,
albeit slow (from 33 per cent in 1990 to 25 per

Figure 1.1 Proportion of the population living below $1.25 purchasing power parity
per day(1990)
47%

Developing regions(1990)
53%

Landlocked developing countries(1990)
57%

Africa excluding North Africa(1990)
5%

Northern Africa(1990)
37%

Asia(1990)
12%

Latin America and the Caribbean
0

10

20

30

40

50

60

Source: UNSD data, 2014.
2 The intensity of poverty, measured by the Poverty Gap
Index, estimates the average poverty gap in the population as aproportion of the poverty line; it estimates the depth of poverty byconsidering how far on average, the poor are from the poverty line.

2

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 1: Eradicate extreme hunger and poverty

cent in 2013). Asia and Latin America and the Caribbean have made the most progress in reducing
hunger, with close to a 45 per cent reduction inincidence of hunger in both regions.

Poverty is falling, albeit slow,
with a real risk of reversals fromshocksAfrica’s progress in reducing poverty has beenslow compared to that of developing regions
as a whole. Africa excluding North Africa only
reduced poverty levels from 56.5 per cent in 1990
to 48.4 per cent in 2010 (a 8 per cent reduction),
which is well below the MDG target of 28.25 percent by 2015. Efforts at the country level vary,
however, with some countries reducing poverty
rates much faster than others (see figure 1.2).
Based on 30 African countries for which at least
two data points are available, the collective poverty reduction efforts resulted in an 8.7 per centdrop in poverty over a period of eight years. The
greatest reduction was in The Gambia, with a
32 per cent reduction, followed by Burkina Faso,
Niger, Swaziland, Ethiopia, Uganda and Malawi.
Poverty declined in varying degrees in 24 out of
the 30 countries, ranging from a 0.1 per cent in
Egypt to 32 per cent in The Gambia. However,
poverty rates also increased in six out of the 30

countries, from an average of 0.4 per cent in Central African Republic and 28.4 per cent in Kenya,
representing the lowest and highest increases
over the same period. Increases in poverty havealso been notable in Mauritania, Nigeria and Zambia, while Madagascar, Sierra Leone and Tunisia
registered significant poverty reduction overeight years.
While many countries have shown progress
towards poverty reduction over the years, in partowing to the positive growth rates of recent times,
the growth has neither been robust nor sufficientenough to sustain such efforts. Many countries,
particularly in Africa excluding North Africa, aresusceptible to shocks that almost always reverse
development gains. Early estimates on the socioeconomic impact of the Ebola outuberculosisreakalone indicate massive losses in livelihoozone-depleting substances, which has already pushed
many households back into poverty and destitution. Liberia, Sierra Leone and Guinea will certainly
experience reversals in their efforts to reduce poverty and generate decent jobs and food security
for at least the next five years (UNDP RBA, 2015).
The knock-on effects for the subregion as a wholeare estimated to be large, with negative impacts

ZambiaUnited Republic of Tanzania

UgandaTunisia

Togo

SwazilandSouth Africa

Sierra Leone

RwandaSenegalNigeria

Niger

Mozambique

Morocco

Mauritania

MalawiMali

Kenya
Madagascar

GuineaGhana

GambiaEthiopia

Egypt

Côte d'Ivoire

Cameroon

10

Burundi15

Angola20

Burkina Faso

25

Central African Republic

Figure 1.2 Poverty reduction in 30 African countries

5
0
-5
-10
-15
-20
-25
-30

% Reduction
Number of years-35
Source: Authors’ calculations based on 2014 UNSD data, which covers different periozone-depleting substances depending on data availability.

Lessons learned in implementing the MDGs

3

MDG 1: Eradicate extreme hunger and poverty

on growth, food security and poverty in the short
to medium term.
Other endogenous shocks such as the commodity
price decline will also have huge spillover effects
in many countries in Africa, since most countries
do not have the fiscal space to respond to suchshocks. Out of the ten fastest growing economies
in Africa, eight are commodity-dependent (Nigeria, Democratic Republic of the Congo, Liberia,
Sierra Leone, South Africa, Côte d’Ivoire, Chad andAngola). Dependence on natural resources is adriver of inequality since it tends to have deleterious impacts on building inclusive and accountable institutions, economic diversification andstructural transformation (UNDP, 2015a).Yet, on a
positive note, Ethiopia and Rwanda have largely
been driven by the expansion of infrastructuredevelopment and services, reflecting a gradualshift to other sectors overtime. Although growth in
GDP has contributed to poverty reduction efforts
in general, the intensity of poverty remains severe
for the rest of Africa excluding North Africa, whichis compounded by growing income inequalities
on the continent and the interaction between
growth, poverty and inequality. These issues
require urgent attention in order to resolve social

unrest and uprisings, growing radicalization, andthe lack of social cohesion within countries andcommunities that Africa has witnessed in recent
times.
The intensity of poverty in Africa excluding North
Africa alone surpasses that of all developing
regions, with a minimal reduction from 25 percent in 1990 to 21 per cent in 2010 (see figure 1.3).
Asia, Latin America and the Caribbean, and North
Africa reduced the intensity of poverty considerably over the same period. Non-inclusive growth
due to structural constraints, underdevelopment
and poor infrastructure, the lack of decent jobs
and food insecurity have all contributed to theintensity of poverty in Africa.
Target 1.B: Achieve full and productive
employment and decent work for all,including women and young people
The achievement of full and productive employment for all remains elusive, particularly for
women and youth. The world and almost all
regions doubled the annual growth rate of GDP
per person employed from 2001. Developing
regions together more than doubled their GDP
growth rate per person employed from 1.4 per

Figure 1.3 Poverty gap ratio (per cent)
1990
2010

16%

Developing regions

7%
25%

Africa excluding North Africa

21%
1%

Northern Africa

0.3%
5%

Latin America and the Caribbean

3%
11%

Asia

Source: UNSD, 2015.

4

3%

0

5

10

15

Assessing Progress in Africa toward the Millennium Development Goals, 2015

20

25

MDG 1: Eradicate extreme hunger and poverty

Figure 1.4 Growth rate of GDP per person employed (per cent)
3.5
2001
2013

3.0

2.5
2.0

1.5
1.0

0.5
0.0

-0.5
World

Developing regions Developed regions

Northern Africa
Africa excluding Northern AfricaLatin America

Asia

Source: UNSD data, 2015

cent in 2001 to 3.2 per cent in 2013, with highstrong growth rates registered in Asia (2.6 per centin 2013), followed by Africa excluding North Africa(1.4 per cent in 2013) (see figure 1.4). On balance,
Africa excluding North Africa made the greatest
effort in increasing its GDP growth rate per person
by 0.6 basis points, compared to Asia’s 0.4 basis
points. However, North Africa experienced negative growth from its strong growth of 2 per centin 2001 to 0.5 by 2013, due largely to the lingering
effects of the mass revolutions and unrest thatswept through North Africa and the Middle East
since 2010.

Although Africa’s growth has been relatively
strong, it has not been sufficient to create adequate decent employment relative to populationand size. In 2013, Southern Africa had the highest
unemployment rates (21.6 per cent), followed by
North Africa (13.2 per cent), Central Africa (8.5 percent), East Africa (7.9 per cent), whereas West
Africa has the lowest unemployment rates (6 percent).
In all regions, youth and female unemployment
are persistently higher than the male unemployment rates across all regions (see figure 1.5), aLessons learned in implementing the MDGs

5

MDG 1: Eradicate extreme hunger and poverty

Figure 1.5 Regional breakdown of unemployment, 201350

Eastern Africa
Central Africa
Northern Africa

40Southern Africa
Western Africa

30

20

10

0
Total unemployment
rate (2013)

Male

FemaleYouth

Youth male

Youth female

Adult

Adult male

Adult female

Source: ILO – Trends Econometric Models, October 2014.

situation that needs urgent attention in order toaddress the persistent gender imbalances andbenefit from the demographic dividend and theyouth bulge.
While the above rates give a sense of unemployment trends in Africa, they do not fully explain
labour force participation in both formal andinformal sectors, including the underemployed,
vulnerable and discouraged workers. Owing to
the lack of decent jobs, most of the population in
Africa are engaged in vulnerable employment andlargely in the informal sector. Using 2013 figures(figure 1.6), most of Africa’s population is engaged
in the informal sector. The figures are relatively
high in West Africa, with a total of 79.6 per centfor both female and male population groups. The
ratio of women engaged in vulnerable employment is much higher, at 86.9 per cent comparedto 74.1 per cent for men. East Africa follows, with
75.8 per cent of its labour force engaged in vulnerable employment (69.3 per cent, males and82.8 per cent, females). Similar situations are mirrored in the rest of the regions, with Central Africa
a close third, with at least more than 50 per centof its labour force in vulnerable unemployment
and North Africa, just above 30 per cent. Southern
Africa’s labour force has the lowest percentage of6vulnerable employment, with combined rates formen and women below 20 per cent. This is partly
due to the relatively highly formalized economic
structures of the subregion. The rates are disproportionally larger for women than men in all
regions, and are definitely much higher for young
people.
Target 1.C: Halve, between 1990 and 2015,
the proportion of people who suffer fromhunger
The proportion of the population facing hunger
is falling slowly; however, disasters and persistent conflict are an impediment to food security.
Although there has been some progress since1990 in reducing global hunger, at least 805 million people were still chronically undernourishedby the end of 2014. The Food and Agricultural
Organization of the United Nations (FAO) notesthat only 63 countries are reaching the MDG 1
hunger target, and that while the hunger target
is globally within reach, Africa and Eastern Asia,
plagued by disaster and conflict, have made modest progress (FAO, 2014). Based on the analysis of
the changes in the proportion of persons fallingunder the dietary requirements in Africa, the overall net change in this target between 2012 and2013 is zero. This implies that, although reduc-

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 1: Eradicate extreme hunger and poverty

Figure 1.6 Regional breakdown of vulnerable employment
100

Total vulnerable employment (2013)
Male vulnerable employment (2013)
Female vulnerable employment (2013)

80

60

40

20

0

Eastern Africa

Central Africa

Northern Africa

Southern Africa

Western Africa

Source: ILO – Trends Econometric Models, October 2014.

tions in dietary deficiency have been observed inaround 20 countries, others, in dietary deficiencies
had also increased, leading to modest or no overall
net progress for the Africa region as whole.3 Africa
excluding North Africa remains the most food-deficient of all regions of the world, with 25 per centof its population facing hunger and malnutritionin 2011-2013, an 8 per cent improvement fromits 1990-1992 figures (see figure 1.7). Persistentconflicts in Central Africa and unfavourable
weather conditions such as droughts and flooding in the Sahel, the Horn of Africa and Southern
Africa continue to put pressure on food security
and nutrition in the region. In addition, the Ebola
outuberculosisreak in Guinea, Liberia and Sierra
Leone has already increased food inflation in the

Figure 1.7 Proportion of the population below minimum level of dietary energy
consumption
1990-1992

19%

World

12%

2011-2013
24%

Developing regions

14%

Developed regions

<5%
<5%

Northern Africa

<5%
<5%
33%

Africa excluding North Africa

25%
15%

Latin America and the Caribbean

8%
20%

Asia

11%

0

5

10

15

20

25

30

35

Source: UNSD data, 2015.

3

The analysis is based on UNSD data, 2014.

Lessons learned in implementing the MDGs

7

MDG 1: Eradicate extreme hunger and poverty

three countries and the subregion, threatening topush many people below the minimum level of
dietary energy consumption.
Dietary deficiencies continue to be more severe inrural than urban areas in all regions of the world.
In Southern Asia there are more underweight8

children in rural areas (around 45 per cent) than inurban areas (33 per cent), whereas in Africa excluding North Africa, around 22 per cent of children
living in rural areas are underweight compared to
15 per cent in urban areas.

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 2: Achieve universal
primary education

A

frica’s future transformation depends toa large extent on its capacity to provide
compulsory and inclusive quality basic
education that will further lead to a productive
workforce, economic prosperity and social stability. In placing education at the heart of theirnational development policies for the past 15
years, African countries have demonstrated theirconviction about the potential contribution of
education to building an equitable, competitiveand cohesive society. That potential is particularly
critical in fragile States. For that reason, Africancountries have consistently allocated substantial
resources to education. Between 2000 and 2012,
the average amount of resources allocated to education increased from 4.2 per cent to 4.9 per centof GDP, compared to a decrease from 4.7per centto 4.6 per cent in all other developing countries.
This unprecedented commitment by African governments has been complemented by consistent development assistance towards education,
including debt savings that contributed to theenrolment of over 54 million children in schools
in the subregions of Southern, East, Central andWest Africa between 2000 and 2012. For example,
to meet its international commitment, Senegal
allocated up to 5 per cent of its GDP to education between 2000 and 2011. The public financial
allocation to the sector registered a significant
increase (on average the annual rate of increasestood at 12.5 per cent over the 2000-2011 period).
This enabled the country to boost the net enrolment rate from 44.7 per cent in 1990 to 79.4 percent in 2012. Burkina Faso also achieved outstanding progress in increasing its net enrolment ratefrom 36.7 per cent in 2000 to 66.8 per cent in 2012.
While the overwhelming majority of countries
have addressed the issue of enrolment and gender imbalances in primary education, almost one
third remain far from meeting the MDG targets.
Despite the continuous rise in the net enrolment
rate in primary education, only 67 per cent of chil-dren starting grade 1 are likely to reach the last
grade of primary education, particularly in Africa
excluding North Africa. This poor performance inprimary completion is due to a number of factors
including insufficient education infrastructure,
limited choice for girls and other vulnerable socialgroups, inadequate consideration of the realityof traditionally hard-to-reach groups such asnomadic people, persons with disabilities, andchildren from disadvantaged economic and ethnic groups. The insufficient number of qualified
teachers and the lack of relevant curricula to meetthe needs of these groups are also root causes ofthe poor quality of education. As a result, Africancountries still perform poorly on international
assessments of student learning achievements.
In 2011, the two countries (Tunisia and Morocco)
which participated in the Trends in International
Mathematics and Science Study (TMISS) at grade
four, ranked 49th and 51th out of 52 participant
countries, respectively with scores of 359 and 335
points in mathematics, well below the TIMSS scalecentre point (500). Botswana scored 396 points inthe sixth grade mathematics test.. The majorityof students tested did not demonstrate a goodknowledge or understanding of basic mathematical concepts. The results of the 2011 international
assessment of reading comprehension (PIRLS
2011) are quite similar. All these impediments
drastically limit the opportunities of children to
progress to upper grades and to move onto secondary education.
Target 2.A: Ensure that, by 2015, children
everywhere, boys and girls alike, will beable to complete a full course of primaryschooling
Africa is surely moving towards universal primaryeducation. Since 2000, the majority of Africancountries have been showing accelerated progress in expanding access to basic education,
thus steadily narrowing the gaps in universal
primary education. In 2012, over 68 per cent of
Lessons learned in implementing the MDGs

9

MDG 2: Achieve universal primary education

the 25 countries for which data were available
achieved a net enrolment rate of at least 75 percent in primary education. Eleven these countries(44 per cent) (Tunisia, Algeria, Rwanda, Zambia,
Mauritius, Cabo Verde, Benin, Republic of theCongo, Cameroon, Morocco and South Africa)
recorded a net enrolment rate over 90 per cent.
Between 2000 and 2012, four of the 25 Africancountries for which data are available (Niger, Burkina Faso, Guinea and Mozambique) experienced
an impressive increase in net enrolment of over
30 per cent (see figure 2.1). These good examples
must be capitalized on and disseminated. As
highlighted by Easterly (2007):

Yet, Burkina Faso has expended elementary education at more than twice therate of Western historical experience, andis even far above the faster education
expansions of all other developing countries in recent decades.
Overall, most of the countries have made significant progress as the result of improved education policy formulation using participatory
approaches, service delivery and governance.
Indeed, the combined effects of the Education for
All and the MDGs have led countries to develop
and adopt holistic policies and legal frameworks

Figure 2.1 Trends in primary school enrolment, 1990, 2000 and 2012
Eritrea
Eq. Guinea
Niger
Burk. Faso
Mauritania
CAR
Mali
The Gambia
GuineaSenegalLesothoGhana
Mozambique
NamibiaSouth Africa
Cameroon
Congo. Rep.
Benin
Cape Verde
Morocco
Mauritius
ZambiaRwandaAlgeria
Tunisia
Botswana
BurundiChadComoros
Cote d'Ivoire
Djibouti
Egypt
Ethiopia
Guinea-Bissau
Kenya
Madagascar
Nigeria
Sao T. Principe
Seychelles
Swaziland
Togo
UgandaTanzania
Zimbabwe

1990
2000
2012

0

20

40

60

Source: UNSD data, 2015.

10

Assessing Progress in Africa toward the Millennium Development Goals, 2015

80

100

MDG 2: Achieve universal primary education

conducive to democratically meeting their citizens’ economic and social education needs, andcapitalizing on the demographic dividend.
Although international aid flows from the traditional education donors have slowed down overthe past five years, especially in 2011 when a 7 percent decrease was registered, domestic financing
tends to be maintained at a significant level in acontext where new needs have been emerging.
In assessing the effectiveness of sector-specific aid
in achieving MDG2 in the 35 countries in Africa
excluding North Africa over the period 2000-2010,
Yogo and Mallaye (CERDI, 2015) concluded:[H]igher aid to education significantly
increases primary completion rate. This
result is robust to the use of various
methozone-depleting substances of estimation, the inclusion of instrument toaccount for the indignity of aid and theset of control variables included in regressions.
The authors also demonstrate that there is astrong heterogeneity in the efficient use of aid.
For instance, countries such as Botswana, Togo
and Kenya show high efficiency gains, whereas
Burkina Faso, Niger and Rwanda are unlikely tomake efficient use of aid to education. Such findings urge international donors to meet their commitment in a timely manner and encourage countries in Africa excluding North Africa to improvesector governance, financing and partnership tosustain their achievements.
One country, Eritrea recorded a net enrolment far
below 50 per cent, and Equatorial Guinea, Namibia
and Cabo Verde experienced a slight regression.
Progress has also been slower in meeting theneeds of the hardest-to-reach categories suchas out-of-school youth, children with disabilities,
children living in fragile States, nomadic people
and some ethnic minorities. There is a need to pay
particular attention to these gaps and carry out
deeper analysis to better identify the bottlenecks
and identify the appropriate ways to address
them in the post-2015 development agenda/Sustainable Development Goals.

Steady progress in achieving primary
completion for all, but one third of pupils
who start grade 1 will likely not reach the last
grade of primary education
With a 67 per cent primary completion rate, Africa
is still far from the achieving primary completion
rates for all by 2015. Barely 20 per cent of Africancountries (i.e. Algeria, Cabo Verde, Egypt, Ghana,Morocco, Sao Tome and Principe, Seychelles andTunisia) reached the target in 2012. In 24 out of the
44 countries (around 53 per cent) for which 2012
data are available (see figure 2.2), the primary education completion rate was at least 70 per cent,and only five countries (Central African Republic,
Chad, Eritrea, Niger and South Sudan) deviatedwidely from the average value with a completion rate not exceeding 50 per cent. Within theregion, the general trend is highly diverse, with
fast progress between 2000 and 2012 recordedin Ghana (net increase of 38.6 per cent), Rwanda(26.9 per cent), Morocco (25.7 per cent) and theUnited Republic of Tanzania (22.5); slight stagnation in others; and severe declines in Benin,
Burkina Faso, Chad, Côte d’Ivoire, Eritrea, Mali and
the Niger. The main causes for this regression may
be due to conflict, political unrest, or the impactof the higher enrolment on education quality inthe short term as some governments have notbeen able to sustain quality in a context where
the operational needs for qualified teachers,classrooms and learning materials have been
dramatically increasing. The disturbing pattern ofstagnation observed in many countries over the
2000-2012 period is partly explained by the lackof rigorous data available because of poor education management information systems, but also
by the lack of sustained and deep reforms focusedon quality improvement. Yet, the UNESCO Education for All Global Monitoring Report states: “Onethird of young people in sub-Saharan Africa fail
to complete primary school and lack skills forwork” (UNESCO, 2010). The overall status has notchanged since then, and the subregion still has
the greatest need for teachers to meet the goalof universal primary education completion, estimated at 1.6 million.

Lessons learned in implementing the MDGs

11

MDG 2: Achieve universal primary education

Figure 2.2 Trends in primary education completion rate, 2000 and 2012
Eritrea
ChadSouth Sudan*
CAR
Niger
Djibouti*
Mozambique
UgandaAngola*Eq. Guinea*
Burkina Faso
RwandaMali
SenegalCôte d'Ivoire
GuineaBurundiGuinea-Bissau**
Liberia*
Mauritania
The Gambia
Madagascar
Benin
Lesotho
Sierra Leone
Cameroon
Congo, Dem. Rep.
Congo, Rep.
Malawi
Nigeria*
Swaziland*
Togo
Tanzania
Namibia
ZambiaGhana
Cape Verde
Mauritius
MoroccoAlgeria
Tunisia**
Seychelles*
Egypt
Sao Tome & Principe*

2000
2012

40
0

20

60

80

100

Source: UNSD data, 2015.

High primary enrolments are bolstering
youth literacy
The development of literacy skills is a critical condition to achieving sustainable development andinclusive growth. “It is generally recognized that aliteracy rate of 70 per cent is essential for a developing country to make a sustainable economic
take-off” (UNESCO EFA-GMR, 2006). The youth literacy rate for the population aged 15-24 years has
overall improved in Africa, reaching 69.61 per centin 2012. This progress is partly due to the resultof the increased access to universal primary education observed since 2000. Based on the sample of countries for which data were available in
12

2012, only Niger, Chad and Côte d’Ivoire recorded
youth literacy rates below 50 per cent. The sample shows great variance in literacy rates, from27 per cent in Niger to 99.1 per cent in Seychelles.
Over 66.7 per cent of the 50 African countries forwhich data are available have achieved at least a
75 per cent youth literacy rate. Globally, 27.8 percent of the countries are on good track to achieve
universal youth literacy. In around 33 per cent ofcountries for which data are available, the youth
literacy rate reached at least 90 per cent in 2012.A
stellar performance is recorded in Libya, Cabo
Verde, South Africa, Equatorial Guinea, Botswana,
Seychelles and Swaziland, where the youth liter-

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 2: Achieve universal primary education

acy rate is above 95 per cent (see figure 2.3). Three
countries have made outstanding progress inincreasing their youth literacy rate over the 20002012 period: the Gambia (increase of 16.8 percent), Guinea-Bissau (increase of 14.8 per cent)and Chad (increase of 11.3 per cent).
Some countries experienced a drop in literacy
rates, such as Côte d’Ivoire, from 60.7 to 48.3 percent between 2000 and 2012. In general, thesecountries have undergone either political or asocial unrest during the past decades, which
resulted in a limited investment on literacy.

Africa excluding North Africa continues to record
the lowest youth literacy rates, and boys are more
likely to be able to read and write than girls. In
spite of the progress achieved since 2000, Africa
excluding North Africa is lagging behind, with ayouth literacy rate of 69.6 per cent in 2015 compared to 89.2 per cent in North Africa, 87.8 per centin other developing countries and 99.6 per centin the developed world. The performance of theregion reflects serious disparities in access to quality basic education and to literacy opportunities
within the countries. Although all governments
recognize the economic, social and human benefits associated with literacy, the impact of sector

Figure 2.3 Youth literacy trend, 2000 and 2012
AngolaBotswana
BurundiCameroon
Cape Verde
CAR

1990

Chad

2000

Comoros

2012

Côte d'Ivoire
Egypt
Eq. Guinea
EritreaGabon
The Gambia
Ghana
Guinea-Bissau
Kenya
LesothoLibya
Madagascar
Mauritania
Mauritius
Niger
RwandaSeychelles
Sierra Leone
South Africa
Swaziland
Togo
Zambia
0

20

40

60

80

100

Source: UNSD data, 2015.

Lessons learned in implementing the MDGs

13

MDG 2: Achieve universal primary education

policies are limited both by inconsistent investment in literacy and the lack of rigorous learningassessments for non-formal education systems.
In addition, an important number of civil society
organizations (CSOs) are investing in literacy andshowcase good examples of best practices thatare insufficiently capitalized on at national leveland disseminated on large scale. In regard to the
low completion rates at the primary educationlevel and limited opportunities for non-formal
education, African countries have no choice but
to develop continuous and flexible lifelong learning and functional literacy programmes in order
to equip youth with the critical basic skills theyneed to further enter and successfully compete
in the labour market. An important reform thathas been used by many African countries since2000 is the transitional use of mother tongue for
instruction in early grades of primary education as
well as in adult literacy. It is urgent to capitalize on
the best innovative practices in this field, particularly in West Africa, and disseminate the findings
to the whole region.

In 2012, the gap in youth literacy rates between
girls (64.2 per cent) and boys (75.5 per cent) was
the widest in Africa excluding North Africa, i.e.
11.35 per cent in favour of boys. The other regions
had a lower gap between youth literacy rates forgirls and boys: 7.2 percentage in North Africa,
5.9 percentage in the developing world and5.2 percentage worldwide (see figure 2.4). The
level of literacy in the countries in the Southern,
East, Central and West African subregions wasvery far from the absolute goal target when they
began. Therefore, the countries that achieved
remarkable results established a set of indicative
benchmarks that could be used to guide future
literacy policy and programme delivery.
The challenges in achieving youth literacy include:
limited national and regional literacy policy frameworks; the lack of quality assurance mechanisms;
and financing gaps that should be bridged toenable Africa to realize its demographic dividend.

Figure 2.4 Youth literacy by region and gender, 2012
100

Male
Female
Total

80

60

40

20

0
World

Developed countries

Developing countries

Northern Africa

Source: UNSD data, 2015.

