Introduction
In 1990, the United Nations created the Millennium Development Goal to help improve the lives of people in developing countries around the World. The Millennium Development Goals consist of eight different goals that are targeting subjects that each developing struggle with. This blog was designed to share information on the progress done in Sub-Saharan Africa. There are 50 countries in Sub Saharan Africa. Each country faces different determinants of health that have hinder the ability to complete one of the MDGs. Even though the entire region was not able to succeed in meeting the MDGs, several countries were able to reach several of the goals. Many of the countries have made progress toward completing the goal and will continue to make progress in the future.
Successes and Health Improvements
MDG 1: Eradicate extreme poverty and hunger. Sub Saharan Africa made minimal improvement in decreasing the amount of people living in poverty between the years of 1990 and 2010. Concluding with a total decrease of 8.1% from 56.5% to 48.4%. There were however, several countries that made huge strides in decreasing poverty, with Gambia having the biggest decrease of 31% followed by Burkina Faso, Niger, Swaziland, Ethiopia, Uganda, and Malawi. One initiative in Ghana to make progress in MDG 1 is the World Food Program. In Ghana, one WFP they have implemented is the Purchase for Progress. The program trains farmers on how to save more of their corps that they can bring to the market to sell. The program is also training the farmers about small business practice so they can make a profit when going to market (http://www.wfp.org/countries/ghana).
MDG 2: Achieve universal primary education. Many countries in Sub Saharan Africa have prioritized to reach achieving universal education into their country. This has been done by the country's government pledging 4.9% of their GDP into country’s education program. An example of how well this has improved school enrollment is Sengel. Sengel pledged 5% of their GDP to school enrollment increasing from 44.7% in 1990 to 79.4% in 2012. This is a good example of how little investments in any country can contribute greatly to progress being made.
Sengel is not the only country to make progress in MDG 2, there are nine countries that have reported a 90% enrollment rate of their children, the countries consist of Rwanda, Zambia, Mauritius, Cabo Verde, Benin, Republic of the Congo, Cameroon, and South Africa. As a country continues to make progress through education and the other MDGs they are able to develop and adopt holistic policies and legal framework which helps mitigate their citizens economical, social, and educational needs.
MDG 3: Promote gender equality and empower women. Cao Verde, Senegal, Mauritania, the Gambia, Sierra Leone, Burkina Faso, Ghana, Nigeria, Liberia and others have all made significant progress in having gender parity in primary schools. Along with improving gender parity in primary schools, many Sub Saharan African countries have been able to increase the number of women in national parliament. Rwanda, Ethiopia, United Republic of Tanzania, Uganda, Burundi, South Africa, Seychelles, Namibia Botswana, Mozambique, Mauritius, Madagascar, Zimbabwe, Angola, Gabon, Soa Tome and Principe have all met the goal of having more than 30% of the parliament being made up of women. This goal was able to be met because of legislated and voluntary quotas that countries put into place to in order to ensure representation of women.
MDG 4: Reduce child mortality. Sub Saharan Africa’s 5 and under mortality rate is 1 in 9, which is the highest globally. The region was able to reduce the mortality rate by 44.6%, reducing from 177 deaths per 1,000 in 1990 to 98 deaths per 1,000 in 2010. This does not meet the goal of reducing child mortality by two-thirds regionally, however, individual countries have meet the goal: Liberia, Malawi, and the United Republic of Tanzania. Other countries like Cabo Verde, Eritrea, Libya, Madagascar, Mozambique, NIger, Rwanda, South Sudan, and Uganda are still on their way to meeting the goal. To improve the survival of the children, countries need to take measure to curb infant mortality, this can be done by skill care at birth and emergency obstetric care, management of preterm births, basic neonatal care, neonatal resuscitation, early identification and early antibiotics for serious infections, inpatient treatment for small and sick newborns, and prevention of mother to child transmission of HIV. Combining the factors above with health services during and post pregnancy, and health interventions at home will give the child the strongest chance to survive.
