metadata: authors: 0: author: Gallego Cuervo,Pablo
1: author: Fall,Khayar
2: author: Magnoli Bocchi,Alessandro
3: author: Pontara,Nicola
4: author: Tejada, Catalina M.
count: Africa
docna: 0: docna: Reaching the millennium development goals :
            Mauritania should care
docty: Policy Research Working Paper
theme: Economic statistics, modeling and forecasting,Public expenditure, financial management and procurement
majtheme: Economic management,Public sector governance
subtopic: Reproductive Health,Early Child and Children's Health,HIV AIDS,Hydrology,Cholera,Malaria,Communicable Diseases,Leprosy,Inequality
teratopic: Health, Nutrition and Population,Poverty Reduction
abstracts: cdata!: Mauritania is a resource-rich developing
            country. As many other African nations, it will not reach
            most of the Millennium Development Goals, unless the
            authorities commit to accelerating progress. To succeed by
            2015, the government needs to: mobilize additional financial
            resources, introduce policy changes at the sector level, and
            strengthen the links between strategic objectives and the
            budget. Adopting the Millennium Development Goals as the
            overarching development framework will keep policy-makers
            focused on concrete results and help them avoid the
            so-called "natural resource curse." This paper
            calculates the total cost of the Millennium Development
            Goals and financing gap (on aggregate and for each goal);
            recommends changes in domestic sector policies; and proposes
            ways to integrate the Millennium Development Goals into the
            budget process. Over 2008-2015, the total cost of reaching
            the goals in Mauritania and the resulting financing gap
            stand at, respectively, around 9 and 3 percent of non-oil
            gross domestic product on average per year. Education is the
            most expensive goal in absolute terms, but the individual
            financing gaps are widest for poverty reduction and
            improving maternal health. On the policy side, sector
            strategies need to be aligned with the goals and resources
            allocated more than proportionally to the disadvantaged
            groups, mainly at the local level.
repnme: repnme: Reaching the millennium development goals :
            Mauritania should care
display_title: Reaching the millennium development
            goals : Mauritania should care
listing_relative_url: /research/2008/07/9698318/reaching-millennium-development-goals-mauritania-care
topicv3: Water m1326522 137,Infant and Child Mortality m1326544 1446,Poverty m1326687 695,Malaria m1327042 1420,HIV/AIDS m1327522 1416
publishtoextweb_dt: 2010-07-01T00:00:00Z
historic_topic: Health, Nutrition and Population,Poverty Reduction
no_of_pages: 48
author_keys: 0: author_key: 863294
1: author_key: 904085
2: author_key: 569527
3: author_key: 563938
model_extractions: WPS4674 Policy ReseaRch WoRking PaPeR 4674 Reaching the Millennium Development Goals:

# Mauritania Should Care

_Alessandro Magnoli Bocchi Nicola Pontara Khayar Fall Catalina M. Tejada Pablo Gallego Cuervo_ The World Bank Africa Region Poverty Reduction and Economic Management July 2008
Policy ReseaRch WoRking PaPeR 4674

# **Abstract**

Mauritania is a resource-rich developing country. As many other African nations, it will not reach most of the Millennium Development Goals, unless the authorities commit to accelerating progress. To succeed by 2015, the government needs to: mobilize additional financial resources, introduce policy changes at the sector level, and strengthen the links between strategic objectives and the budget. Adopting the Millennium Development Goals as the overarching development framework will keep policy-makers focused on concrete results and help them avoid the so-called “natural resource curse.” This paper calculates the total cost of the Millennium Development Goals and financing gap (on aggregate and for each goal); recommends changes in domestic sector policies; and proposes ways to integrate the Millennium Development Goals into the budget process. Over 2008-2015, the total cost of reaching the goals in Mauritania and the resulting financing gap stand at, respectively, around 9 and 3 percent of non-oil gross domestic product on average per year. Education is the most expensive goal in absolute terms, but the individual financing gaps are widest for poverty reduction and improving maternal health. On the policy side, sector strategies need to be aligned with the goals and resources allocated more than proportionally to the disadvantaged groups, mainly at the local level.

This paper—a product of Africa Region, Poverty Reduction and Economic Management —is part of a larger effort in the department to help Governments reach the Millennium Development Goals. Policy Research Working Papers are also posted on the Web at http://econ.worldbank.org. The authors may be contacted at amagnoli@worldbank.org and npontara@worldbank.org.

_The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about development issues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent._ Produced by the Research Support Team
# **Reaching the Millennium Development Goals: Mauritania Should Care**<sup>**1**</sup>

Alessandro Magnoli Bocchi _World Bank, Washington DC, USA_ Nicola Pontara _World Bank, Washington DC, USA_ Khayar Fall _Ministry of Economy and Finance, Nouakchott, Mauritania_ Catalina M. Tejada _World Bank, Washington DC, USA_ Pablo Gallego Cuervo _London School of Economics, London, UK_

**JEL Classification:** C-20, C-53, H-50, H-68, O-21

**Key words:** Mauritania, Millennium Development Goals, Costing, Public Expenditures, Public Policies.

> 1 We are grateful to the Mauritanian authorities for their support, notably Hassen Ould Zein (Economic Advisor to the Prime Minister) and Mohyedine Ould Sidi Baba (Advisor to the Minister of Economy and Finance). We thank Guisset Djalel (data collection), Pierre Lenaud, Elianne Tchapda and Cristina Otano (logistical support). We also thank for insight and comments Hans Logren and Boris Samuel (modeling), Hawa Wague Cissé, Bakari Coulibaly (public expenditure management), and Vincent Turbat (health). The findings, interpretations, and conclusions are our own and should not be attributed to the World Bank, its Executive Board of Directors, or any of its member countries. The usual disclaimers apply.
ii

# **Table of Contents**

|**INTRODUCTION................................................................................................................................. 1**|
|---|
|**1.**<br>**MDGS IN MAURITANIA: PROGRESS TO DATE................................................................ 3**|
|**2.**<br>**DATA AND METHODOLOGY................................................................................................. 4**|
|**3.**<br>**HOW MUCH WILL THE MDGS COST?................................................................................ 7**|
|3.1 <br>TOTALCOST ANDFINANCINGGAP....................................................................................... 7|
|3.2<br>INDIVIDUALGOAL’SCOSTS ANDFINANCINGGAPS.............................................................. 9|
|_MDG 1: Eradicate Extreme Hunger and Poverty.......................................................................... 9_|
|_MDG 2: Achieve Universal Primary Education .......................................................................... 11_|
|_MDG 3: Promote Gender Equality and Empower Women.......................................................... 12_|
|_MDG 4: Reduce Child Mortality ................................................................................................. 13_|
|_MDG 5: Improve Maternal Health .............................................................................................. 15_|
|_MDG 6: Combat HIV/Aids, Malaria & other Diseases............................................................... 16_|
|_MDG 7: Ensure Environmental Sustainability ............................................................................ 17_|
|**4.**<br>**ACCELERATING PROGRESS: POLICY CHANGES AND INSTRUMENTS ................ 19**|
|4.1<br>POLICYCHANGES NEEDED AT THESECTORALLEVEL......................................................... 19|
|_MDG 1: Eradicate Extreme Hunger and Poverty........................................................................ 19_|
|_MDG 2: Achieve Universal Primary Education .......................................................................... 20_|
|_MDG 3: Promote Gender Equality and Empower Women.......................................................... 21_|
|_MDG 4: Reduce Child Mortality ................................................................................................. 22_|
|_MDG 5: Improve Maternal Health .............................................................................................. 22_|
|_MDG 6: Combat HIV/AIDS, Malaria & other Diseases.............................................................. 23_|
|_MDG 7: Ensure Environmental Sustainability ............................................................................ 24_|
|4.2<br>INTEGRATING THEMDGS INTO THE BUDGET PROCESS........................................................ 25|
|**5. CONCLUSIONS.............................................................................................................................. 30**|
|**REFERENCES .................................................................................................................................... 32**|
|A. BIBLIOGRAPHY............................................................................................................................. 32|
|B. WEBRESOURCES.......................................................................................................................... 35|
iii

# **Figures**

|FIGURE1. ACHIEVING THEMGDS INMAURITANIA: FINANCINGGAP...................................................... 7|
|---|
|FIGURE2. MDG 1: CURRENTSITUATION ANDTRENDS.......................................................................... 10|
|FIGURE3. MDG 1: FINANCINGGAP....................................................................................................... 11|
|FIGURE4. MDG 2: CURRENTSITUATION ANDTRENDS.......................................................................... 11|
|FIGURE5. MDG 2: FINANCING GAP....................................................................................................... 12|
|FIGURE6. MDG 3: CURRENTSITUATION ANDTRENDS.......................................................................... 13|
|FIGURE7. MDG 3: FINANCINGGAP....................................................................................................... 13|
|FIGURE8. MDG 4: CURRENTSITUATION ANDTRENDS.......................................................................... 14|
|FIGURE9. MDG 4: FINANCINGGAP....................................................................................................... 14|
|FIGURE10. MDG 5: CURRENTSITUATION ANDTRENDS........................................................................ 15|
|FIGURE11. MDG 5: FINANCINGGAP..................................................................................................... 16|
|FIGURE12. MDG 6: CURRENTSITUATION ANDTRENDS........................................................................ 16|
|FIGURE13. MDG 6: FINANCINGGAP..................................................................................................... 17|
|FIGURE14. MDG 7: CURRENTSITUATION ANDTRENDS........................................................................ 17|
|FIGURE15. MDG 7: FINANCINGGAP..................................................................................................... 18|
|FIGURE16. STRATEGY ANDBUDGETELABORATIONFRAMEWORK........................................................ 26|

# **Tables**

|TABLE1. MDGS INMAURITANIA: PERFORMANCE, TARGETS,ANDLIKELIHOOD..................................... 3|
|---|
|TABLE2. ACHIEVING THEMDGS INMAURITANIA: TOTALCOST, BUDGET ANDFINANCINGGAP........... 8|
|TABLE3. INCIDENCE OFPOVERTY BYREGION ANDRELATIVECONTRIBUTIONS(2000-2004)............... 10|
|TABLE4. MDG 1: COST, BUDGET ANDFINANCINGGAP(2008-2015)................................................... 11|
|TABLE5. MDG 2: COST, BUDGET ANDFINANCINGGAP(2008-2015)................................................... 12|
|TABLE6. MDG 3: COST, BUDGET ANDFINANCINGGAP(2008-2015)................................................... 13|
|TABLE7. MDG 4: COST, BUDGET ANDFINANCINGGAP(2008-2015)................................................... 14|
|TABLE8. MDG 5: COST, BUDGET ANDFINANCINGGAP(2008-2015)................................................... 16|
|TABLE9. MDG 6: COST, BUDGET ANDFINANCINGGAP(2008-2015)................................................... 17|
|TABLE10. MDG 7: COST, BUDGET ANDFINANCINGGAP(2008-2015)................................................. 18|
|TABLE11. MDGS: POLICYCHANGES ANDLINKS WITH THEBUDGET.................................................... 27|

# **Boxes**

|BOX1. DATA ANDMETHODOLOGY: LIMITATIONS................................................................................... 4|
|---|
|BOX2. FOR EACHMDG,TWOFIGURES................................................................................................... 9|
|BOX3. THESTATEBUDGET FUNCTIONAL CLASSIFICATION:AN OPPORTUNITY NOT TO BE MISSED........ 26|

# **Annexes**

ANNEX 1. DETAILED COST AND FINANCING GAPS FOR ACHIEVING THE MDGS .................................... 36
1

# **Introduction**

**Mauritania is rich in natural resources, but its human development is low.** Natural resources constitute the backbone of the Mauritanian economy. For decades, iron ore and fisheries have contributed to the public coffers. In 2006, the country joined the rank of oil-exporters. However, both exports and growth have been unable to bring about significant human development over the years. The 2007 Human Development Index (HDI) ranked Mauritania 137<sup>th</sup> out of a total of 177 countries (UNDP 2007).