14

Assessing Progress in Africa toward the Millennium Development Goals, 2015

Africa excluding
North Africa

MDG 3: Promote Gender Equality
and Empower WomenS

ince 1990, Africa has made considerable progress in the achievement of gender equality
and women’s empowerment, but challenges
remain. Structural and cultural impediments continue to limit progress and expose significant gender and socioeconomic inequalities, which will
require focused attention if Africa is to achieve its
long-term vision of prosperity, structural transformation, human development and enhanced productive capacities. Achieving gender equality andwomen’s empowerment is central to the achievement of many other goals, including reducing
poverty and mitigating hunger, improving healthand educational outcomes in families and communities, as well as ensuring environmental sustainability. Gender inequality therefore represents
the archetypal inequality trap that reproduces
further inequalities, with negative developmental
consequences that continue to be experienced in
the world to date. The initial conditions for genderequality and empowerment of women in Africa
were relatively poorer than the rest of the world
and only slightly comparable to the Western Asian
region in 1990 (UNSD, 2014). In 1990, the Gender
Parity Index (GPI) for gross enrolment ratios inall levels of education was 0.82 in North Africa
and 0.83 in Africa excluding North Africa. South
Asia’s initial conditions were the poorest, with a
combined GPI of 0.74 over the same time period.
Africa has therefore made progress towards closing the gender gap in primary education andincreasing literacy levels for women and girls. Thisis due to Africa’s drive to achieve universal primaryeducation and other gender-informed policies
that have accounted for the impressive results
observed in gender parity in many countries. Similar success stories abound in increasing women’s
participation in political spaces and society, as evidenced by a higher share of women in national
parliaments in Africa, with significant subregionaland country variations. Although there have been
more modest advances in the share of women inwage employment in the non-agricultural sector

since 1990, the structural rigidities of most countries in the region have made it difficult to close
the gender gap in this target. There is a similar
narrative for other countries where gender gaps
have narrowed considerably, especially in Europe,
Central Asia, Latin America and the Caribbean,
East Asia and the Pacific, the Middle East andNorth Africa, and South Asia, in that order, withvariations across countries and subregions.
In spite of these efforts, however, Africa as a region
continues to lag behind in most areas measured
by MDG 3 (Promote gender equality and empower
women). Important lessons and considerations
can be drawn from the failure to meet this goal.
Gender-informed policy interventions such as
stipends, conditional cash transfers and vouchers
have had significant pay-offs in increasing theparity ratios in education, while candidate quotas
and reserved seats that were adopted by a large
number of countries in the 1990s have accounted
for notable increases in women’s participation innational parliaments. Because of legislated quotas and voluntary party quotas, there have been
substantial increases in the proportion of seats
held by African women in national parliaments.
Impressive progress has been recorded by mostof the countries in East and Southern Africa, andmore recently, by a few West African countries
such as Burkina Faso, Cabo Verde, Senegal andTogo. However, progress in the non-agricultural
wage employment sector has remained limited,showing modest increases in some countries but
a lack of progress in most. Trends and patterns are
difficult to monitor for this indicator owing to lackof data and limited reporting on this target.
Important lessons can be drawn from 15 yearsof experience implementing the MDGs, which
will inform the implementation of the post-2015
development agenda and the Sustainable Development Goals. For MDG 3, the positive experiences reflect the good practices that accelerate
Lessons learned in implementing the MDGs

15

MDG 3: Promote Gender Equality and Empower Women

progress, while the challenges reveal areas where
further efforts need to be made. Over time, there
have been increases in enrolment in primary education and completion rates, girls’ school retention, and in maintaining the transition between
levels of education, which are imperative for longterm objectives.
Although vital for addressing multiple deprivations, improving the share of women in non-agricultural wage employment is currently beyond
the scope of many low-income countries, whereformal employment is not a main source ofincome or jobs. Barriers to women’s participationin the non-agricultural sector include, but are
not limited to, low educational attainment; timeburden of domestic tasks; limited availability ofchild care; and the impact of laws and customs
on women’s ability to work outside the home. In
addition, women’s political participation is only
captured at the national level, whereas participation in democratic spaces should also include
the provincial and local levels where access towomen’s decision making is also important (ECA
et.al, 2012). All of these are important lessons thatshould provide information on gender equality
and the empowerment of women beyond 2015,
which has yet to be accomplished. The MDGs
have certainly laid important foundations that
Africa should build on for the future.
Target 3.A: Eliminate gender disparity inprimary and secondary education, preferably
by 2005, and in all levels of education nolater than 2015
Education is one sure source for imparting skills
and competencies that are central to humandevelopment and an enhanced quality of life,
bringing multiple benefits to individuals and societies. It is a basic human right that should be madeavailable to all. Investing in education for all has
long been recognized as a fundamental right with
far-reaching consequences for human development and societal progress. Investing in girl’s andwomen’s education in particular, produces exceptionally high social and economic returns (World
Bank, 2014a). There are many benefits to having
an educated population in general; for womenand girls, the benefits are large since educated16

women tend to invest more in the welfare of theirchildren and households, therefore contributing
directly to a well-educated and healthier population. By breaking of the cycle intergenerational‘scourges’ of illiteracy and poverty, education
facilitates the participation of individuals in thelabour market, which allows them to earn decent
and reliable incomes, know and claim their rights,
and contribute positively to their households andsocieties. At a time that the world is contending
with inequalities of different kinds, educating andempowering women and girls remains a criticalavenue for reducing inequalities.
Africa is close to achieving the universal
primary education target
Gender parity in primary education has increasedin most regions of the world, with several countries adapting universal primary education andimplementing gender-responsive interventions
that have helped increase enrolments substantially over the years. The rate of gross enrolment
for school-aged girls have increased significantly
in most regions, yet Africa excluding North Africa,
Oceania, Western Asia and North Africa still facecontinued disparities for girls. The global averageassessment, however, does not reveal regionaland country variations including degrees of effort.
Developing regions which had relatively low
initial conditions in 1990 made notable strides
towards improving parity levels with an increaseof at least 10 per cent from 0.84 in 1990. From1990 to 2012, Southeast Asia made the greatest
effort in achieving gender parity, having increased
its primary school enrolment ratios from 0.74 to
1.00. Other most improved regions include North
Africa (0.82 to 0.96), Western Asia (0.85 to 0.93) and
Africa excluding North Africa (0.83 to 0.92) (UNStatistics, 2013).

Within Africa, West Africa is the most improved
subregion within the continent, followed by
North Africa. In terms of reaching parity at all levels of education, Southern Africa has continued
to register strong performances over the years,
followed by North Africa, which has reached parity in all levels except for primary education andhas made exceptional progress in tertiary education. East Africa is making steady and significant

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 3: Promote Gender Equality and Empower Women

Figure 3.1 Ratio of girls to boys in primary, secondary and tertiary education in
Africa, before and after 2012
1.60
Before

After

1.40
1.20

1.22

1.20

1.00

1.08

1.02
.93
.86

0.80

.96

.91

.87

.81

.88

.84

.82

.82

0.60

1.18
1.07

.95

.90

.87

.80

.77

.74

.75

.67

.65

.56

.53

.55

0.40

.95
.88

.93

1.12

.56

.36

0.20

.33

AfricanContinent

CentralNorthern

Western

Eastern

Tertiary

SecondaryPrimary

Tertiary

SecondaryPrimary

Tertiary

SecondaryPrimary

Tertiary

SecondaryPrimary

Tertiary

Secondary

Tertiary

SecondaryPrimary

0.00

Primary.26

Southern

Source: Authors’ calculations based on UNSD, 2015.
Note: The closest data points to 1990 and 2012 are used.

Figure 3.2 Ratio of girls to boys in primary, secondary and tertiary education,
West Africa
1.39

1.4
Before 2012

2012

1.08
.73

.85

.59
2010
.51
.31

.46

.43

.47

.52

.54 .61

.60
2011
.73

.81
2000
.69

.71
.40

.68

Primary
Secondary
Tertiary

Primary
Secondary
Tertiary

Primary
Secondary
Tertiary

GuineaBisseau

Ghana

Burkina
Faso

Sierra
Leone

Benin

Cape Verde

Liberia

Nigeria

Primary
Secondary
Tertiary

1992 1990

Primary
Secondary
Tertiary.15
1990 1990 1990

.13

Primary
Secondary
Tertiary.30

Primary
Secondary
Tertiary

.31

.50

.56

.61

.63

.81

.84
.66

.91
2011

1.05

1.04
.95
2010

.99

.90

.95

.94

.93
2010
.67
.55

.55

Primary
Secondary
Tertiary

Togo

1990 1999

Primary
Secondary
TertiaryMali

1990 1990 1990 1990 1990 1992

1998 1990 1990

Primary
Secondary
Tertiary

Cote D’Ivoire

1992 1990 1990

.27

.24
.14

Niger

1990 1994 1990 1990 1990

1990 2000

Primary
Secondary
Tertiary.15

Primary
Secondary
Tertiary

Guinea1990 1990 1991

Primary
Secondary
Tertiary

.34

.27
2011

.31
1990 1990 1990 1990 1999 1991

Primary
Secondary
Tertiary.14
1990 1999

Primary
Secondary
Tertiary.09

1990 1990 1990

.92
.64

.78

.53
2007

.65

.63

.65

.72

.79

.82

.92
2010
.89
.79
1999

1.03

.61
2011
.5
.43

.45

.5

.54*
.37

.34

.91

.72
2011

.78
.61

.71

.67

.67

.89

.88

.85

.84
.37
.32

1990 1990 1990

Primary
Secondary
Tertiary0

No available data

0.2

.60

.45

0.4

.63
2011

0.6

No available data

0.8

.84

1

.92
2011

.97
1990
1.07 1.19

1.2

Gambia Mauritania Senegal* only data is available

Source: UNSD, 2015.

progress from its initial conditions in closing thegender gap in tertiary education, although it is
yet to reach target 3.A. Central Africa, on the other
hand, trails behind all regions in making progress
towards this target (see figure 3.1). A number ofcountries have contributed to the increase in
the West African average, such as Cabo Verde,

Senegal, Mauritania, the Gambia, Sierra Leone,
Burkina Faso, Ghana, Nigeria and Liberia, among
many others (see figure 3.2). These countries havealmost reached (see figure 3.3) or exceeded parity (in primary education); similar progress is also
observed in almost all North African countries.

Lessons learned in implementing the MDGs

17

MDG 3: Promote Gender Equality and Empower Women

Figure 3.3 African countries reaching parity in primary enrolment
1.4

Before 2012

2012

1.2
1.07

1.08

1.05

1.04

.94

.91

0.6

.88
(2009).80.75(2009)

.65

.59

.54

.51

.46

0.4

(2011).58(2010)

.58

.55

.43

.39
.35

.31

.23

Secondary

Tertiary

Primary

Secondary

Tertiary

Primary

Primary

Tertiary

Tertiary

SecondaryPrimary

Secondary

Tertiary

Primary

Primary

Tertiary

Secondary

Secondary

1991

Primary

1991

Tertiary

1990

Primary

1990

1990

Rwanda

1990

1990

1990

Malawi

1994

1990

1990

Senegal

1990

1990

1990

1995

1992

1990

Mauritania

1990

1992

The Gambia

.19

1990

1990

Congo

.13

1990

1990

1990

Secondary.20

Tertiary

0.2

0

.83

.80
.73

(2011).47.99(2011)

.90
.81

.60

.63

(2011)

1.02

.73

.73

.69

.87

(2011)

.85

.87
.76

1.03

1.07

.99

.95

(2010)

0.8

1.02

1.04

Secondary

1

UgandaUnitedRepublic of
Tanzazia

Source: UNSD, 2015.

Countries that have exceeded parity in primaryschool enrolment include Algeria, Tunisia and
Libya in North Africa (GPI scores of around 1.10);
Sao Tome and Principe (1.14) and Equatorial
Guinea (1.07) in Central Africa; Cabo Verde, Sierra
Leone, the Gambia, Mauritania and Senegal (anaverage GPI of 1.09) in West Africa, and 14 othercountries in Eastern and Southern Africa that havean average combined index of 1.06 with high GPIscores observed in Lesotho (1.25), Namibia (1.09),
Botswana (1.07) and Seychelles (1.05). While thisis remarkable progress, increasing disparities
against boys at any level of education is an element that needs to be followed closely to avert
negative developmental effects in the long term.
However, a number of countries continue to facechallenges in closing gender gaps in educationsuch as Niger, Chad, Central African Republic andAngola with indices below the 1990 levels.
Gender barriers still exist at different levelsof education
While there has been substantial progress in closing gender gaps in education, gender barriers
remain and are more pronounced at different
levels of education. These disparities manifest

18

themselves in low completion rates for girls at the
primary level and low transition rates between
levels – primary to secondary, tertiary and into
wage employment, with the exception of theSouthern and North Africa subregions. Consequently, while parity may have been achieved atprimary school enrolment, the gap widens andenrolment is much lower for girls at secondary
and tertiary levels. Furthermore, the transition to
paid employment in Africa excluding North Africa
and other developing regions is much more difficult for girls than boys. The unfinished agenda
in gender equality in education requires resolving
some key challenges in the quality of educationin most countries, but also particularly in fragile
states and countries in recovery, such as those inCentral Africa that face persistent developmental
challenges (World Bank, 2007). These challenges
include: reaching out to disadvantaged andsocially excluded groups, which in most cases
are in rural areas; increasing enrolments rates atsecondary and tertiary levels with incentives andrelevant policy interventions informed by genderequality concerns; and promoting transitioning
from one level to the next in the education levels
through to the labour market.

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 3: Promote Gender Equality and Empower Women

Uneven gains in the share of women in wage
employment in the non-agricultural sector
Income inequalities may be the most pronounced
form of inequalities that have been rising over time
globally. Africa is no exception, with a number ofcountries showing sharper increases in income
inequalities than others. For a continent that is
growing rapidly, this trend reveals the non-inclusiveness of Africa’s growth and the limited impact
on the welfare of women and youth. Women constitute nearly half of the population of the worldand should make up close to half of the world’s
labour force. Yet, owing to several constraints,
such as low educational qualifications and skills,
large wage differentials, conditions of work, family
responsibilities and cultural barriers, significant
gender gaps persist in their participation in gainful
employment in the formal sector. The removal of
barriers they face to gainful employment is a huge
step towards reducing inequalities and unlocking
the potential for their meaningful contribution
to socioeconomic development. Therefore, thecall for economic structural transformation contained in the African Union’s Agenda 2063 andthe African Common African Position on the post2015 Development Agenda is a justifiable development objective for the economic and social
inclusion of Africans including women.
Progress towards this end has been made with
uneven gains across countries and subregions.
The analysis of this target, however, is constrainedby data limitations, especially in Africa where lessthan 25 per cent of the countries have reported
on it (see figure 3.4). Different datasets have therefore been used as proxies for women’s participation in the labour market, including in the formal
and informal sectors.
For the purposes of this report, women’s labour
force participation has been limited to three main
sectors in most economies – agriculture, industry
and services. Globally, there is a general declineof labour force participation for both women and

Figure 3.4 Countries with sufficient and insufficient data of women in wage
employment in the non-agricultural sector in Africa

Sufficient data
Insufficient data

Not on map
Seychelles
Mauritius

Source: Authors ‘computations based on UNSD data, 2015.

Lessons learned in implementing the MDGs

19

MDG 3: Promote Gender Equality and Empower Womenmen in the agricultural sector, with gradual shifts toservices and industry, which has absorbed labour
force mainly from agriculture. The reductions havebeen much faster in some regions depending on
the pace of economic transformation and diversification. Developed regions and Latin America
and the Caribbean have significantly lower levelsof female than male labour force participation inall sectors, whereas Asia and Africa had higher
shares of women than men in the agricultural
sector between 2004 and 2007 (see table 3.1) (ILO,
2014).
The more advanced economies are, the lower thelabour force participation in the agricultural sector, which shifts to other sectors. This shift can beobserved to a great extent in the services sector
and industry. In the African region, participationin the agricultural sector is highest in East, Central
and West Africa for both women and men, followed by North Africa (42 per cent of women and28 per cent of men), while Southern Africa hasmuch lower participation of women (16 per cent)than men (26 per cent). However, female labour
participation in the services sector (26 per cent)is higher than that of men in Southern Africa andEast, Central and West Africa, with the exceptionof North Africa where male participation (49 percent) is higher than female participation.
There are large gender gaps in the labour force
participation in the industrial sector. In all regions,
there are more males than females in the industrial sector (i.e. at least 20 per cent males against
11 per cent females).
For countries with recent data (see figure 3.5),
there is steady but slow progress towards meeting this target. Botswana, Ethiopia, Mauritius,
Namibia, Seychelles and South Africa, have raised
the share of women in the non-agricultural sector
to at least above 40 per cent, while a few other

Table 3.1 Sectoral distribution of employed persons, by region and gender,
2004-2007 (per cent)
Women
Region/country

Men

Agriculture

Industry

Services

Agriculture

Industry

Services

Africa

43

11

46

42

20

39

North Africa

42

16

41

28

25

47

Southern Africa

19

11

70

26

25

49

East, Central and West
Africa

68

6

26

9

9

20

Asia

31.8

12.4

56

25.6

25.4

48.6

Eastern Asia

11

13

76

13

25

62

Southeast Asia

30

17

54

34

23

43

South Asia

55

17

28

32

24

43

West Asia

15

8

77

8

32

59

Common Wealth of Independent States and Asia

48

7

45

41

23

36

Latin America and the
Caribbean

3

12.67

80

22

27

51

Caribbean

4

10

85

15

29

56

Central America

6

16

78

30

24

46

South America

10

12

78

21

27

51

More Developed Regions

6.2

15

78.8

8.2

36.4

55.4

Source: Computed using ILO Key Indicators of the Labour Market data – 6th ed., 2010 and UNMDG Report, 2014.

20

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 3: Promote Gender Equality and Empower Women

Figure 3.5 Share of women in wage employment in the non-agricultural sector
60
Before 2012
50

49.4

40

20.5

20
15.1

(2010)

19.1

21.5
20.9

34.9

(2010)(2010)

29.3

30.8

30.9

31.1

(2011)

42.4

41.1

33.9

33.5

(2011)

30.5

26.5

25.9

(2010)

22.7

20.7

26.4

(2010)

19.2

Botswana

NamibiaSouth Africa

Seycelles

Cameroon

Mauritius

Benin

Madagascar

Zimbabwe

Ethiopia

United Rep. of
Tanzania

Gabon

UgandaTunisia

2000

Egypt

2004

1992

1990

1990

1996

1993

1992

1999

1999

1993

2006

1994

2003

1994

Morocco

13.4

Algeria

47.3

15.4

2001

0

35.4

(2010)

37.4

34.5(2010)(1990)

41.4

38.3

40.7

30

42.8

(2000)

41.6

10

2012

54.0

Source: UNSD data, 2015.

countries, – Benin, Burkina Faso, Burundi, Gabon,
Madagascar, Tunisia and Zimbabwe – have madethe greatest improvements (by at least 5 per cent)from their initial conditions.
Enhancing women’s productive capacities iscritical in women’s empowerment
Enhancing women’s productive capacities is critical, whether women are engaged in self- or wage
employment; working women are more likely toinvest their earnings in building human capitalin their homes and communities. Such microeconomic contributions can be crucial in keeping
households out of poverty, increasing educational
attainment and contributing to health outcomesin order to meet larger macroeconomic objectives.
It is important, therefore, to ensure that women’s
productive capacities are enhanced by removing the barriers to entry in both the formal andinformal sectors. The upward trend in the share ofwomen in the non-agricultural and formal sectors
is a strong indication of the gradual shift towards
decent jobs for the majority of population groups
including women. More women, however, arelikely to be unemployed than men, and likely to
be engaged in the informal sector (including theservices sector) and vulnerable employment thantheir male counterparts in all regions (see figure3.6). The ratio of women in vulnerable employ-ment is persistently higher than that of men,
especially in West, East and Central Africa. A similar trend is also observed in the unemployment
ratios, which are typically much higher for women(adult and youth) than for their male counterparts.
Self and vulnerable employment provides opportunities for most women and men where there
are barriers to entry into the formal sector. The
share of women in vulnerable employment ispersistently higher than that of men in all regions;West Africa has the largest share, followed by East
and Central Africa, whereas Southern and Northern Africa have the lowest shares. It should behighlighted that the economies in Southern andNorthern Africa are relatively well transformed
and diversified enough to offer more formal andreliable employment opportunities than the restof the continent. The reality for most of Africa,
however, is the lack of decent jobs in the formal
sector, which has left many people unemployed
or in vulnerable employment. Women and theyouth make up the majority of the population thatis either unemployed or in vulnerable employment, and unemployment is persistently higher
for adult women and female youth in all regions
than for their male counterparts. The subregionswith the least shares of vulnerable employment(i.e. Southern and Northern Africa) have relatively
Lessons learned in implementing the MDGs

21

MDG 3: Promote Gender Equality and Empower Women

Figure 3.6 Regional breakdown of vulnerable employment
100

Total vulnerable employment (2013)
Male vulnerable employment (2013)
Female vulnerable employment (2013)

80

60

40

20

0

Eastern Africa

Central Africa

Northern Africa

Southern Africa

Western Africa

Source: ILO, Trends Econometric Models, October 2014.

the highest rates of unemployment and inequalities in Africa compared to the other subregions
where vulnerable employment is most prevalent
in all age groups, and particularly for female youth
and women. This is due to the lack of informal
employment options available to them and theavailability of social protection programmes thatcushion the unemployed. In countries with weaksocial protection systems, unemployment is not
an option and therefore precarious jobs provide
the much needed cushion and the means for survival for a large share of the working poor.
By 2013, Southern Africa had an adult male unemployment rates of 14.6 per cent compared to an
adult female unemployment rate of 19.1 per cent,and a male youth unemployment rate of 35.4 percent compared to a female youth unemployment
rate of 44.6 per cent. In North Africa, in the same
year, adult male unemployment was 7.9 per centcompared to 14.9 per cent for the adult female
population; youth unemployment rates were
26 per cent for males and 46.6 per cent for females(ILO, 2014). These trends account for a significant
portion of the rising inequality patterns observedin Africa in recent times, which is disproportionately affecting large segments of the population
within countries and regions. This needs urgent
attention.
22

Africa is leading in women’s representationin national parliaments
Ensuring that women are well represented inpositions of power and decision making canremove some of the barriers they face in accessto education, health and employment, thereby
substantially reducing inequalities. Although thefull impact of women’s representation is yet to berealized, their slow but increasing representationin national parliaments has empowered women
globally. This has been achieved by promoting
women’s issues and concerns through the legislature in order to reduce inequalities between
genders. From 2000 to 2014, the global average
for women’s representation in national parliaments rose steadily from 14 to 22 per cent (UNSD,
2014). Over the same period, Africa has made themost progress on this target, with an increase of
the share of women in national parliaments by atleast 15 per cent, followed by Latin America andthe Caribbean (11 per cent increase), Asia (9.8 percent) and developed regions (9 per cent) (see figure 3.7).

There are significant differences, however, withinregions and across countries, with results showing a direct correlation between policy measures
put in place and the increase in numbers andlevels of representation of women in national

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 3: Promote Gender Equality and Empower Women

Figure 3.7 Proportion of Seats held by Women in national parliaments, 2000 and2014 (per cent), per region
30

2000
2014

25
20
15
10
5
0

Asia and Central
Asia

Africa excluding
North Africa

North Africa

Latin American &the Caribbean

Developed
Regions

Source: Authors’ computations based on UNSD data, 2015.

parliaments (see figure 3.8). Female members ofparliament remained unchanged in 2014 from2012 and accounted for 20 per cent of all parliamentary seats in Africa with significant variations
across subregions and countries. East Africa
continues to lead (see figure 3.8), with Rwanda
registering 63.8 per cent of women in its national
parliament followed by Ethiopia (41.6 per cent),
United Republic of Tanzania (36 per cent), Uganda(35 per cent) and Burundi (31.1 per cent). Several
countries in Southern Africa maintained a steady

growth in the share of women in national parliaments: South Africa has maintained its leadershipin the subregion, with a share of 44.8 per cent of
women in its national parliament, followed by
Seychelles (43.8 per cent), Namibia (42.4 per cent),
Botswana (41.4 per cent), Mozambique (39.2 percent), Mauritius (38.3 per cent), Madagascar(35.4 per cent) and Zimbabwe (31.5 per cent), allof which have met the 30 per cent target and areaiming at a 50 per cent share of representation.
In Central Africa, three countries have reached

Figure 3.8 Seats held by women in national parliaments (per cent)

1990

2014

Africa7%

20%

Northern

3%15%Western

9%16%

Central

11%20%Southern

5%23%

Eastern

8%0

80% Men

27%
20

40

60

80

100

Source: UNSD data, 2015

Lessons learned in implementing the MDGs

23

MDG 3: Promote Gender Equality and Empower Women

Figure 3.9 African countries with more than 30 per cent of seats held by women innational parliaments
64%

60

50
43%

40
32%

45%

Seychelles

South Africa

39%

37%
31%

31%

30

44%

20

10
0

Algeria

AngolaBurundiCameroon Mozambique

RwandaSenegal

Source: Authors’ calculations based on UNSD data, 2015.

the 30 per cent target: Angola (36.8 per cent),
Gabon (34.5 per cent) and Sao Tome and Principe (32.1 per cent). Recently, Senegal has showna very strong performance in its representationlevels in the national parliament. In 2014, Senegal
registered a share of 43.3 per cent of women in its
national parliament, up from 22.7 per cent in 2010.
Although only one country (Algeria) has reached
the target in North Africa, the subregion is themost improved of all regions. From 2010 to 2014,
Algeria more than tripled its share of women in its
national parliament from 7.7 per cent to 31.6 per
cent; Morocco, from 10.5 per cent to 17 per cent;and Libya, from 7.7 per cent to 16.5 per cent.

adopters of such policies in Southern and East
Africa in the early 1990s. However, there is a pushfor more gender reforms within political parties
to field and support more women candidates.
In addition to the quotas at the national level,
however, it is important to increase women’s participation at local levels in order to have a pool ofcandidates that can participate and increase thenumber of women at the national level as wellas to address political violence against women,
which has acted as a deterrent for women’s political participation.

Legislated or voluntary quotas have had a positive
impact on the share of women in national parliaments as seen in most countries that were early

24

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 4: Reduce child mortalityT

his section provides the progress madein reducing child mortality and achieving
MDG 4 both globally and in Africa. It also
looks into the variations in progress made to date.
Target 4.A: Reduce by two-thirds, between
1990 and 2015, the under-five mortality rate
Impressive progress in reducing child mortality
Continent-wide, U5MR was reduced by 55.5
percent, from 146 deaths per 1,000 live births in1990 to 65 deaths in 2012, against the target of
the two-thirds reduction. Yet, the continent is still
the region with the highest proportion of U5MR
globally, accounting for 1 in 9 child deaths before
the age of five as indicated in figure 4.1.

Globally, an estimated 6.6 million children underfive died in 2012, a remarkable decline from the12.6 million deaths in 1990 (UNICEF, 2013b). Yet,
there are variations in the rate of reduction ofchild mortality across the various regions (see figure 4.1). Although Africa has shown encouraging
progress in reducing child mortality, 3.2 million of
the continent’s children did not reach their fifthbirthday in 2012. Consequently, Africa accounts
for almost half of all child deaths globally, an
increase from 29 per cent two decades ago (Ibid.);most died as a result of easily preventable infectious diseases.
Twenty-seven developing countries are expectedto achieve MDG 4 by 2015 (McKinnon, et al.,2014; The Lancet, 2014). In addition, the annualized rates of change from 1990 to 2013 ranged
from –6.8 per cent to 0.1 per cent. Ninety-nine outof 188 countries, including 43 of 48 countries inAfrica excluding North Africa, had faster decreases
in child mortality during 2000–2013 than during
1990–2000. The average annual rate of decline inchild deaths reached 4.1 per cent in 2005–2012,
against 0.8 per cent in 1990–1995 (UNICEF, 2013b).
In Africa excluding North Africa, under-five mortality rate was reduced by 44.6 per cent, from 177
deaths per 1,000 live births in 1990 to 98 deaths in
2012, against the target of the two-thirds reduction.

Figure 4.1 Under-five mortality rates by region, 1990, 2012 and 2015 target
200
1990
2012
2015 Target
150

100

50

0
Africa excluding
North Africa

South Asia

Western Asia

Eastern Asia

Developed regions Developing regions

World

Source: UNSD, 2013.

Lessons learned in implementing the MDGs

25

MDG 4: Reduce child mortality

Egypt, Ethiopia, Liberia, Malawi, Tunisia and theUnited Republic of Tanzania met the under-five
mortality rate target in 2012; Algeria, Cabo Verde,
Eritrea, Libya, Madagascar, Morocco, Mozambique, Niger, Rwanda, South Sudan and Uganda
reduced their rate by 60 per cent or more, or havecome very close to the target of reducing it by
two thirds. Increases were recorded in the underfive mortality rate during this period in Botswana,
Lesotho, Swaziland and Zimbabwe is largely
attributed to HIV/AIDS-related deaths.
There is also wide variation in the level of achievement among countries on the infant mortality
rate target. The continent-wide infant mortality
rate fell from 90 deaths per 1,000 live births in1990 to 54 deaths per 1,000 live births in 2014, adecline of 40 per cent. In addition, from 1990 to2012, 18 countries reduced their infant mortality
rates by more than one half, including Egypt, Liberia, Malawi and Tunisia (by over 65 per cent); and26 countries registered reductions of between 20
and 49.9 per cent. Over the same period, Lesotho, Swaziland and Zimbabwe also registered
increases in their infant mortality rates and in theirunder-five mortality rate. In 2012, the Democratic
Republic of the Congo, Sierra Leone, Somalia
and the Central African Republic remained thecountries with the highest infant mortality rates,
all registering rates above 100 deaths per 1,000
live births. Botswana’s under-five mortality rateincreased from 57 in 1990 to 76.0 in 2007, andthen declined to 28 in 2011, while its infant mortality rate increased from 48 in 1990 to 57.0 in
2007, and declined to 17 in 2011.
Many of the African countries have demonstrated
either slow progress or stagnating neonatal mortality rates. The situation is worse for the large
rural populations of Africa that have poor accessto and utilization of maternal and newborn healthservices. Globally, some countries have madesubstantial progress in reducing neonatal mortality rates, most notably China and Egypt (bothwith a 60 per cent per cent reduction in newborn

26

deaths) and Cambodia (51 per cent). In contrast,
Africa excluding North Africa, where about a thirdof under-five deaths occurred during the neonatal
period, has the highest neonatal mortality rate (32deaths per 1,000 live births in 2012) and accounts
for 38 per cent of global neonatal deaths (UNICEF,
2013b).
Overall, African countries have made substantial
progress towards achieving MDG 4 (Reduce childmortality). In particular, Africa excluding North
Africa has seen a faster decline in its under-five
mortality rate, with the annual reduction rate doubling between 1990–2000 and 2000–2011. Accelerated efforts in reducing the under-five mortality
rate in Africa has enabled the continent achieve
good progress at reaching this target.
Curbing neonatal mortality is critical for improving
child survival. Among the proven, cost-effective
and high-impact interventions are: skilled care atbirth and emergency obstetric care; managementof pre-term births, including antenatal corticosteroids for lung maturation; basic neonatal care; neonatal resuscitation; early identification and antibiotic treatment of serious infections; inpatient carefor small and sick newborns; and prevention of
mother-to-child transmission) of HIV. Prioritizationand integration of these interventions into theservice delivery modalities is crucial. Combining
quality health services at the health facility, supported by strong outreach, follow-up and referral
services, promoting healthy behaviours at homeand making early decisions to seek care will havethe greatest impact. Concerted effort should befocused on social determinants of health (education, income, gender orientation, household foodsecurity, water and sanitation etc.) and an education campaign is crucial. For children living in
the poorest households, social protection mechanisms including health insurance are needed to
improve access to high-impact interventions.