MDG 2: Achieve universal primary education. Many countries in Sub Saharan Africa have prioritized to reach achieving universal education into their country. This has been done by the country's government pledging 4.9% of their GDP into country’s education program. An example of how well this has improved school enrollment is Sengel. Sengel pledged 5% of their GDP to school enrollment increasing from 44.7% in 1990 to 79.4% in 2012. This is a good example of how little investments in any country can contribute greatly to progress being made.
Sengel is not the only country to make progress in MDG 2, there are nine countries that have reported a 90% enrollment rate of their children, the countries consist of Rwanda, Zambia, Mauritius, Cabo Verde, Benin, Republic of the Congo, Cameroon, and South Africa. As a country continues to make progress through education and the other MDGs they are able to develop and adopt holistic policies and legal framework which helps mitigate their citizens economical, social, and educational needs.
MDG 3: Promote gender equality and empower women. Cao Verde, Senegal, Mauritania, the Gambia, Sierra Leone, Burkina Faso, Ghana, Nigeria, Liberia and others have all made significant progress in having gender parity in primary schools. Along with improving gender parity in primary schools, many Sub Saharan African countries have been able to increase the number of women in national parliament. Rwanda, Ethiopia, United Republic of Tanzania, Uganda, Burundi, South Africa, Seychelles, Namibia Botswana, Mozambique, Mauritius, Madagascar, Zimbabwe, Angola, Gabon, Soa Tome and Principe have all met the goal of having more than 30% of the parliament being made up of women. This goal was able to be met because of legislated and voluntary quotas that countries put into place to in order to ensure representation of women.
MDG 4: Reduce child mortality. Sub Saharan Africa’s 5 and under mortality rate is 1 in 9, which is the highest globally. The region was able to reduce the mortality rate by 44.6%, reducing from 177 deaths per 1,000 in 1990 to 98 deaths per 1,000 in 2010. This does not meet the goal of reducing child mortality by two-thirds regionally, however, individual countries have meet the goal: Liberia, Malawi, and the United Republic of Tanzania. Other countries like Cabo Verde, Eritrea, Libya, Madagascar, Mozambique, NIger, Rwanda, South Sudan, and Uganda are still on their way to meeting the goal. To improve the survival of the children, countries need to take measure to curb infant mortality, this can be done by skill care at birth and emergency obstetric care, management of preterm births, basic neonatal care, neonatal resuscitation, early identification and early antibiotics for serious infections, inpatient treatment for small and sick newborns, and prevention of mother to child transmission of HIV. Combining the factors above with health services during and post pregnancy, and health interventions at home will give the child the strongest chance to survive.
MDG 5: The Sub Saharan Region faces many different conflicts within their countries that have caused the mortality rate to increase. Maternal mortality rate in Burundi, Chad, the Democratic Republic of the Congo, Sierra Leone, and Somalia have all reported a high rate of maternal mortality rate due to conflict happening in the country. As MDG 5 is also targeting to have deliveries be supported by Healthcare professionals, more than 80% of deliveries in Sub Saharan Africa have been done without the presence of a healthcare professional.
MDG 6: Combat HIV/AIDS, malaria, and other diseases. When looking at target 6.a. the goal is to halt and the then reverse the spread of HIV/AIDS,and so far all countries have reported downward trends in the occurrence of new infections. There are only two countries that have reported a worsening situation which is Angola and Uganda. HIV prevalence among adults in Sub-Saharan Africa had a decrease from 5.6 to 4.7 and an AIDS related deaths from 1.8 million people to 1.1 million people from 2005 to 2013 (http://www.undp.org/content/dam/rba/docs/Reports/MDG%20Report%202015_ENG.pdf). This progress has been made possible because of many different factors including improvement in testing counseling, the access to antiretroviral therapy, reduction in mother to child transmission, the increase in prevention through the education and use of condoms and treatment as prevention, and the improvement and awareness of the general knowledge of the disease.