**To improve the living standards of the population and sustain broad-based growth, the authorities need to achieve the Millennium Development Goals (MDGs).** The government has laid out an ambitious strategy to propel the country into the middleincome group in the medium-term (GIRM 2007a).<sup>2</sup> To achieve this, Mauritania needs to differentiate growth beyond natural resources, and ensure that all segments of the population – 47 percent of which still lives in poverty (GIRM 2006) -- benefits from inclusive broad-based growth.

**However, with current policies and resources (both national and external), Mauritania is unlikely to reach most of the MDGs.** As of today, only gender equality in primary and secondary education (MDG3) can be reached, while the poverty reduction goal (MDG1) is at risk. The probability of reaching the other MDGs including the primary school retention rate and all the health-related goals is minimal. The country may reach the goal for HIV/AIDS, given its low prevalence, and – given recent progress – the goal for maternal mortality (GIRM 2007).

**The authorities should consider the MDGs as the centerpiece for the development strategy of Mauritania.** The MDGs provide a valuable set of result-oriented monitoring indicators. Adopting them as the government’s overall development framework will keep policy-makers focused on concrete results; help them avoid the so-called “natural resource curse”<sup>3</sup> ; and ultimately increase the likelihood that reforms will be kept on track. Indeed, establishing a credible roadmap to achieve the MDGs (i.e.: invest resources to reduce poverty and promote human development) can mitigate the risk of reduced commitment to reform due to the easing of resource constraints, notably if oil production picks up in the future.

**To accelerate progress towards the MDGs, more resources and better policies are needed.** Over 2008-2015, simulations show that the total cost of reaching the MDGs and the resulting financing gap are, respectively, 8.9 and 3.2 percent of non-oil GDP on average per year. Education is the most expensive goal in absolute terms, but the financing gaps are widest for poverty reduction and improving maternal health. On the policy side, sectoral strategies need to be better aligned with the MDGs, and resources allocated more than proportionally to the disadvantaged groups, notably at the local level.

> 2 In 2006, the country’s Gross Domestic Product (GDP) was US$2.7 billion, which conferred a per capita Gross National Income (GNI) of US$938 on its 2.9 million people.

> 3 Evidence suggests that resource-rich developing countries lag the resource-poor countries in terms of per capita income (Sachs and Warner 2001) and the quality of institutions and governance (Sala-iMartin and Subramanian 2003).
2 This can be achieved only if the links between MDGs and public resources are strengthened, through improved sector strategies.

**This paper is structured as follows.** <u>Section 1</u> takes stock of progress made to date in reaching the MDGs and discusses the likelihood of achieving each goal. <u>Section 2</u> discusses the methodology and the data sources. <u>Section 3</u> presents for each MDG the current situation and trend, and illustrates both the cost and the financing gaps of reaching each goal. Section 4 proposes key policy changes and suggests how the ”costing of the MDGs” exercise can be linked to the existing budget elaboration process to link the available resources to the government’s objectives. <u>Section 5</u> summarizes the main results and presents the key recommendations that emerge from the analysis.
3

# **1. MDGs in Mauritania: Progress to Date**

**The government has set ambitious targets to improve the country’s human development** . The objectives of the PRSP-2 are closely aligned with the MDGs, and in some cases exceed them (Table 1). For instance, the PRSP-2 target for poverty incidence (at 25 percent) is more ambitious than its corresponding MDG (at 28 percent). The same is true for the retention rate. By contrast, recognizing slow progress in reducing maternal and child mortality and expanding access to safe-drinking water, the PRSP-2 targets in these areas are less ambitious than the corresponding MDG targets.

**Table 1. MDGs in Mauritania: Performance, Targets, and Likelihood**

||**Pa**|**st**|**Targ**|**ets**|**Likelihood**<br>|
|---|---|---|---|---|---|
|**MDG**|**Pf**||||_(with current_|
||**eror**|**mance**|**PRP-2**|**MD**|<br>|
|Betw_een 1990 and 2015_|||||_resources and_|
||**1990**|**2004**|**2015**|**2015**|_policies)_|
|**_Goal 1. Eradicate extreme poverty and hunger _**||||||
|**Target 1.**Halve the % ofpeople with income of <$1-a-day<br>||||||
|_Indicator 1._Poverty incidence (% below national poverty<br>line)|56.6|46.7|25.0|28.0|**Low**|
|**_Goal 2. Provide primary education for all_**||||||
|**Target 3.**Ensure that all children completeprimaryschool||||||
|_Indicator 7._% ofpupils starting grade 1 who reachgrade 5|73.8|40.2|100.0|78.0|**Low**|
|**_Goal 3. Promote gender equality and empower women _**||||||
|**Target 4.**Eliminategender disparityin education||||||
|_Indicator 9._Ratiogirls / boys inprimaryand secondary||||||
|_Indicator 9a._Ratio ofgirls to boys inprimaryeducation|72.0|99.0|100.0|98.0|**High **|
|_Indicator 9b._Ratio ofgirls to boys in secondaryeducation|n/a|85.0|100.0|98.0|**High **|
|**_Goal 4. Reduce child mortality_**||||||
|**Target 5.**Reduce by2/3 the under-five mortalityrate||||||
|_Indicator 13._Under-five mortalityrate(per 1,000)|137.0|135.0|55.0|45.7|**Low**|
|_Indicator 14._ Infant mortalityrate(per 1,000)|126.0|87.0|40.0|42.0|**Low**|
|**_Goal 5. Improve maternal health_**||||||
|**Target 6.**Reduce by3/4 the maternal mortalityratio||||||
|_Indicator 16._Maternal mortality (per 100,000 live births)|930.0|747a/<sup>1</sup>|300.0|232.0|**Low/medium**|
|**_Goal 6. Combat HIV/AIDS, malaria and other diseases_**||||||
|**Target 7.**Halt and begin to reverse HIV/AIDS||||||
|_Indicator 18._HIVprevalence(%)|0.52|1.77|<1|0.68|**Medium**|
|**Target 8.**Halt and begin to reverse malaria + other diseases||||||
|_Indicator 21._ Prevalence of malaria(%)|12.7|8.85|n/a|4.78|**Low**|
|_Indicator 23._Prevalence of tuberculosis(%)|0.13|0.40|n/a|0.24|**Low**|
|**_Goal 7. Ensure environmental sustainability_**||||||
|**Target 10.**Halve the % ofpeople without water / sanitation||||||
|_Indicator 30._%population with sustainable access to water|37.0|40.0|75.0|68.0|**Low**|

_Source:_ GIRM 2006, 2007, http://www.unmillenniumproject.org/reports/index.htm. a Corresponds to 2001. 1/ Latest estimate: 684 (GIRM 2007b), not available when this analysis was carried out.

**However, with current resources and policies, Mauritania is highly unlikely to reach most of the MDGs.** Only MDG3 (gender equality) is at hand; with MDG1 (poverty reduction) also a possible – if unlikely – candidate, as it depends on the successful interaction of sustained growth and effective delivery of pro-poor programs. In primary education, reaching 100 percent retention rate, in the light of the negative performance in recent years (Figure 4), also seems unlikely. In addition, Mauritania is off-track with respect to the health-related MDGs, barring the HIV/AIDS indicator and possibly maternal mortality if recent progress is sustained.
4

# **2. Data and Methodology**

**The data and methodology were agreed with the Mauritanian authorities and main development partners.** Extensive consultations were carried out to: (i) ensure a common understanding of the data sources and methodology; (ii) clarify the limitations of the exercise to all parties (Box 1); and (iii) make sure that the exercise could be owned by the Mauritanian authorities, independently of future technical assistance. In this respect, the emphasis was put on developing a simple methodology, adapted to the context of Mauritania. Each update of the database and modification of the methodology was carried out in full consultation and partnership with the Mauritanian authorities.

## **Box 1. Data and Methodology: Limitations**

**Data are scarce.** The calculation of the cost and financing gap for certain MDG targets was not carried out due to data scarcity. As a result, within MDG1-7, this exercise focuses on the 8 targets and eleven indicators listed in Table 1 (for the full list of goals, indicators and targets, see http://www.un.org/millenniumgoals/). Moreover, the absence of data on sectoral interactions (e.g.: synergies in social services delivery), led to the use of a partial - instead of general - equilibrium model.

**A partial-equilibrium accounting model.** As the methodology needs to be easy-to-grasp and use, the accounting model utilized in this study abstracts from general-equilibrium considerations, for three reasons.

_First_ , exogenous factors as diverse as macroeconomic shocks or a fast expansion of private provision of social services are difficult to forecast. To overcome this challenge, the model utilizes the latest IMF macro-framework, which endogenizes – hence not allowing for exogenous _ad hoc_ calibrations – all key macro issues (i.e. foreign aid inflows, the possible resulting exchange rate appreciation, the dynamics of labor demand and supply, the public crowding out of private investment, and their effect on economic growth).

_Second,_ this study narrowly focuses on the achievement of the MDGs, a sub-set of the country’s development strategy. Hence, it only calculates the cost of the few key inputs that – in Mauritania – are directly linked with the achievement of each MDG (i.e., to reduce child mortality, key factors are the access to a health post, specialized personnel and drugs). Other crucial inputs for the overall improvement of education, health and water and sanitation (such as public infrastructure) have not been factored into the calculations. As a result, underestimation of the effective cost is possible.

_Third,_ the absence of data on synergies between sectors does not allow for the elaboration of a generalequilibrium approach. Undeniably, the steady achievement of some goals will help the attainment of others: for example, a higher income, better education, and improved access to clean drinking water should improve women’s health outcomes, and – as a consequence – reduce child mortality and malnutrition. Alas, country-specific (or even general) information on these interactions is not available. As these sectoral synergies are not captured, overestimation of the effective cost, via double-counting, is possible, especially in the very last years.

**Main parameters and key assumptions of the model.** For each of the seven goals<sup>4</sup> , intermediate yearly targets (indicated with MDG1-7) were developed for the period 2008-

4 The eighth goal, Develop a Global Partnership for Development (MDG8), is not considered, as it refers to donor nations.
5 2015. These targets have been estimated by establishing a linear projection between the 1990 value and the 2015 objective. The Mauritanian expected outcomes – as declared in the government’s plan – are indicated with M1-7. The resulting projected gap in coverage is calculated over time as the MDG target minus the Mauritanian expected outcome (i.e. MDG1-7 minus M1-7), and is represented with X1-7. Respectively, CI1-7, CR1-7 and C1-7 indicate the investment, recurrent and total average unit cost. B1-7 designates the official budget projections allocated to each MDG, by both government and donors. Finally, F1-7 represents the projected financing gap per MDG, i.e. the required change in budget projections – to be obtained via either cross-sector reallocations or new negotiation of extra resources with donors and lenders.