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 5: Improve maternal healthEnsuring that African countries meet MDG 5(Reducing the maternal mortality ratio by
three quarters between 1990 and 2015)
remains a challenge. Less than two fifths of countries have a complete civil registration systemwith good attribution of cause of death, which
is necessary for the accurate measurement ofmaternal mortality. Owing to the existence of
only scant data on MDGs, particularly on maternal
health, most countries and development partners
are relying on estimates to have an idea of thematernal health situation in Africa.
Globally, WHO reported 800 maternal deaths per
100,000 live births daily in 2013 alone, as a resultof complications of pregnancy and childbirth. It
is indicated that the risk of a woman in a developing country especially in Africa dying from amaternal cause is around 23 times higher thanfor a woman living in a developed country (WHO,2014a). Maternal mortality in Africa has been
largely associated with three kinds of delays in thechildbearing process – delays in seeking healthcare, delays in reaching caregivers, and delays inreceiving care (ECA et al., 2011).

The Yamoussoukro Declaration gave a boost
to the measurement of maternal mortality. The
Declaration arose out of the third Conference ofAfrican Ministers Responsible for Civil Registration,
held in Côte d’Ivoire on -13 February 2015. Amongother resolutions adopted at the Conference, theDeclaration focused on the strengthening of statistics on death and causes of death. Implementation of the resolutions will be a great opportunity
for the continent to accurately measure maternal
deaths and consequently contribute to strengthening policies to improve maternal health. Furthermore, the United Nations Secretary-General’s Global Strategy for Women’s and Children’s
Health, launched in September 2010, has been
instrumental in the mobilization of commitments
among African governments, civil society organizations and development partners to accelerate
progress in meeting MDG 5 (UNSD, 2010).

Africa has made tremendous progress in improving maternal health, but only a few countries(Cabo Verde, Equatorial Guinea and Rwanda) have
met the target of reducing the maternal mortality
ratio by two thirds by 2015.
Target 5.A: Reduce by three quarters,
between 1990 and 2015, the maternalmortality ratio
Africa has the highest maternal mortality ratio
globally
Africa is the region with the highest maternalmortality ratio (MMR) in the world. According toUnited Nations Statistics Division (UNSD) data, by
2013, Africa had 289 maternal deaths per 100,000
live births, compared to the world average of210
maternal deaths per 100,000 live births. In 2013,
the developed regions of the world reported thelowest MMR (16 deaths per 100,000 live births),
followed by Eastern Asia (33 deaths per 100,000
live births), and Caucasus and Central Asia (39deaths per 100,000 (table 5.1).

Between 1990 and 2013, only four African countries
reduced their MMR by over 75 per cent, thereby
meeting MDG 5: Cabo Verde, 77 per cent; Equatorial Guinea, 81.9 per cent; Eritrea, 77.6 per cent; andRwanda, 77.1 per cent. Some countries reduced
their MMR by over 60 per cent and are therebyon track to meeting MDG 5: Ethiopia, 70 per cent;Angola, 67 per cent; Mozambique, 63 per cent;Egypt, 62.5 per cent; and Morocco, 61.3 per cent.
Some African countries only slightly reduced their
MMR, by less than 10 per cent: Zimbabwe, 9.6 per
cent; South Africa, 6.7 per cent; and Côte d’Ivoire,
2.7 per cent. Only Mauritius increased its MMR, by
4.3 per cent (70 per cent in 1990 to 73 per cent in2013). However, countries that already had a low
MMR in 1990 found it difficult to further reduce itby 2013. Countries that have emerged from, or are
in conflict, such as Burundi, Chad, the Democratic
Republic of the Congo, Sierra Leone and Somalia
reported exceedingly high MMRs (see figure 5.1).

Lessons learned in implementing the MDGs

27

MDG 5: Improve maternal health

Table 5.1 Global comparisons on maternal mortality ratio (maternal deaths per
100,000 live births, women aged 15-49)
Maternal mortality ratio

1990

2000

2013

World

380

330

210

Developing regions

430

370

230

Africa

575

470

289

Latin America and the Caribbean

140

110

85

Eastern Asia

95

63

33

Southern Asia

530

360

190

South-East Asia

320

220

140

Western Asia

130

97

74

Oceania

390

290

190

Caucasus and Central Asia

70

65

39

Developed regions

26

17

16

Source: UNSD data, updated on 7 July 2014.

Limited access to skilled health personnel
constrains the fight against child andmaternal deaths
Global data on the proportion of births attended
by a skilled health personnel indicate that Africa is
still one of the regions with the lowest proportionof births attended by a skilled health personnel(68 per cent), although it performed better thanSouthern Asia, which reported 51 per cent in 2012(table 5.2).

28

Four African countries registered an impressive
performance, with over 95 per cent of the births
being attended by skilled health personnel (Libya,
99.8 per cent; Tunisia, 98.6 per cent; Mauritius,
98.4 per cent; and Algeria, 95.2 per cent). Results
also indicate that Chad, Eritrea, Ethiopia, Niger andSudan were the weakest performers in Africa (seefigure 5.2).

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 5: Improve maternal health

Figure 5.1 Progress in reducing the maternal mortality ratio, 1990-2013
Algeria
Libya
Egypt
Tunisia
Cape Verde
Mauritius
MoroccoNamibiaSouth Africa
Botswana
Sao Tome and Principe
Djibouti
Gabon
ZambiaEquatorial Guinea
Swaziland
Mauritania
RwandaSenegalBenin
Comoros
UgandaEritrea
Ghana
Burkina Faso
Kenya
Congo, Rep.
Tanzania
Ethiopia
The Gambia
Madagascar
Togo
AngolaZimbabwe
Mozambique
Lesotho
MalawiMali
Guinea-Bissau
Nigeria
Cameroon
Niger
Liberia
GuineaCôte d'Ivoire
Congo, Dem. Rep.
BurundiSomalia
CAR
Chad
Sierra Leone

1990
2013

0

500

1000

1500

2000

2500

Source: UNSD data, updated on 7 July 2014.

Table 5.2 Global proportion of births attended by skilled health personnel(per cent)
Births attended by skilled health personnel (per cent)

1990

2000

2012

World

57

58

69

Developing regions

56

57

68

Africa47

56

68

Caribbean

70

71

74

Eastern Asia

94

97

100

South Asia

33

38

51

South-East Asia

49

66

79

Western Asia

60

70

80

Caucasus and Central Asia

97

92

98

Source: UNSD, 2015.

Lessons learned in implementing the MDGs

29

MDG 5: Improve maternal health

Figure 5.2 Proportion of births attended by skilled health personnel (per cent)Ethiopia (2011)
Sudan (2010)
Chad (2010)
Eritrea (2002)
Niger (2012)
Somalia (2006)
Guinea-Bissau (2010)
Kenya (2009)
Madagascar (2009)
Guinea (2012)
Liberia (2007)
Zambia (2007)
Angola (2007)
Nigeria (2011)
Tanzania (2010)
CAR (2010)
Mozambique (2011)
Mali (2010)
The Gambia (2010)
Uganda (2011)
Cote d'Ivoire
Togo (2010)
Burundi (2010)
Sierra Leone (2010)
Cameroon (2011)
E.Guinea (2000)
Mauritania (2011)
Senegal (2011)
Burkina Faso (2010)
Zimbabwe (2011)
Ghana (2011)
Rwanda (2010)
Malawi (2010)
Morocco (2011)
Cape Verde (2005)
Lesotho (2014)
Egypt (2008)
Congo, Dem. Rep. (2010)
Namibia (2007)
Sao Tome & Principe (2009)
Swaziland (2010)
Comoros (2012)
Benin (2012)
Gabon (2012)
South Africa
Djibouti (2006)
Congo, Rep. (2012)
Botswana (2007)
Algeria (2006)
Mauritius (2003)
Tunisia (2012)
Libya (2008)

40
0

20

60

80

100

Source: UNSD data, updated on 7 July 2014.

Target 5.B: Achieve, by 2015, universal
access to reproductive health
Increasing contraceptive prevalence rates canlower maternal deaths
The contraceptive prevalence rate for married
women indicates the ability of a woman’s choice
to determine the number of children she will bear
and the timing of child birth (UNFPA, 2012). UNSD
data on the 2012 contraceptive prevalence rate30

indicates that Africa (44.3 per cent) registered thehighest improvement during the MDG era andmoved ahead of Oceania (37.3 per cent) (Table
5.3).
More than 70 per cent of African countries have acontraceptive prevalence rate of less than 50 per
cent, which may explain the high maternal deaths
that have persisted in Africa. Five countries, namely
Chad, Eritrea, the Gambia, Guinea and Mauritania,

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 5: Improve maternal health

Table 5.3 Global contraceptive prevalence rates among women aged 15 - 49 years,
married or in union, using any method of contraception (per cent)Contraceptive prevalence rate

1990

2000

2012

World

55.2

61.5

63.5

Developing regions

51.8

59.8

62.5

Africa

28.0

38.2

44.3

Latin America and the Caribbean

61.1

69.9

73.2

Eastern Asia

78.1

85.7

83.5

Southern Asia

39.2

48.3

57.0

South-East Asia

48.1

57.1

63.1

Western Asia

44.0

51.0

57.6

Oceania

28.4

31.6

37.3

Caucasus and Central Asia

49.3

57.9

56.4

Developed regions

68.4

70.1

69.8

Small Island Developing States

49.6

53.1

55.7

Source: UNSD, 2014.

reported a rate of less than 10 per cent, in contrast
to Mauritius, which has the highest contraceptive
prevalence rate in Africa (see figure 5.3).
Condom use is one of the most important modesof contraception, especially in the spacing ofpregnancies. Despite the popularity of condom
use in Africa, only a small proportion of married
women use it as a method of contraception. Fig-ure 5.4 indicates that Botswana, the Congo, Lesotho, Namibia and Swaziland are the highest usersof condoms among married women aged 15-49
years, although all African countries have condom
prevalence rates of less than 50 per cent. Other
African countries reported less than a 10 per centprevalence rate for condom use among womenin 2013 (UNSD, 2015).

Lessons learned in implementing the MDGs

31

MDG 5: Improve maternal health

Figure 5.3 Contraceptive prevalence rate, any method (per cent)Mauritius (2002)
Morocco (2011)
Swaziland (2010)
Tunisia (2012)
Algeria (2006)
Cape Verde (2005)
Egypt (2008)
Lesotho (2014)
South Africa (2004)
Zimbabwe(2011)
Namibia (2007)
Botswana (2008)
Rwanda (2011)
Malawi (2010)
Kenya (2009)
Congo, Rep. (2012)
Libya (2007)
Zambia (2007)
Madagascar (2009)
Sao Tome & Principe (2009)
Tanzania (2010)
Gabon (2011)
Uganda(2011)
Ethiopia (2011)
Cameroon (2011)
Burundi (2011)
Liberia (2013)
Comoros (2012)
Ghana (2013)
Djibouti (2012)
Côte d'Ivoire (2012)
Senegal (2013)
Angola (2009)
Congo, Dem. Rep. (2010)
Sierra Leone (2013)
Burkina Faso (2011)
CAR (2011)
Togo (2010)
Nigeria (2013)
Somalia (2006)
Guinea-Bissau (2010)
Niger (2012)
Benin (2012)
Eq. Guinea (2011)
Mozambique (2011)
Mali (2013)
Mauritania (2007)
The Gambia (2013)
Eritrea (2002)
Guinea (2012)
Chad (2010)
0

10

20

30

40

50

60

70

80

Source: UNSD data, updated on 7 July 2014.

Early childbearing is a maternal health risk
Early childbearing is associated not only withhealth risks to both the young mother and herchild, but also with missed opportunities at school
and work, and the consequent intergenerationaltransmission of poverty. Therefore, reducing earlychildbearing can impact the achievement of other
MDGs on poverty, education, gender equality andchild mortality (UNSD, 2014).

32

Globally, almost all the regions are witnessing
a decline in adolescent birth rates among girls
aged 15-19 years. Africa has also seen substantially higher decline in adolescent births rates
than Latin America and the Caribbean by 2011
see table 5.4).
Nevertheless, Africa still has a major challenge inaddressing adolescent birth rates; half of African

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 5: Improve maternal health

Figure 5.4 Current condom use among married girls and women 15-49 years (fivehighest African countries) (per cent)Botswana (2008)
0.5

0.4

0.417

0.3

Lesotho (2010)

0.2
0.1
0.094

Swaziland (2010)
0.224
0

0.106

Namibia (2007)

0.123

Congo (2012)

Source: UNSD data, updated on 7 July 2014.

Table 5.4 Live births per 1,000 adolescent girls aged 15 - 19
Live births per 1,000

1990

2000

2011

World

58.8

51.6

50.1

Developing regions

63.7

56.1

54.3

Africa

82.8

76.5

74.6

Latin America and the Caribbean

85.8

86.2

75.9

Eastern Asia

15.3

5.8

6.0

Southern Asia

87.6

60.8

49.5

South-East Asia

54.2

43.4

43.2

Western Asia

62.9

50.5

47.0

Oceania

84.1

64.5

58.5

Caucasus and Central Asia

44.6

28.5

31.8

Developed regions

33.7

25.5

20.6

Small Island Developing States

77.2

72.7

62.7

Source: UNSD data, updated on 7 July 2014.

countries have adolescent birth rates of more than
100 births per 1,000 women. Since, according toWHO, rates above 100 are considered very high,concerted efforts are required to minimize thesepregnancies if Africa is to witness a high reduc-tion in maternal deaths (WHO, 2013). Only seven
African countries reported adolescent birth rates
of less than 50 births per 1,000 women –Libya,
Algeria, Tunisia, Djibouti, Mauritius, Morocco and
Rwanda (see table 5.5).

Lessons learned in implementing the MDGs

33

MDG 5: Improve maternal health

Table 5.5 Country performance on adolescent births per 1,000 womenOver 150 births

100-150 births

50-99 births

10-49 births

Below 10 births

CentralAfricanRepublic(2009)

229.0

Liberia(2011)

149.0

Benin
(2009)

98.1

Rwanda(2008)

41.0

Tunisia(2011)

6.9

Niger(2010)

206.0

Congo
(2009)

147.0

Lesotho(2007)

92.0

Morocco(2008)

32.0

Algeria(2006)

4.4

Chad(2009)

203.4

Madagascar(2006)

147.0

Cabo Verde(2003)

92.0 Mauritius

31.0

Libya
(2002)

4.1

Angola(2008)

188.0

Uganda(2009)

146.0

Swaziland(2009)

89.0

Djibouti(2010)

20.6

Mali(2011)

172.0

Guinea-Bissau(2009)

136.7

Mauritania(2001)

88.1

Mozambique(2009)

166.0

Burkina Faso
(2008)

136.0

Togo(2009)

88.0

Malawi(2008)

157.0

Democratic
Republic of
the Congo(2009)

135.0

Gambia(2011)

88.0

Guinea(2009)

154.0

Equatorial
Guinea(2001)

128.1

Ethiopia(2008)

87.0

Zambia(2005)

151.0

Cameroon(2008)

128.0

Eritrea(1999)

85.0

Tanzania(2007)

128.0

Senegal(2011)

80.0

Côte d’Ivoire(2009)

125.0

Namibia(2004)

74.0

Sierra Leone(2012)

125.0

Seychelles(2011)

70.3

Somalia(2005)

123.0

Ghana
(2006)

70.0

Nigeria(2011)

122.0

Comoros(2011)

70.0

Gabon(2009)

115.0

Burundi(2008)

65.0

Zimbabwe(2008)

112.0

South Africa(2007)

54.0

Sao Tome andPrincipe(2006)

110.0

Botswana(2006)

51.0

Kenya(2006)

106.0

Egypt
(2005)

50.0

Source: UNSD data, updated on 7 July 2014.

34

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 5: Improve maternal health

Increasing antenatal care coverage is a lifesaver for mothers and newborns
The WHO has recommended a minimum of fourantenatal care visits to ensure the well-being of
mothers and newborns (WHO, 2014a). According
to the global MDG Report 2014, only 52 per centof pregnant women had four or more antenatal
care visits during pregnancy in 2012, an increase
from 37 per cent in 1990. The findings indicatethat Africa continues to show a poor performanceon this indicator with less than 50 per cent attendance of the recommended four antenatal care visits. However, it should be noted that 80 per centof the women in Africa attended antenatal care ina health facility at least once.

Among African countries, Ghana, South Africa andTunisia have the highest antenatal care coverage,i.e. above 80 per cent of the pregnant women,
whereas Djibouti and Somalia have the lowest(see figure 5.5).
Regular contact with health professionals among
pregnant women is essential and presents a number of benefits including prevention of motherto-child transmission of HIV/AIDS micronutrient
supplementation, birth preparedness information,
as well as treatment of any imminent diseases.

Early detection of problems in pregnancy will befacilitated by antenatal care, and timely referrals
will also be facilitated in case of pregnant womenwith complications (UNICEF, 2013a).
The unmet need for family planning remainsa challenge
According to a 2012 report by United Nations Population Fund (UNFPA), women who wish to delay
pregnancy for two or more years, or avoid pregnancy, but are not using a contraceptive method
have an unmet need for family planning (UNFPA,2012). According to data from UNSD, Africa had
the highest unmet need for family planning in
2012, a figure slightly higher than that of the small
island developing States.

Sao Tome and Principe reported the highest
unmet need for family planning, whereas Mauritius has the lowest unmet need for family planning in Africa. Although all the rates for the unmet
need for family planning are lower than 50 per
cent, the target should be to achieve a rate of zero(see figure 5.6). The proactive role of the Government of the Niger in reducing the unmet need forfamily planning through the involvement of husbands has been commendable and has resulted
in a reduction of 16 per cent in 2012 (UNSD, 2014).

Table 5.6 Global unmet need for family planning among married or women inunion aged 15-49 (%)
Unmet need for family planning (per cent)

1990

2000

2012

World

15.2

12.8

12.0

Developing regions

16.5

13.5

12.4

Africa

24.9

20.3

18.5

Latin America and the Caribbean

17.3

12.8

10.6

Eastern Asia

5.7

3.2

3.9

Southern Asia

21.3

17.6

14.4

South-Eastern Asia

18.8

15.5

12.5

Western Asia

21.6

19.3

15.9

Oceania

27.4

26.7

24.6

Caucasus and Central Asia

18.0

14.0

14.1

Developed regions

10.4

9.7

9.8

Small Island Developing States

20.2

19.5

18.4

Source: UNSD data, updated on 7 July 2014.

Lessons learned in implementing the MDGs

35

MDG 5: Improve maternal health

Figure 5.5 Antenatal care coverage, at least four visits (per cent)Mauritius(2002)
Guinea-Bissau(2010)
Tunisia(2012)
Morocco(2011)
Egypt(2008)
Swaziland(2010)
South Africa(2004)
Zimbabwe(2011)
Niger(2012)
Cape Verde(2005)
Lesotho(2014)
Congo(2012)
Nigeria(2011)
Madagascar(2009)
Namibia(2007)
Rwanda(2011)
Gambia(2010)
Guinea(2005)
Cote d'Ivoire(2012)
Cameroon(2011)
DRC(2010)
Burkina Faso(2011)
Tanzania(2010)
Kenya(2009)
Malawi(2010)
Ethiopia(2011)
Gabon(2012)
Zambia(2007)
CAR(2011)
Libya(2007)
Sierra Leone(2010)
Mali(2006)
Chad(2010)
Eritrea(2002)
Mozambique(2011)
Senegal(2013)
Mauritania(2001)
Burundi(2011)
Benin(2012)
E.Guinea(2011)
Uganda(2011)
Comoros(1996)
Liberia(2007)
Togo(2010)
Ghana(2013)
Sao Tome & Principe(2009)
0

5

10

15

20

25

Source: UNSD data, updated on 7July 2014.

36

Assessing Progress in Africa toward the Millennium Development Goals, 2015

30

35

40

MDG 5: Improve maternal health

Figure 5.6 Unmet need for family planning, total (%)
Mauritius (2002)
Guinea-Bissau (2010)
Tunisia (2012)
Morocco (2011)
Egypt (2008)
Swaziland (2010)
South Africa (2004)
Zimbabwe (2011)
Niger (2012)
Cape Verde (2005)
Lesotho (2014)
Congo, Rep. (2012)
Nigeria (2011)
Madagascar (2009)
Namibia (2007)
Rwanda (2011)
The Gambia (2010)
Guinea (2005)
Côte d'Ivoire (2012)
Cameroon (2011)
Congo, Dem. Rep. (2010)
Burkina Faso (2011)
Tanzania (2010)
Kenya (2009)
Malawi (2010)
Ethiopia (2011)
Gabon (2012)
Zambia (2007)
CAR (2011)
Libya (2007)
Sierra Leone (2010)
Mali (2006)
Chad (2010)
Eritrea (2002)
Mozambique (2011)
Senegal (2013)
Mauritania (2001)
Burundi (2011)
Benin (2012)
Eq. Guinea (2011)
Uganda (2011)
Comoros (1996)
Liberia (2007)
Togo (2010)
Ghana (2013)
Sao Tome & Principe (2009)
0

5

10

15

20

25

30

35

40

Source: UNSD updated on 7 July 2014.

Challenges in measuring maternal health
Lack of data is one of the major hurdles in tackling the implementation of the MDGs, particularly MDG 5. The latest available data from theUnited Nations Statistics Division, which is the
major repository of MDG data, is 2013. Without
updated data, countries cannot adequately determine whether certain interventions are working,including how to distribute the meagre resources
on improving maternal health (ECA et al., 2012).

African countries have faced challenges in measuring maternal deaths according to the recommended WHO definition. This definition allows

the identification of maternal deaths based on
their causes as either indirect or direct. Directmaternal deaths are those resulting from obstetric complications of the pregnant state including
pregnancy, delivery and postpartum. Other directcauses of maternal deaths are associated withinterventions, omissions, incorrect treatment or achain of events resulting from any of the above.
This implies that deaths due to obstetric hemorrhage, complications of anesthesia or caesarean
section are part of the direct causes of maternal
deaths. Indirect maternal deaths result from diseases developed during pregnancy and are aggra-

Lessons learned in implementing the MDGs

37

MDG 5: Improve maternal healthvated by the physiological effects of pregnancy
such as cardiac or renal diseases (WHO, 2012).
In African countries where most deliveries anddeaths occur outside the health facilities, identification of causes of maternal death becomes
highly challenging, including obtaining the accurate figures of MMR. In settings where there is alack of medical certification of causes of death, it
is difficult to accurately attribute female deaths
to maternal deaths. According to a joint reportby WHO, UNICEF and UNFPA, maternal deaths indeveloped countries may also be underreported
owing to miscalculations of the International Statistical Classification of Diseases and related healthproblems, despite routine death registration thathas been taking place for over a decade (WHO,
UNICEF and UNFPA, 2014a).
In addition, with weak civil registration systems in
Africa, it is challenging to identify maternal deaths
since the deaths of women within the reproductive age group of 15 to 49 years might not havebeen recorded. According to the United Nations
principles and recommendations of Civil Registration and Vital Statistics revision 3, civil registration
remains the most ideal and accurate system toprovide maternal deaths statistics and causes ofthese deaths. Accordingly, the African Programmeon Accelerated Improvement of Civil Registration
and Vital Statistics was established to remove
barriers to death and causes of death registration
ought to be supported (UNSD, 2014).

Conclusion

tion in maternal deaths even after the set deadline of 2015 in meeting the MDGs. A number ofinnovative approaches have been implemented
in several African countries to reduce maternalmortality that should be adopted and replicatedin the other African countries.
Routine civil registration systems including registration of births, death and causes of deaths
should be strengthened. For deaths outside
health facilities, WHO recommends that the verbal autopsy approach should be applied. Verbal
autopsy is essential in obtaining information on
the probable cause of death, which is performed
through interviews with family members orcommunity members. In 2012, WHO published arevised shortened verbal autopsy questionnaire
called Release Candidate 1 (WHO, 2012b). Thisapproach is often used where medical certification of cause of death is not available.
The contraceptive prevalence rates as well as
the unmet need for family planning indicators
in Africa show that, inasmuch as contraceptives
should be made available and affordable, concerted efforts should focus on raising awarenesson the different contraceptive products and how
they can address the needs of women.
With the upcoming post-2015 development
agenda, the steady progress witnessed to date,especially in Africa, indicates that maternal healthwill be improved in the long term provided thatthe current and additional interventions are maintained.

Given the enormous efforts by the African countries in improving maternal health, the current
momentum is likely to lead to a significant reduc-38

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 6: Combat HIV/AIDS,
malaria and other diseases

E

fforts to combat HIV/AIDS, malaria and tuberculosis in Africa have yielded impressive
results since 1990 and are placing the continent on a solid path to reversing the spread of all
the above diseases. Indeed, a downward trend isobserved in the incidence, prevalence and death
rates associated with HIV/AIDS, malaria and tuberculosis, especially since 2000. The efforts to combat these diseases have been mostly made by:adopting WHO recommended programmes andinterventions such as DOTS for tuberculosis; using
insecticide-treated nets and artemisinin-based
combination therapy for malaria; and using
condoms and antiretroviral medicines for HIV/
AIDS. These efforts demonstrate the high level ofpolitical commitment to combating each of thediseases, one of the highest for any of the MDGs.
Notwithstanding the progress being made, Africa
carries the highest burden of HIV/AIDS, malaria
and tuberculosis, accounting for more than half of
all cases and deaths worldwide.
Target 6.A: Have halted by 2015 and begun toreverse the spread of HIV/AIDS
Significant strides in the battle against HIV/AIDS
In the last 15 years, Africa has made significant
strides in combating HIV/AIDS and is succeeding inreversing the evolution of the pandemic and reducing its death toll. The progress has encompassed all
five of Africa’s geographical subregions. Between
2001 and 2013, the incidence of the disease among
adults, i.e. the number of new HIV infections per
year per 100 people aged 15-49 years, was morethan halved in Southern, West and Central Africa,
reduced by 46 per cent in East Africa, and remained
constant at the low level of 0.01 per cent in North
Africa (see table 6.1). In fact, all countries but Angola
and Uganda are registering downward trends inthe occurrence of new infections. The two countries are actually faced with a worsening situation.

As a result of the decline in new infections, from2005 to 2013, the HIV prevalence4 among adults in
Africa excluding North Africa decreased from 5.6 to
4.7 per cent (see figure 6.1) and AIDS-related deathsin the population (all ages) recorded a 40 per centdrop, from 1.8 million people to 1.1 million people (figure 6.2).In North Africa, the prevalence of
HIV among adults was 0.1 per cent over the same
period; however, the AIDS-related deaths in the
population (all ages) increased slightly, from 6,700
to 10,100 people (UNSD, 2015, Statistical Annex).
Countries that recorded major declines in AIDS-related deaths in the continent include Rwanda(76 per cent), Eritrea (67 per cent), Botswana (58 percent), Burkina Faso (58 per cent), Ethiopia (63 percent), Kenya (60 per cent), Zimbabwe (57 per cent),
Malawi (51 per cent), South Africa (48 per cent)and the United Republic of Tanzania (44 per cent)(UNAIDS, 2014).
Progress rests on a number of factors including:
improvement in testing, counselling and accessto antiretroviral therapy; the reduction in motherto-child transmission; the increase in prevention
through the use of condoms and treatment as
prevention; and the improvement in the generalawareness and knowledge of the disease, including a better understanding of the link between
HIV and tuberculosis.
Having accurate and comprehensive knowledge
is captured here through: (i) the ability to identify the two major ways of preventing the sexualtransmission of HIV (using condoms and limiting
sex to one faithful, uninfected partner); and (ii)the ability to reject common misconceptions,such as that a healthy-looking person cannot
4
Prevalence is now a complex measure that may actually
increase as people living with HIV survive due to treatment. Thus,a better measure is incidence, as presented on table 6.1. Incidence
among adults refers to the number of new HIV infections per year
per 100 people aged 15 - 49 years.