MDG 7:Ensure environmental sustainability. The target for MDG #7 is to give people access to safe drinking water and basic sanitation, this is one of the most important deciding factors to the health of the people. When people are limited to contaminated water and no sanitation they are more likely to get sick from the environment, making target 7.C important to Sub-Saharan Africa more than other regions. Sub-Saharan Africa has made little progress in completing the targets with only having 64% of the people having access to clean drinking water, this is the second lowest amount behind the Oceania region. The region has not been able to make significant strides in accessing sanitation as there was only a 6% increase from 24% in 1990 to 30% in 2010. In the region only one country have completed the target: Cabo Verde. However there are several countries in the region that have reports to be on track: Angola, Botswana, Libya, Rwanda, and South Africa (http://www.undp.org/content/dam/rba/docs/Reports/MDG%20Report%202015_ENG.pdf). Some countries in Sub Saharan Africa have come together to achieve MDG #7, Kenya, Tanzania, and Uganda has created an initiative to develop clean water and sanitation. The initiative is call Lake Victoria Region Water and Sanitation. The initiative is designed to give the people that surround the lake region access to water that they can use, which is important because more than 50% of the people living in this region are considered poor (http://mirror.unhabitat.org/content.asp?cid=2289&catid=462&typeid=24&subMenuId=0).
MDG #8: Develop a global partnership for development. While looking at the technology aspects of MDG 8, Africa steadily continues its progress. However, there seems to be challenges with matching the growth of subscribers to communications technology to improvements in quality of service and costs. Sub-Saharan Africa contains 33 LDC's, making Africa one of the most underdeveloped countries in the world. The reason that most of the countries in Africa struggle so much with development is because they don't have enough trade value to build an economy, and without that they lack the money to build modern infrastructure. If the LDC's want to improve then they will most likely have to make business deals that will help them put money in investment. Some countries have already called for plans that would abolish trade quotas, helping the flow of money, but so far foreign neighbors have refused to buy or sell with them.
Through the years there has been a decrease in ODA due to economic growth, however the ODA's should not stop aiding the countries because the of the complex relationship of the aid being received and the economic growth that is happening in the countries.
MDG 6: Combat HIV/AIDS, malaria, and other diseases. When looking at target 6.a. the goal is to halt and the then reverse the spread of HIV/AIDS,and so far all countries have reported downward trends in the occurrence of new infections. There are only two countries that have reported a worsening situation which is Angola and Uganda. HIV prevalence among adults in Sub-Saharan Africa had a decrease from 5.6 to 4.7 and an AIDS related deaths from 1.8 million people to 1.1 million people from 2005 to 2013 (http://www.undp.org/content/dam/rba/docs/Reports/MDG%20Report%202015_ENG.pdf). This progress has been made possible because of many different factors including improvement in testing counseling, the access to antiretroviral therapy, reduction in mother to child transmission, the increase in prevention through the education and use of condoms and treatment as prevention, and the improvement and awareness of the general knowledge of the disease.
MDG 7:Ensure environmental sustainability. The target for MDG #7 is to give people access to safe drinking water and basic sanitation, this is one of the most important deciding factors to the health of the people. When people are limited to contaminated water and no sanitation they are more likely to get sick from the environment, making target 7.C important to Sub-Saharan Africa more than other regions. Sub-Saharan Africa has made little progress in completing the targets with only having 64% of the people having access to clean drinking water, this is the second lowest amount behind the Oceania region. The region has not been able to make significant strides in accessing sanitation as there was only a 6% increase from 24% in 1990 to 30% in 2010. In the region only one country have completed the target: Cabo Verde. However there are several countries in the region that have reports to be on track: Angola, Botswana, Libya, Rwanda, and South Africa (http://www.undp.org/content/dam/rba/docs/Reports/MDG%20Report%202015_ENG.pdf). Some countries in Sub Saharan Africa have come together to achieve MDG #7, Kenya, Tanzania, and Uganda has created an initiative to develop clean water and sanitation. The initiative is call Lake Victoria Region Water and Sanitation. The initiative is designed to give the people that surround the lake region access to water that they can use, which is important because more than 50% of the people living in this region are considered poor (http://mirror.unhabitat.org/content.asp?cid=2289&catid=462&typeid=24&subMenuId=0).