**A partial-equilibrium accounting model calculates the cost and financing gap.** For each goal, the data were collected and projected along three building blocks: (i) the unit cost, or C1-7; (ii) the gap in coverage, or X1-7; and (iii) the official budget projected allocations, or B1-7. The unit costs are Mauritania-specific<sup>5</sup> and not constant, as they factor in both the expected macroeconomic performance (i.e. growth, inflation, and exchange rate do influence the unit cost) and the social services delivery’s decreasing returns to scale. The Mauritanian expected outcomes are quantified explicitly in the government’s plan only for 2010 and 2015; for the remaining years, the values were extrapolated with a linear projection. The official budget allocation includes past, current, and projected amounts.

**Five key equations.** Equation (1) represents the main hypothesis. For every year, each target (represented with MDGi) is multiplied by its average unit cost. Subsequently, the financing gap is obtained by subtracting the official budget projection.

Equation (2) is the main identity and the accounting model’s working assumption. Each year, the projected gap in coverage (MDG1-7 minus M1-7), multiplied by the average unit cost, is equal to the required change in budget allocation, which represents the financing gap.

Equation (3) provides, for advocacy purposes, the net present value (NPV) of the summation of the financing gaps. By so doing, the cost of reaching the MDGs can be compared with the NPV of key revenues (debt forgiveness, oil, etc.) and expenditures.

5 When local costs were not available, standardized international costs for the region were used.
6

**For MDG1, the poverty reduction value is calculated through a simplifying assumption.** Equation (4) assumes that poverty reduction is mostly driven by the growth of the economy, via the elasticity<sup>6</sup> of non-oil GDP on poverty.<sup>7</sup> The residual reduction is achieved through government spending, indicated with E _p_ . This shows the expenditure that each year needs to be allocated to poverty reduction programs to close the gap with the MDG1 target (or the expected cost of reaching each year’s poverty target), once the reduction of poverty associated with economic growth has been taken into account. Hence, for the period 2008-2015 equation (4) constructs an indicator, normalized between zero and one, by which the required change in poverty spending, or ΔEp, is equal to one minus the change in the elasticity of non-oil GDP on poverty.<sup>8</sup>

Once equation (4) determines ΔEp, equation (5) calculates E _p_ , by multiplying ΔEp by the budget allocated to poverty reduction programs in the previous year. Then, the financing gap for MDG1 is obtained with Equation (1), by subtracting from E _p_ the budget projection already officially allocated to poverty reduction programs.

> 6 In this paper we assume linearity between growth and poverty reduction – i.e.: growth reduces poverty uniformly across population’s quintiles. However, according to the evidence shown in recent literature, the elasticity of poverty reduction with respect to growth is not linear, especially in Africa – i.e.: the poorest the population, the lower the lifting effect of growth (Easterly, 2007).

> 7 Between 2008 and 2015, the elasticity of non-oil GDP with respect to poverty is calculated by using the available yearly projections for both non-oil GDP growth and poverty incidence until 2015.

> 8 The change in the required poverty spending is equal to the change in the absolute value of the elasticity of poverty on non-oil GDP; in this simulation however, it is calculated the other way, as it is easier to grasp intuitively.
7

# **3. How Much Will the MDGs Cost?**

## **3.1 Total Cost and Financing Gap**

**For the period 2008-2015, the model estimates the total cost of reaching the MDGs and the corresponding financing gap.** The information can be broken down per MGD and per year, and can be expressed as a percentage of GDP<sup>9</sup> , in US$ and in Mauritanian Ouguiya (MRO). Over 2008-2015, Table 2 presents yearly estimates of the total cost, budget projections and financing gap for each MDG. Reaching the MDGs would yield a _total cost of 8.95 percent of GPD on average per year_ (US$ 1.62 billion in total). According to the official budget projections, over the same period, the Government plans to assign to the MDGs 5.73 percent of GDP on average per year (US$1.03 billion in total). Hence, the _total projected financing gap amounts to 3.22 percent of GDP on average per year_ (US$ 579.9 million in total). Despite a rising cost in terms of absolute US$ (Figure 1 – blue line), the acceleration of the economic growth reduces the financing gap expressed in terms of non-oil GDP (Figure 1 – green line).

**Education is the most expensive goal in absolute terms, but the financing gaps are widest for poverty, maternal health, and child mortality.** Between 2008 and 2015, achieving a 100 percent retention rate in education (MDG2) has the highest cost, corresponding to 3.8 percent of GDP on average per year (US$ 679.7 million in total). Reducing poverty (MDG1) is the second most expensive, with a total cost of 1.5 percent of GDP on average per year (US$ 275.6 million in total). However, when the government’s budget projections are taken into account, MDG1 comes first in terms of financing requirements, with a financing gap of 0.9 percent of GDP on average per year (US$ 162.2 million in total). The second and third widest financing gaps are for improving maternal health and reducing child mortality (MDG5 and MDG4). For a detailed disaggregated analysis, including yearly data, see Annex 1.

**Figure 1. Achieving the MGDs in Mauritania: Financing Gap**

<!-- Start of picture text -->
-75 -3.10<br>2008 2009 2010 2011 2012 2013 2014 2015<br>-3.14<br>-3.15 Millions of US$<br>-90 -86.25 % of non-oil GDP (secondary axis) -3.15<br>-3.18 -3.19<br>-93.22<br>-3.20<br>-3.22 -3.20<br>-105<br>-104.66 -104.36<br>-115.49 -3.25<br>-120 -3.27<br>-122.41 -3.30<br>-135 -131.48<br>-3.35<br>-140.74<br>-3.37<br>-150 -3.40<br><!-- End of picture text -->

_Source:_ Authors’ calculations.

9 Figures expressed in percentage of GDP always refer to non-oil GDP, unless otherwise specified.
8

# **Table 2. Achieving the MDGs in Mauritania: Total Cost, Budget and Financing Gap**

## **(US$ and MRO, unless otherwise indicated)**

|||**CO**|**ST**|**BUD**|**GET**|**FINANCI**|**NG GAP**|
|---|---|---|---|---|---|---|---|
||||**Per**||**Per**||**Per**|
|**MDGs**||**Total (M)**|**Capita**|**Total (M)**|**Capita**|**Total (M)**|**Capita**|
|**Goal 1. Eradicate extreme poverty and hunger**|US$|275.57|16.04|113.33|6.60|**_-162.24_**|-9.44|
|_Target 1, Indicator 1_|MRO|75,736.05|4,435.21|31,161.84|1,825.61|-44,574.21|-2,609.59|
|**Goal 2. Provide primary education for all**|US$|**_679.71_**|40.45|613.29|36.37|-66.43|-4.08|
|_Target 3, Indicator 7_|MRO|187,221.60|11,206.73|168,863.47|10,073.23|-18,358.13|-1,133.50|
|**Goal 3. Promote gender equality and empower women**|US$|52.61|3.00|10.79|0.65|-41.83|-2.35|
|_Target 4, Indicator 9_|MRO|14,430.03|827.43|2,973.47|178.92|-11,456.55|-648.51|
|**Goal 4. Reduce child mortality**|US$|202.50|12.12|91.60|5.56|**_-110.90_**|-6.56|
|_Target 5, Indicators13 and 14_|MRO|55,816.45|3,360.86|25,280.47|1,543.00|-30,535.98|-1,817.85|
|**Goal 5. Improve maternal health**|US$|163.26|9.97|38.86|2.41|**_-124.40_**|-7.56|
|_Target 6, Indicator 16_|MRO|45,094.16|2,770.94|10,753.74|671.41|-34,340.42|-2,099.53|
|**Goal 6. Combat HIV/AIDS, malaria and other diseases**|US$|26.61|1.49|10.05|0.61|-16.56|-1.00|
|_Target 7,8, Indicators 18, 21, and 23_|MRO|7,285.70|410.36|2,772.32|167.89|-4,513.38|-271.72|
||US$|392.37|23.58|140.51|8.58|-250.16|-15.12|
|_Subtotal Health_|MRO|108,196.30|6,542.16|38,806.53|2,382.30|-68,903.34|-4,189.11|
|**Goal 7. Ensure environmental sustainability**|US$|220.83|11.04|161.52|7.93|-59.31|-2.81|
|_Target 10, Indicator 30_|MRO|59,919.94|3,008.51|43,783.77|2,159.59|-16,136.17|-771.58|
|**TOTAL ESTIMATIONS**|US$|**1,621.10**|**94.12**|**1,039.44**|**60.12**|**-579.96**|**-33.81**|
||MRO|**445,503.92**|**26,020.04**|**285,589.08**|**16,619.66**|**-159,428.40**|**-9,352.29**|
||% GDP|**8.95**|**n/a**|**5.73**|**n/a**|**3.22**|**n/a**|

_Source:_ Authors’ calculations.
9

# **3.2 Individual Goal Costs and Financing Gaps**

**This section focuses on the individual goals, presenting the current situation and trends and financing needs, while the proposed policy changes are discussed in Section 4** . For each goal, the discussion evolves around two figures: the _first_ refers to the MDG target, and highlights the current situation and past and future trends; the _second_ quantifies the financing gap to achieve the goal. Box 2 explains how to read the figures presented in this section.<sup>10</sup>

# **Box 2. For each MDG, two Figures**

**How to read the symbols?** Triangular data markers indicate past performance, while circular markers indicate future projections. Data markers filled with color indicate that data were available and are upto-date, while unfilled data markers indicate estimated values. The PRSP-2 targets for 2010 and 2015 are indicated with circular markers filled with color. Discontinuous lines indicate that, due to lack of data, the series were generated.

**Graph 1: Current situation and trends.** For each MDG, the first graph illustrates: (i) the hypothetical trend, indicated with the green line, which is estimated with a linear projection between the 1990 value and the 2015 stated objective. This is the path the indicator should yearly follow to steadily reach the objective by 2015; (ii) the Mauritanian outcome, indicated with the blue line, where the past performance is indicated with a dark blue solid line, and the expected performance – i.e., the Government’s plan for each indicator – is represented with a light blue dashed line; and (iii) where possible, the projected status quo, i.e. a forecast of the indicator’s expected performance assuming no incremental resources or policy changes, calculated with a regression, and indicated with the orange, dotted line.

**Graph 2: Financing gap.** For each MDG, the second graph illustrates the financing gap, indicated in terms of millions of US$, and in percentage of non-oil GDP. Depending on the case, the two lines converge, intersect or diverge. Indeed, if the financing gap is small in absolute terms, the US$ curve “moves faster” than the non-oil GDP one, and the lines tend to diverge. On the contrary, if the gap is big, they tend to converge.

# **MDG 1: Eradicate Extreme Hunger and Poverty**

# _Target 1: Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day._

**_A. Current Situation:_ high rural poverty and rapid urbanization.** In Mauritania, poverty affects around 47 percent of the population and is predominately a rural phenomenon, as 75 percent of poor people live in rural areas (Table 3)<sup>11</sup> . Nevertheless, the country has witnessed a dramatic urbanization in the past four decades, and urban poverty pockets are becoming sizeable. The post-colonial capital, Nouakchott, hosts over 50 percent of the urban population and around a quarter of the national population.