Lessons learned in implementing the MDGs

39

MDG 6: Combat HIV/AIDS, malaria and other diseases

Table 6.1 HIV incidence rates in subregions of Africa(No. of new HIV infections per year per 100 people aged 15 to 49 years)

2001

2013

Change (percent)

Central Africa

0.67

0.25

62

East Africa

0.38

0.20

46

North Africa

0.01

0.01

No change

Southern Africa

2.15

0.95

56

West Africa

0.38

0.14

63

Source: UNAIDS HIV Estimates, 2013.

Figure 6.1 Estimated HIV prevalence among individuals 15-49 years of age (%)
6
2005
2013

5

4

3

2

1

0
Africa excl. North Africa

North Africa

World

Source: UNSD, 2014.

Figure 6.2 Number of AIDS-related deaths, all ages (million)
2.5
2005
2013
2.0

1.5

1.0

0.5

0.0
Africa excl. North Africa

North Africa

Source: UNSD, 2014.

40

Assessing Progress in Africa toward the Millennium Development Goals, 2015

World

MDG 6: Combat HIV/AIDS, malaria and other diseases

transmit HIV. Figures from 2013 indicate that such
HIV/AIDS awareness is estimated at 26.7 per centamong young women and 35.7 per cent among
young men aged 15-24 (UNSD 2014 Statistical
Annex). This level is still low but encouraging
when compared to the situation in Southern Asia,
for instance, where the proportions are 17.1 percent for young women and 30.2 per cent foryoung men. Increasing awareness about HIV cancontribute to curbing the pandemic by limiting
risky behaviours, which are still high, especiallyamong young people. This is illustrated by the
relatively low percentage of people aged 15-24
years reporting the use of a condom during sexual intercourse with a non-regular sexual partnerin the past 12 months: the indicator was of 37 percent for women and 57.4 per cent for men in2013. Stigma continues to be a challenge to thenational response in the effort to eliminate HIV.
There is the need to educate people to avoid discrimination against people living with HIV.
Target 6.B: Achieve, by 2010, universal
access to treatment for HIV/AIDS for all those
who need it
Currently, the proportion of people living withHIV that have access to treatment is estimated at
37 per cent in Africa excluding North Africa; however, there are large disparities among countries.
Nigeria and South Africa, for instance, are the twocountries with the largest number of people living with HIV in the region, i.e. 3.2 and 6.3 million,
respectively, but access to treatment covers 20 per
cent of the infected people in Nigeria and 42 percent in South Africa (UNAIDS, 2014). There are also
treatment differentials within countries; children
and men less likely than adults and women toundergo treatment (Ibid).

Access to HIV counselling, testing and therapy has
improved among people who have tuberculosis.
In 2012, 74 per cent of all notified tuberculosis
cases were tested for HIV. It is established that
HIV treatment lowers the risk of death amongpeople who have both HIV and tuberculosis by
50 per cent. Similarly, among tuberculosis-free
HIV patients, antiretroviral treatment reduces therisk of contracting the tuberculosis by 66 per cent
(UNAIDS, 2014).

According to UNAIDS Gap Report 2014 (UNAIDS,
2014), there are around 24.9 million people livingwith HIV in Africa, of whom only 154,000 in North
Africa. The rest are distributed across the four othergeographical subregions, with Nigeria and South
Africa alone accounting for up to 38.4 per cent ofpeople living with HIV. More specifically, the bulkof people living with HIV in Africa excluding North
Africa are concentrated in ten countries, namely
Ethiopia, Kenya, Malawi, Mozambique, Nigeria,
South Africa, Uganda, the United Republic of
Tanzania, Zambia and Zimbabwe. Taken together,
these countries account for 81 per cent of all people living with HIV in the region. The situation isskewed towards women,58 per cent of the people
living with HIV are female. It is of serious concernthat 2.9 million children are infected, in addition
to other vulnerable groups such as young people
and the people affected by conflicts, disaster ordisplacement. Young women and adolescent girls
face specific inequities that render them more
vulnerable to the pandemic, which calls for specific attention in order to protect them, includingfrom gender-based violence and sexual abuse.
They also lack of access to education, health services and social protection. These circumstances
are likely to undermine their ability to protect
themselves against HIV and to access antiretroviral therapy when they become adults.
Engaging men in the fight against HIV has also
proven a winning strategy. Voluntary medical
male circumcision has the potential of reducing
the risk of acquiring HIV among men by 66 percent (UNAIDS, 2014). In addition, when men know
their HIV status, they are more likely to appropriately resort to prevention and seek treatment. Sex
workers, men who have sex with men, and people
who inject drugs are also part of the group thatneeds to be followed closely owing to the particularly high level of infection among them.
Notwithstanding the appreciable progress, HIV
is still a real challenge in Africa, and efforts must
continue until the zero-case situation is reached.
To date, Africa excluding North Africa accounts foraround 71 per cent of the total people living with
the HIV in the world; therefore, even though thesupport of the international community will be a
Lessons learned in implementing the MDGs

41

MDG 6: Combat HIV/AIDS, malaria and other diseases

determining factor to win the battle, the region
and more specifically, the most affected countries
will have to lead. UNAIDS estimates for 2012 indicate that around $6.6 billion was invested in the
AIDS response in Africa excluding North Africa,
47 per cent of which came from domestic sources
and the rest from international sources. This situation is commendable but needs to be strengthened with much more domestic funding. HIV/AIDS can undermine human capital and productivity, and hence become an obstacle to structuraltransformation that countries must address by all
possible means.
Target 6.C: Have halted by 2015 and begun
to reverse the incidence of malaria and othermajor diseases
Downward trend in malaria cases and deaths
Africa continues to make good gains in combating malaria and is progressing towards halting
its spread in the continent. Impressively, the percentage reduction in malaria cases and deaths in
Africa is slightly higher than the world average seetable 6.2). Since 2000, in Africa excluding North
Africa, malaria cases have dropped by 34 per centand the death rate by 54 per cent compared to
30 per cent and 47 per cent at the global level,
respectively (WHO, 2014b). According to WHO
projections, if the current rate of reduction continues, globally malaria deaths will be reduced by
55 per cent, and in Africa excluding North Africa,
by 62 per cent (total for both adults and children)and 67 per cent (children under five).

The global burden of malaria mortality and morbidity is highest in Africa excluding North Africa.
In 2013, 90 per cent of all malaria deaths occurredin Africa excluding North Africa. The Democratic Republic of the Congo and Nigeria alone
accounted for 34 per cent of all malaria cases and39 per cent of all malaria deaths in 2013 (WHO,2014b). International targets for reducing casesand deaths will not be attained unless considerable progress is made in these two countries.
Northern African countries with ongoing malariatransmission are in particular progressing very
well in malaria elimination efforts. In 2013, Egypt
and Morocco were among a group of 11 countries that succeeded in stabilizing the number ofcases of malaria. In fact, Morocco was declaredmalaria-free in 2010, while Egypt has eliminatedmalaria and is at the stage of preventing its reintroduction. Cabo Verde and Algeria are in the
pre-elimination and elimination stages of malaria
respectively, each having recorded less than 10
malaria cases in 2013 (WHO, 2014b). In addition to
the above countries, Botswana, Eritrea, Namibia,
Rwanda, Sao Tome and Principe, South Africa andSwaziland have reduced their malaria incidence
by no less than 75 per cent between 2000 and
2013.
The use of effective interventions remains at theheart of Africa’s success in combating malaria.
Vector control interventions, use of insecticide-treated bednets, quality-assured artemisinin-based combination therapy and rapid diag-

Table 6.2 Malaria cases and death rates, 2000 and 2013
Number of cases,
2000

Number ofcases, 2013

Number ofcases, %changeDeaths, 2000

Deaths, 2013

Deaths %changeTotal malaria figures
World

227,000,000

198,000,000-30

882,000

584,000

47 per centAfrica174,000,000

163,000,000-34

801,000

524,000

54 per cent

Source: WHO, 2014b.
Notes: Here, Africa refers to Africa excluding North Africa.

42

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 6: Combat HIV/AIDS, malaria and other diseases

nostic tests have expanded in Africa over the past
10 years. In 2013, 49 per cent of the at-risk population in Africa excluding North Africa had access toan insecticide-treated bednet, compared to 3 percent in 2004. At least 55 million people at-risk ofmalaria lived in homes that were regularly sprayed(WHO, 2014b). However, specific efforts to protect
pregnant women and children against malaria
are progressing rather slowly. The World Malaria
Report 2014 (WHO, 2014b) indicates that approximately 15 million of the 35 million pregnant
women in Africa excluding North Africa in 2013
did not receive any dose of the preventive malaria
treatment in pregnancy. Similarly, only 6 out of
the 16 countries for which WHO recommended
the adoption and rolling out of preventive therapies for children under five have adopted thetreatment as national policy, while only one country (Burkina Faso) has adopted the recommended
preventive therapy for infants.

rates decreased by an average of 15 per centand 26 per cent, respectively, the incidence rateincreased by an average of 14 per cent. Central
African Republic, Egypt, Eritrea, Ghana, Malawi,
Niger, Rwanda and Uganda are some of the best
performing countries, recording reductions ofmore than 50 per cent in all three indicators. By
contrast, Cameroon, Equatorial Guinea, Lesotho,
Liberia, Mauritania, Sierra Leone, South Africa
and Swaziland all more than doubled their 1990
rates for at least two of the above tuberculosis
indicators.

Slow progress in tuberculosis control
Since 2000, Africa has experienced a downward
trend in tuberculosis prevalence, incidence anddeath rates (see figure 6.3). The incidence rate
declined together with the prevalence rate after
peaking in 2000. However, the average percentage reductions between 1990 and 2012 are low.
Indeed, while tuberculosis prevalence and death

The challenges in tuberculosis control are rife,
however, and require much greater effort to overcome, such as tuberculosis and HIV co-infection,and the occurrence of multi-drug resistant and
now extensively resistant tuberculosis strains.
Therefore, making quality care accessible to all
people regardless of the type of disease (tuberculosis), gender, age and social status must be the

The changes in tuberculosis prevalence and death
rates mirror the rate of detection and treatment
success under DOTS. Average tuberculosis detection rate under DOTS improved from 47.77 percent in 1995 to 60.47 per cent in 2012, while thetreatment success rate improved from 64.05 percent to 78.98 per cent in 2011 (figure 6.4)

Figure 6.3 Tuberculosis prevalence, incidence and death rate, 1990-2012
500
400
300
200
100
0

1990

1995

Average prevalence rate

2000

2005

Average incidence rate

2010

2011

2012

Average death rate

Source: Based on UNSD, 2015.

Lessons learned in implementing the MDGs

43

MDG 6: Combat HIV/AIDS, malaria and other diseases

Figure 6.4 Tuberculosis detection rate and treatment success under Directly
Observed Treatment Shortcourse (DOTS), 1995-2012
100

80

60

40

1995
Average detection rate

2000

2005

2010

2011

2012

Average treatment success rate

Source: Based on UNSD 2015.

foundation of tuberculosis control. The challenges
must be addressed by focusing on ‘at risk’ groups
including women, children, refugees and prison-

44

ers, and by tailoring tuberculosis response to eachof the identified groups.

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 7: Ensure environmental
sustainability
Target 7.A: Integrate the principles ofsustainable development into country
policies and programmes and reverse theloss of environmental resources

Africa’s progress on environmental targets exceed
global performance
Land area covered by forests
orests serve multiple environmental, socioeconomic and cultural roles in many countries. They are among the most diverse andwidespread ecosystems of the world. Forests
provide many significant resources and functions
including wood products and non-wood products, recreational opportunities, wildlife habitats,conservation of biological diversity, water and soil.
They also play a crucial role in the global carbon
cycle. There is general concern over the impact ofhuman activity on forest health and on the naturalprocesses of forest growth and regeneration.

F

A continuing and fast-decreasing forest area in acountry might be a signal of unsustainable practices in the forestry and agricultural sector. The
availability of accurate data on a country’s forest
area, a basic characteristic of its forest resources,
is an essential requirement for forest policy andplanning within the context of sustainable development.
The global rate of deforestation has slowed in thelast decade, but is still alarmingly high in many
parts of the world, and the MDG indicator onforests has not been achieved. In most regions of
the world, the proportion of land area covered byforest shrank between 1990 and 2010 (table 7.1).
Without convincing evidence of the many contributions of forests to sustainable development,
policymakers are unlikely to take decisive action
to discontinue land-use policies that favour theconversion of forests to agriculture and other land
uses. There is a need to develop and implement

Table 7.1 Proportion of land area covered by forest (%)
World
Developing regions

1990

2000

2010

32.0

31.4

31.0

29.4

28.2

27.6

North Africa

1.4

1.4

1.4

Africa excluding North Africa

31.2

29.5

28.1

Latin America and the Caribbean

52.0

49.6

47.4

Eastern Asia

16.4

18.0

20.5

15.2

14.0

12.8

14.1

14.1

14.5

7.8

7.3

7.1

56.9

51.3

49.3

		

Eastern Asia excluding China

Southern Asia
		Southern Asia excluding India

South-East Asia
Western Asia

2.8

2.9

3.3

Oceania

67.5

65.1

62.5

Caucasus and Central Asia

3.9

3.9

3.9

Developed regions

36.3

36.6

36.7

Landlocked developing countries

19.3

18.2

17.1

Small Island Developing States

64.6

63.7

62.7

Source: UNSD, 2014.

Lessons learned in implementing the MDGs

45

MDG 7: Ensure environmental sustainability

policies that encourage the sustainable management of forests in order to provide a wide range of
goozone-depleting substances and services andthat also contribute to poverty reduction and thedevelopment of rural communities.
Carbon dioxide emissions
Rising carbon dioxide (CO2) emissions in few
countries raise concern about future trends. Overthe period 1990–2010, only 16 African countries5reduced their carbon dioxide emissions,while 38 increased them. Gabon recorded thelargest reduction (3.5 metric tonnes per capita),
whereas Equatorial Guinea (6.4 metric tonnes)
and Seychelles (6.5 metric tonnes) recorded thegreatest increases (UNSD, 2013). Carbon dioxide
emissions per capita were highest in developed
regions and lowest in Africa. Most regions of theworld recorded an increase in carbon dioxide
emissions between 1990 and 2010 except Africa

excluding North Africa and Oceania. Developed
regions also experienced a decline (see table 7.2).
Consumption of ozone-depleting substancesThis indicator measures the progress madetowards meeting the commitments to phase out
the use of Ozone-depleting substances in the
countries that have ratified the 1987 Montreal Protocol on Substances that Deplete the Ozone Layerand its Amendments of London (1990), Copenhagen (1992), Montreal (1997) and Beijing (1999).
Ozone-depleting substances is any substancecontaining chlorine or bromine, which destroys
the stratospheric ozone layer that absorbs mostof the biologically damaging ultraviolet radiation.
The phasing out of Ozone-depleting substances,and their substitution by less harmful substancesor new processes are aimed at the recovery of theozone layer.

Table 7.2 Carbon dioxide (CO2) emissions (metric tonnes of CO2 per capita)
World
Developing regions

1990

2000

2005

2010

4.08

3.91

4.30

4.57

1.66

2.03

2.57

3.16

North Africa

1.91

2.33

2.57

2.80

Africa excluding North Africa

0.91

0.83

0.84

0.83

2.29

2.57

2.70

2.90

		Caribbean

Latin America and the Caribbean

2.76

2.87

2.88

3.63

		Latin America

2.26

2.55

2.68

2.85

Eastern Asia

2.46

2.95

4.60

6.30

		

Eastern Asia excluding China

Southern Asia
		Southern Asia excluding India

7.42

7.31

7.40

8.30

0.83

1.17

1.31

1.66

0.94

1.28

1.49

1.70

South-East Asia

0.95

1.48

1.79

2.05

Western Asia

4.85

5.73

6.32

6.85

Oceania

1.00

0.96

1.25

1.09

7.33

4.59

5.25

6.10

Developed regions

Caucasus and Central Asia

12.37

11.67

11.79

10.90

Landlocked developing countries

0.26

1.21

1.25

1.37

Small island developing States

3.20

3.15

2.74

2.85

Source: UNSD, 2015.
5 These countries are Burundi, the Central African Republic, Côte
d’Ivoire, the Democratic Republic of the Congo, Djibouti, Gabon,
Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, the Niger, Rwanda,
Western Sahara, Zambia and Zimbabwe.

46

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 7: Ensure environmental sustainability

Figure 7.1 Consumption of ozone-depleting substances (1,000 metric tonnes)
2000000
1500000
1000000
500000
0

1986
World

1990
Developing regions

2000
Northern Africa

2012
Africa excluding North Africa

Source: UNSD, 2014

Global consumption of Ozone-depleting substances decreased by over 98 per cent between
1986 and 2013 (UNSD, 2014). Consumption ofsuch substances declined by 94 per cent in Africa,
by 86 per cent in developing regions, and by
100 per cent in developed regions between 1986
and 2012 (see figure 7.1).
Most African countries are on the right trackin terms of reducing their consumption of
Ozone-depleting substances. Furthermore, mostAfrican countries that are currently party to theMontreal Protocol have made remarkable progress with respect to reducing their consumptionof substances that deplete the Earth’s ozone layer.
The best performers are Algeria, the Comoros,
Djibouti, Sao Tome and Principe, Sierra Leone,
Uganda, United Republic of Tanzania, and Zimbabwe, which achieved a reduction of over 95 percent between 2000 and 2012; four other countries namely Angola, Libya, Morocco and Tunisia
achieved a reduction of between 90 and 95 per
cent, and 156 achieved between 80 and 90 per
cent reductions. Botswana, Egypt, Libya, Nigeria,
South Africa, Swaziland, Togo and Sierra Leone
have seen reversals in progress between 2011
and 2012. Despite the achievements made bymost African countries in this indicator, six countries experienced an increase in Ozone-depleting
substances consumption between 2000 and2012; Swaziland and the Central African Republic,
6
Burundi, Cabo Verde, Cameroon, Democratic Republic of theCongo, Equatorial Ethiopia, Guinea, Guinea Bissau, Kenya, Liberia,
Malawi, Namibia, Nigeria, Rwanda, Somalia and Zambia.

for instance, recorded an increase of over 100 per
cent. This might be due to imports of hydrochlorofluorocarbon (HCFC)-based equipment (ECA etal., 2013).
Target 7.B: Reduce biodiversity loss,
achieving, by 2010, a significant reduction in
the rate of loss

Increasing proportion of terrestrial and marine
areas protected
Protected areas are essential to the conservationof species, ecosystems and the livelihoozone-depleting substances they support. They also playa key role in adaptation and mitigation of the
impacts of climate change. The proportion of protected terrestrial and marine areas has increased
in all regions of the world. Globally, 14 per centof terrestrial and marine areas were protected in2012.In Africa excluding North Africa, protectedarea coverage increased from 10.7 in 1990 to 15.2
in 2012 (see figure 7.2).

Protected areas, which have been the focus ofefforts in order to conserve the world’s species
and ecosystems, and a key element in climatechange mitigation, have been expanding in
Africa. By 2014, a total of 32 African countries had
reached the target of protecting at least 10 per
cent of their territorial and marine areas compared to 19 countries in 1990. The Congo, Gabon,
Guinea, Guinea-Bissau, Morocco, Namibia, Togoand the Niger also made large strides in extendLessons learned in implementing the MDGs

47

MDG 7: Ensure environmental sustainability

Figure 7.2 Protected terrestrial and marine areas, 1990, 2000 and 2012
Caucasus and Central Asia

1990
2000

Oceania2012

Southern Asia
Northern Africa
Southeast Asia
Developing regions
Developed regions
World
Western Asia
Africa excluding North Afirica
Eastern Asia
Latin America and the Caribbean
0

5

10

15

20

25

Source: UNSD, 2015.

ing protection. The poorest performers are Cabo
Verde, Djibouti, Eritrea, Lesotho, Liberia, Libya,
Mauritania, Mauritius, Seychelles and Somalia
Target 7.C: Halve, by 2015, the proportion of
the population without sustainable access tosafe drinking water and basic sanitation
Access to safe drinking water is improving, but
progress remains skewed towards urban areas
Since 2000, almost one quarter of the current
African population (24 per cent) – the lowest
globally – has gained access to an improved
drinking water source. Furthermore, only 16 percent of the population has access to piped drinking water; this is also the lowest figure in the world(ECA et al., 2014). There are also wide rural urban
disparities in access to safe drinking water that
tend to bring down national aggregate figures insome countries. The weak initial conditions (low1990 baseline) combined with high population
growth relative to the rest of the world exacerbate
the challenge of meeting the target in Africa. In
2012, in Africa excluding North Africa, the use of
improved drinking water sources (64 per cent of
the population) is the second lowest in the world,
following Oceania (56 per cent of the population)(see table 7.3).
48

Access to an improved sanitation facility is still adaunting challenge
The proportion of people with access to improved
sanitation is low for all developing regions. From1990 to 2012, access to improved sanitation
facility this indicator has increased moderately
in Africa excluding North Africa (from 24 percent to 30 per cent), compared to North Africa(from 72 per cent to 91 per cent) and developing
regions (from 36 to 57 per cent) during the same
period. Africa also remains far from the target of
66 per cent coverage to be met by 2015. There aredisparities across countries. Only 4 out of the 77
countries that met this target in 2012 were fromAfrica (Algeria, Cabo Verde, Egypt and Tunisia) andsix countries (Angola, Botswana, Libya, Morocco,
Rwanda and South Africa) are on track. Nevertheless, eight countries doubled their 1990 levelin 2012 (Angola, Benin, Burkina Faso, Ethiopia,
Ghana, Guinea, Mozambique and Rwanda), albeit
from a very low base (below 30 per cent). Libya
and Seychelles stagnated over the period and six
countries experienced setbacks (Djibouti, Gambia, Nigeria, Sudan, Togo and Zimbabwe). The
rural-urban divide, lack of adequate infrastructure
and the poor situation of slum dwellers further
compound this slow progress (see figure 7.3).

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 7: Ensure environmental sustainability

Table 7.3 Use of improved drinking water sources, 2012
Urban

Rural

Total

Oceania

94

45

56

Africa excluding North Africa

85

53

64

Caucus and Central Asia

96

78

86

Developing regions

95

80

87

World

96

82

89

Western Asia

96

79

91

Southern Asia

96

89

91

North Africa

95

89

92

Eastern Asia

98

85

92

Latin America and Caribbean

97

82

94

Developed regions

100

98

99

Source: UNICEF and WHO, 2012.

Figure 7.3 Access to improved sanitation by region (per centof the population),
2012
100

80

60

40

20

0
Africa excluding
North Africa

OceniaSouthern
Asia

Developing
regions

World

Eastern Latin America Western
Asia and the Caribbean Asia

Urban

Rural

Northern Caucasus and Developed
AfricaCentral Asia
regions

Total

Source: WHO and UNICEF,2014.

Target 7.D: Achieve, by 2020, a significant
improvement in the lives of at least 100
million slum dwellers
Target on slum dwellers achieved globally
Slums are characterized by the lack of basic services
such as improved drinking water and adequate
sanitation, and poor energy supply, together with
insecure tenure, non-durable housing and overcrowding. One out of every three people living

in cities of the developing world lives in a slum.
United Nations Human Settlements Programme(UN-Habitat) estimates indicate that in 2012, slum
prevalence – i.e. the proportion of people living
in slum conditions in urban areas – was highest
in Africa excluding North Africa (62 per cent); thelowest prevalence was observed in North Africa,
at 13 per cent. From 2000 to 2012, the share ofurban residents in the developing world living
in slums decreased from 39 to 33 per cent. More
Lessons learned in implementing the MDGs

49

MDG 7: Ensure environmental sustainability

Figure 7.4 Proportion of urban population living in slum areas, 2000 and 2012 (%)
2000

Northern Africa

2012

Latin America and the Caribbean
Oceania
Western Asia
Eastern Asia
South East Asia
Developing regions
Southern Asia
Africa excluding North Africa
Countries emerging from conflict
0

10

20

30

40

50

60

70

80

Source: UN Habitat, 2013.

than 200 million of these people gained access toeither improved water, sanitation or durable andless crowded housing (see figure 7.4). This MDG
target has thus been attained, 10 years in advance.
However, in absolute terms, the number of slum
dwellers continues to grow, owing in part to thefast pace of urbanization. The number of urban
residents living in slum conditions is now estimated at approximately 863 million, compared to
650 million in 1990 and 760 million in 2000 (UNHabitat 2013).

50

In slum areas, where there are few or no streets,
provision of basic services is hampered since there
is no network in place that allows for the provisionof water, sanitation and electricity, among otherservices. One main physical characteristic of slumareas or informal settlements in cities of the developing world is the lack of streets, which makes it
difficult to provide urban basic services to slumareas. Therefore, street networks are a precondition for slum upgrading.

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 8: Develop a global
partnership for development

T

he Ninth Ministerial Conference of the World
Trade Organization (WTO), held in Bali, Indonesia, in December 2013, revitalized theDoha Development Agenda with an agreement
known as the ‘Bali Package’. The Agenda’s threecomponents consist of trade facilitation, agricultural issues, especially those concerning cotton
production, and issues affecting developed andleast-developed countries (WTO, 2013). However, in Africa, the gap between MDG 8 targets
and delivery remains very wide. New forms ofprotectionism through a proliferation of non-tariff barriers, including subsidies, are prejudicial toAfrica’s trade. This is already reflected in the shareof Africa’s exports in global merchandise exports,
declining marginally from 3.5 per cent in 2012 to
3.3 per cent in 2013, compared to 4.9 per cent in
the 1970s (ECA, 2015).
Concurrently, official development assistance(ODA) from the States members of the Development Assistance Committee (DAC) of the Organisation for Economic Co-operation and Development (OECD) in 2014 is projected to be 0.5 percent lower in real terms than the previous year. In
nominal terms total ODA from DAC countries are
estimated to be $135.2 billion in 2014, compared
to $135.1 billion in 2013. Provisional data alsosuggest that bilateral aid to least developed countries in 2014 was 16 per cent lower, in real terms,
than the year before. On average DAC countries
deliver only 0.29 per cent of the group’s GNI as
ODA, which is substantially lower than the United
Nations target of 0.7 per cent. Nevertheless, Denmark, Luxembourg, Norway, Sweden and theUnited Kingdom continue to exceed the 0.7 percent target. The United Arab Emirates, a country
that is not a member of DAC, topped the list of
ODA to GNI providers with a share of 1.17 per centin 2014 (OECD, 2015a).
Beyond the limited progress in meeting theircommitments, there are also concerns about thequality of ODA, since substantial amounts stayin donor countries, while some ODA reachingrecipient countries is associated with little or evennegative development impact.
In terms of the technology aspects of MDG 8,
Africa continues to progress well. However, on acountry-by-country case, there seem to be challenges in matching the growth of subscribers tocommunications technology to improvements inquality of service and affordability.
Target 8.A: Develop further an open, rulebased, predictable, non-discriminatory
trading and financial system
During the Ninth Ministerial Conference, WTO
members reached a trade facilitation agreement
aiming to cut trade transaction costs and increase
trade competitiveness in developing countries.
In the area of agriculture, decisions were maderesponding to demands by the developing countries on issues of food security, tariff rate quota
administration and export competition. On development issues, Members agreed to put in place amonitoring mechanism for special and differential
treatment provisions, and took decisions specificto least developed countries on duty-free, quota-free market access, preferential rules of origin,
operationalization of the services waiver and cotton trade reform.