MDG #8: Develop a global partnership for development. While looking at the technology aspects of MDG 8, Africa steadily continues its progress. However, there seems to be challenges with matching the growth of subscribers to communications technology to improvements in quality of service and costs. Sub-Saharan Africa contains 33 LDC's, making Africa one of the most underdeveloped countries in the world. The reason that most of the countries in Africa struggle so much with development is because they don't have enough trade value to build an economy, and without that they lack the money to build modern infrastructure. If the LDC's want to improve then they will most likely have to make business deals that will help them put money in investment. Some countries have already called for plans that would abolish trade quotas, helping the flow of money, but so far foreign neighbors have refused to buy or sell with them.
Through the years there has been a decrease in ODA due to economic growth, however the ODA's should not stop aiding the countries because the of the complex relationship of the aid being received and the economic growth that is happening in the countries.
Shortcomings of MDG'
MDG 1: Many countries in Sub Saharan Africa were able to make progress toward Millennium Development Goal 1 of eradicating extreme poverty and hunger; however, several countries were not able to meet the goal due to the shock that happened in their country. Most notably was the shock of the ebola outbreak that occurred in the Liberia, Sierra Leone, and Guinea. The Ebola outbreak caused an increase of poverty and food insecurity, reversing the progress made.
When examining Target 1.C there appears to be moderate progress in Sub Saharan Africa due to the disasters and conflict that happens in the region. Many countries have made progress in this target but it doesn’t show in the regional progress due to other countries lack of progress.
MDG 2: Even though many countries have significant progress in reaching MDG 2, there are still groups that are being marginalized in receiving an education. The groups that are not receiving adequate education are girls, nomadic people, people with disabilities, and children from disadvantage and economic and ethnic groups. Even with the increase of education happening, the overall literacy rate for sub saharan africa is around 70% while other developing countries report having a literacy rate of 89.2% and developed countries having a literacy of 99.6%.
MDG 3: There is a push for political parties in Sub Saharan Africa to reform in order to support more women candidates. There is also a push to get women involved on local level politics in order to increase the number involved in national politics. Sub Saharan countries are also trying to eliminate the political violence happening toward women, which is deterring many women from becoming involved in politics.
MDG 4: Rural areas in Sub Saharan Africa were not able to make significant progress towards MDG 4 due to having limited access to health centers. As some countries in the region decreased child mortality rates, there were several countries saw that saw an increase in child mortality rates. The main cause of this was due to HIV/AIDS. The countries that were affected by increase were Botswana, Lesotho, Swaziland, and Zimbabwe.
MDG 5: The Sub Saharan Region faces many different conflicts within their countries that have caused the mortality rate to increase. Maternal mortality rate in Burundi, Chad, the Democratic Republic of the Congo, Sierra Leone, and Somalia have all reported a high rate of maternal mortality rate due to conflict happening in the country. As MDG 5 is also aiming to have deliveries be supported by Healthcare professionals, more than 80% of deliveries in Sub Saharan Africa have been done without the presence of a healthcare professional.
MDG 6: The control of Tuberculosis has been rather difficult due to the chemical changes that have happened, including the natural relationship with HIV/AIDS. Tuberculosis is harder to manage when person is also having co-infection with HIV. The disease has also become multi-drug resistance and strands of TB have become resistant on their own. The changes in Tuberculosis have caused the disease harder to treat.
MDG 7: The process of gaining access to clean water and sanitation has been slow with very few achievements. There are many different compounding factors that have caused the process to be slow. The factors that are slowing the process are the rural-urban divide, lack of infrastructure, and the poor situation of slum dwellers.
MDG 8: Millennium Development Goal 8 faced a lot of challenges on being achieved. There are 33 landlocked countries in the Sub-Saharan Region, causing difficulties in improving economic stability. The landlocked countries are forced to transit fees when transporting through countries to reach the coast. Along with the transit fees with neighboring countries, they are forced to pay tariffs causing a cost that is to high to pay for the developing countries.
When examining Target 1.C there appears to be moderate progress in Sub Saharan Africa due to the disasters and conflict that happens in the region. Many countries have made progress in this target but it doesn’t show in the regional progress due to other countries lack of progress.