> 10 All data presented in this paper were collected by the authors in collaboration with the Mauritanian authorities and consolidated in the database described in Section 2. Specific references are indicated otherwise.

> 11 In 2004, the poverty line was fixed at MRO 94,600, which roughly corresponds to the World Bank's poverty line of US $1 per day (GIRM 2006).
10

**Table 3. Incidence of Poverty by Region and Relative Contributions (2000-2004)**

||**20**<br>P0|**00**<br>C0|**20**<br>P0|**04**<br>C0|
|---|---|---|---|---|
||Incidence|Rel.<br>Contribution|Incidence|Rel.<br>Contribution|
|National|51|100|47|100|
|Rural|66|80|59|75|
|_Senegal River Valley_|_77_|_35_|_66_|_17_|
|_Other Rural_|_60_|_45_|_57_|_58_|
|Urban|28|20|29|25|
|_Nouakchott_|_29_|_12_|_26_|_13_|
|_Other Urban_|_27_|_8_|_33_|_12_|

_Source:_ GIRM (2006)

**_B. Trends and Likelihood:_ a low probability of achieving MDG1** . During 2001-2006, non-oil growth did not make a significant dent on poverty.<sup>12</sup> Between 2000 and 2004, the overall poverty incidence declined from 51 to 46.7 percent, the net effect of a decline from 66 to 59 percent in rural areas, and an increase from 28 to 29 percent in urban areas. Over the same period, the Gini coefficient remained at 0.39, indicating that the moderate decrease in poverty was not accompanied by a comparable decline in inequality. If the rhythm of poverty reduction continues to follow the historical trend, the incidence of poverty will stay well above the very ambitious PRSP-2 target and the corresponding MDG (Figure 2).

**Figure 2. MDG 1: Current Situation and Trends**

<!-- Start of picture text --> 0.60<br>0.52 0.57 0.56 0.56 0.55 0.55 0.55 0.54 0.53 0.53 0.52 0.51 0.50 0.49<br>0.48 0.47<br>0.45<br>0.44 0.43<br>0.41<br>0.39<br>0.37<br>0.36 0.35 0.33<br>0.31<br>0.29<br>0.28 Past performance 0.27 0.25<br>Government plan<br>Projected status quo<br>MDG-1<br>0.20<br>1990 1995 2000 2005 2010 2015<br>Source: Authors’ calculations.<br><!-- End of picture text -->

**_C. Financial Needs:_ 0.9 percent of GDP on average per year.** The financing gap for poverty reduction is the widest of all considered in this paper, but reaching this goal would equally yield the biggest developmental impact. The cost of achieving this target for the period 2008-2015 amounts to 1.5 percent of GDP on average per year, corresponding to US$ 275.6 million in total. Once the allocation of government expenditure is taken into account, the country needs additional total financing of 0.9 percent of GDP on average per year (Figure 3), equivalent to a total of US$ 162.2 million (Table 4). For a detailed, yearly cost breakdown, see Annex 1.

12 During 2001-2006, non-oil growth averaged around 4 percent per annum, driven mainly by activity in the tertiary sector of the economy (telecommunication, transport). Non-oil growth is forecasted to increase to 4.6 over 2007-2012, in line with historical trends (IMF 2007).
11

**Figure 3. MDG 1: Financing Gap**

<!-- Start of picture text -->
-18<br>2008 2009 2010 2011 2012 2013 2014 2015<br>-22.12 -0.83 -0.8<br>-23 -0.80<br>-0.85 -0.86<br>-0.88<br>-28 -28.93 -27.21 -0.90 -0.9<br>-29.91<br>-33.26<br>-33<br>-0.98 -32.90<br>-1.0<br>-38 -36.21<br>Millions of US$ -39.88<br>-1.07 % of non-oil GDP (secondary axis)<br>-43 -1.1<br> Source:  Authors’ calculations.<br><!-- End of picture text -->

**Table 4. MDG 1: Cost, Budget and Financing Gap (2008-2015)**

<!-- Start of picture text --> US$ 275.57 m<br>Total Cost<br>MRO 75,736 m<br>Budget US$ 113.33 m<br>Allocation MRO 31,161.8 m<br>US$ 162.24 m<br>Financing MRO 44,574 m<br>gap 0.90 % of non-oil GDP<br>US$ 9.44 p.c.<br>Source: Authors’ calculations.<br><!-- End of picture text -->

# **MDG 2: Achieve Universal Primary Education**

_Target 3: Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling._

**_A. Current Situation:_ high enrollment but low retention rates.** Mauritania has one of the highest gross enrollment rate (GER) in the sub-region. But the retention rate is low. Rural schools that offer an incomplete cycle have been found to be amongst the major reasons for low completion rates, affecting some two-third of dropouts. Also, evidence shows that the mere existence of a school in the areas of residence is no guarantee of better retention rates: the low quality of education and cost associated to sending children to schools are also important factors affecting the high drop-our rate.

**Figure 4. MDG 2: Current Situation and Trends**

<!-- Start of picture text --> 100<br>Past performance<br>Government plan<br>Projected status quo<br>88 MDG-2<br>76 78.0<br>73.8 71.9 72.4 75.2<br>64 70.0 68.2 66.3 66.7 69.5<br>64.4 62.5 64.0<br>60.6 58.8 59.0<br>56.9<br>52 55.0 54.0<br>49.0 48.0 49.0 49.0<br>40 44.0 44.0 44.0<br>1990 1995 2000 2005 2010 2015<br>Source: Authors’ calculations.<br><!-- End of picture text -->

**_B. Trends and Likelihood:_ a low probability of achieving MDG2.** Between 1990 and 2006, while the GER at the primary level increased significantly, the retention rate deteriorated markedly – from 73.8 to 44 percent. In other words, in 2006 only 44 percent of children enrolled in Grade 1 completed successfully Grade 6. Given the current trend, the retention rate would increase only marginally by 2015, returning to the level it reached in 2000. The likelihood of achieving the ambitious government plan, therefore, is low (Figure 4).
12

**_C. Financial Needs:_ 0.4 percent of GDP on average per year.** The financing gap for MDG2 is the fourth in order of magnitude, after poverty reduction (MDG1), maternal mortality (MDG5) and child mortality (MDG4). The cost of achieving this target for the period 2008-2015 amounts to 3.8 percent of GDP on average per year, corresponding to US$ 679.71 million in total. Once the allocation of government expenditure is taken into account, the country needs an additional total financing of 0.4 percent of GDP on average per year (Figure 5), or US$ 66.4 million in total (Table 5). For a detailed, yearly cost breakdown, see Annex 1.

**Table 5. MDG 2: Cost, Budget and Financing Gap (2008-2015)**

<!-- Start of picture text --> Figure 5. MDG 2: Financing gap<br>Financing Gap (2008-2015)<br>-5 -0.10<br>2008 2009 2010 2011 2012 2013 2014 2015<br>-6.73 -6.47<br>-0.20<br>-10 -0.22 -11.03<br>-0.24 -12.19 US$ 679.71 m<br>Total Cost<br>-0.30 MRO 187,221.60 m<br>-15 -0.35 -15.23 -0.40 Budget US$ 613.29 m<br>-0.37 -0.40 Allocation MRO 168,863.47 m<br>-0.43 -19.43 -17.53 US$ 66.43 m<br>-20 -20.85 -0.50 Financing MRO 18,358 m<br>Millions of US$ -0.51 -0.51 gap 0.38% of non-oil GDP<br>% of non-oil GDP (secondary axis) US 4.08 p.c.<br>-25 -0.60<br>Source: Authors’ calculations. Source: Authors’ calculations.<br><!-- End of picture text -->

# **MDG 3: Promote Gender Equality and Empower Women**

_Target 4: Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015._

**_A. Current Situation:_ gender parity in enrollment in primary education** . At the primary level, gender parity has already been reached. In 2007, girls’ GER exceeded that of boys for the fourth consecutive year. Also, in 2007, 68.1 percent of girls registered in the first grade reached Grade 6, against 58 percent for boys. In secondary school, progress on gender parity has been slower due to, _inter alia_ , the household workload that girls are asked to perform, early marriage or pregnancy. Evidence from recent labor market research suggests that nearly half or women in the 15-24 age-group do not participate in the labor market because of domestic duties, while only 20 percent cite being a student as a non-participating reason (Rajadel et al., 2008).

**_B. Trends and Likelihood:_ a high probability of achieving MDG3** . At the primary level, between 1990 and 2004, the ratio of girls to boys rose from 0.72 to 0.99. Between 1990 and 2007, girls’ participation as a percent of total enrollment increased from 42 to 50 percent. At the secondary level, the ratio of girls to boys rose from 0.79 in 2000 to 0.85 in 2004 (Figure 6). Reaching gender parity at the secondary level is possible but crucially depends on easing girl’s ability to avoid the household workload (Figure 6).
13

**Figure 6. MDG 3: Current Situation and Trends**

<!-- Start of picture text --> Primary Education Secondary Education<br>1.00 1.00 0.98 0.98 0.98 0.98<br>0.99<br>0.99 0.98 0.96 0.98 0.98<br>0.99 0.98 0.99 0.99 0.98 0.98 0.98 0.98 0.98 0.98 0.98 0.95 0.92 0.94<br>0.97<br>0.96 0.90 0.89<br>0.87<br>0.96<br>0.95 0.85<br>0.85<br>0.83<br>0.94<br>0.80 0.79 0.81<br>0.93 0.92 Past performance Past performance<br>Government plan Government plan<br>0.91 MDG-3 0.75 0.76 MDG-3<br>2000 2003 2006 2009 2012 2015 2000 2003 2006 2009 2012 2015<br> Source: Authors’ calculations. Source: Authors’ calculations.<br><!-- End of picture text -->

**_C. Financial Needs:_ 0.2 percent of GDP on average per year.** A modest increase in resources would allow Mauritania to achieve this goal. The financing gap to reach MDG3 is the smallest of the MDGs considered in this paper. The cost of achieving this target for the period 2008-2015 amounts to 0.3 percent of GDP on average per year, corresponding to US$ 52.6 million in total. Once the allocation of government expenditure is taken into account, the country needs an additional total financing of 0.23 percent of GDP on average per year (Figure 7), which translates into US$ 41.8 million in total (Table 6). For a detailed, yearly cost breakdown, see Annex 1.