The most important component for Africa istrade facilitation because it can help countries toreduce trade costs and increase competitivenessof the private sector. However, that raises someconcerns. Indeed, Africa has little export capacity
reflected in its declining share in global merchandise from 3.5 per cent in 2012 to 3.3 per cent in2013 see table 8.1), compared with 4.9 per cent in
the 1970s. Thus, in the short term, it is expectedthat Africa’s imports will increase more than its
exports, deteriorating national trade balances. In
the meantime, intra-African trade, at 16.3 per centLessons learned in implementing the MDGs

51

MDG 8: Develop a global partnership for development

Table 8.1 Growth in merchandise trade by region, 2012-2013
Exports

Imports

2012

2013

2012

2013

Africa

6.5

-2.4

12.9

4.1

Asia

2.8

4.7

3.7

4.5

Commonwealth of Independent States

0.9

0.8

6.8

-1.3

Europe

0.8

1.5

-1.8

-0.5

Middle East

5.2

1.9

10.5

6.2

North America

4.4

2.8

3.1

1.2

South and Central America

0.7

1.4

2.3

3.1

World

2.4

2.5

2.1

1.9

Source: WTO 2014, International Trade Statistics on http: //www.wto.org.

of total trade in 2013, is still low compared withother regions (ECA and AUC, 2015).
Greater efforts are required to address supply-side
constraints and ensure that multilateral trade
agreements deliver for Africa. This not only highlights the critical need for Africa to diversify its
economy, but also to meet international norms
and standards and rules of origin. Failing to doso could undermine gains from trade facilitation
reforms. Further discussions on these reforms
should emphasize the reduction or removal of
agricultural subsidies in major developed countries
and on non-agricultural market access (NAMA)
negotiations. On 27 November 2014, the then-160
WTO members reached an agreement that will
formally incorporate the Bali Package into the legal
framework of WTO and will enter into force whenat least two thirds of members have completed
their national ratification process, which is a promising development.
Negotiations on economic partnership agreements between African countries and the European Union are continuing, but little progress has
been made. Such agreements have not had thedesired impact on Africa’s economies. Renegotiated economic partnership agreements, which
technically came into effect on 1 October 2014,
were aimed at changing this. The United States
African Growth and Opportunity Act entered its
final year on 1 October 2014 and has been renewed
until 20 September 2025. Nevertheless, in bothcases, there is no evidence that the stated goals of
trade development and sustainable growth havebeen achieved in African countries. Despite efforts,
52

many countries have found it difficult to expand
trade and take advantage of the preferential
market access programmes (World Bank, 2012).
Indeed, trade preferences spur growth assumingthat required skills and infrastructures that meetglobal standards are available. For many Africancountries, logistical bottlenecks at ports and foreign exchange policy constraints constitute major
hindrances. There is also a shortage of skilled workforce in many countries. The continent continues
to run a very large infrastructure deficit and there
are other supply-side constraints as well, including relatively lower labour productivity, little orno scale economies, and shallow capital markets.
The expected relocation of the more value-adding, employment-generating and growth-driving
labour-intensive manufacturing from Asia to Africa
has not been forthcoming owing in part to these
constraints.
Most DAC countries continue to ignore theirlong-standing United Nations commitment to
disburse 0.7 per cent of their GNI in ODA (see figure 8.1). However, the United Kingdom increased
its ODA by 29 per cent between 2012 and 2013,
which translates into a disbursement of 0.72 percent of GNI. This was the first time that the United
Kingdom surpassed the important target of 0.7 percent of GNI (UNSD, 2015).7 The United Kingdom
also surpassed the 0.7 level in 2014, disbursing
7 Note that nearly all of the additional British aid in 2013 wasprovided through the Department of Energy and Climate Changeof the United Kingdom (Government of the United Kingdom 2015.
Excel tables: Statistics on International Development 2014, www.
gov.uk/government/statistics/statistics-on-international-development-2014,

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 8: Develop a global partnership for development

previous years. This is equivalent to half of the total
GDP of South Africa, or to the combined GDP of
the 28 smallest African countries. Thus, the annual
delivery gaps are huge and could have contributed
significantly to speeding up Africa’s development.

current US$17.9 billion, or 0.71 per cent of thecountry’s GNI in ODA (OECD, 2015a).
Five countries surpassed the 0.7 target in 2013 and2014 compared to four in 2012: Denmark, 0.85;
Luxembourg, 1.07; Norway, 0.99; Sweden, 1.10;
and United Kingdom, 0.71. ODA disbursements
among the 28 DAC countries vary between 0.11
(Czech Republic and Greece) to 1.10 (Sweden) in2014 (OECD, 2015a). The total amount of ODA isestimated at current US$ 135.2 billion in 2014, up
from current US$ 135.1 billion in 2013. However,the 2014 amount represents a downturn of 0.5 percent in real 2013 prices. The 2014 current US dollar
disbursements ranged from only 35 million (Iceland) to 31.5 billion (United States). As a group,
total ODA reached only 0.29 per cent of the combined GNI of DAC countries in 2014, which implies
a delivery gap of 0.41 per cent when comparedwith the United Nations target. This delivery gap
was lower the year before, at 0.40 (OECD, 2015a).
The delivery gap in absolute dollars was $169.6
billion in 2013, on top of similar delivery gaps over

It is estimated that ODA from DAC countries to
Africa will be substantially lower in 2014 ($46billion) compared to 2013 ($50 billion), bothamounts in 2013 US dollars. Moreover, a 2014 survey conducted by OECD shows that ODA to Africa
is projected to remain low over the period 20152018 at an average of around constant 2013 US$
47 billion annually (OECD, 2015a). This does notseem promising ahead of the post-2015 development agenda.
Target 8.B: Address the special needs of theleast developed countries
In addressing the special needs of the least
developed countries (LDCs), the ninth WTO Bali
Ministerial Conference called for: full implementation of duty-free and quota-free market accessFigure 8.1 DAC ODA as a percentage of GNI, by country, in 1990, 2000 and 2014
1.2

1990
2000
2014

1.0

0.8

0.6

0.4

United Kingdom

United States of America

Switzerland

SwedenSpain

Slovenia

Slovakia

PolandPortugal

NorwayNetherlands

New Zealand

Luxembourg

Japan

Korea, Rep.

Italy

Ireland

Iceland

GreeceGermany

FranceFinlandDenmark

CanadaCzech Republic

Belgium

Austria

0.0

Australia

0.2

Source: UNSD, 2015 and OECD, 2015 for 2014 estimates data.

Lessons learned in implementing the MDGs

53

MDG 8: Develop a global partnership for developmentfor LDCs; the simplification of preferential rules oforigin benefitting LDCs; the operationalization of
the services waiver for LDCs; and a reaffirmation of
the Doha mandate on cotton with respect to bothits trade and development components (WTO,2013). These decisions, which are of particularimportance to African LDCs, need to be translated
into their broader economic and social development objectives. Greater efforts will be required
to help these countries increase their capacities toenhance their global competitiveness and exploit
the opportunities provided by the increased
market access. It will also be important to ensurethat African LDCs have the appropriate skills andcapabilities to comply with product standards inmajor markets.
ODA to LDCs deteriorated between 2011 and2012, then resurged in 2013, but is estimated tohave deteriorated further in 2014 to $37.8 billion,
representing 28 per cent of all ODA from DAC
countries. Indeed, ODA from those countries to
LDCs amounts to only about one third of total
ODA disbursed since 1990 (UNSD, 2015). In fact,according to the most recent metadata available,
only eight DAC countries met the 0.15 per cent
United Nations target of net ODA to LDCs in 2012.
ODA from DAC countries to African LDCs has notchanged much in recent years. Between 2004 and2013, the share of ODA flows averaged 20 per
cent to LDCs and only 13 per cent to African LDCs(see figure 8.2).
The Istanbul Declaration and Programme of
Action on the Least Developed Countries (2011)
primarily emphasizes shared responsibility andstrengthened joint efforts as the key to the successful achievement of the overriding objectiveof reactivating and accelerating growth and sus-

54

tained development in LDCs. The midpoint reviewof the implementation of the Istanbul Programmeof Action will take place in Turkey, in 2016. The
latest assessment of progress in the priority areasof the Programme of Action indicates that the
GDP growth rates of African LDCs declined from
5.6 per cent in 2010 to 3.37 per cent in 2012 andthen rose to 3.53 per cent in 2013 (ECA and African
Union, 2015).
Measured by GDP output per person employed,
productive capacities have been rising since 2005,
despite a dip in 2011. Notwithstanding a series ofongoing regional infrastructure projects initiatedin Africa, recent data suggests that, after expanded
considerably in 2007, road infrastructure has deteriorated ever since, while rail infrastructure hasremained stagnant. African LDCs account for lessthan 1 per cent of global trade and their economies are dependent on a few primary commodities, which makes them vulnerable to shocks andhighly dependent on ODA.
There have been some improvements in thehealth sector, particularly with respect to childand maternal mortality and malnourishment.
However, the Ebola pandemic in Sierra Leone,
Liberia and Guinea has exposed the vulnerabilityof the health systems of African LDCs to shocks.
The Paris Declaration on Aid Effectiveness (2005)
has not worked, since it involved a commitment
to provide more aid to LDCs (High Level Forum2005). The stated objective of ODA is to improve
the livelihoods substances of the most vulnerableof the world. This would be particularly importantfrom an African perspective since 34 of the 54
countries in the continent are classified as LDCs.

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 8: Develop a global partnership for development

Figure 8.2 ODA from DAC countries in constant 2012 US$ million, 2004-2013
150000120000
90000
60000
30000
0

2004

2005

All ODA recipients

2006

2007
LDCs

2008

2009

2010

2011

2012

2013

African LDCs

Source: OECD, 2014.

Target 8.C: Address the special needs oflandlocked developing countries and Small
Island Developing States
Lack of access to the sea, remoteness and isolation from world markets, as well high transit costs
impose real burdens on socioeconomic progressin landlocked developing countries (LLDCs) (ECA
et al., 2012). The Almaty Declaration and the Almaty
Programme of Action, adopted in 2003, marked
an effort to address these problems. Implementation of the latter was to be supported by donors
through funding and technical assistance. However, donors did not fulfil their commitments asevidenced by lower ODA flows to these countries.
In general, African LLDCs as a group experienced
ODA reductions (see figure 8.3), so that the average ODA as a percentage of their GNIs dropped

steadily from 14.1 in 2004 to 11.1 in 2012 (UNSD,
2015). Over the longer time horizon, 1990-2012,
the average ODA to African LLDCs amounted to13.6 per cent of the recipient group’s GNI, while
being 14.4 during the 1990-2003 period, compared with 12.3 over the 2004-2012 period.
Recognizing the trend, in 2012, the United Nations
General Assembly decided to hold a comprehensive 10-year review conference of the Almaty
Programme of Action. The eleventh Annual Ministerial Meeting of Landlocked Developing Countries called for accelerated implementation of theAlmaty Programme of Action by ensuring that Aidfor Trade to LLDCs takes into account their special
needs and requirements (UN-OHRLLS, 2012).

Lessons learned in implementing the MDGs

55

MDG 8: Develop a global partnership for development

Figure 8.3 ODA to African LLDCs, as a percentage of their GNI, in 1990, 2000 and
2012
30

1990
2000
2012

25

20

15

10

5

0
Botswana Burkina
Faso

BurundiCentralAfricanRepublic

Chad

Ethiopia Lesotho

Malawi

Mali

Niger

RwandaSouth Swaziland Uganda
Sudan

Zambia Zimbabwe

Source: UNSD, 2015.
Note: Data is missing for Rwanda and Zimbabwe for 2012.

Similarly, SIDS have not been spared from cuts in
ODA (see figure 8.4). In 2012, the average ODA asa percentage of SIDS’s GNI was only 9.6, comparedto the1990-2003 average of 18.3, and the 20042012 average of 10.7. Four of the six African SIDS
experienced reductions of ODA as a percentage of
their GNI of over 25 per cent, namely, Cabo Verde,
the Comoros, Guinea-Bissau and Seychelles.
Clearly, the ODA reductions as stated in relative
terms are highly related to economic growthin some of the LLDCs and particularly SIDS. The
donor community, however, should not lose focus
on the special needs of these countries while utilizing the momentum of economic growth to further boost development and poverty reduction.
This is particularly important given the complex
relationship between economic growth and poverty reduction (ECA et al., 2014).

56

In the area of trade, LLDCs depend on theirneighbours for efficient procedures for clearing
transit goods. The trade facilitation agreementof the Ninth WTO Ministerial Conference will
create a common platform that WTO members
are expected to implement in order to respect
the principles of transparency, consistency andpredictability, which will help traders in LLDCs.
One of the decisions in Bali also reaffirmed theimportance of the WTO Work Programme on
Small Economies, which covers all of the countries
that are included in the SIDS category. This Work
Programme calls for framing responses to thetrade-related issues identified in improving theparticipation of LLDCs and SIDS in the multilateral
trading system.

Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 8: Develop a global partnership for development

Figure 8.4 ODA to African SIDSs, as a percentage of their GNI, in 1990, 2000 and
2012
60

1990
2000
2012

50

40

30

20

10

0
Cape Verde

Comoros

Guinea-Bissau

Mauritius

Sao Tome & Principe

Seychelles

Source: UNSD, 2015.

Target 8.D: Deal comprehensively withthe debt problems of developing countries
through national and international measuresin order to make debt sustainable in the longterm
Since 2010, total foreign debt has been higher
than 30 per cent of GDP in Africa and is expected
to rise to 37.1 per cent of GDP in 2015. In 2015, net
foreign debt (total debt minus reserves) as a shareof GDP is projected to be only 1 per cent of GDP,following a negative trend since 2006 due to highinternational reserves in oil-exporting economies(ECA, 2015b). Mineral-rich and oil importing
African countries have positive net foreign debt,
and some extreme cases8 have very high ratios,raising issues of debt sustainability (ECA, 2015).

the debt burden of countries that qualify for debt
relief. As of September 2014, 29 African countries
were eligible under HIPC, reached the completion
point and received irrevocable debt relief (IMF,
2015a).The total debt relief effort for all eligible
African HIPC amounted to $105 billion in nominal
terms by the end of 2012 (ECA and OECD, 2014).
Over $5.5 billion of external commercial debt has
been written-off in 15 African HPIC supported by
the World Bank’s Debt Reduction facility (Ibid).In
addition, after the recommendation of the Groupof Eight (G8)in the 2005 G8 Summit, the International Monetary Fund (IMF) provided a 100 per
cent debt cancellation under the Multilateral
Debt Relief Initiative (MDRI) to low-income Africancountries, amounting to $3.4 billion in nominal
terms (IMF, 2015b).

The Heavily Indebted Poor Countries (HIPC) Initiative continues to make an impact on reducing

8 These include Cabo Verde (59 per cent of GDP), Ghana (28 percent of GDP); Sudan (55 per cent of GDP); Mauritania (52 per centof GDP); Mozambique (28 per cent of GDP); Sao Tome and Principe(117 per cent of GDP); Senegal (25 per cent of GDP); Seychelles(90 per cent of GDP); Tunisia (50 per cent of GDP) and Zimbabwe(338 per cent of GDP).

Lessons learned in implementing the MDGs

57

MDG 8: Develop a global partnership for development

Figure 8.5 Inflows of external finance, 2010–2015 ($ billion)
40
35
30
25
20
15
10
5
0
-5
-10

2010
FDI

2011

2012

Portfolio Investment

2013
Remittances

2014e
ODA

2015f

Net Foreign Debt

Total Foreign Debt

Source: ECA and AUC, 2015.

The HIPC Initiative is almost completed, as 35 outof 39 HIPC eligible countries have now reached
the completion point. However, three Africancountries are currently eligible for the HIPC initiative, but have yet to start the process: Eritrea,
Somalia and Sudan. Still, Africa’s long-term debt
sustainability remains a challenge for post-completion point countries owing mainly to structuralproblems and inadequate debt management
capacity. With completion of the HIPC Initiative,
the growing concern about debt sustainability
raises the more basic issue of how to ensure a fairdebt workout mechanism to address future sovereign debt crises.
Target 8.F: In cooperation with the private
sector, make available the benefits of newtechnologies, especially information andcommunications
Notable progress on technology indicators
Fixed telephone subscriptions
The number of fixed telephone subscriptions per
100 inhabitants seem to have reached its tipping
point in 2009 for the African continent as a whole.
This figure grew steadily from 1.44 in 1990 to 4.17
in 2009; thereafter, it steadily dropped to 3.60 in
2013. The range between the countries is very
58

large, however. Twenty-five African countries
recorded one or less subscriptions per 100 inhabitants whereas Mauritius and Seychelles recorded
the highest numbers in 2013, with 29.17 and23.43, respectively. Out of the 53 African countries
with available 2013 data for 2013, 25 recorded lessthan 10 fixed telephone subscriptions per 100
inhabitants (UNSD, 2015). Clearly, the stagnation
is closely related to existing or slow growth of telephone lines with respect to population growthand mobile telephone subscription growth,which is the next indicator on this target.
Mobile-cellular subscriptions
In 1990, only four African countries recorded
mobile-cellular subscriptions: Egypt, Mauritius,South Africa and Tunisia, but with an average of
only 0.005 per 100 inhabitants. Ten years later,48 out of the 53 countries with available data
had mobile subscriptions, with an average of
2.57, ranging between 32.54 (Seychelles) to 0.1(Mali). Regional changes for mobile-cellular subscriptions can be seen in table 8.2. In 2013, all 53
countries with available data had mobile subscriptions, averaging 80.20 per 100 inhabitants,
ranging between 214.75 (Gabon) and 5.6 (Eritrea);
15 countries recorded over 100 subscriptions per
100 inhabitants. This is due to the common practice of multiple subscriptions for each mobile-cel-Assessing Progress in Africa toward the Millennium Development Goals, 2015

MDG 8: Develop a global partnership for development

Table 8.2 Mobile-cellular subscriptions per 100 inhabitants, by regions
1995

2000

2012

World

1.6

12.1

89.3

Developing regions

0.4

5.4

82.6

North Africa

<0.1

2.8

116.1

Africa excluding North Africa

0.1

1.7

59.3

Latin America and the Caribbean

0.8

12.1

109.1

Caribbean

1.2

7.5

63.6

Latin America

0.8

12.5

112.4

Eastern Asia

0.5

9.8

82.1

Eastern Asia excluding China

3.4

50.2

98.7

Southern Asia

<0.1

0.4

69.2

Southern Asia excluding India

<0.1

0.5

67.5

South-East Asia

0.7

4.2

111.8

Western Asia

0.6

13.1

101.5

Oceania

0.2

2.4

47.4

Caucasus and Central Asia

<0.1

1.3

107.3

Developed regions

6.4

39.8

120.3

Least developed countries

<0.1a

0.3

48.6

Landlocked developing countries

<0.1

1.1

59.4

Small island developing States

1.5

11

70.3

Source: UNSD, 2015.

lular phone user in Africa. It is difficult, therefore,
to trace the accurate number of individuals who
own a mobile-cellular phone, and who are alsoable to use it. For instance, Africa Renewal (2013)
reports that phone users are buying several SIM
cards in order to switch between operators andsave interconnection fees.
What is clear, however, is that mobile-cellularsubscriptions continue to grow. In 2013, there
were 823.7 million mobile-cellular subscriptionsin Africa. Its growth has recently stagnated, but
continues to surpass the global average, with
11.1 per cent against 6.3 in 2013. Over a longer
horizon, between 2004 and 2013, the averageannual growth of mobile-cellular subscriptions
was 33 per cent in Africa compared to 17 percent globally (UNSD, 2015); i.e. Africa has recently
made significant progressing in the use of thistechnology (see figure 8.6 and 8.7). Moreover, Africans have been able to utilize the mobile phone
technology in a number of innovative ways. CNN(2012) lists seven ways in which mobile phones

have changed lives in Africa: in banking, activism,
education, entertainment, disaster management,
agriculture and health.
Internet users
Similarly, over 2004-2013, the number of Internet
users per 100 inhabitants has grown much fasterin Africa than in the world, an average annual
growth of 21.7 per cent versus 10.2 per cent(see figure 8.6 and 8.7). Currently, this indicatoris 14.7 per cent for the African continent, against
43.7 per cent for the world. However, if the current growth rates are maintained over the coming
decades, Africa as a whole may reach the global
levels. Yet, Internet access will not be consistently
available throughout and within the Africancountries. Once again, there are great variances
between the countries. The top performers in2013 were Egypt (49.6), Morocco (56.0), Seychelles(50.4), South Africa (48.9) and Tunisia (43.8). At thesame time, 14 countries had less than five Internet
users per 100 inhabitants.

Lessons learned in implementing the MDGs

59

MDG 8: Develop a global partnership for development

Figure 8.6 Growth of number of mobile-subscriptions, 1995-2013
120
World

Africa

100
80
60
40
20
0

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Source: UNSD, 2015.

Figure 8.7 Growth of mobile-cellular subscriptions per 100 inhabitants, 2000-2013
120
World

Africa

100
80
60
40
20
0

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

Source: UNSD, 2015.

In general, Africa has shown notable progress onthese technology indicators. However, the quality aspects of the technology usage are still very
limited, owing to costs, disturbances in service

60

and energy supply, as well as close monitoring of
information flows by the authorities to obstructpolitical activism (Donovan and Martin, 2014).

Assessing Progress in Africa toward the Millennium Development Goals, 2015

Box 8.1. Mauritius and MDG 8
Mauritius, a small island developing State, continued
to benefit from ODA, but the amount granted wasconsistently less than 1 per cent of GNI in 2014. Mauritius
received 406 million Mauritian rupees in ODA, representing only around 0.1 per cent of its GNI.

The debt burden measured as a proportion of external
debt service to export revenue declined from 8 to 4 percent over the 2002-2014 period. The improvement in thedebt burden reflects an improvement in the country’s
vulnerability to economic shocks. From 2002 to 2007, theproportion was around 6 to8 per cent; it then dropped
significantly to about 4 per cent until 2014.

Share (%) of debt service on total exports of goods and services in Mauritius, 2002-2014
10.0

Per centage

8.0

6.0

A downward trend
4.0

In addition, 100 per cent of the population have accessto essential drugs, since the Government provides freehealth care and services with essential drugs in all publichealth centres located in various parts of the country.
Mauritius has attained substantial progress in information and communications technology. The usage ofcellular phones and Internet has increased substantially.
The number of fixed line telephone subscribers per 100
inhabitants increased from 7 per cent in 1990 to 31 percent in 2010. It then decreased to 29 per cent in 2013

2014

2013

2012

2011

2010

2009

2008

2007

2006

2005

2004

2003

0.0

2002

2.0

owing to the emergence and rapid expansion of cellular
phones, which are more accessible and also provide
a large variety of services such as Internet access. The
number of mobile-cellular subscriptions per 100inhabitants, which was 0.2 per cent in 1990, has been over
100 per cent since 2011.
Internet penetration is also increasing rapidly: in 2006,
Internet users made up 19 per cent of the population
aged 12 years and over; in 2012, the proportion doubled
to 38 per cent.

Lessons learned in implementing the MDGs

61

Lessons learned from implementation of the Millennium Development Goals

SECTION II:
Lessons learned from theimplementation of theMillennium Development GoalsO

ver a decade’s worth of experience with
the Millennium Development Goals(MDGs) has generated invaluable lessons
that can guide policymakers in implementing thepost-2015 development agenda. The lessons are
categorized along the following themes: overarching lessons; lessons in poverty reduction andinclusive growth; lessons in social development;
and lessons in environmental sustainability.

Overarching lessons
The MDGs will not be achieved by all countries or
all regions; however all countries have made progress on at least one target of the MDGs. This istrue both globally and for Africa. The experiencesof countries on the MDGs reveal some overarching lessons that should inform the successor
development framework.
Initial conditions matter
An often overlooked issue in the assessment of
MDG achievements is the role of initial conditions.
Initial conditions influence the character and paceof a country’s progress towards the MDGs. As aresult, differentiated approaches to supportingand evaluating progress are imperative. For countries and regions that are furthest from the target,
the pace of progress relative to their baselines isjust as important as proximity to the target.
Effective communication and follow-up are
critical for the success of global agendas
An important lesson to be drawn from implementing the MDGs is that, although the commitments
made by its signatories were not binding, somesuccess was generated. This positive outcome waspartly due to the effective communication and62

continual follow-up processes undertaken at thenational, regional and global levels. Effective communication of performance, including throughnational country reporting, mobilized civil society
and helped to sustain pressure on governments tofulfil their social compacts. Regional MDG reporting provided a mechanism for cross-country
comparisons and peer learning. Good performing
countries unwittingly encouraged weaker performers to improve their performance by generating a spirit of positive competition.
MDGs induced demand for morecomprehensive and timely data
The MDGs underlined the importance of timely
access to disaggregated data as an important
ingredient for monitoring results and holding relevant stakeholders accountable for their actions
and or inactions. The desire of governments todemonstrate results and of stakeholders to track
performance invariably generated demand fordata and contributed to improvements in data
availability (WHO, 2014a). Notwithstanding progress in data access, data deficits persist and canbe improved, including through investments incivil registration and vital statistics as well as innovative methods to optimize the use of ”big data”.
Strengthening both access and quality ofservice delivery
The MDGs have also revealed that improvementsin access to basic services have often not been
associated with improvements in the quality ofservice delivery. Given the substantial resources
required to leverage change and the urgency toimprove access, the quality of service delivery
has not received the desired attention; more

Assessing Progress in Africa toward the Millennium Development Goals, 2015

Lessons learned from implementation of the Millennium Development Goals

efforts must be made in this area. Poor quality
can also be linked to failure by policymakers to
fully account for the recurrent cost implicationsof capital expenditure. More attention has been
paid to capital investments, such as building
schools and clinics, than in investing in the recurrent costs that assure the smooth functioningof such projects. The recurrent costs of runningschools and medical facilities including humanresources, for instance, are often not appropriately
factored into the capital costs of constructing
such facilities, especially when such investments
take place outside the budget. Where such capitalcosts are funded by donors, there is the need tosituate such initiatives in a broader conversation
about sustainability and quality of service delivery
over the long term. In this context, donors must
not only be more flexible about the parametersof their aid, but align aid with national strategic
frameworks and priorities.
Sustainability requires adopting an
integrated approach to development
The MDG focus on outcomes such as poverty
reduction without particular attention to theunderlying causes has led in some cases toundesirable, unintended and often unsustainable consequences. For instance, Africa has madesubstantial progress in reducing HIV, malaria andtuberculosis as a result of access to vertical funds.
However, these funds narrowly target specific diseases, paying less attention to the health systemsof the countries. Cumulatively, signed funding
expenditures by the Global Fund on strengthening health systems accounted for 2.5 per centof the total for the 2002-2013 period (The Global
Fund, 2015). These developments raise two
important issues: the sustainability of health-care
programmes dependent on vertical funding andthe sustainability of the vertical funding approachin general in a context of weak health systems. In
effect, while vertical interventions have undoubtedly been beneficial, the Ebola experience clearly
demonstrates that to be sustainable, they must becomplemented by horizontal or integrated interventions to strengthen the health-care system ingeneral.

Exploiting inter-sectoral synergies heightens
impact
The MDGs have highlighted the benefits and efficiency gains that can be achieved by leveraging
inter-sectoral synergies as well as the importantrole of development planning in making this happen. African countries have been more successful
in integrating the MDGs in their development
planning frameworks than in exploiting synergies
among the goals and targets. This is perhaps dueto the lack of technical capacities required toobjectively assess and estimate the interrelationships among the different goals and identify theentry points that generate the greatest impact.

Country experiences in child and maternal deaths
illustrate that an integrated approach to addressing health needs is critical to success. In effect,
improving child and maternal health is not merelya health issue, but requires related non-healthinterventions such as changing nutritional or
infant-care behaviours, and improving access tosanitation and improved water sources. Further,
it is necessary to address cultural practices that
promote early marriages and discourage theeducation of the girl-child. Gender parity in education and women’s empowerment has a positiveeffect on fertility and access to health information.
Similarly, poorer women are disproportionately
affected by higher mortality rates owing to lower
access and use of health services. Malaria, HIV/
AIDS, tuberculosis and other health threats topregnant women significantly impacts on maternal mortality ratios. On the other hand, reducing
early childbearing can impact the achievement ofother MDGs on poverty, education, gender equality and child mortality (UNSD, 2014).
Notwithstanding the significant payoffs fromtackling teenage pregnancy, investing in better
sanitation, and expanding access to improved
drinking water, progress in these areas has been
limited. Only seven African countries reported
adolescent birth rates of less than 50 births per
1,000 women (UNSD, 2015); since 2000, only one
in four Africans (24 per cent) has had access to an
improved drinking water source, and only one inthree Africans has access to improved sanitation.

Lessons learned in implementing the MDGs

63

Lessons learned from implementation of the Millennium Development Goals

Progress is tied to a robust means of
implementation
The MDGs lacked a robust mechanism for theirimplementation. While the Monterrey Consensus
provided a framework for funding the MDGs, thefollow-up mechanism was ineffective; the Consensus focused exclusively on financial resource
mobilization with little attention to complementary factors such as technology, institutions andcapacity-building. Furthermore, excessive relianceon ODA undermined the economic sustainabilityof several MDG interventions, rendering themsusceptible to the economic fortunes of donor
countries. Strengthening the means of implementation of global agendas is therefore key tosuccess. While such efforts must emphasize all
sources of development financing, it must also
include non-financial enablers of development
such as technology and capacity-building efforts.
In this context, critical areas of priority should
include: supporting Africa’s agenda for structural transformation, including value addition(e.g. in banking and microfinance development)
and quality of public spending and planning;
strengthening domestic capacities for resource
mobilization; strengthening cooperation in stemming illicit outflows (e.g. tax evasion, abusive
trade mispricing), including by limiting the useof secrecy jurisdictions by development financeinstitutions); returning stolen assets; supporting
technology, innovation and science; promoting
fair trade; strengthening trade facilitation; andfacilitating good governance.