MDG 2: Even though many countries have significant progress in reaching MDG 2, there are still groups that are being marginalized in receiving an education. The groups that are not receiving adequate education are girls, nomadic people, people with disabilities, and children from disadvantage and economic and ethnic groups. Even with the increase of education happening, the overall literacy rate for sub saharan africa is around 70% while other developing countries report having a literacy rate of 89.2% and developed countries having a literacy of 99.6%.
MDG 3: There is a push for political parties in Sub Saharan Africa to reform in order to support more women candidates. There is also a push to get women involved on local level politics in order to increase the number involved in national politics. Sub Saharan countries are also trying to eliminate the political violence happening toward women, which is deterring many women from becoming involved in politics.
MDG 4: Rural areas in Sub Saharan Africa were not able to make significant progress towards MDG 4 due to having limited access to health centers. As some countries in the region decreased child mortality rates, there were several countries saw that saw an increase in child mortality rates. The main cause of this was due to HIV/AIDS. The countries that were affected by increase were Botswana, Lesotho, Swaziland, and Zimbabwe.
MDG 5: The Sub Saharan Region faces many different conflicts within their countries that have caused the mortality rate to increase. Maternal mortality rate in Burundi, Chad, the Democratic Republic of the Congo, Sierra Leone, and Somalia have all reported a high rate of maternal mortality rate due to conflict happening in the country. As MDG 5 is also aiming to have deliveries be supported by Healthcare professionals, more than 80% of deliveries in Sub Saharan Africa have been done without the presence of a healthcare professional.
MDG 6: The control of Tuberculosis has been rather difficult due to the chemical changes that have happened, including the natural relationship with HIV/AIDS. Tuberculosis is harder to manage when person is also having co-infection with HIV. The disease has also become multi-drug resistance and strands of TB have become resistant on their own. The changes in Tuberculosis have caused the disease harder to treat.
MDG 7: The process of gaining access to clean water and sanitation has been slow with very few achievements. There are many different compounding factors that have caused the process to be slow. The factors that are slowing the process are the rural-urban divide, lack of infrastructure, and the poor situation of slum dwellers.
MDG 8: Millennium Development Goal 8 faced a lot of challenges on being achieved. There are 33 landlocked countries in the Sub-Saharan Region, causing difficulties in improving economic stability. The landlocked countries are forced to transit fees when transporting through countries to reach the coast. Along with the transit fees with neighboring countries, they are forced to pay tariffs causing a cost that is to high to pay for the developing countries.
Post MDG 2015
Through the Millennium Development Goals, Sub Saharan Africa has made significant progress to improve the lives of people living in the region. However not all of the goals were completed through the region and some groups did not get reach in the millennium development goals. Post 2015, the region should continue to work on the targets that were not met. The specific targets that should be met after 2015 to help benefit the health of the region are eradicating poverty and hunger, completion of primary school and further education; and access to health care for children in rural areas.
Sub Saharan Africa was not able to complete the MDG 1, which includes the eradication of poverty and hunger, because of the sets back countries faced in the last couple years with the Ebola Outbreak. As the countries were affected by ebola, many people who worked and owned farms lost their crops due to becoming sick and having to feed their children the seeds in order to feed the family. Not being able to feed or grow crops many families fell into poverty by not selling their crops and began to suffer from Malnutrition. After 2015, the countries are trying to rebuild after the effects of ebola, they are getting support from the World Bank and USAID who have donated new seeds and fertilizers to the farmers in order for the farmers to grow their crops. By doing this the farmers are able to restart their food supplies and begin their life over (http://www.worldbank.org/en/news/feature/2015/06/15/giving-new-life-to-farms-in-ebola-hit-countries).
Completion of primary school and furthering education is part of MDG 2. Sub Saharan Africa has reporting having the highest amount of enrollment during the MDGs but with the high enrollment rate there has also been a high dropout rate. A solution to this is to have continuous support from the government that can abolish school fees so students are able to continue school without being hindered. This initiative has worked in several Sub Saharan African countries, and needs to be implemented through the rest of the region.