**Figure 7. MDG 3: Financing Gap**

**Table 6. MDG 3: Cost, Budget and Financing Gap (2008-2015)**

<!-- Start of picture text -->
-7.60 2008 2009 2010 2011 2012 2013 2014 2015 -0.15 Financing Gap (2008-2015)<br>-7.64<br>-7.65 -0.18 -0.18<br>-0.19 Total Cost  US$ 52.61 m<br>-7.70 -7.71 -0.20 -0.21 MRO 14,430 m<br>-7.75 -0.22 -7.73 Budget  US$ 10.79 m<br>-7.75 -7.76 Allocation  MRO 2,973.47 m<br>-7.75 -0.24<br>-0.24 US$ 41.83 m<br>-7.79 -0.25 Financing  MRO 11,456.55 m<br>-7.80 -0.26 -0.27 gap  0.23% of non-oil GDP<br>-0.28 Millions of US$% of non-oil GDP (secondary axis) -7.83 US$ 2.35 p.c.<br>-7.85 -0.30<br>Source:  Authors’ calculations.<br>     Source:  Authors’ calculations.<br><!-- End of picture text -->

# **MDG 4: Reduce Child Mortality**

_Target 5: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate._

**_A. Current Situation:_ High infant and child mortality rates.** The latest available data shows a child mortality rate (CMR) of 135 per 1.000 live births in 2000, while the infant mortality rate (IMR) stood at 87 per 1.000 live births during the same year. Chronic malnutrition amongst children (at 32 percent in 2004) continues to be a serious problem notably in rural areas and among the poorest and the very young (0–3 years), contributing significantly to infant and child deaths. Health care delivery suffers from the low quality
14 of services provided, owing to the inadequacy of human resources in the sector and poor physical and financial access to health facilities, notably in rural areas.

**_B. Trends and Likelihood:_ a low probability of achieving MDG4** . Despite some progress – especially in child vaccination – during the 1990s, trends are not encouraging. Between 1988 and 2001, chronic malnutrition rates in children stagnated. Between 1990 and 2000, infant mortality diminished from 126 to 87 per 1,000 live births, but under-5 mortality rate remained virtually stagnant. In particular, progress slowed down since 1996 for child mortality and from 2000 for infant mortality. If past trends are maintained, Mauritania will remain very far from reaching the child mortality target in 2015, but closer to reach the infant mortality target (Figure 8).

**Figure 8. MDG 4: Current Situation and Trends**

<!-- Start of picture text --> Child mortality Infant mortality<br>145<br>130 137134.5 132 129.5127 124.5 128.5 125.25131.75 135 134.3133.6132.9132.2131.5130.8130.1 129.4128.1287 125110 126.0 122.1 118.2 114.3<br>115 122 113.4 110.4 106.5 102.6<br>95 98.7<br>10085 98.8 84.2 80 94.8 90.9 87.0 86.3 85.6 84.9 84.283.5 82.882.1 81.480.7 80.0 72.0<br>65 64.0<br>70 69.6<br>56.0<br>55 Past performanceGovernment planProjected status quo 55.0 50 Past performanceGovernment planProjected status quo 48.0<br>MDG-4 MDG-4 40.0<br>40 35<br>1990 1995 2000 2005 2010 2015 1990 1995 2000 2005 2010 2015<br><!-- End of picture text --> _Source:_ Authors’ calculations. _Source:_ Authors’ calculations.

**_C. Financial Needs:_ 0.6 percent of GDP on average per year.** The financing gap to reach MDG4 is the third widest gap, after poverty reduction (MDG1) and maternal mortality (MDG5). The cost of achieving this target for the period 2008-2015 amounts to 1.1 percent of GDP on average per year, corresponding to US$ 202.5 million in total. Once the allocation of government expenditure is taken into account, the country needs an additional total financing of 0.6 percent of GDP on average per year (Figure 1), which translates into US$ 110.9 million (Table 7). For a detailed, yearly cost breakdown, see Annex 1.

**Figure 9. MDG 4: Financing Gap**

<!-- Start of picture text -->
-13.0 -0.55<br>2008 2009 2010 2011 2012 2013 2014 2015<br>-17.0 -16.35 -17.46 -0.57 -0.58 -0.58<br>-17.57<br>-0.59<br>-21.0 -0.59 -19.04 -21.86 -0.61<br>-0.62 -24.49<br>-25.0 -0.64<br>-0.64 -27.40<br>-29.0 -0.67 -30.59 -0.67<br>Millions of US$<br>% of non-oil GDP (secondary axis) -0.69<br>-33.0 -0.70<br>Source:  Authors’ calculations.<br><!-- End of picture text -->

**Table 7. MDG 4: Cost, Budget and Financing Gap (2008-2015)**

|**Total Cost**|US$ 202.5 m<br>MRO 55,816.45 m|
|---|---|
|**Budget**|US$ 91.60 m|
|**Allocation**|MRO 25,280.47 m|
||US$ 110.90 m|
|**Financing**<br>**gap**|MRO 30,535.98 m<br>0.62% of non-oil GDP|
||US$ 6.56 p.c.|

_Source:_ Authors’ calculations.
15

# **MDG 5: Improve Maternal Health**

_Target 6: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio._

**_A. Current Situation:_ maternal mortality remains high.** Maternal mortality stood at 747 per 100,000 live births in 2000. It is high notably in the rural and amongst the poorest segments of the population, where access to childbirth and attendance to obstetrical urgencies is low. In 2007, only 61 percent of births were attended by qualified health personnel, while the remaining 39 percent were assisted by a relative, an unqualified person, or without any type of assistance (GIRM 2007b). High-risk pregnancies, hemorrhages during delivery, anemia, as well as cesarean intervention are the principal causes of prenatal and maternal deaths.

**_B. Trends and Likelihood:_ a low to medium probability of achieving MDG5.** Between 1990 and 2000, maternal mortality decreased from 930 to 747 deaths for 100,000 live births. Recent data – not available at the time of the analysis – show in 2007 maternal mortality stood at 684 per 100.000 live births (GIRM 2007b). Also, the proportion of births attended by skilled personnel increased from 57 percent in 2001 to 61 percent in 2007. If these trends are sustained and accelerated, the country’s low probability of attaining the MDG target could increase (Figure 10).

**Figure 10. MDG 5: Current Situation and Trends**

<!-- Start of picture text --> 1000<br>930 912 893 875 857<br>840 839 820 802 784 765 747<br>712<br>678<br>680 643<br>608<br>574<br>539<br>504<br>520 469<br>435<br>400 380<br>360<br>360 Past performanceGovernment plan 340 320 300<br>Proyected status quo<br>MDG-4<br>200<br>1990 1995 2000 2005 2010 2015<br><!-- End of picture text --> _Source:_ Authors’ calculations.

**_C. Financial Needs_ : 0.7 percent of GDP on average per year.** The financing gap to reach this goal is the second widest after poverty reduction (MDG1). The cost of achieving this target for the period 2008-2015 amounts to 0.9 percent of GDP on average per annum, corresponding to US$ 163.2 million in total. Once the allocation of government expenditure is taken into account, the country needs an additional total financing of 0.7 percent of GDP on average per year (Figure 11), which translates into US$ 124.4 million in total (Table 8). For a detailed, yearly cost breakdown, see Annex 1.
16

**Figure 11. MDG 5: Financing Gap**

<!-- Start of picture text -->
-10 -0.4<br>2008 2009 2010 2011 2012 2013 2014 2015<br>-13.79<br>-15 -16.60 -0.5<br>-0.50 -20.12<br>-20 -0.56 -22.52 -0.6<br>-25 -26.53<br>-0.65<br>-0.69 -30.23 -0.7<br>-30<br>-33.58<br>-0.75 -0.8<br>-35 -0.79<br>-0.82 -0.89<br>-40 Millions of US$ -39.13 -0.9<br>% of non-oil GDP (secondary axis)<br>-45 -1.0<br>  Source:  Authors’ calculations.<br><!-- End of picture text -->

**Table 8. MDG 5: Cost, Budget and Financing Gap (2008-2015)**

<!-- Start of picture text --> US$ 163.26 m<br>Total Cost<br>MRO 45,094.16 m<br>Budget US$ 38.86 m<br>Allocation MRO 10,753.74 m<br>US$ 124.4 m<br>Financing MRO 34,340.4 m<br>gap 0.71% of non-oil GDP<br>US$ 7.56 p.c.<br><!-- End of picture text --> <!-- Start of picture text --> Source: Authors’ calculations.<br><!-- End of picture text -->

# **MDG 6: Combat HIV/AIDS, Malaria and Other Diseases**

_Target 7 and 8: Have halted by 2015 - and begin to reverse - the spread of HIV/AIDS, tuberculosis, malaria and other diseases._

**_A. Current Situation:_ low levels of HIV/AIDS and tuberculosis, but high malaria prevalence.** Mauritania is characterized by a low prevalence of HIV/AIDS, estimated at 1.9 percent in 2003. Around 80 percent of the population in Mauritania is exposed to malaria. The prevalence rate for malaria was in the order of 10 percent on 2000, with 250.000 new cases per year. In the seven southern _wilayas_ , Malaria accounts for a significant proportion of deaths and is responsible for 60 percent of hospitalization. In 2005, the prevalence of tuberculosis was estimated at 0.44 percent of the population, but it detection is feeble (less than 58 percent of cases are reported).

**_B. Trends and Likelihood:_ a medium probability of achieving MDG6.** The HIV/AIDS goal is attainable. However, between 1990 and 2003 HIV prevalence increased from 0.5 to 1.9 percent (World Bank 2005), hence it needs to be monitored closely. Since 2006, the treatment of malaria has improved, but between 1990 and 2000, the prevalence rate has only marginally decreased from 12.7 to 10 percent. There are little data on tuberculosis trends. On the basis of current information, Mauritania has a medium probability of reversing the spread of these diseases by 2015.

**Figure 12. MDG 6: Current Situation and Trends**

<!-- Start of picture text -->
1.75 9.00<br>1.6 Prevalence rate of HIV/AIDS pop. 15-49 ages in %<br>1.4 Prevalence rate of Tuberculosis in %<br>Prevalence rate of Malaria in % (secondary axis)<br>1.40 8.4 1.3 8.00<br>1.2<br>7.9 1.1<br>1.0<br>1.05 7.4 0.9 7.00<br>7.0 0.8<br>0.7<br>6.6 0.7<br>0.70 6.2 6.00<br>5.8<br>5.1<br>0.35 0.42 0.40 0.38 0.36 0.34 0.32 0.30 0.285.5 0.26 0.244.8 5.00<br>0.00 4.00<br>2006 2008 2010 2012 2014<br>     Source:  Authors’ calculations.<br><!-- End of picture text -->
17

**_C. Financial Needs:_ 0.12 percent of GDP on average per year.** The financing gap to reach this goal is the smallest of all MDGs, although this might be due to the lack of available data. The cost of achieving this target for the period 2008-2015 amounts to 0.14 percent of GDP on average per year, corresponding to US$ 26.6 million in total. Once the allocation of government expenditure is taken into account, the country needs an additional total financing amount of 0.12 percent of GDP on average per year (Figure 13), which translates into US$ 16.6, million in total (Table 9). For a detailed, yearly cost breakdown, see Annex 1.

<!-- Start of picture text --> Figure 13. MDG 6: Financing Gap Table 9. MDG 6: Cost, Budget and<br>-1.2 0.00 Financing Gap (2008-2015)<br>2008 2009 2010 2011 2012 2013 2014 2015<br>-1.70<br>-0.03<br>-2.0 -2.13<br>-0.04<br>-2.49 US$ 26.61 m<br>-0.05 -0.06 Total Cost<br>-2.8 -2.82 -0.07 MRO 7,285.70 m<br>-3.07 Budget US$ 10.05 m<br>-3.41 -0.08 -0.09 Allocation MRO 2,772.32 m<br>-3.59 -0.09 US$ 16.56 m<br>-3.6 -3.81 -0.11 -0.12 Financing MRO 4,513.4 m<br>-0.12 Millions of US$ gap 0.12% of non-oil GDP<br>% of non-oil GDP (secondary axis)<br>-4.4 -0.14 -0.15 US$ 1.00 p.c.<br>Source: Authors’ calculations.<br><!-- End of picture text --> _Source:_ Authors’ calculations.