Lessons in poverty reduction andinclusive growth
Inclusive and sustained growth promotes poverty reduction. Africa is unlikely to achieve the
MDG target of halving extreme poverty; however,important lessons can be drawn from the efforts
made in addressing the poverty and hunger
challenge over the past 15 years. The continent
has made remarkable progress since 1990: Egypt,
Cameroon, the Gambia, Guinea, Senegal and Tunisia have already achieved the target on extreme
poverty reduction.

64

Poverty reduction is underpinned by rapid,
sustained and inclusive growth
For example, critical to Tunisia’s success in
reducing extreme poverty by 76.3 per cent overthe1990-2005 period was rapid and sustained real
GDP growth of around 5 per cent over the past
two decades combined with a long-standing
commitment to social and physical development.
Investments in infrastructure across rural andurban areas facilitated a more equitable spatial
distribution of the benefits of growth. Agriculturaldevelopment, especially in rural areas, promoted
self-sufficiency, generated employment andimproved living conditions. The events of the ArabSpring, however, suggest that reducing extreme
poverty is not a sufficient condition for satisfying
the basic needs of all countries or societies. A
differentiated approach to establishing poverty
benchmarks is necessary to reflect the realities ofcountries at different levels of development (ECA
et al., 2013).

Ethiopia has also made remarkable progress on
the MDGs through investments in rural development and in agricultural productivity, andsocial protection despite limited natural resource
endowments. The proportion of Ethiopians living
below the poverty line fell from 45.5 per cent during the period 1995-1996, to 29.6 per cent during
the period 2010-2011, a decline of around one
third. This represents an annual average declineof 2.32 per cent against 0.5 per cent for Africa
excluding North Africa over the same period. As
a result, the country is just around 7 percentage
points short of achieving MDG 1. Both rural andurban communities have benefited from thedeclines in poverty, which fell by 36.0 and 22.8 per
cent, respectively, between 1995 and 2011 (Federal Republic of Ethiopia, 2012).
Rural poverty declined as a result of a wide rangeof pro-poor programmes in rural areas, including
improved agricultural technologies; expansion ofagricultural extension services; commercializationof smallholder farming; rural infrastructural development; access to social protection programmes,
especially those relating to productive safety net
programmes; and provision of credit. Progress on
urban poverty reduction, especially during theAssessing Progress in Africa toward the Millennium Development Goals, 2015

Lessons learned from implementation of the Millennium Development Goals

2006-2011 period, was linked to improvementsin the investment climate, the provision of foodsubsidies to the urban poor during periods of rising food prices, and job creation efforts (ECA etal., 2012).
Although the poverty headcount ratio and poverty gaps are declining, there are still issues forurgent policy consideration, such as a widening
poverty gap between rural and urban areas since2006 and a rising poverty severity index. Widening inequality in rural areas is also a concern: theGini coefficient in rural areas increased from 0.26
to 0.27 but fell in urban areas from 0.44 to 0.37
between 2006 and 2011. The poverty disparity
among regions also requires policy and programme attention (Federal Republic of Ethiopia,
2012).
Burkina Faso cut poverty by 37.3 per cent from1994 to 2009, aided by livestock farming. Thisinitiative is also contributing to food security andhuman development in rural areas. During theperiod 2007-2008, income from livestock covered
56 per cent of households’ food needs, 42 per centof their health expenses and 16 per cent of children’s educational costs (ECA et al., 2012).
Growth need not compromise on equality
Rwanda’s experience illustrates how growth
can occur hand-in-hand with improvements inincome distribution. The country’s growth has
been associated with falling inequality since2007. This is in contrast to the figures registered
between the 2000-2001 and 2005-2006 periods,
when inequality, as measured by the Gini coefficient, rose from 0.51 to 0.52. Thereafter, the Gini
coefficient declined from 0.52 to 0.49 during the
2006-2011 period. All provinces (except for the
Northern Province) benefitted from the growth
process. Specific policy measures contributing
to this trend included: investments in accessto energy; improved agricultural productivity
and market access; increased access to credit
by small- and medium-sized enterprises; andinvestments in social protection. During the 20062011 period, household access to electricity forlighting increased by 6.5 per cent while the shareof marketed agricultural output increased from22 to 27 per cent. Furthermore, participation insocial protection programmes, such as the Ubudehe credit scheme, the Rural Sector Support
Project and direct support from the Vision 2020
Umurenge Programme, increased substantially(NISR, 2011; NISR and UNDP, 2007).
Strengthening capacities through social
protection reduces poverty and inequalities
Social protection programmes have played aneffective complementary role in reducing poverty
and enhancing the skills and capacities of vulnerable groups. Such programmes have been effective in countries that view it not as a ”handout”,
but rather as a long-term investment in people,
reinforced by regular budgetary allocations. For
example, in Algeria, it accounts for approximately
11 per cent of the State budget.

Rwanda’s system of multiple social mechanisms,,
including universal health insurance (which covers 91 per cent of the population), free educationand social transfers such as a pension scheme –have been linked to the overall decrease in
extreme income poverty from 39 per cent in 2006
to 34.5 per cent in 2009 (ECA et al., 2011).
Mauritius’s universal social pension has been
instrumental in lowering the poverty rate. Likewise, South Africa’s old age pension plan has
reduced the country’s poverty gap by 2.5 per
cent, while its disability grants have reduced thetotal rand poverty gap by 5.1 per cent, and thechild support grant that extends to 18 years, has
contributed to a 21.4 per cent reduction in thepoverty gap (ECA et al., 2014).
The Namibian multidimensional social protection programme has had a significant impact onpoverty reduction of vulnerable groups. Malawi’ssocial protection programme has also significantly
reduced hunger. Ethiopia’s Productive Safety Net
Programme has reached 8 million beneficiaries inaround 1.5 million households, by providing cash
and food support through public works in areas
affected by drought.
Ghana, Kenya, Mozambique, Nigeria, Senegal
and the United Republic of Tanzania have set up
Lessons learned in implementing the MDGs

65

Lessons learned from implementation of the Millennium Development Goals

a variety of safety nets such as emergency food
distribution to support vulnerable groups (e.g.
orphans, widows and the elderly). Benin, Burkina
Faso, Mali and the Niger have provided emergency food distribution through cereal banks thatsell food staples at subsidized prices, while Kenya
has developed an extensive set of hunger safety
net programmes targeting arid and semi-arid
areas (APP, 2014).
Notwithstanding the successes, more efforts need
to be made to improve access to funding, ensure
fiscal sustainability, expand coverage, reduce fragmentation and improve targeting of social protection programmes in Africa. Kenya and United
Republic of Tanzania still spend less than 0.3 percent of GDP on social protection programmes.
Although 75 per cent of Madagascar’s population
are classified as poor, its social protection programme only covers 1 per cent of the population.
In Burundi, 67 per cent are below the national
poverty line, but only 5 per cent are reached bysocial safety nets. Social protection programmes
also tend to be fragmented, comprising small,donor-funded pilots or projects that operate inisolation from other similar projects. Most of theseinterventions are at the pilot stage and a very
limited number are scaled up. Other challenges
include targeting the suitable beneficiaries andimproving programme coordination (APP, 2014;
ECA et al., 2011; World Bank, 2012).
Public works programmes are a form of social
protection that has played an important role inproviding livelihoods for vulnerable groups. A
review by the Overseas Development Institute ofnearly 170 public works programmes found thatearnings from public works programmes contribute significantly to household incomes. However,while such programmes reduce the depth ofpoverty, their impact on the poverty headcounttends to be negligible. Furthermore, the effectiveness of such programmes depends on theirability to target vulnerable groups. Well-targeted
programmes have a greater impact on poverty
reduction. Targeting is, however, a data-intensive
process requiring timely access to information on
potential beneficiaries. In most African countries,
however, access to data is limited.
66

Public works programmes also tend to rely heavily on donor funding, rendering them susceptible to volatilities in the flow of such resources.
Approximately 83 per cent of the public works
programmes reviewed by Overseas Development
Institute were donor-funded (McCord and Slater,2009).
Employment subsidies can create jobs
Access to decent jobs is a sustainable exit strategy from poverty. The experience of Algeria provides some insights into how job creation can beaddressed through employment subsidies. Like
several African countries, Algeria experienced aformidable unemployment challenge. Unemployment rates were as high as 30 per cent in 2000
and 48 per cent in 2001. To tackle the problem, theGovernment implemented a rigorous employment policy that focused on granting subsidies
to firms as incentives to hire the unemployed
and establishing a public works programme forthe unskilled. Firms were given the opportunity
to hire the unemployed at no cost for one year,
while the Government paid the salaries for skilled
youth. Subsidies and financing were provided tomicro-enterprise projects to take on skilled youth
with relevant qualifications. Tax incentive measures were also provided to employers who wereable to create and safeguard jobs.

These efforts improved performance in terms ofmatching labour supply (job seekers) with labourdemand (vacancies). As a result, the annual number of job seekers matched through the National
Employment Agency (ANEM) over the period
2005-2009 increased by 167 per cent. Moreover,during this period, female employment rosefrom 1.2 million to almost 1.5 million, an increaseof around 20 per cent. Between 2004 and 2009,
the Algerian Government was able to create
1.3 million new jobs. This development led to a
reduction in the total unemployment rate from30 per cent in 2000 to 15.3 per cent in 2005, falling further to 10.2 per cent in 2009. In particular,
youth unemployment dropped from 48 per centin 2001 to 31 per cent in 2005. The Government’s
employment policy has surely contributed to thesignificant reduction of the poverty rate in the
country, which decreased from 14.1 per cent inAssessing Progress in Africa toward the Millennium Development Goals, 2015

Lessons learned from implementation of the Millennium Development Goals

1995 to 5 per cent in 2008, as measured by thenational poverty line (Kpodar, 2007 and Government of Algeria, 2010).
Nigeria’s Youth Empowerment Scheme administered by Oyo State has also been effective in generating jobs for youth. Established in July 2011,
the project aims to: generate 20,000 jobs annuallyin agriculture, public works, health and education,and environmental services; and build capacity inlife skills, including cognitive and entrepreneurial
skills. It is supported by seed money to build acritical mass of small entrepreneurs for the state.
In less than a year, the project had created 20,000
jobs in different sectors, including 5,000 in agriculture and related activities, 3,000 as traffic control
officers and 2,500 as environmental officers. The
outcomes were achieved by re-activating eightabandoned farm settlements for agricultural production and processing by youth. The main challenge is sustaining the project, scaling it up andreplicating it in other states of the country.
In conclusion, countries have largely focused onrural and infrastructure development complemented by social protection programmes to promote inclusiveness and reduce poverty. However,in many countries, the pace of reduction in thepoverty levels could have been further accelerated by improving targeting of the poor andimproving labour productivity. To promote inclusive growth and have a further multiplier effect onpoverty, attention needs to be given to improving
labour productivity as key driver of economic
growth and change in living standards. Labour
productivity growth implies a higher level of output for every hour worked. This can be achieved
if more capital is used in production or throughimproved overall efficiency with which labour andcapital are used together, i.e. higher multifactor
productivity growth. Labour productivity is also
a key driver of international competitiveness, asmeasured by, for example, unit labour cost. Paying greater attention to vulnerable employment
with a focus on youth is imperative to the poverty
reduction.
Improving targeting will require a greater emphasis on producing disaggregated data to capture

the gender, spatial and age dimension of poverty.
Targeted interventions to address child and youth
poverty are vital for realizing Africa’s demographic
dividend.

Lessons in social development
Most African countries are on track to achieve
the goal of universal primary enrolment by 2015.
Although improving the quality of education andreducing dropout rates still remain a challenge,some African countries have demonstrated success through innovative policies.

Education
Investments in rural education infrastructure
Investments in rural education infrastructure have
proven effective in expanding access to primaryschools. Ethiopia increased its net primary enrolment rate from 50 per cent in 1990 to 86.5 percent during the period 2009-2010, owing in partto the construction of classrooms, particularly inrural areas where access poses an acute challenge.
Sixteen thousand classrooms were constructed in
2004 and 25,000 during the period 2008-2009;80 per cent of these are in rural areas. In addition,
education is emphasized in public policies andprioritized in public spending
Community empowerment
Empowering local communities to run their own
schools has boosted primary enrolment, particularly in poor communities. Prompted by fiscal constraints, Burundi and Togo adopted an innovative
approach of direct community involvement in
the running of schools. In the poorest region ofTogo, Savanes, most of the schools are entirely
funded by rural households, which include building classrooms and paying teachers’ wages. As aconsequence, the net enrolment rate increased
from 67 per cent in 1990 to 87 per cent in 2008. At
the same time, the country was able to score 0.95
in the Gender Parity Index for primary education(National MDG Progress Reports 2010 – Ethiopia,
Egypt and Togo).
Policy reforms
Education policy reforms that reduce financial
and cultural barriers to education, enforce comLessons learned in implementing the MDGs

67

Lessons learned from implementation of the Millennium Development Goals

pulsory primary education and prioritize earlychildhood development have yielded successin spurring enrolment. These inclusive policies
were also adopted in other subsectors such as
secondary education and non-formal education
where access has also been expanded. From 1995
to 2008, Egypt increased net primary enrolment
rates from 83 to 90 per cent, through investmentsin early childhood development projects, cashtransfers to poor families and the launch of girlfriendly schools.
Uganda doubled its gross primary enrolment overa three-year period, from 1996 to 1999, by abolishing school fees for up to four children per family.
This policy not only improved access, but also
signalled to households the economic benefit oflower fertility rates. To sustain such subsidies, theGovernment prioritized economic growth, macroeconomic stability and social spending (ECA,2005).
Other countries such as Namibia have enshrined
compulsory education in their constitution andhave established educational policies and programmes to enforce compulsory primary education. Mauritius imposes penalties on parents
who do not send their children to primary school.
Seychelles has eliminated all forms of educational
discrimination, including against disabled people.
By contrast, increased budgetary allocations, a primary education development plan and capitation
grants are driving progress in the United Republicof Tanzania (UNDP–RBA 2010; ECA et al., 2012).
Reducing dropout rates
Increasing access to primary schools must becomplemented by improved completion rates
if education is to have its intended effects. Low
completion rates in primary school have been
attributed to: poor health or malnutrition statusof pupils; household situation (including childlabour and poverty); and school factors such asteacher absenteeism, school location and poor
educational provision (Sabates et al., 2010). Other
factors include late entry of pupils into the school
system, which increases the pressure to join thelabour market, or for girls, start a family, prior tocompleting the cycle. This reduces the incentive
68

to advance to secondary and higher levels of
education (UN, 2007). Countries have adopted
wide-ranging responses to the dropout challenge.
Tracking attendance and enhancing thelearning experience
The United Republic of Tanzania is addressing
this challenge by mapping, as much as possible,
all primary education facilities and identifying all
school-aged children, including tracking down
out-of-school children. This information is usefulin gauging the scope of the nation’s educational
resource needs. The Government then instituteda policy of compulsory enrolment of all childrenof seven years and over, including over-aged
children who were out of school. Furthermore,education was devolved to the regions, with acommunity approach to education. To tackle inefficiencies in the system, children were enrolled
at the official age of entry in primary school. At
the same time, the Government introduced quality-improvement measures, such as child-friendly
teaching and learning skills for teachers; flexible
learning hours; the abolition of corporal punishment and compulsory school uniforms; wider
availability of textuberculosisooks; school healthmeasures, such as improved access to water andsanitation facilities in school; and school meals
in drought-prone areas. Over-aged and out-ofschool children were accommodated through acondensed curriculum of three years equivalent,rather than the traditional seven years (Sabates etal., 2010; ECA et al., 2012).

Gender and women’s
empowerment
There has been considerable progress in increasing the share of women in national parliament but
less progress in increasing the share of women in
paid non-agricultural employment. The economic
and political empowerment of women cannot
however be decoupled from inequities in accessto primary education.
The importance of removing barriers tofemale education
The removal of economic and social cultural barriers to education is an imperative for progressin gender equality and the empowerment ofAssessing Progress in Africa toward the Millennium Development Goals, 2015

Lessons learned from implementation of the Millennium Development Goals

women. This is also true for the labour market andwomen’s participation in the social and politicalspheres.
Increased gender mainstreaming in education
has enabled countries to achieve gender parity inenrolment in primary education. The various campaigns conducted at different stages throughout
the continent have helped to steadily address thedifferential educational needs of girls and boys inprimary education. With the technical and financial support of relevant United Nations agencies
and multilateral and bilateral donors, many Africancountries have developed a follow-up framework
including gender-disaggregated education indicators. Morocco and Senegal, for example, havegone further by adopting gender-budgetingmechanisms. The focus on girl’s education has
also been strengthened by the non-State organizations that have contributed to developing anddisseminating best practices in removing the traditional and social barriers to girls’ education andinstitutionalizing gender-equitable practices andpolicies both at the national and regional levels.
From 1990 to 2008, in Zambia, the ratio of girls
to boys in primary school enrolment increased
from 0.90 to 0.97 due in part to the Government’s
Programme for Advancement of Girls’ Education,
introduced in 1994.The programme has focusedon policy development, capacity-building, gender sensitization, material development andresearch. In addition, it has introduced single-sex
classes, strengthened parent-teacher associations,increased the number of women in educational
management, introduced girl-friendly curricula,provided education grants for vulnerable children, and launched advocacy programmes atthe community level for girls’ education. Despite
these efforts, boys are more likely than girls toremain enrolled in school (Mumba, 2002; Ministry of Finance and National Planning and UNDP,
2011).
Improving household incomes contributes togender parity in education
Studies have shown that household income andwealth are important in explaining gender parity
in primary education. The Gender Parity Index ishigher among high-income groups, and lower
among children from low-income groups. Thus,
females from higher income households are more
likely to attend school than those from lower
income households. Commitment to educationsuch as the proportion of the national budget
devoted to education at all levels and the numberof years of compulsory education are also important drivers (ECA et al., 2012; UNSD, 2010).
Empowering women economically
Kenya’s innovative approach to women’s empowerment through the Table banking initiative has
generated notable success. Launched by thenon-governmental organization (NGO) Joyful
Women in 2009, the initiative is a revolving fundfor women’s groups. Minimum savings deposits
of $2 provide a revolving fund of short- and longterm loans for business ventures. From an initial
number of 17 women’s groups with a $750 fund,the group has grown to over 12,000 groups witha revolving fund of $17.5 million. The group hasraised $1.2 million for on-lending and paid out$1million in bonuses and dividends. As a result of
its activities, the average incomes of participating
women increased from $20 to $2,000 per month.

Joyful Women is also training women to takeadvantage of the Kenya’s affirmative action legislation, which sets aside 30 per cent of all government procurement projects for women andpeople with disabilities. In total, this amounts toapproximately $2.4 billion in potential resources
for women entrepreneurs. To date, the group has
trained 2,000 women in public procurement. As
a result, more than 500 women businesses havebeen recorded, and over 50 of the registered businesses have won procurement tenders.9
Policy reforms and affirmative action
promote political empowerment
The introduction of legislated quotas and voluntary quota systems has been instrumental inboosting the representation of women in national
parliaments and political parties. Mauritania, forexample, mandated a minimum quota of 20 per
cent women’s representation in municipal and9

See www.joywo.org

Lessons learned in implementing the MDGs

69

Lessons learned from implementation of the Millennium Development Goals

legislative bodies in an Act promulgated in July
2006. Subsequently, the proportion of seats held
by women in the national parliament reached
18 per cent in 2007, from no seats in 1992 and4 per cent in 2003. The most significant progress
was at the local level. In the 2007 municipal council elections, 1,120 out of 3,688 seats were held by
women (around 30 per cent, against 18 per centof national parliamentary seats).
Uganda has made a legal provision for 69 women
representatives in the national parliament –around 22 per cent of the total (Electoral Commission, 2006). Recent gains in Egypt and Mauritania
can also be attributed to legal provisions. Similarly,
affirmative actions and explicit constitutional
provisions for dealing with gender-based discrimination have advanced women’s positions inEthiopia, Mozambique, Rwanda, South Africa andthe United Republic of Tanzania.
Notwithstanding the progress in representation,much remains to be done to ensure that womenleverage their representation to advocate forissues that advance gender equality and women’s empowerment. Affirmative action should beviewed as a means to achieve gender equality
and women’s empowerment, not an end. To linkgender equality to sustained development, Africa
should go beyond participation to capacity-building. The latter can be achieved through training
and advocacy on how women can enhance theirleadership role and contribute fully to publicdebate and policy decisions.

HealthThe main adversaries of child survival are preventable and treatable. Most child deaths in low-income countries are primarily the result of diarrhoea, pneumonia, measles, malaria, HIV/AIDS,
undernutrition, asphyxia, preterm delivery, sepsis,and tetanus for deaths among neonates (WHO,2014a). Globally, in 2013, approximately 45 percent of deaths of children under five occurred
during the first month of life. Risk factors of neonatal mortality include unsafe and unhygienic
delivery environments, delays in seeking skilled
medical care, home deliveries, poor antenatal surveillance and poor postnatal care, and complex
70

ancestral traditions. Improving quality and accessto primary health care throughout pregnancy,
birth, and neonatal periods greatly enhancesneonatal survival; women’s education and othereducational campaigns are also important as ishealth insurance.
Scaling up high-impact interventions
Scaling up of cost-effective, high impact interventions and best practices in service delivery mechanisms is crucial to reduce preventable child deaths.
High-impact interventions that can significantly
reduce preventable maternal, neonatal and childdeaths have already been identified. These interventions increase maternal, newborn and childsurvival by addressing the main causes of maternal, newborn and child mortality, are suitablefor implementation in low- and middle-income
countries, and can be delivered from the community up to the first referral level of health service
delivery systems. However, the level of coverageand quality of these interventions in many Africancountries leaves much to be desired. Inadequate
financing, weak health systems and inadequate
mobilization of communities are among the key
factors contributing to low coverage. Countries
that have reduced their under-five mortality rate
have prioritized these interventions and adopted
health systems strategies that enhance the coverage and quality of these services.
Investing in health-care workers
Improving the skills of health workers in delivering high-impact interventions is fundamental to
improving child survival. Ethiopia’s Health Extension Programme and integrated Community CaseManagement programme, and the Health Development Army have been critical for successfulcommunity-based newborn care (Pearson et al.,2014). The impact of such initiatives is further
strengthened through investments in training. A
report from Ethiopia indicated that health extension workers that have been provided with adequate training have performed better on provision of integrated community case managementof childhood illnesses (Pearson et al., 2014).

Assessing Progress in Africa toward the Millennium Development Goals, 2015

Lessons learned from implementation of the Millennium Development Goals

Socioeconomic status influences health outcomes
Levels of education and income are important
determinants of health. Studies show that childmortality trends have been worse for children
born to women who do not have basic education
and are in the low socioeconomic class. Somestudies have shown that in Africa excluding North
Africa, higher per capita incomes and improved
maternal education have been associated 0.9
million and 2.2 million fewer child deaths, respectively. Hence, promoting and securing women’s
economic empowerment and maternal well-being are a critical and integrated component ofaddressing child survival.
Improving maternal health
Although the decline in the maternal mortality
ratio between 1990 and 2015 has been relatively
slow, several African countries have made significant progress in reducing maternal deaths.
Almost all African countries have experienced
some reduction in maternal deaths.

Key to the progress achieved are interventions
that target the main causes of death and the mostvulnerable newborn babies and children. Some ofthe primary causes of maternal deaths are haemorrhage, sepsis, hypertensive disorders, unsafe
abortion and prolonged or obstructed labour.
These complications can often be avoided with ahealth system that provides skilled personnel andfacilities to handle emergencies and post-partum
care. Thus, access to and use of health services
focused on childbearing is vital (UNSD, 2010; ECA
et al., 2012). Progress has also been associatedwith leadership, partnerships, evidence-based
data, innovations, development of dual short- andlong-term strategies, as well as the adaptation tochange for sustained progress (WHO, 2013).
Enhancing access to skilled health-care
workers, particularly for rural dwellers
North Africa has made significant progress in
reducing the maternal mortality ratio by strengthening access to professional health workers. Most
births in this subregion are attended by professional health workers. In Egypt, in 2002, skilled
personnel attended 61 per cent of all births,
leading to a 50 per cent decline in all maternal

deaths in only eight years. In stark contrast, in
Africa excluding North Africa, only about 50 per
cent of all births are attended by health workers, although exceptions are found in Botswana,
Cabo Verde, and Mauritius. From 1990 to2013,
Ethiopia reduced its maternal mortality ratio from1,400 to 420 deaths per 100,000 live births, byusing low-cost impact interventions through the
deployment of the Health Extension Programme,
especially in rural areas (ECA et al., 2014). The
programme has succeeded in bringing services
closer to the people, particularly rural dwellers
who historically have had challenges in accessing
health services and who live in areas where thematernal mortality ratio is highest.
Rwanda significantly reduced maternal deaths
by increasing access to the services of professional health workers. In 1995, following the 1994
genocide and years of conflict, Rwanda had an
extremely high maternal mortality ratio of 1,400
deaths per 100,000 live births, then the highest in Africa. Less than one third of births wereattended by a skilled health worker, only 13.7 percent of women used contraceptives; and just
10 per cent of women had the recommended
four antenatal visits. The Government deployedcommunity health workers and volunteers toaddress immediate and urgent health needs ofwomen. Furthermore, there was huge investmentin the continuous development and training of aprofessional health workforce within and outside
the country. The Ministry of Health in Rwanda
institutionalized maternal audits to identify better
when, where and how maternal deaths occurred
throughout the country. To further address maternal health challenges, the Government launched
the Rapid Short Message Services initiative in2010. The service trains health providers to track
expectant mothers and to provide antenatal careand delivery advice via short message service.
Between March and May 2010, 432 community
health workers were trained in using the service,and 14,000 pregnancies were tracked. During theperiod, they reported 583 births, 115 pregnancy-related risks, and no maternal or child deaths.
This service also increased the share of women
receiving antenatal visits: since the launch of the
programme, nearly 100 per cent of Rwandan
Lessons learned in implementing the MDGs

71

Lessons learned from implementation of the Millennium Development Goals

women have attended at least one antenatal carevisit, and the proportion who have attended atleast four visits has more than doubled since 1995.
Reducing financial barriers to health services
A number of countries including Burundi, Ghana
and Sierra Leone have abolished user fees in theprovision of maternal health-care services while
many others are providing subsidies and protection schemes in a bid to improve maternal health.
(ECA et al., 2011).

Nigeria’s Conditional Grant Scheme is considered asuccess story in the fight against maternal deaths.
The Government of Nigeria introduced the Conditional Grant Scheme in 2007 to help scale up progress on the MDGs by supporting over 100,000
pro-poor high impact projects in states and local
governments. This involved the construction of
6,005 health facilities; the provision of 152,164
pieces of health equipment; rehabilitation of 89
health institutions; and recruitment of 75,103
health workers. The result was a dramatic decline,from 1990 to 2013, in the maternal mortality ratio
from 1,200 to 560 deaths per 100,000 live births(ECA et al., 2014).
The rapid-roll-out of anti-retroviral therapy inthe past few years has brought about a significant reduction in mortality, particularly maternal
deaths, owing to their links with HIV/AIDS. A
2013 UNAIDS report indicated that in at least 10
countries, 80 per cent or more of adults including
pregnant women are eligible for anti-retroviraltherapy: Botswana, Cabo Verde, Eritrea, Kenya,
Namibia, Rwanda, South Africa, Swaziland, Zambia and Zimbabwe (UNAIDS, 2013a).
Breaking down cultural barriers
Even when health-care services are available,
access is often constrained by patriarchal cultural
practices. However, some countries have beenable to overcome such barriers through innovative approaches. The Niger’s Ecole des Maris(School for Husbands) initiative has been successful in transforming men into allies in promoting
women’s reproductive health, family planning andbehavioural change towards gender equality. The
project is anchored by a spirit of volunteerism and72

community participation involving health authorities, health agents, national NGOs and marriedmen from local communities (25 years or older).
These schools meet twice a month to discuss andanalyse specific challenges related to reproductive health in the community, propose solutions
and raise awareness on the issues. In 2011, a totalof 131 schools were operational in Zinder and46 schools were operational in Maradi region.
The initiative has engendered political and financial commitment as well as country ownershipresulting in fiscal allocations for the procurementof reproductive health commodities. Husbands
have obtained a better understanding of women’s reproductive health, which has consequently
contributed to putting an end to certain cultural
taboos and misconceptions about reproductive
health. Furthermore, the Governments of Burkina
Faso and Guinea have expressed interest in replicating the programme to encourage demand forfamily planning services (UNFPA, 2012).
Regional initiatives
Although, it is difficult to measure the impact of
global and African initiatives on improving maternal health, clearly, the reduction in maternal deathsin Africa is attributable in part to programmes
including the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CAARMA),
launched by the African Union and partners in
2009. By 2011, 26 African countries implemented
the programme at the national level and instituted follow-up mechanisms to minimize maternal deaths. In line with the CAARMA initiative, six
African countries allocated a minimum of 15 percent of their budget to fast-track health-related
MDGs by the end of 2010 in accordance with the2001 Abuja Declaration on HIV/AIDS, Tuberculosis
and Other Related Infectious Diseases.