# **MDG 7: Ensure Environmental Sustainability**

_Target 10: Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation._

**_A. Current Situation:_ access to safe water is still a major problem.** In Mauritania, the data concerning access to safe drinking water depend on the definition of the indicators. In 2004, only 32 percent of urban households and 17 percent of rural household were connected through a tap to a safe drinking water source. Conversely, these proportions rise to 64 and 42 percent respectively when the access to improved water sources is via a protected well, a public fountain, or an external tap. Still, more than half of the rural population still struggle to find safe drinking water, with clear adverse effects on physical well-being, notably amongst children (WHO/UNICEF 2006).

**Figure 14. MDG 7: Current Situation and Trends**

<!-- Start of picture text --> 70<br>Past performanceGovernment plan 65.6 66.2 66.867.4 68.0<br>Projected status quo 65.0<br>63 MDG-4<br>60.8<br>56 56.7<br>52.5<br>49 48.3<br>44.2<br>42 37.0 37.2 37.4 37.6 37.9 38.1 38.3 38.5 38.7 38.9 39.1 39.4 39.6 39.8 40.0<br>35<br>1990 1995 2000 2005 2010 2015<br><!-- End of picture text --> _Source:_ Authors’ calculations.
18

**_B. Trends and Likelihood:_ a low probability of achieving MDG7** . Between 1990 and 2004, the proportion of households with access to an improved drinking water source increased from 37 to 40 percent (GIRM 2007b), a modest improvement (note that official data slightly differ from the estimates presented above). If the historic trend is maintained Mauritania will be unable to reach this MDG target in 2015 (Figure 14).

**_C. Financial Needs:_ 0.27 percent of GDP on average per year.** The financing gap to reach this goal is the third smallest of those considered in this paper, despite the scale of the problem.<sup>13</sup> The cost of achieving this target for the period 2008-2015 amounts to 1.1 percent of GDP on average per year, corresponding to US$220.8 million in total. Once the government allocation of expenditure is taken into account, the country needs an additional total financing of 0.27 percent of GDP on average per year (Figure 15), which translates into US$ 59.3 million in total (Table 10). For a detailed, yearly cost breakdown, see Annex 1.

**Figure 15. MDG 7: Financing Gap**

<!-- Start of picture text -->
-4 0.0<br>2008 2009 2010 2011 2012 2013 2014 2015<br>-6 -5.23 -5.60 -5.87 -0.1<br>-8 -0.14 -0.14 -0.13<br>-0.2<br>-10<br>-11.53 -11.42 -0.3<br>-12 -12.39 -12.59 -0.32<br>-0.37 -0.38 -0.4<br>-14<br>-0.42<br>-15.69<br>-0.5<br>-16<br>Millions of US$<br>-0.57 % of non-oil GDP (secondary axis)<br>-18 -0.6<br><!-- End of picture text -->

_Source:_ Authors’ calculations.

**Table 10. MDG 7: Cost, Budget and Financing Gap (2008-2015)**

|**Total Cost**|US$ 220.83 m<br>MRO 59,919.94 m|
|---|---|
|**Budget**|US$ 161.52 m|
|**Allocation**|MRO 43,783.77 m|
||US$ 59.31 m|
|**Financing**|MRO 16,136.2 m|
|**gap**|0.27% of non-oil GDP|
||US$2.81p.c.|

_Source:_ Authors’ calculations.

> 13 Funds have already been secured for the “ _Aftout Essaheli_ ” project, which will start in 2010 and provide drinking water from the Senegal River to the capital city Nouakchott.
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# **4. Accelerating Progress: Policy Changes and Instruments**

**To reach the MDGs, Mauritania needs to allocate adequate resources and improve sector policies.** _First,_ to achieve its development vision the government needs to focus on the MDGs and allocate sufficient resources to the delivery of social services. _Second,_ to maximize effectiveness, the government needs to significantly change its sector strategies and policy instruments, notably those linked to the budget. This section highlights the policy changes needed at the sector level (Section 4.1), and proposes ways in which the link between policies, available resources, and outcomes can be strengthened via the budget process (Section 4.2).

## **4.1 Policy Changes Needed at the Sector Level**

## **MDG 1: Eradicate Extreme Hunger and Poverty**

_Target 1: Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day._

**_Policy objective._ Reduce the incidence of poverty via faster and more inclusive nonoil growth.** In Mauritania, a number of significant binding constraints hamper the inclusiveness of economic growth (World Bank 2007a). _First_ , the country displays a distorted economy, characterized by rent-seeking, which tend to prioritize rent distribution over wealth creation (Auty and Pontara, 2008).<sup>14</sup> _Second_ , poor governance and corruption are central concerns. Evidence on bribe propensity and intensity suggests that medium-size firms are the productive actors that suffer most (Francisco and Pontara, 2007). As a result, the Government has been unable to: (i) diversify the sources of growth besides natural resources and the tertiary sector; and (ii) attract investment by creating an enabling environment for private sector development.

**_What to do?_ Target the poorest segments of the population, boost rural incomes, and stimulate private sector investment.** While faster growth is a necessary driver of poverty reduction, it is not sufficient, notably if inequality is not reduced (Bourguignon, 2004). A consensus is beginning to emerge of how to tackle poverty and boost inclusive growth in Mauritania. Key elements of this consensus include:

- 1) _Targeting the poorest segments of the population._ Tackling widespread rural poverty and pockets of indigence in urban areas requires expanding access to basic services for the poorest, providing basic rural (e.g.: irrigation pumps) and urban (e.g.: clean water wells) infrastructure, creating the conditions for the development of income generating activities, and extending support to local communities. The implementation of specific poverty alleviation programs – such as _Twize_ in urban areas and _Toumza_ and _Lemniha_ in rural areas – need to be improved by extending the beneficiary base and reducing targeting errors.

> 14 Rural neglect of successive governments – in terms of both policy focus and investment – as well as repeated droughts have encouraged Mauritanians to migrate to cities, where they have drawn upon rent subsidies.
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- 2) _Boosting rural growth._ While the contribution of the primary sector to GDP is low, and below the sub-regional average, agriculture continues to furnish the principal livelihood for at least half the population, through precarious and inadequately remunerated (under-)employment in herding and farming. There is scope to accelerate rural growth by investing in irrigated agriculture in the Senegal River valley, and developing agro-processing and the livestock sector.

- 3) _Attracting investment by establishing early-reform economic zones._ Large private monopolies and inefficient public utilities skim rent from the urban economy and hamper economic dynamism and competition. The port of Nouakchott suffers from capacity constraints and high operating costs, and cannot compete with Dakar as an outlet for exports from Mali and other enclave countries. Establishing economic zones (EZ)<sup>15</sup> – starting, for example, from the port of Nouakchott – can spur growth and postpone confrontation with established rent-seekers. Success in economic zones can – in the longer term – forge a pro-growth political coalition eventually able to take on the rent-seekers.

**_Link with the budget._ Increase poverty spending and upgrade economic infrastructure.** Over 2008-15, the budget allocated to poverty alleviation programs should increase by around 1 percent of GDP on average per year (Annex 1), and finance basic services and infrastructure for the poorest, in both rural and urban areas, i.e.: irrigation pumps, clean water wells, and both the construction and rehabilitation of rural roads (World Bank, 2005). Spending allocated to agriculture should also target the development of agro-processing, to tap the opportunities that exist in canning, fooddrying, and juice production. In the livestock sector spending should target improving cattle quality through scientific breeding, developing transportation and refrigeration, and increasing market access for hides, milk and meat sub-sectors (Auty and Pontara 2008). Resources should be allocated to the establishment of economic zones, the rehabilitation of the Nouakchott port and the provision of reliable and affordable electricity by the national energy company SOMELEC.

# **MDG 2: Achieve Universal Primary Education**

_Target 3: Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling_

**_Policy objective._ Give students the opportunity to access the primary cycle and remain enrolled throughout.** In Mauritania, students drop out prematurely from primary school because their families are not satisfied with the services offered, especially in rural areas. Teachers are often absent, the quality of teaching is low, and often parents prefer female teachers to educate their daughter while the majority of teachers continue to be males. Moreover, the household direct (e.g.: uniforms, didactic material) and opportunity (i.e.: contribution to family labor) costs are too high for parents to keep their children in school. In the priority action plan for education (2007-2010), the Government plans to guarantee universal access to primary education and attain a retention rate of 64 percent by 2010 (see Figure 4).

15 These are geographically defined areas within which post-reform conditions apply, comprising world class infrastructure, unsubsidised incentives for efficient investment, and enabling institutions.
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**_What to do?_ Match the supply of education services to the existing demand of parents.** This involves: (i) continuing the programs geared at constructing and rehabilitating school classes; (ii) recruiting additional teachers (especially females); (iii) identifying schools that do not offer the full primary cycle, and upgrade their quality and efficiency (e.g. regroup schools, establish multi-grade classrooms); (iv) reducing the parents’ direct and opportunity cost of sending their children to school by abolishing school fees, providing free meals, and relaxing uniforms requirements (or providing them for free); (v) improving the quality of primary education; and (vi) expanding the private sector supply of primary education (10 percent of the total by 2010).

**_Link with the budget._ Invest in upgrading schools, provide teachers’ incentives and subsidize school meals, especially in rural areas.** By 2010, key priorities are to: (i) construct, rehabilitate and equip 3200 classrooms; (ii) recruit 3800 (mainly female) teachers, ensure their geographical distribution (the ration pupil-teacher should be 40 by 2010); (iii) ensure that 80 percent of schools offer a full primary cycle by upgrading them; (iv) organize awareness-rising campaigns to stimulate parents’ demand for education and increase the percentage of school canteens that offer free meals by 32 percent, in the most disadvantaged zones; and (v) allocate resources to make sure that teachers’ incentives and training schemes are fully funded and guarantee enough didactic material (e.g. a school manual for every 4 pupils by 2010).

# **MDG 3: Promote Gender Equality and Empower Women**

_Target 4: Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015_

**_Policy objective._ Prevent poor teenage girls from dropping out of school in secondary and higher education.** Gender gaps are now very small at the primary school level but continue to exist in secondary and higher education. Hence, the Government should maintain the pace on gender parity at the primary level, and increase efforts on the secondary level, where teenage girls are negatively affected by household and family duties. At the secondary level, the Government plans to reduce gender disparities in the most disadvantages wilayas by implementing specific programs focusing on girls.

**_What to do?_ Inform the families, reduce the parents’ opportunity cost, and strengthen ad-hoc institutions.** Throughout the country, efforts are needed to promote information campaigns about the benefit of remaining enrolled in school (e.g.: stressing the future income stream, etc.), especially at the secondary level. Moreover, it is necessary to identify and target families living in extreme poverty, where the opportunity cost of schooling for young girls is highest. In addition, programs need to be put in place to assist the young females affected by early marriage or pregnancy. At the institutional level, the authorities should continue to implement the _National Strategy for the Promotion of Women_ .

**_Link with the budget._ Finance awareness campaigns, subsidize disadvantaged girls, and invest in inter-ministry coordination.** By 2015, the Government should: (i) finance awareness-rising campaigns to encourage demand for girls’ schooling; (ii) budget adequate subsidies for children, notably girls in secondary school, coming from the disadvantaged environments; and (iii) establish an inter-ministry arrangement for
22 coordinating the _National Strategy for the Promotion of Women,_ to support women entrepreneurs and women’s access to markets and decision-making centers.

# **MDG 4: Reduce Child Mortality**

_Target 5: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate_

**_Policy objective._ Provide access to health and nutrition services to children and their mothers, in particular in rural areas.** Despite the complexity of this goal and the challenges it faces,<sup>16</sup> it is key to take advantage of the synergies and complementarities between policy instruments. To do so, it is necessary to implement the _National Health, Nutrition and Sanitation Policy_ (NHNSP) in a comprehensive way. As indicated in the NHNSP’s first pillar, it is important to focus on the mother-infant population – especially in remote areas – and facilitate their access to health and nutritional services, such as prenatal and postpartum care, vaccination, food, vitamins, and fight against the most common diseases.

**_What to do?_ Provide preventive care in remote areas, improve efficiency and quality of spending, and strengthen institutional coordination.** To do so, it is necessary to address the key weaknesses of the health sector: (i) in rural areas, there is little awareness about disease prevention, human resources are scarce and unskilled, and the utilization of primary and secondary care units remain very low; and (ii) the level, efficiency and quality of the overall spending are low (World Bank 2006b). Hence, special attention is needed to: (i) set up communication campaigns at the local level aimed at disease prevention stressing the importance, _inter alia_ , of access to clean water, and training programs for health staff; (ii) increase access to health services within a 5 km range (or establish mobile clinics) and improve the quality of services offered; (iii) establish a coordination program for the key players involved in food security, community and school nutrition, and food quality control; and (iv) improve the links between spending and outcomes.

**_Link with the budget._ Increase health spending and link resources to outcome indicators.** By 2015, the Government should: (i) increase budget allocations to finance effectively the implementation of the _National Health, Nutrition and Sanitation Policy_ , with a focus on prevention at the local level; strengthen community participation to health services; (ii) construct, furnish, stock up and staff 90 new health unit; establish 5 inter-regional medical centers, and ensure adequate stock of medicines; and (iii) make the planned _Relief and Nutrition Centers_ operational, to coordinate food delivery in remote areas.

# **MDG 5: Improve Maternal Health**

_Target 6: Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio._

> 16 Recent analytical work on developing countries worldwide shows that there is little progress when children’s mortality rates (CMR) are above 220 per 1000 and diminishing returns once they reach about 120 (Easterly, 2007). Mauritania’s CMR stood at 126 percent in 1990.
23

**_Policy objective._ Improve the geographical coverage and the quality of medical assistance.** In Mauritania, the high maternal mortality rate is essentially caused by the high proportion of pregancies at risk (premature and frequent pregnancies) and the low access of pregnant women to emergency obstetric services. Emorragies, complication , arterial hypetension and anemy are the principal causes of prenatal deaths. Policies aimed at reducing maternal mortality should be geared towards: (i) increasing the population’s awareness of maternal mortality risks; (ii) making sure that medicines and emergency obstetrical services are available, notably in rural and remote areas; and (iii) invest in training train health workers in pre- and post-natal areas.

**_What to do?_ Organize information campaigns and increase access to assisted-childbirths in rural areas.** It is important to put in place an integrated system that includes supply of medicines and equipment, as well as attendance before and during child-birth, though inter alia the creation of mobile clinics. Additional important tasks consists of increasing the knowledge of the population about the risks associated to pregnancy – and and what to do if problems arise – and the benefits of contraceptive methods.

**_Link with the budget._ Increase spending on communication, medicine supply and mobile clinics.** It is important: (i) to finance awareness campaigns, with the goal of preventing pregnancy under unfavorable condition. It is also necessary to allocate resources to: (i) a treatment system for obstetric urgencies and neonatal infections, by making operational 17 mobile medical teams at the regional level; and (iii) putting in place an institutional framework to ensure that obstetrical urgencies and post-natal infection are adequately addressed, especially in rural areas.

# **MDG 6: Combat HIV/AIDS, Malaria and Other Diseases**

_Target 7 and 8: Have halted by 2015 - and begin to reverse - the spread of HIV/AIDS, tuberculosis, malaria and other diseases_

**_Policy objective._ Reduce the incidence of the HIV/AIDS, tuberculosis and malaria epidemics.** In the most vulnerable geographical areas, for all epidemics there is a need to improve the monitoring of trends through data collection; the availability of medical and laboratory equipment and distribution of (free, in some cases) medicines); and the training of doctors and health workers engaged in the prevention and cure of these diseases. Efforts should be aimed at increasing the awareness of the population about the transmission mechanisms of the HIV virus, and the use of contraceptive methods.

**_What to do?_ Strengthen the epidemiologic monitoring systems, ensure greater availability of treatments and inform on prevention.** For all epidemics, it is important to set up effective and performing programs of epidemiological surveillance. To fight HIV/AIDS it will be important to: (i) ensure greater availability of the use of cheap antiretroviral drugs (ART), transfusions, and free HIV testing and contraceptive methods; and (ii) train health workers on HIV/AIDS and set up centers for the social and psychological treatment for HIV positive pregnant women. It is also necessary to strengthen the management of multi-drug resistant tuberculosis. In the fight against malaria, preventative actions include the use of mosquito nets or other insecticide-treated materials, as well as campaigns to improve hygiene and sanitation.
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**_Link with the budget._ Increase epidemics-related spending and subsidize essential treatment and services.** On HIV/AIDS, the budget should guarantee: (i) the free provision of certain tests and medicines such as HIV/AIDS tests, condoms, ART, micronutrients; (ii) the setting up of centers for anonymous and free HIV testing, as well as services of psychological and social support. On TB, enough resources need to be allocated to: (i) the implementation of the PNLT; (ii) the availability of anti-tuberculosis vaccines and drugs; and (iii) the expansion of coverage of the TB short, directly supervised treatments (DOTS). For malaria prevention, it is necessary to subsidize free supply of insecticide-treated mosquito nets in the endemic zones.

# **MDG 7: Ensure Environmental Sustainability**

_Target 10: Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation_

**_Policy objective._ Promote greater access to water at an affordable price, notably for the poorest segments of the population** . Given the wide disparities in access to potable water, there is the need to improve access to water for the urban and rural poor, as water has a key impact on the health status of poor households (World Bank, 2006b). It is also important to find solutions to deal with the cost of the maintenance of hydraulic works and the problems of micro-pollution. To do so, it is necessary to strengthen the capacity in the sector.

**_What to do?_ Increase access to potable water and sanitation services, research new water sources and improve governance in the sector.** Water access needs to be expanded in both urban and rural areas. In urban areas, particular attention needs to be paid to the rehabilitation of infrastructure and provision of electricity in secondary centers. In Nouakchott, the priority is to expand access to water in poor peripheral neighborhoods. In rural areas, new planned constructions of water networks in centers between 500-5000 people and simpler interventions planned in localities with 150-500 people need to be carried out. In addition, an inventory of water sources in Mauritania needs to be set up. Support needs to be delivered to strengthen capacity in the water sector, and promote public-private partnerships, by define the role and responsibility of the different actors, including public enterprises, regulation agencies and the private sector.

**_Link with the budget._ Finance the expansion of water networks in both rural and urban areas.** Massive amounts of resources will be invested in the near future to improve access to safe drinking water in Mauritania, notably by bringing water from the Senegal River to Nouakchott. In urban areas, the budget needs to support: (i) the upgrade of infrastructure in Nouakchott, Nouadhibou, Selibaby and Kaedi; (ii) the pursuit of the Aftout Essaheli works, and (iii) the funding of water distribution in Nouakchott. In rural areas, funds should be geared at: (i) building 136 water networks in centers between 5005000 people, and 166 basic water infrastructures in centers between 150-500 people; (ii) constructing 145 water points; (iii) rehabilitating 8000 family toilets; and (iv) installing 1000 toilet mobile blocks.
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# **4.2 Integrating the MDGs into the Budget Process**

**The MDG costing exercise needs to be integrated into the process of strategic planning and budget elaboration** . This needs to happen sequentially, starting from the strategic phase, and moving on to policy making, budget execution and MDG monitoring at the sectoral level, through the MTEF process. Four steps are identified: (1) embed the MDGs in the national strategy (PRSP-2), and its periodical revisions; (2) incorporate the MDGs financial needs during the elaboration of sectoral and global MTEFs; (3) use the global MTEF as a guide for the preparation of the national budget; and (4) revise the budget preparation calendar accordingly. These steps are briefly discussed below.

- 1) **Embed the MDGs in the PRSP.** The PRSP-2 acknowledges the MDGs as national priorities, but does not adopt them as the objectives on which the country is expected to deliver. As noted, the PRSP-2 objectives for the 2015 horizon are more ambitious than the corresponding MDG targets. In other cases, the reverse is true. Looking forward, as the PRSP is reviewed on a periodical basis, the Government needs to: (i) monitor the MDG status, specifying which targets and indicators are priorities and why (i.e. because of data problems, non-relevance); (ii) specify how key sectoral (or sub-sectoral) policies can accelerate progress on the attainment of selected MDGs; and (iii) update the costing exercise, on the basis of the revised macro-budgetary framework and sectoral costing.

- 2) **Incorporate the MDG financial needs into the MTEF** . The second step consists in fitting the MDG envelope into the sectoral and overall spending envelopes (MTEFs), which, over a rolling three-year period, serve as a guide to budget formulation. _First,_ policy actions geared to the attainment of the MDGs need to be specified and “costed” at the sectoral level. So far, only a few sectors (i.e. education, water and sanitation) have been able to develop quality strategies and MTEFs, due to the weak capacity of sectoral ministries. _Second,_ sectoral MTEFs should feed into the elaboration of the global MTEF, i.e.: an intersectoral allocation of resources obtained through a process of arbitrage. _Third,_ it is important that all sectors share: (i) the same macro-budgetary framework; and (ii) the same hypotheses, notably on the estimation of unit costs.