HIV/AIDS
There are approximately 24.9 million people living with HIV in Africa, of whom only 125,000 are
located in North Africa. The others are distributed
across the four other geographical subregions,with Nigeria and South Africa alone accounting
for up to 38.4 per cent. The bulk of people livingwith HIV in Africa excluding North Africa are concentrated in 10 countries, namely Ethiopia, Kenya,

Assessing Progress in Africa toward the Millennium Development Goals, 2015

Lessons learned from implementation of the Millennium Development Goals

Malawi, Mozambique, Nigeria, South Africa,
Uganda, the United Republic of Tanzania, Zambia
and Zimbabwe. These countries together accountfor 81 per cent of all people living with HIV in theregion.
Botswana, a country with a historically high HIV
prevalence rate, has had a successful programme
for the prevention of mother-to-child transmission of HIV. By September 2009, over 90 per centof HIV-infected pregnant women had benefitted
from services under the programme. Mother-tochild transmission of HIV had been reduced from
20 to 40 per cent in 2001 to around 4 per centduring the period 2008-2009. The Government
plans to ensure access to highly active antiretroviral therapy for all pregnant women infected with
HIV, which should reduce mother-to-child transmission further, to under 1 per cent (UNSD, 2010).
Recent innovations in HIV/AIDS testing adopted
by African countries are contributing to more
effective treatment regimes. CD4 cells are a typeof white blood cell that identifies and destroys
harmful bacteria and viruses. Together with othertests, a CD4 count helps to indicate the strengthof our immune system and to identify and treat
HIV patients. According to new WHO guidelines,
a person with HIV becomes eligible to begin
life-saving highly active antiretroviral therapy
when his/her CD4 count falls below 500. Several
countries in Africa are already rolling out theseguidelines. Malawi has made the most advancesof any country by enhancing access to CD4 testing through investments in the relevant testing
equipment. The country is currently using a CD4
threshold of 350 for diagnosis. The lower range of
CD4 cell counts reflects the fact that HIV-negative
populations in Malawi have CD4 counts considerably lower than their European reference range(Crampin et al, 2011).
In general, engaging men in the fight against HIV
has proven a winning strategy. Voluntary medical
male circumcision has the potential of reducing
the risk of acquiring HIV among men by 66 percent (UNAIDS, 2014). In addition, when men know
their HIV status, they are more likely to appropriately resort to prevention and seek treatment.

Sex workers, homosexuals and people who injectdrugs also need to be followed closely as the levelof infection is particularly high among them.
In general, relentless advocacy and partnerships
have placed HIV/AIDS high on the development
agenda and helped to address stigma and mobilize substantial resources to address the scourgeof the disease.

Malaria
The WHO made recommendations of pertinentinterventions that have proven effective in controlling, and some cases, eliminating malaria incountries across the world. They include: vector
control, which reduces malaria transmission fromhumans to mosquitoes and back to humans; useof insecticide-treated nets; indoor residual spraying; chemoprevention; and case management,
which includes diagnosis and treatment of infections. Indeed, all countries that were successful incontrolling malaria have done so by employing
one of the above interventions, but in most cases,
a combination of them.
Rwanda’s entire population was once at risk ofmalaria, but is now one of Africa’s success stories in combating malaria. The country initiallyadopted two major strategies –a preventive one(promoting the use of insecticide-treated nets)
and a curative one (providing early diagnosis andtimely treatment with a combination of amodiaquine and sulfadoxine/pyrimethamine). The
preventive strategy focused on vulnerable groups
such as pregnant women and children under
five, and yielded faster results compared to thecurative strategy, in part because of widespread
resistance to the drugs that were older first-line
antimalarials. Rwanda then changed the drugs
used in treatment of malaria, and in 2005, artemisinin-based combination therapy was made thecountry’s official first-line antimalarial drug.
Strengthening health systems
Furthermore, the Rwandan Government, with thesupport of multiple donors, went beyond these
two strategies and engaged in strengthening
the health system as a way to ensure success ofthese interventions. The Global Fund, for examLessons learned in implementing the MDGs

73

Lessons learned from implementation of the Millennium Development Goals

ple, approved a grant of $33.9 million to financethe strengthening of the country’s health system
in 2005. As a result, more than 100 health-careadministrators were trained in health financing
and management for health information systems,
the quality of health care provided in health centres improved, and the cost of health services
declined (World Bank, 2010). Within four years,
more people were seeking treatment in healthfacilities, as evidenced by a 10 per cent increasein the use of health centres and a 16.8 per centincrease in use of district hospitals (Malaria Free
Future, 2008). Additionally, from 2006 to 2008, thenumber of people infected by malaria fell from
1.5 million people to 800,000, and the malaria
mortality rate decreased from 41 to 16 per cent.
Rwanda has reduced malaria incidence by morethan 75 per cent (WHO, 2014b).
In Zambia, the Ministry of Health identified
malaria control as one of its main public healthpriorities and included it in both the National
Development Plan (2006-2010) and the National
Health Strategic Plan (2006-2010). It developed
a detailed National Malaria Strategic Plan, whose
objective was to reduce the malaria burden significantly and achieve a malaria-free Zambia. The
focus was on scaling up malaria control interventions and supporting broader improvements inhealth systems, such as decentralizing budgetingand planning, capacity-building throughout the
supply chain for procurement, and forecastingof commodities, among others. By 2008, malaria
deaths had fallen by more than 40 per cent,prevalence by more than 50 per cent, and prevalence in children under five from 22 per centto 10.2 per cent (Government of Zambia, 2008).
However, a delay in external financing between
June 2009 and December 2010 slowed down theimplementation of malaria control interventions,which led to a loss in the gains that had alreadybeen made in parts of the country. Between 2008
and 2010, malaria resurged, especially in rural
areas and among the poorest populations who
could not afford mosquito nets (Government ofZambia, 2010). Zambia was able to regain successby improving access to artemisinin-based combination therapy, one of the most effective interventions for malaria treatment. It also provided
74

life-saving malaria medicines to health centres inselected districts. Nevertheless, the volatility in aid
reinforces the call for more sustainable financing
mechanisms to fund development programmes.
Involving local communities
In northern Ethiopia, the pioneer community
health programme in the Tigray region started in
1992 and over a period of eight years, contributed
to a 40 per cent reduction in death rates amongchildren under five, most of whom would havedied from malaria (WHO et al., 2000). The scheme
used village networks of community health volunteers including traditional birth attendants andmothers to provide health and malaria education.
This contributed to: improving the identificationand home treatment of malaria; supervising andensuring regular supply of preventive malaria
drugs for pregnant women; and organizing vector control activities such as insecticide spraying
and environmental management to destroy andprevent the increase of mosquito breeding sites.
The scheme focused on women and children
who were most at risk of malaria infections anddeaths. Mothers were recruited to teach othermothers how to treat malaria at home, ensuring
availability of malaria drugs before the disease
became severe, particularly in children under five.
In Western Tigray, a community financing scheme
was established to supply insecticide-treated nets
for use by returnees and demobilized soldiersin resettlement areas with high rates of malaria.
The communities involved agreed on financing
and management responsibilities for the sale ofimported bednets and insecticide for re-treatment.
Integrated approaches
Mauritius, a country with relatively high transmission potential, has nevertheless been successful
in eliminating malaria and preventing its reintroduction. Financed almost entirely from domestic
resources, the programme requires residents toparticipate in environmental management andvector control, resulting in high coverage of populations at risk with effective interventions. Entomological surveillance and geographical reconnaissance with detailed hand-drawn maps wereused extensively to identify transmission foci andAssessing Progress in Africa toward the Millennium Development Goals, 2015

Lessons learned from implementation of the Millennium Development Goals

provide information for interventions. Mauritius’s
unique passenger screening programme closely
tracks people arriving from malaria-endemic
countries to reduce the risk of cross-border transmission of the disease (Government of Mauritius
and WHO, 2012).
Swaziland has also made remarkable progress in
reducing malaria incidence by over 75 per centbetween 2000 and 2012, and also by significantly
reducing malaria-related death rates. Malaria
control and prevention efforts were intensified in
Swaziland in 2000 in a bid to achieve the Abuja
target of halving malaria mortality and morbidity
by 2010; the 2003-2007 Strategic Plan to reduce
malaria morbidity and mortality was developed
for this purpose. The interventions included: highcoverage of indoor residual spraying in mostat-risk areas; use of insecticide-treated nets, especially among vulnerable groups; improving healthfacility surveillance; and information sharing andawareness-raising activities.

system and improvements in socioeconomic
development is required to address the malaria
challenge. Poverty, low levels of education andrural dwelling are major impediments to intervention coverage since they undermine accessto insecticide-treated nets, diagnostic testing andartemisinin-based combination therapy.
Ethiopia’s experience highlights the importanceof community involvement and commitment forthe success of malaria-related interventions. It also
showcases the importance of targeting the mostat risk populations for good results. There is also aneed for sufficient and timely funding to sustain
and protect the gains made in malaria control. In
this context, Zambia’s experience shows how easily funding gaps and delays, however short, canderail malaria control efforts.

Tuberculosis

Swaziland developed the Malaria Elimination Strategic Plan (2008-2015) with the aim of reducing
local malaria cases to 0 per 1,000 of the population by 2015. Previously used interventions werescaled up and four key areas of intervention wereidentified for the elimination strategy: integrated
vector management; surveillance; case management; and information, education and communication on malaria-related issues. As a result of
these efforts, at least 53 per cent of the at-risk
population has been protected through spraying
and use of treated nets; all malaria cases are now
treated with artemisinin-based combination therapy; in one year alone (2011 to 2012), confirmed
cases decreased by 42 per cent; and between
2000 and 2012, approximately 33,000 cases were
averted.

Over the years, numerous initiatives have beendeveloped to address tuberculosis. The Directly
Observed Treatment Shortcourse (DOTS) is oneof the most widely advocated and used strategies that was developed and proved to be a
low-cost effective strategy for the detection andtreatment of tuberculosis through which millionsof tuberculosis deaths could be prevented. It is afive-pronged strategy for tuberculosis control thatinvolves: government commitment to sustained
tuberculosis control; detection of tuberculosis
cases through sputum smear microscopy among
symptomatic people; regular and uninterrupted
supply of high-quality tuberculosis drugs; six toeight months of regularly supervised treatment;
and reporting systems to monitor treatment
progress and programme performance. DOTS
achieved great success initially; the average global
treatment success rate under DOTS was almost
80 per cent in 1997.

The above experiences show that there are indeed
effective interventions for malaria prevention andtreatment, and even more importantly, that theseinterventions are cost-effective and affordable.
However, political commitment is imperative
for initiating and implementing the intervention. A key lesson is that an integrated approachencompassing the strengthening of the health

China had the world’s largest DOTS programmein the 1990s and achieved massive success, serving more than 700 million people and preventing approximately 50 per cent of all tuberculosis
deaths in areas covered by the programme. In
the first seven years of operation, about 30,000
lives were saved annually and more than 90 per
cent of patients were cured under the DOTS proLessons learned in implementing the MDGs

75

Lessons learned from implementation of the Millennium Development Goals

gramme (WHO et al., 2000). Pilot projects werelaunched in 1991, in which expensive and usuallyineffective hospital-based treatment was abandoned and replaced by the DOTS programme,
which provided tuberculosis care and treatment
at the village level through the supervised use of
a combination of four inexpensive drugs. Drugs
were obtained on the international market atcompetitive prices of about $20 for a six-monthcourse of drugs, supplies were centralized, anddiagnosis and treatment were free for patients.
Village health workers gave a bonus for every
tuberculosis case identified and every patient
who was cured. This served as an incentive forpeople to seek treatment. The health workers
were responsible for: storing the drug; monitoring
every patient to ensure they took the correct doseof drugs at the right time; and organizing periodic
sputum checks in a laboratory to monitor progress and validate eventual cure. As a result, DOTS
had a 94 per cent cure rate in the pilot provinces
and was consequently expanded to cover 13 ofChina’s 31 provinces in 1992 (WHO et al., 2000).
Cambodia also achieved success in halving theincidence of tuberculosis and meeting global
targets for tuberculosis detection and treatmentby providing universal access to tuberculosis carethrough primary health centres. Following yearsof conflict and economic hardship, Cambodia’s
health system was destroyed, and it had one of thehighest tuberculosis infection rates in the world.
In 1993, Cambodia re-launched its national tuberculosis programme, adopting the DOTS strategy,
and by the late 1990s, had decentralized healthservices for the communities. This changed theway tuberculosis services were delivered. Cambodia has transformed its tuberculosis programmefrom a hospital-based system to one with free,
universal access to tuberculosis care at the grassroots level. In tandem, health system reforms
helped to expand access to primary health care.
Community-based health centres providing free,
DOTS-based tuberculosis services surged from 60
in 2000 to more than 1,000 in 2005, and the number of health workers trained in tuberculosis careand control increased from 800 to 2,500 (WHO,2012a).
76

Evidence-based tuberculosis policy and planningwere helpful in Cambodia’s policy formulation andplanning. A 2002 survey showed that Cambodia
had one of the highest tuberculosis prevalence
rates (more than 1,500 cases per 100,000 people)
in the world. The results of this survey helped todefine the tuberculosis problem, map out local
conditions, guide resource allocation and attract
international attention. Such surveys further
facilitated knowledge generation and trainingof so-called ”DOTS watchers” at the village level,
who helped in early detection of tuberculosis toenable effective treatment at home, with local
support and reduced spread of infection. By 2005,
Cambodia had achieved the global tuberculosis
targets of a 70 per cent case detection rate andan 85 per cent treatment success under DOTS;
between 2002 and 2011, tuberculosis prevalence
had fallen from more than 1,500 cases to 820
cases per 100,000 people, a reduction of 45 percent (WHO, 2012a).
These experiences underscore the importance ofevidence-based policies and planning, government leadership and strong technical expertisefor successful implementation and results. They
also highlight the important role of DOTS in promoting effective interventions for tuberculosis
controlLessons in environmental
sustainability
Africa is making good progress in limiting carbon
dioxide emissions and ozone-depleting substances; by 2012 at least 32 countries had protected 10 per cent or more of their terrestrial andmarine areas. However, as more African countries
industrialize, carbon dioxide emissions will likely
increase. One challenge to Africa’s industrialization
efforts is that under the United Nations Framework Convention on Climate Change, current
and future international obligations on climatechange mitigation and adaptation could impose
constraints on how Africa can industrialize. As theinternational community accelerates plans for
cutting greenhouse gas emissions, African industries might need to comply with environmental
standards and laws at national and international
levels.

Assessing Progress in Africa toward the Millennium Development Goals, 2015

Lessons learned from implementation of the Millennium Development Goals

Investing in renewable energy
African governments should invest heavily inpromoting the efficient production and use ofenergy sources over which they have a comparative advantage. The Government of Seychelles
has recently geared up its efforts to promoterenewable energy through investments in windturbines and solar water heaters. These activities
have been supported and encouraged by the
National Energy Act (ECA et al., 2013). Cabo Verde,
the Gambia, Rwanda and Tunisia have launchedreforestation programmes.
Intensifying reforestation efforts
In Cabo Verde, the proportion of forested area
climbed by 6.7 percentage points to 21.1 during the 1990-2010 period. The Great Green Wallof the Sahara and Sahel is another initiative
conceived as a set of cross-sectoral actions andinterventions aimed at conserving the natural
resources, securing economic development and,particularly, reducing poverty. The declining trend
cannot be significantly reversed, however, unlessthese actions are supported by strong forestry
institutions, policies and regulatory frameworks
combined with adequate human resources andaccompanying effective monitoring systems.

Malawi has had some success in addressing
deforestation. A project run by RIPPLE Africa in
Malawi provides a sustainable source of timberby planting fast-growing, exotic trees, conserving
indigenous trees by decreasing the demand forwood from Malawi’s natural forests, and restoring degraded land by planting indigenous trees
where appropriate. Since its launch in 2006, theproject has helped over 175 community groups
to plant more than 3 million trees in the Nkhata
Bay District. The programme provides a long-term
solution to deforestation by planting thousandsof quick growing exotic trees in community
woodlots that provide a sustainable source oftimber for local people. These trees provide an
immediate benefit to the community who usethem like a crop; coppicing the trees (i.e. cutting
off the branches for firewood without felling thewhole tree), which then grow back quickly to provide more wood. This eases the heavy pressure
on the indigenous forests and helps change theway people in Malawi think about their natural
resources10 (RIPPLE Africa).

Water and sanitation
Progress on access to safe drinking water in thecontinent has been steady; however, many countries are experiencing water stress, which is likely
to be exacerbated by climate change. As water
use for irrigation and other agricultural purposescontinues to increase, countries will need to introduce more efficient water management systems.
Some countries have achieved interesting resultsin this area (ECA et al., 2013). For example, Ghana
has rehabilitated its infrastructure, expanding
and building new elements to meet current andgrowing demand with funding from governmentand development partners. These investments areenhancing access to urban, rural and small town
water supplies and improving irrigation facilities
for more than 2,400 peasant farmers.
Mozambique has also given high priority towater-related infrastructure development byfinancing large schemes for rainwater harvestingin order to minimize the severity of droughts. In
Benin, many boreholes, hand-dug wells and pipedsystems were built for rural and small towns’ watersupply, and as a result, the average coverage ofdrinking water in rural areas increased from 39 percent in 2004 to 57 per cent in 2010.
With respect to sanitation, Ethiopia’s efforts have
led to a decrease in the practice of open defecation from 82 per cent in 1990 to 34 per cent in2012. The key to success was advocacy aimed at
encouraging communities to stop open defecation and investments in the construction of sanitation facilities. The result was a remarkably steep
decline in open defecation and steady progress insanitation coverage across all 11 states of Ethiopia,
despite wide variations in wealth, ethnicity andother socio-economic characteristics (WHO and
UNICEF, 2014).Benin was also able to reduce open
defecation from 80 per cent to 54 per cent during
the same period.

10 www.rippleafrica.org/environment-projects-in-malawi-africa/
tree-planting-africa

Lessons learned in implementing the MDGs

77

Lessons learned from implementation of the Millennium Development Goals

Advocacy targeted at local communities
With respect to sanitation, Ethiopia’s efforts have
led to a decrease in the practice of open defecation from 82 per cent in 1990 to 34 per cent in2012. The key to success was advocacy aimed at
encouraging communities to stop open defecation and investments in the construction of sanitation facilities. The result was a remarkably steep
decline in open defecation and steady progress insanitation coverage across all 11 states of Ethiopia,
despite wide variations in wealth, ethnicity andother socioeconomic characteristics (UNICEF and
WHO, 2012). Benin was also able to reduce open
defecation from 80 per cent to 54 per cent during
the same period.

Conclusions
The MDGs have helped African countries to madetremendous efforts towards poverty and social
sectors. Even if African countries will not meet
all the MDGs because of challenging initial conditions, this should not overshadow the progress
made in devising innovative solutions to some of
their pressing development challenges. In poverty and social development, progress has been
underpinned by rapid growth and investments
in social and economic infrastructure, greater
involvement of local communities in service
delivery, and policy reforms aimed at reducing
financial and cultural barriers to access to social
services. Girls and women have been empowered
through affirmative action programmes, and by78

addressing cultural biases and investing in gender-appropriate infrastructure.
Country experiences suggest that, while verticalinterventions have contributed to the advancement of health goals, more integrated approaches
that strengthen health systems and improve thesocioeconomic contexts of households yield
more enduring health outcomes; taking into
account cultural rigidities is also important.
Strengthening governance systems throughrigorous monitoring mechanisms for results andbudget tracking are critical. The availability ofdata on pupils’ enrolment, completion, learningachievement and other budget- and results related-information is also critical. The experiences
underline the importance of addressing data gaps
at the national and regional levels to ensure effective follow-up.
Reforestation and rain harvesting interventions
have helped to reduce the rate of deforestationand improve access to improved water sources.
Despite limited progress on sanitation, advocacy
and awareness raising have generated progress inthis area.
Moving forward, countries will benefit from continued support to develop home-grown solutions
to development challenges.

Assessing Progress in Africa toward the Millennium Development Goals, 2015

Section III:
Conclusions and policy
perspectives
in attaining almost three out of the eight MDGs
– MDG 2 (Achieve universal primary education),
MDG 3 (Promote gender equality and empower
women) and the targets related to MDG 6 (Combat HIV/AIDS, malaria and other diseases).

The MDG report 2015 marks the 10th edition of
the series that began in 2005, when the African
Union Assembly of Heads of State mandated the
AUC, ECA and AfDB to monitor the progress inAfrica towards the MDGs. UNDP-RBA joined theseorganizations later on. This year’s report also represents the final year of implementation of the
MDGs.

Recommendations based on someoverarching and thematic lessons
learned from the MDGs process

Overall progress on the MDGs

Producing MDG reports for 10 years now has
generated a wealth of knowledge that needs tobe tapped into in order to be well prepared forthe process of inclusive structural transformationand prosperity for all in Africa. For this reason, thethematic focus of this year’s MDG report is on thelessons learned after over a decade of experiencesin pursuing the MDGs in Africa. The overall rela-

At this turning point, the MDG report 2015 canbe seen as a broad baseline informing on where
the continent stands on the eve of the new development agenda. Although more efforts need tobe made, the detailed review of the eight goals
has highlighted that Africa has achieved great
progress across the board. Thus, Africa is on track

AFRICA’S MDG PERFORMANCE AT A GLANCE
Goals

StatusRemarks

Goal 1: Eradicate extreme
poverty and hunger

Off track• Poverty in Africa excluding North Africa declined from
56.5% in 1990 to 48.4% in 2010, and in North Africa from
5% to1%.
• Poverty is perpetuated by rising inequalities, unemployment, the youth bulge, unplanned urbanization, lack ofdiversification, etc.
• Hunger declined by 8% in Africa excluding North Africa
between 1990 and 2013.
• Africa excluding North Africa is the most food-deficientof all regions of the world, with 25% of its population
facing hunger and malnutrition in 2011-2013.

Goal 2: Achieve universal
primary education

On track• In 2012, over 68% of African countries had a net enrolment rate of at least 75% in primary education.
• Average primary completion rate stands at 67%.
•

The youth literacy rate reached 69.61% in 2012, in partowing to increased access to universal primary education.

Lessons learned in implementing the MDGs

79

Conclusions and policy perspectives
Goals

StatusGoal 3: Promote gender
On track (GPI in primaryequality and empower women education and seats
held by women innational parliaments)

Remarks• GPI in primary education increased from 0.82 to 0.96 in
North Africa and from 0.83 to 0.92 in Africa excluding
North Africa between 1990 and 2012.
• Gender barriers manifest themselves in low transition
rates between education levels and into employment
and at higher educational levels owing to pregnancy
and other barriers.
• Africa has made the most progress in increasing thenumber of seats held by women in national parliaments,
with an average increase of 15% between 2000 and
2014.

Goal 4: Reduce child mortality

Off track• Under-five mortality rate fell by 55% between 1990 and2012, while the infant mortality rate fell by 40%.
• Only Egypt, Liberia, Malawi and Tunisia have achieved
both targets on reducing child mortality.

Goal 5: Improve maternal
healthOff track• By 2013, Africa had 289 maternal deaths per 100,000 live
births, compared to the world average of 210 maternal
deaths per 100,000 live births.

Goal 6: Combat HIV/AIDS,
malaria and other diseases

On track• A downward trend is observed in the incidence, prevalence and death rates associated with HIV/AIDS, malaria
and tuberculosis, especially since 2000.

Goal 7: Ensure environmental
sustainability

Off track• Declining forest cover in Africa.
• Consumption of ozone-depleting substances declinedby 94% between 1986 and 2012.
• Increasing proportion of terrestrial and marine areas
protected.
• In 2012, only 64% of the population in Africa excluding
North Africa used an improved drinking water source.
• The proportion of people with access to improved
sanitation between 1990 and 2012 increased only
moderately in Africa excluding North Africa (from 24% to30%), compared to North Africa (from 72% to 91%).

tively low progress made on the MDGs, together
with the overarching and theme specific lessons
learned throughout their implementation processsuggest a number of recommendations:
Effective communication and follow-up is
critical for the success of global agendas
Countries and pan-African organizations needto continue efforts and commitment towards
effective communication on progress registeredin achieving internationally agreed goals. In particular, they need to pursue the production ofnational and regional progress reports for the
successor to the MDGs. Indeed, experience showsthat national MDG reports helped mobilize civil
80

society organizations and other stakeholders to
put pressure on governments to intensify efforts
and devote resources towards achieving agreed
goals, while regional reports such as the MDG
report for Africa permitted cross-country comparison, peer-learning and emulation.
Address the root causes rather than thesymptoms of underdevelopment.
Countries and their development partners including donors need to adopt an integrated approachto development and put emphasis on the root
causes rather than the symptoms of underdevelopment. The recent Ebola outbreak in West Africa
provides a good illustration. The crisis shed light

Assessing Progress in Africa toward the Millennium Development Goals, 2015

Conclusions and policy perspectives

on the fragility of health systems demonstratingthat all the efforts in the fight against HIV, malaria
and tuberculosis through MDG 6 did not contribute enough to the establishment of strong healthsystems. With the Ebola outbreak, the health systems of the three most affected countries almost
collapsed, to the extent of jeopardizing progress
made in several areas, including the diseases concerned by MDG 6.
Exploiting inter-sectoral synergies tomaximize impact
For benefits and efficiency, countries should strive
and leverage inter-sectoral synergies in the implementation of development objectives. This will beeven more necessary in the post-MDG era withthe three dimensions of sustainable development,
namely economic, social and environmental. This
will be achieved through improved technicalcapacities in development planning and result
based management, which will require appropriate studies and analyses identifying interrelations
among the different objectives together with theinterventions and measures that are likely to maximize positive impacts.
Invest in data collection and analysis
Monitoring and evaluation has proven key toadvance development agendas by detecting
problems in the implementation process andproposing adequate corrective actions. To takefull advantage of the monitoring and evaluation(M&E) function, countries and donors need toinvest in data collection and analysis, with particular emphasis on generating disaggregated datafor key social groups.
Reduce poverty, inequality andunemployment through inclusive andsustained growth
To achieve inclusive and sustained growth Africancountries need to structurally transform theireconomies including through value addition andcommodity-based industrialization where feasible. This will require investing in people, promoting
rural development, enhancing agricultural productivity, prioritizing social protection, improving
access to energy, markets and credit banking, andsupporting small- and medium-sized enterprises.

Countries need to explore job creation opportunities by, inter alia, increasing labour productivity;
providing employment subsidies to firms willingto hire the unemployed and young people with
relevant qualifications; and providing tax incentives to employers able to create and safeguard
jobs. A focus on agriculture could also be a winning strategy, as re-activating or upgrading farm
settlements for agricultural production and processing has created jobs for thousands of young
people, for instance, in Nigeria.
Inclusiveness, economic growth and structuraltransformation are mutually reinforcing. Countries need to define transformative agendas that
promote all these objectives in a well-articulatedmanner.
There is also a need to strengthen resilience toexternal and internal shocks such as those associated with international prices and the recent
Ebola outbreak in West Africa because theseshocks almost always reverse development gains.
In this regard it is recommended that countries,
particularly those that are natural resources-rich,develop fiscal buffers to respond to shocks.
Enhance social development
There is a need to redouble efforts in social development in African order to increase its productive
capacity and generate the quantity of wealthrequired to bring about prosperity for all. In thearea of education, countries need to focus on
quality together with improving access. They alsoneed to promote higher levels of education while
sustaining the achievements in primary education and implementing preschool programmesthat develop innovative behaviours. Vocational
training must be promoted to ensure a good
matching of skills with the labour requirementsof Africa’s structural transformation and industrialization agenda. In this respect, investments in
education infrastructure, curricula and qualified
teachers will be vital.

Empowering local communities to run their own
schools may boost enrolment, particularly in poor
communities; countries should foster it. Education
policy reforms that reduce financial and cultural
Lessons learned in implementing the MDGs

81

Conclusions and policy perspectives

barriers to education, enforce compulsory primaryeducation, and prioritize early childhood development are recommended to spur enrolment.
Examples of such reforms include cash transfers
to poor families and the launch of girl-friendly
schools; abolishing school fees; enshrining compulsory education in the constitution and establishing educational policies and programmes toenforce compulsory primary education.
In the area of health, scaling up of cost-effective,
high-impact interventions and best practices inservice delivery mechanisms is crucial to reducechild and maternal mortality and sustain progress
in HIV, malaria and tuberculosis, and all other diseases.
Non-communicable diseases are becoming a
growing concern in the continent; this situation
calls for a special attention. Countries shouldmake greater efforts in financing health systems
adequately, and mobilizing communities better inview of enhancing the coverage of health services.
It is also paramount to invest in skilled health-care
workers and in removing the barriers to healthcare services, including financial and physicalones. Specific measures in connection to thisinclude the abolishment of user fees in the provision of some health-care services, notably thosetargeting maternal and child health. The provisionof subsidies and protection schemes in a bid toimprove health for such targets is also advisable.
As regards HIV, malaria and tuberculosis, countries
are encouraged to pursue the adoption of WHO
recommended programmes, which have provenhighly effective in curbing this disease. Morespecifically the use of condoms and antiretroviraltherapy are advised for HIV, insecticide-treatednets and artemisinin-based combination therapy
for malaria, and DOTs for tuberculosis.
The Ebola crisis has underscored the fragility ofhealth systems and the harsh consequencesthat such a situation may have on income, jobs
and livelihoods of households and on the fiscal
position of a country as a whole. This experiencecalls for major efforts from countries and theirdevelopment partners to establish solid healthsystems along with adequate infrastructures to82

improve access to health-care facilities. These
medium-term development objectives should
be clearly integrated into national development
planning frameworks for them to be given adequate priority.
Women’s empowerment is central to the achievement of many other social development goals,
notably in the areas of poverty, inequality, hunger,
employment, education, and health. Hence countries should promote gender informed policy
interventions such as stipends, conditional cashtransfer to enhance parity in education together
with quotas and reserved seats measures toincrease representation in the political sphere.
Countries should also take bold steps to remove
structural and cultural impediments hindering
women’s economic and social opportunities
through limited access to and control over productive resources.
Access to energy, safe drinking water and sanitation, and improved dwellings and settlements arealso crucial elements that countries need to pay
greater attention to for an enhanced social development and an optimal contribution of humanresources to production and consumption. Measures recommended in these areas include rehabilitating, expanding and building water, sanitationand housing infrastructures to meet current andgrowing demand with funding from government,
development partners and the private sector.
In order to enhance socioeconomic development
prospects, African countries should devote all
efforts to the preservation of their natural asset
such as forests, oceans and marine resources, andpromote environmental-friendly development
strategies.
Promote diversification as a major strategy
to improve productive capacities andimprove global partnership prospects
African countries must be proactive in responding
to development challenges that prevent themfrom fully taking advantage of global partnership opportunities. In this respect diversificationof their economies is identified as a priority inview of removing the supply-side constraints andAssessing Progress in Africa toward the Millennium Development Goals, 2015

Conclusions and policy perspectives

improving their production capacities. Effective
diversification requires the prudent economic
management of natural resources. Well-defined
economic reform programmes targeting macroeconomic stability and long-term growth throughexport-led industrialization may help promote
export diversification. Diversification may also
be envisaged as part of a private sector development strategy. This entails outlining diversification
among the specific policies and strategies thatneed to be pursued in order to enhance private
sector growth and competitiveness in the country.
Countries and the international
community to commit to effective means of
implementation
Finally, it is imperative to mobilize adequatemeans of implementation if countries are toachieve their priority development goals andobjectives. There is a need, therefore, for Africancountries to negotiate a more catalytic role for
ODA that leverages domestic resources and productive capacities. Strengthening tax administration and improving capacities to stem the tide ofillicit financial outflows are critical for increasing
domestic resources. ODA can play an importantrole in financing investments in both areas. In thisrespect, donors should fulfil their existing ODA
commitments and allocate a greater share of such
resources to the strengthening of fiscal capacities.
African countries should strengthen cooperation
with their external partners in curbing illicit outflows, returning stolen assets, and diversifying thedestination and sectoral composition of foreign
direct investment flows to Africa. Notwithstanding some improvements, foreign direct investment is concentrated in a few countries and in theextractive sectors. The international community
should support African countries in promoting
technology, innovation and science, fair trade,
strengthening trade facilitation and facilitating
good governance. Governments should also reinforce and improve their cooperation with theirdomestic private sector and involve them morein the implementation of national development
strategies. All internal and external efforts should
be directed towards critical priority areas startingwith Africa’s agenda for structural transformation
through value addition and industrialization.
The MDGs remain an unfinished business in Africa,
but the numerous lessons generated throughout their implementation can expedite progress
towards achievement of the goals provided that
adequate measures are adopted to take advantage of the new knowledge.
Recommendations on the successor to the
MDG report
The end of the MDGs era provides the opportunity to think about how to improve the process of
tracking and assessing progress towards achieving the internationally agreed development goals.
In the past ten years, the MDG reports have served
greatly to provide a rigorous assessment of Africa’s
progress in achieving the MDGs, they have served
as a basis for policy discussion, peer learning andadvocacy. They have also provided the impetus forstrong and coordinated action by Africa’s top decision makers towards accelerating progress in the
MDGs. Against this background, underscoring theimportance of the MDG report, the expert groupmeeting organized for the validation of the 2015
edition expressed support for a successor reportthat would go further than the mere monitoringof progress. The meeting recommended that the
new report should contribute more to the debate
on policies and reforms underlining progress
towards achieving the Sustainable Development
Goals (including promotion of national debatesaround the report). By way of innovation, it wassuggested to the four partners currently producing the MDG report to undertake original country
case studies jointly with experts from the selected
countries. Such studies aim to be a flagship section of the next report.

Lessons learned in implementing the MDGs

83

Official list of MDG indicators

Annex 1: Official list of MDG indicators
Millennium Development Goals (MDGs)
Goals and Targets(from the Millennium Declaration)

Indicators for monitoring progress

Goal 1: Eradicate extreme poverty and hunger
Target 1.A: Halve, between 1990 and 2015, the proportionof people whose income is less than $1.25 a day

Target 1.B: Achieve full and productive employment anddecent work for all, including women and young people

Target 1.C: Halve, between 1990 and 2015, the proportionof people who suffer from hunger

1.1 Proportion of population below $1 purchasing power
parity per day*
1.2 Poverty gap ratio
1.3 Share of poorest quintile in national consumption
1.4 Growth rate of GDP per person employed
1.5 Employment-to-population ratio
1.6 Proportion of employed people living below $1
purchasing power parity per day
1.7 Proportion of own-account and contributing family
workers in total employment
1.8 Prevalence of underweight children under-five yearsof age
1.9 Proportion of population below minimum level of
dietary energy consumption

Goal 2: Achieve universal primary education
2.1 Net enrolment ratio in primary education
Target 2.A: Ensure that, by 2015, children everywhere,
2.2 Proportion of pupils starting grade 1 who reach lastboys and girls alike, will be able to complete a full course of
grade of primaryprimary schooling
2.3 Literacy rate of 15-24 year-olds, women and men
Goal 3: Promote gender equality and empower women
3.1 Ratios of girls to boys in primary, secondary andtertiary education
Target 3.A: Eliminate gender disparity in primary and3.2 Share of women in wage employment in the non-agrisecondary education, preferably by 2005, and in all levels ofcultural sector
education no later than 2015
3.3 Proportion of seats held by women in national
parliament
Goal 4: Reduce child mortality
Target 4.A: Reduce by two-thirds, between 1990 and 2015,
the under-five mortality rate

4.1 Under-five mortality rate
4.2 Infant mortality rate
4.3 Proportion of 1-year-old children immunized against
measles

Goal 5: Improve maternal health
Target 5.A: Reduce by three quarters, between 1990 and2015, the maternal mortality ratio

Target 5.B: Achieve, by 2015, universal access to reproductive health84

5.1 Maternal mortality ratio
5.2 Proportion of births attended by skilled healthpersonnel
5.3 Contraceptive prevalence rate
5.4 Adolescent birth rate
5.5 Antenatal care coverage (at least one visit and at least
four visits)
5.6 Unmet need for family planning

Assessing Progress in Africa toward the Millennium Development Goals, 2015

Official list of MDG indicators
Millennium Development Goals (MDGs)
Goals and Targets(from the Millennium Declaration)

Indicators for monitoring progress

Goal 6: Combat HIV/AIDS, malaria and other diseases
Target 6.A: Have halted by 2015 and begun to reverse thespread of HIV/AIDS

6.1 HIV prevalence among population aged 15-24 years
6.2 Condom use at last high-risk sex
6.3 Proportion of population aged 15-24 years withcomprehensive correct knowledge of HIV/AIDS
6.4 Ratio of school attendance of orphans to school
attendance of non-orphans aged 10-14 years

Target 6.B: Achieve, by 2010, universal access to treatment
for HIV/AIDS for all those who need it

6.5 Proportion of population with advanced HIV infection
with access to antiretroviral drugs

Target 6.C: Have halted by 2015 and begun to reverse theincidence of malaria and other major diseases

6.6 Incidence and death rates associated with malaria
6.7 Proportion of children under 5 sleeping under insecticide-treated bednets
6.8 Proportion of children under 5 with fever who aretreated with appropriate anti-malarial drugs
6.9 Incidence, prevalence and death rates associated withtuberculosis
6.10 Proportion of tuberculosis cases detected and cured
under DOTS

Goal 7: Ensure environmental sustainability
Target 7.A: Integrate the principles of sustainable development into country policies and programmes and reverse
the loss of environmental resources

Target 7.B: Reduce biodiversity loss, achieving, by 2010, a
significant reduction in the rate of loss
Target 7.C: Halve, by 2015, the proportion of the population without sustainable access to safe drinking water andbasic sanitation

7.1 Proportion of land area covered by forest
7.2 Carbon dioxide emissions, total, per capita and per $1
GDP purchasing power parity
7.3 Consumption of ozone-depleting substances
7.4 Proportion of fish stocks within safe biological limits
7.5 Proportion of total water resources used
7.6 Proportion of terrestrial and marine areas protected
7.7 Proportion of species threatened with extinction
7.8 Proportion of population using an improved drinking
water source
7.9 Proportion of population using an improved sanitation
facility

Target 7.D: Achieve, by 2020, to have achieved a significant
improvement in the lives of at least 100 million slum
7.10 Proportion of urban population living in slums**
dwellers

Lessons learned in implementing the MDGs

85

Official list of MDG indicators
Millennium Development Goals (MDGs)
Goals and Targets(from the Millennium Declaration)

Indicators for monitoring progress

Goal 8: Develop a global partnership for development
Some of the indicators listed below are monitored
separately for the least developed countries, Africa,
landlocked developing countries and small island
developing States.
Includes a commitment to good governance, development
and poverty reduction – both nationally and internationally Official development assistance (ODA)
8.1 Net ODA, total and to the least developed countries,
as percentage of OECD/DAC donors’ gross national
Target 8.B: Address the special needs of the least develincome
oped countries
8.2 Proportion of total bilateral, sector-allocable ODA
of OECD/DAC donors to basic social services (basic
Includes: tariff and quota free access for the least develeducation, primary health care, nutrition, safe water
oped countries’ exports; enhanced programme of debt
and sanitation)
relief for heavily indebted poor countries (HIPC) and
8.3 Proportion of bilateral official development assistance
cancellation of official bilateral debt; and more generousof OECD/DAC donors that is untied
ODA for countries committed to poverty reduction
8.4 ODA received in landlocked developing countries as aproportion of their gross national incomes
Target 8.C: Address the special needs of landlocked
8.5 ODA received in small island developing States as adeveloping countries and Small Island Developing States
proportion of their gross national incomes(through the Programme of Action for the Sustainable
Market access
Development of Small Island Developing States and the
8.6 Proportion of total developed country imports (byoutcome of the twenty-second special session of thevalue and excluding arms) from developing countries
General Assembly)
and least developed countries, admitted free of duty
Target 8.D: Deal comprehensively with the debt problems 8.7 Average tariffs imposed by developed countries on
agricultural products and textiles and clothing fromof developing countries through national and international
developing countries
measures in order to make debt sustainable in the long
8.8 Agricultural support estimate for OECD countries asterm
a percentage of their gross domestic product8.9 Proportion of ODA provided to help build tradecapacity
Debt sustainability
8.10 Total number of countries that have reached their
HIPC decision points and number that have reachedtheir HIPC completion points (cumulative)
8.11 Debt relief committed under the HIPC and Multilateral Debt Relief Initiatives
8.12 Debt service as a percentage of exports ofgoozone-depleting substances and services
Target 8.E: In cooperation with pharmaceutical companies,
8.13 Proportion of population with access to affordable
provide access to affordable essential drugs in developing
essential drugs on a sustainable basis
countries
8.14 Fixed-telephone subscriptions per 100 inhabitants
Target 8.F: In cooperation with the private sector, make8.15 Mobile-cellular subscriptions per 100 inhabitants
available the benefits of new technologies, especially
8.16 Internet users per 100 inhabitants
information and communications
Target 8.A: Develop further an open, rule-based, predictable, non-discriminatory trading and financial system

86

Assessing Progress in Africa toward the Millennium Development Goals, 2015

References
ActionAid. 2005. Real aid: An agenda for making
aid work. ActionAid.org.
––––. 2014. Aid to, with and through the private sector: emerging trends and ways forward. ActionAid.
org.
AfDB (African Development Bank) 2014. African
Economic Outlook, 2014. Abidjan, Côte d’Ivoire.
Africa Progress Panel (APP). 2014. Grain Fish
Money: Financing Africa’s Green and Blue Revolutions, Africa Progress Panel Report 2014.
Africa Renewal. 2013. Africa’s mobile youth drivechange. New York, United Nations. Retrieved fromhttp://www.un.org/africarenewal/magazine/
may-2013/africa%E2%80%99s-mobile-youthdrive-change.
Bountagkidis, G.K., Fragkos, K.C., and Fragkos, C.C.
2015. EU development aid towards sub-SaharanAfrica: exploring the normative principle. Social
Sciences Vol. 4, 85-116.
Crampin, A.C., Mwaungulu, F.D., Ambrose, L.R.,
Longwe, H., and French, N. 2011. Normal Rangeof CD4 Cell Counts and Temporal Changes in Two
HIV-Negative Malawian Populations. Open AIDS J.
Vol. 5, 74-79.

––––. 2007. ‘How the MDGs are unfair to Africa’,
Brookings Global Economy and Development,
Working Paper 14. November. Washington, DC.
ECA (Economic Commission for Africa). 2005. The
Millennium Development Goals in Africa: Progress
and Challenge. Addis Ababa, Ethiopia.
––––. 2015. Economic Report on Africa. Industrialization through trade. Addis Ababa, Ethiopia.
ECA (Economic Commission for Africa) and OECD
(Organisation for Economic Co-operation andDevelopment). 2014. THE MUTUAL REVIEW of
Development Effectiveness in Africa: Promise &Performance. 2014. Addis Ababa, Ethiopia.
ECA (Economic Commission for Africa), AUC(African Union Commission), AfDB (African Development Bank) and UNDP (United Nations Development Programme). 2011. Assessing Progress inAfrica toward the Millennium Development Goals.
2011. Addis Ababa, Ethiopia.
––––. 2012. Assessing Progress in Africa toward
the Millennium Development Goals, 2012. Emerging Perspectives from Africa on the post-2015
Development Agenda. Addis Ababa, Ethiopia.

CNN. 2012. Seven ways mobile phones havechanged lives in Africa. CNN.com.

––––. 2013. Assessing Progress in Africa toward
the Millennium Development Goals, 2013. Food
Security in Africa: Issues, Challenges and Lessons.
Addis Ababa, Ethiopia.

Donovan, K. and Martin, A. 2014. The rise of African
SIM registration: the emerging dynamics of regulatory change. First Monday – Peer-reviewed journal
on the Internet Vol. 19, No. 2, 3 February 2014.

––––. 2014, Assessing Progress in Africa toward theMillennium Development Goals, 2014. Analysis of
the Common African Position on the post-2015
Development Agenda. Addis Ababa, Ethiopia.

Easterly, W. 2006, The white man’s burden: Why theWest’s efforts to aid the rest have done so much ill
and so little good. Penguin Press.

FAO (Food and Agriculture Organization of theUnited Nations). 2014. Food Security World Report,
2014. Rome, Italy.
Federal Republic of Ethiopia. 2012. Ethiopia’s
Progress towards Eradicating Poverty: An Interim
Lessons learned in implementing the MDGs

87

References

Report on Poverty Analysis Study (2010/11). Ministry of Finance and Economic Development,
Addis Ababa, Ethiopia.

Malaria Free Future. 2008. Rwanda: Winning theFight against Malaria. Baltimore, United States ofAmerica.

Government of Algeria. 2010. Algérie 2ème Rapport National sur les Objectifs du Millénaire pourle Développement

McCord, A. and Slater, R. 2009. Overview of Public Works Programmes in Sub-Saharan Africa.
Overseas Development Institute, London, United
Kingdom.

Government of Egypt. 2010. The National MDG
Report, Cairo, Egypt.
Government of Ethiopia. 2010. The National MDG
Report, Addis Ababa, Ethiopia.
Government of Mauritius and WHO (World HealthOrganization). 2012. Eliminating Malaria, Case
Study 4: Preventing Reintroduction in Mauritius.
Geneva, Switzerland.
Government of Togo. 2010. The National MDG
Report, Lomé, Togo.
ILO (International Labour Organization). 2010. Key
Indicators of the Labour Market – Sixth Edition,2010.
––––. 2014 Trends Econometric Models, October2014.
IMF (International Monetary Fund). 2015a. HIPC
Factsheet: Debt Relief under the Heavily Indebted
Poor Countries (HIPC) Initiative. Retrieved fromhttp://www.imf.org/external/np/exr/facts/hipc.
htm.
––––. 2015b. MDRI Factsheet: The Multilateral
Debt Relief Initiative. Retrieved from http://www.
imf.org/external/np/exr/facts/mdri.htm Accessed
10 March 2015.
Kpodar, K. 2007. Why Has Unemployment in
Algeria Been Higher than in MENA and Transition
Countries? Washington, DC: IMF.
Kuziemko, I. and Werker, E. 2006. How much is aseat on the Security Council worth? Foreign aid
and bribery at the United Nations .Journal of Political Economy. The University of Chicago University
Press.
88

McKinnon, B., Kaufman, J.S. and Bergevin, Y. 2014.
Socioeconomic inequality in neonatal mortality
in countries of low and middle income: A multicountry analysis. The Lancet Global Health, Vol. 2,
Issue 3, e165 - e173, March 2014.
Ministry of Finance and National Planning of Zambia and UNDP. 2011. Millennium Development
Goals Progress Report 2011. Ministry of Financeand National Planning, Lusaka, Zambia.
Mumba, E.C. 2002. Education for All: Increasing
Access to Education for Girls in Zambia. Paper presented at the 2nd Pan-Commonwealth Forum on
Open Learning, Durban, South Africa. 29 July – 2
August 2002.
NISR (National Institute of Statistics of Rwanda).
2011. The Third Integrated Household Living Conditions Survey (EICV3): Main Indicators Report.
Kigali: NISR.
NISR (National Institute of Statistics of Rwanda)
and UNDP (United Nations Development Programme). 2007. Millennium Development Goals –Towards Sustainable Social and Economic Growth:
Country Report 2007. Kigali: NISR.
OECD (Organisation for Economic Co-operation
and Development). 2005a. High Level Forum2005 Paris Declaration on Aid Effectiveness. Paris,
France.
––––. 2014. “Aid to developing countries rebounds
in 2013 to reach an all-time high” (Press release,
Paris, 8 April 2014).
––––. 2015a. States of Fragility 2015: Meeting Post2015 Ambitions, OECD Publishing, Paris, France.

Assessing Progress in Africa toward the Millennium Development Goals, 2015

References––––. 2015b. 2015 Dataset: Aid (ODA). Paris, France.
Olukoshi, A.O. 2006. The quest for a new paradigm
for Swedish development co-operation in Africa– issues, problems, and prospect. In Swedish and
EU Africa Policy (ed. L. Wohlgemuth). Center for
African Studies, Gothenburg University, Sweden.
Pearson, L., Degefie, T., Hiluf, M., Betamariam, W.,
Wall, S., Taylor, M., Admasu, K. 2014. From integrated community case management to community-based newborn care. Ethiop Med J, 2014, Vol.
52, Sup. 3.
Riddel, R.C. 2007. The political and commercial
dimensions of aid. In Does foreign aid really work?
Oxford University Press, Oxford, United Kingdom.
RIPPLE Africa. Retrieved from http://www.rippleafrica.org/environment-projects-in-malawi-africa/
tree-planting-africa).
Sabates, R., Akyeampong, K., Westbrook, K. andHunt, F. 2010. School Dropout: Patterns, Causes,
Changes and Policies. Paper commissioned for the
EFA Global Monitoring Report 2011, The Hidden
Crisis: Armed Conflict and Education. UNESCO.
The Global Fund. 2015. Maximizing the Impact
of Global Fund Investments by Improving the
Health of Women and Children: Second report to
the independent Expert Review Group (iERG) on
Information and Accountability for Women’s andChildren’s Health. June 2015.
The Lancet. 2003. Child survival II. How many childdeaths can we prevent this year? By Gareth Jones.
2014. Every newborn, every mother, every adolescent girl, Vol. 383, Issue 9919, p. 755, 1 March 2014.
The Reality of Aid International Coordinating
Committee, 2011. Achieving progress for development effectiveness in Busan: an overview of CSO
evidence IBON books. Quezon City, Philippines.
UNAIDS (Joint United Nations Programme on HIV/
AIDS). 2013a. Access to Antiretroviral Therapy in
Africa: Status Report on Progress towards the 2015
Targets. Geneva, Switzerland.

––––. 2014. The Gap report. UNAIDS. Geneva,
Switzerland.
UNDP (United Nations Development Programme).
2015a. Drivers of Inequalities in sub-Saharan Africa(in press). New York, United States of America.
UNDP. 2015b. RBA Policy Notes. New York, UnitedStates of America.
UNESCO (United Nations Educational, Scientificand Cultural Organization). 2006. EFA Global Monitoring Report 2006: Literacy for Life. Paris, France.
––––. 2010. EFA Global Monitoring Report 2010:
Reaching the Marginalized. Paris, France.
UNFPA (United Nations Population Fund). 2012.
Ten Good Practices in Essential Supplies for Family
Planning and Maternal Health. UNFPA Niger: Niamey, Niger.
UN-Habitat (United Nations Human Settlements
Programme). 2013. State of the world’s cities
2012/2013, Nairobi, Kenya.
UNICEF (United Nations Children’s Fund). 2013a.
Immunization facts and figures. www.unicef.org/
immunization/files/UNICEF_Key_facts_and_figures_on_Immunization_April_2013(1).pdf.
–––– .2013b. Levels and Trends in Child Mortality;
New York, United States of America.
UNICEF and WHO (World Health Organization).
2012. Progress on Drinking Water and Sanitation:2012 Update, New York, United States of America.
United Nations. 2010. Ban Ki-Moon: The Global
Strategy for Women’s and Children’s Health. New
York, United States of America.
––––. 2014. The Millennium Development
Goal report 2014. New York, USA. www.un.org/
en/development/desa/publications/mdg-report-2014.

Lessons learned in implementing the MDGs

89

References––––. 2015. Millennium Development Goals
Indicators database. New York, USA. http://mdgs.
un.org/unsd/mdg/Data.aspx.
UN-OHRLLS (United Nations Office of the High
Representative for the Least Developed Countries, Landlocked Developing Countries and Small
Island Developing States). 2012. Report of the
11th Annual Ministerial Meeting of Landlocked
Developing Countries, New York, United States ofAmerica.
UNSD (United Nations Statistics Division). 2014.
Principles and Recommendations for a Vital Statistics System. Revision 3. Department of Economic
and Social Affairs. Statistics Division Statistical
Papers, Series M, No. 19/Rev.3. New York, UnitedStates of America.
WHO (World Health Organization). 2012a. Application of ICD-10 to deaths during pregnancy,
childbirth and the puerperium: ICD maternalmortality (ICD-MM). Geneva, Switzerland.
––––. 2012b. Verbal autopsy standards: The 2012
WHO verbal autopsy instrument. Release Candidate 1.WHO, HMN and INDEPTH Network. Geneva,
Switzerland.
––––. 2013. Women’s and children’s health: evidence of impact of human rights. Geneva, Switzerland.

World Bank. 2007, Confronting the Challenges ofGender Equality in Fragile States – Global Monitoring Report, 2007. Washington, D.C., United Statesof America.
––––. 2010. World Bank Policy Note: Enhancing
Supply Chain Management in Zambia. Africa
Health Unit. Washington, D.C., United States ofAmerica.
––––. 2012. De-Fragmenting Africa. Deepening
Regional Trade Integration in Goods and Services.
Washington, D.C., United States of America.
––––. 2013. World Bank Statistics, April 2013.Washington, D.C., United States of America.
WTO (World Trade Organization). 2013. NinthWTO Ministerial Conference. Geneva, Switzerland.
http://mc9.wto.org/.
Yogo U.T. and Mallaye D. 2015. How Aid Helps
Achieving MDGs in Africa: the Case of Primary
Education, Centre d’études et de recherches endéveloppement international (CERDI), Clermont
Ferrand, France.
Zambia NMCC (National Malaria Control Center).
2008. Zambia Malaria Indicator Survey 2008. Ministry of Health, Lusaka, Zambia.
––––. 2010. Zambia Malaria Indicator Survey 2010.
Ministry of Health, Lusaka, Zambia.

––––. 2014a. Trends in maternal mortality: 1990
to 2013. Estimates by WHO, UNICEF, UNFPA, WorldBank and United Nations Population Division.
WHO Press, World Health Organization, Geneva,
Switzerland.
––––. 2014b. World Malaria Report 2014. Geneva,
Switzerland.
WHO, UNICEF, UNAIDS, World Bank, UNESCO andUNFPA. 2000. Health a key to prosperity: successstories from developing countries. Retrieved
from http://documents.worldbank.org/curated/
en/2013/01/17985497/health-key-prosperity-success-stories-developing-countries.
90

Assessing Progress in Africa toward the Millennium Development Goals, 2015

One important lesson from the MDG experience is that initial conditions invariably influence
the pace of progress on global development agendas. Given their relatively low scores on most
MDG indicators in 1990, it is not surprising that Africa will not achieve all the MDGs by 2015.
Nevertheless, several countries introduced successful institutional and policy reforms to improvegovernance, promote economic growth and enhance access to social services. As a result, the paceof progress on all indicators has accelerated since 2005.
In particular, African countries have made significant strides in enhancing women’s representationin national parliaments, reducing maternal, infant, and HIV-related deaths, and placing morechildren in primary schools. These achievements are a testament to the effort and commitment of
the African people and their governments to meet the Goals.
However, several challenges remain: a high degree of inequity still characterizes access to social
services including health and education; much remains to be done to achieve full and productive
employment for all, particularly for women and youth; the threat of conflict and climate change
looms large and could derail the progress made so far; and shocks such as the Ebola crisis have
exposed the weakness of the health systems in some countries.
Sustaining the momentum and advancing the gains made under the MDGs will therefore require
new approaches which embrace all three dimensions of sustainability – environmental, economic
and social. In this context, African countries will need to adopt more inclusive growth strategies
that create decent jobs for broad sections of society, promote equity and meet the development
needs of present generations without compromising the ability of future generations to meet theirown needs.
Africa’s regional strategy for sustained and inclusive development complemented by the global
post 2015 development agenda provide an appropriate framework for sustainable development.
Nevertheless, an important lesson of the MDGs is that success will hinge on a credible means of
implementation. This report highlights successful policy interventions in Africa that should guidethe implementation of the post 2015 development agenda going forward.

15-01163

ISBN: 978-99944-61-73-8

Printed in Addis Ababa, Ethiopia by the ECA Printing and Publishing Unit.
ISO 14001:2004 certified.

9 789994 461738