- 3) **Assimilate the MTEF within the national budget.** The MDGs costing exercise should be linked to the budget through the global MTEF (Figure 16). The new functional classification, available since 2006 (Box 3), can be used to establish more coherent links between budget allocations and the actions conducive to the attainment of the MDGs (Table 11). In the transition towards performance-based program budgeting, it would important to gradually move away from a MTEF (and budget) formulation based on the extrapolation of previous exercises (e.g. standard augmentation of X percent of resources each year on the basis of previous years’ levels) towards a more transparent evaluation of the resources deemed necessary to reach well-specified objectives. This process, however, will take time and considerable strengthening of the existing capacity.
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# **Table 11. MDGs: Policy Changes and Links with the Budget**

|**MDG**|**Policy Objectives**|**What to do?**|**Link with the Budget**|
|---|---|---|---|
|**_Goal 1. Eradicate extreme_**<br>**Target 1. **Halve, between 1<br>|**_poverty and hunger_**<br> 990 and2015, the proportionofpeople <br>|whoseincomeisless than$1a day<br>||
|_Indicator 1._Proportion of<br>population below the national<br>poverty line – poverty incidence<br>(%)|•<br>Reduce the incidence of poverty via<br>faster and more inclusive non-oil<br>growth|•<br>Target the poorest segments of the<br>population, boost rural incomes, and<br>stimulate private sector investment|•<br>Increase poverty spending and upgrade<br>economic infrastructure, e.g. Irrigation<br>pumps, clean water wells, construct<br>and rehabilitate rural roads<br>•<br>Target spending in agriculture to<br>develop agro-processing (e.g. canning,<br>food-drying, and juice production)<br>•<br>Target spending in livestock to<br>improve cattle quality through<br>scientific breeding, develop<br>transportation and refrigeration, and<br>increase market access for hides, milk<br>and meat sub-sectors<br>•<br>Establish economic zones (e.g. port of<br>Nouakchott)|
|**_Goal 2. Provide primary e_**|**_ducation for all_**|||
|**Target 3. **Ensure that, by2|015, childreneverywhere, boys and girls|alike, willbe able to complete afullco|urse ofprimary schooling|
|_Indicator 7._Proportion of pupils<br>starting grade 1 who reach grade<br>5|•<br>Give students the opportunity to access<br>the primary cycle and remain enrolled<br>throughout|•<br>Match the supply of education services<br>to the existing demand of parents|•<br>Construct, rehabilitate and equip 3200<br>classrooms<br>•<br>Recruit 3800 (mainly female) teachers,<br>ensure their geographical distribution<br>and set up incentives and training<br>schemes<br>•<br>Ensure that 80 percent of schools offer<br>a full primary cycle by upgrading them<br>•<br>Increase the percentage of school<br>canteens that offer free meals by 32<br>percent, in the most disadvantaged<br>zones<br>•<br>Fund teachers’ incentives and training<br>schemes and guarantee a school<br>manual for every4pupils by2010|
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|**MDG**|**Policy Objectives**|**What to do?**|**Link with the Budget**|
|---|---|---|---|
|**_Goal 3. Promote gender eq_**<br>**Target 4.**Eliminate gender|**_uality and empower women_**<br>disparityinprimary and secondary edu|cation, preferably by2005 (andinall le|vels ofeducation nolaterthan 2015)|
|_Indicator 9._Ratio of girls to boys<br>in primary, secondary (and<br>tertiary) education|•<br>Prevent poor teenage girls from<br>dropping out of school in secondary<br>and higher education|•<br>Inform the families, reduce the<br>parents’ opportunity cost, and<br>strengthen ad-hoc institutions|•<br>Finance awareness-rising campaigns to<br>encourage demand for girls’ schooling<br>•<br>Budget adequate subsidies for<br>children, notably girls in secondary<br>school, coming from the<br>disadvantaged environments<br>•<br>Establish an inter-ministry<br>arrangement for coordinating the<br>_National Strategy for the Promotion of_<br>_Women_|
|**_Goal 4. Reduce child mort_**|**_ality_**|||
|**Target 5.**Reduce by two-thi|rds, between 1990 and2015, the unde|r-fivemortalityrate||
|_Indicator 13._Under-five mortality<br>rate(per 1,000)<br>_Indicator 14._ Infant mortality rate<br>(per 1,000)|•<br>Provide access to health and nutrition<br>services to infants in the poorest<br>quintile of the population|•<br>Provide access to health and nutrition<br>services to children and their mothers,<br>in particular in rural areas|•<br>Increase budget allocations to finance<br>effectively the implementation of the<br>_National Health, Nutrition and_<br>_Sanitation Policy_<br>•<br>Construct, furnish, stock up and staff<br>90 new health unit; make operational<br>17 mobile medical teams at the<br>regional level; establish 5 inter-<br>regional medical centers, and ensure<br>adequate stock of medicines<br>•<br>Make the planned_Relief and Nutrition_<br>_Centers_operational, to coordinate food<br>deliveryin remote areas|
|**_Goal 5. Improve maternal_**|**_health_**|||
|**Target 6.**Reduce by three-q|uarters, between 1990 and2015, them|aternal mortalityratio||
|_Indicators 16._Maternal mortality<br>ratio (per 100,000 live births)|•<br>Improve the geographical coverage<br>and the quality of medical assistance|•<br>Organize information campaigns and<br>increase access to assisted-child-births<br>in rural areas|•<br>Finance awareness campaigns to<br>prevent pregnancy under unfavorable<br>condition<br>•<br>Set up a treatment system for obstetric<br>urgencies and neonatal infections, by<br>making operational 17 mobile medical<br>teams at the regional level<br>•<br>Put in place an institutional framework<br>to ensure that obstetrical urgencies and<br>post-natal infection are adequately<br>addressed,especiallyin rural areas|
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|**MDG**|**Policy Objectives**|**What to do?**|**Link with the Budget**|
|---|---|---|---|
|**_Goal 6. Combat HIV/AID_**|<br>**_S, malaria and other diseases_**|h h idili||
||•<br>Reduce the incidence of the<br>HIV/ADIS, tuberculosis and malaria<br>epidemics|•<br>Strengten te epemoogc<br>monitoring systems, ensure greater<br>availability of treatments and inform<br>onprevention||
|**Target 7.**Havehalted by20|15 and beguntoreverse the spread of|HIV/AIDS||
|_Indicator 18._HIV prevalence (%)<br>**Target 8. **Havehalted by20|15 and beguntoreverse theincidence|of malaria and other majordiseases|•<br>Provide for free certain tests and<br>medicines such as HIV/AIDS tests,<br>condoms, ART, micro-nutrients<br>•<br>Set up centers for anonymous and free<br>HIV testing, as well as services of<br>psychological and social support<br>|
|_Indicator 21._ Prevalence and<br>death rates associated with<br>malaria|||•<br>Allocate enough resources to the<br>implementation of the PNLT<br>•<br>Ensure the availability of anti-<br>tuberculosis vaccines and drugs<br>•<br>Expand the coverage of the TB short,<br>directlysupervised treatments(DOTS)|
|_Indicator 23._Prevalence and<br>death rates associated with<br>|||•<br>Subsidize free supply of insecticide-<br>treated mosquito nets in the endemic|
|tuberculosis(WHO)|||zones_._|
|**_Goal 7. Ensure environme_**|**_ntal sustainability_**|||
|**Target 10.**Halve, by2015,|the proportionofpeople without sustai|nable access to safe drinking waterand b|asic sanitation<br><br>|
|_Indicator 30._Proportion of<br>population with sustainable<br>access to an improved water<br>source, urban and rural (%)|•<br>Promote greater access to water at an<br>affordable price, notably for the<br>poorest segments of the population|•<br>Increase access to potable water and<br>sanitation services, research new water<br>sources and improve governance in the<br>sector|•<br>In urban areas, upgrade water<br>infrastructure in Nouakchott,<br>Nouadhibou, Selibaby and Kaedi<br>•<br>Pursuit the works of the A. Essaheli<br>•<br>Fund water distribution in Nouakchott<br>•<br>In rural areas, build 136 water<br>networks in centers between 500-5000<br>people, and 166 basic water<br>infrastructure in centers between 150-<br>500 people<br>•<br>Construct 145 water points<br>•<br>Rehabilitate 8000 family toilets<br>•<br>Install 1000 toilet mobile blocks|

_Source:_ Authors’ elaboration from Government’s sectoral priority action plans (GIRM 2007b).
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# **5. Conclusions**

**With current policies and financial resources, Mauritania is unlikely to reach most of the MDGs.** Poverty reduction (MDG1) is an improbable candidate, as it crucially depends on a successful interaction of sustained economic growth and the effective delivery of pro-poor programs. In primary education, reaching 100 percent retention rate (MDG2), in the light of the poor performance in recent years, seem also unlikely. Only gender equality (MDG3) is at hand. With respect to the health-related goals (MDG4-6), barring HIV/AIDS, Mauritania is also off-track. Finally, ensuring environmental sustainability (MDG7) has a low probability of being reached.

**The country, however, is not a special case** . On current trends, only Asia is on track to halve extreme poverty by 2015. Sub-Saharan Africa could miss all the MDGs, notwithstanding the remarkable growth performance of recent years. Worldwide, serious shortfalls are expected in education, health – especially for the goals of reducing child and maternal mortality – nutrition, and sanitation (World Bank 2008).<sup>17</sup> This is because the MDGs were conceived as political targets intended to mobilize international support, and were established on the basis of global, and not country–specific, trends (UNDP, 2007b).

**Still, the MDGs should become the overarching framework on which policy makers are expected to deliver** . If Mauritania wants to achieve its bold development vision, it needs to deliver on the MDGs. This paper aimed at aiding policy makers in this task. As _the delivery of additional financial resources is as essential as improvements in the overall policy and institutional framework_ , the following three key recommendations emerge:

- 1) _Mobilize additional financial resources, and spend them at the local level and in rural areas._ To bridge the existing financing gap (on aggregate and for each goal), additional resources need to be allocated to the MDGs. For the period 2008-2015, this paper estimates the total cost of reaching the MDGs at around 9 percent of non-oil GDP on average per year – and the financing gap at around 3.2 percent. These resources need to be allocated more than proportionally to the disadvantaged groups, mainly at the local level and in rural areas.<sup>18</sup>

- 2) _Introduce policy changes at the sectoral level._ Money is not the (only) answer, however: sectoral strategies need to be better aligned with the MDGs and the Government needs to improve the delivery of social services. In order to accelerate progress on the goals that are off-track, this paper recommends specific changes in domestic sectoral policies, concisely presented in Table 11.

> 17 In particular, malnutrition has been labeled the “forgotten MDG“, while being the MDG with the greatest multiplier effect: it is the largest risk factor for kids under five and the underlying cause of an estimated 3.5 million of their deaths each year. More than 20 percent of maternal deaths are traced to malnutrition (World Bank 2008).

> 18 Financial resources could be made available. The _Fifth Mauritania Consultative Group_ met on December 4-5, 2007 in Paris. Partners committed to finance Mauritania’s 2008-2010 development plan by granting US$2.104 billion in external assistance.
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- 3) _Strengthen the links between strategic objectives and budget._ To achieve 2) above, the Government needs to strengthen the links between public resources and MDG outcomes, by improving both the PRSP process and the existing public financial management instruments, and moving towards a result-based MTEF. This paper proposes ways to integrate the MDGs into the process of strategic planning and budget elaboration (Figure 16 and Table 11). The in-country review of the MDGs costing exercise should also lead to a redesign of the indicators themselves.

**The focus on the MDGs can also temper the “natural resource curse”, and increase the likelihood that reforms will be kept on track.** Mauritania is a resource-rich developing country. The country’s economy has been dependent on natural resources since the 1950s: iron ore, fisheries, and more recently oil, gold and copper. In 2006, the main exported goods were natural resources: oil (48 percent of the exports), iron ore (34 percent), fish (14 percent) and other minerals (gold, copper, 4 percent). The risk of a “natural resource curse” is substantial. Establishing a credible roadmap to achieve the MDGs (i.e.: invest resources to reduce poverty and promote human development) can mitigate the risk of reduced commitment to reform on the part of the authorities due to the easing of resource constraints.