Access to children in rural areas was an obstacle to help achieve MDG 4: reducing child mortality. Another obstacle in reducing child mortality was the spread of HIV/AIDS, causing child mortality rates to increase in several countries drastically. One solution that could help children get access to health care professional and services is to create mobile health clinics that can travel to remote areas. Mobile health clinics have already been implemented in Botswana to help give HIV testing to women in remote areas. The same mobile health clinics can be used to help children receive proper health care.
Sub Saharan Africa was not able to complete the MDG 1, which includes the eradication of poverty and hunger, because of the sets back countries faced in the last couple years with the Ebola Outbreak. As the countries were affected by ebola, many people who worked and owned farms lost their crops due to becoming sick and having to feed their children the seeds in order to feed the family. Not being able to feed or grow crops many families fell into poverty by not selling their crops and began to suffer from Malnutrition. After 2015, the countries are trying to rebuild after the effects of ebola, they are getting support from the World Bank and USAID who have donated new seeds and fertilizers to the farmers in order for the farmers to grow their crops. By doing this the farmers are able to restart their food supplies and begin their life over (http://www.worldbank.org/en/news/feature/2015/06/15/giving-new-life-to-farms-in-ebola-hit-countries).
Completion of primary school and furthering education is part of MDG 2. Sub Saharan Africa has reporting having the highest amount of enrollment during the MDGs but with the high enrollment rate there has also been a high dropout rate. A solution to this is to have continuous support from the government that can abolish school fees so students are able to continue school without being hindered. This initiative has worked in several Sub Saharan African countries, and needs to be implemented through the rest of the region.
Access to children in rural areas was an obstacle to help achieve MDG 4: reducing child mortality. Another obstacle in reducing child mortality was the spread of HIV/AIDS, causing child mortality rates to increase in several countries drastically. One solution that could help children get access to health care professional and services is to create mobile health clinics that can travel to remote areas. Mobile health clinics have already been implemented in Botswana to help give HIV testing to women in remote areas. The same mobile health clinics can be used to help children receive proper health care.
Determinants of Health
Six of the determinants of health were affected by the progress of the millennium development goals. Income and social status was affected due to Gambia reducing their poverty rates by 32%. Ethiopia also reduced poverty by 1/3rd. Reduction of the poverty rates indicates that their income levels are increasing which further improves the overall social status. By reducing poverty their health has improved because families have more money to spend on things such as health care and services, food and other essential things. Sub-Saharan Africa also had the fastest growth of ensuring all students are enrolled in primary education. Education is another determinant of health and because they have improved their education, students will also be healthier. The physical environment of Sub-Saharan Africa has also improved. They have found a solution to decreasing the risk of getting malaria by putting of mosquito nets. Sub-Saharan Africa also has the lowest rates of CO2 emissions making their air cleaner to breath and their contributions to global warming less. Finally, they have improved their access to clean drinking water by 22% and have greatly improved their sanitation habits. By improving the environment they live in they are decreasing their risk of disease which also decreases mortality rates further improving their overall health. They haven’t made much progress in increasing their health services. Consequently, this negatively affects their health because a lack of health care, lack of access to medicine, and limited health policies makes it more likely that someone will be in poor health. One way they have helped improved the genetic determinant of health is by increasing education and awareness on the transmission of HIV/AIDS. One way this disease is transmitted is from mother to child (genetically) so by educating people on how to prevent this they improve the genetic health of individuals who know they have the disease and know to not spread it genetically. Lastly, they have made some progress on gender disparities among people in Sub-Saharan Africa. Many disparities still remain but they have started a program called the School for Husbands which educates men on sexual and reproductive health. By educating men and not just the women they broaden their horizon of people that are educated on reproductive and sexual health. They have created more equality between genders by making it not just about the women when discussing reproductive health. The overall health of both genders can now be improved with having men also become educated.
Conclusion
Sub-Saharan Africa is still, in the end, a developing region. While it is making progress in most of, if not all of it’s MDGs, it still can improve. Besides progress made on MDG 2, 3, and 6 Africa has lacked in all other regions in terms of progress. Africa, like most other regions who are struggling with MDGs right now, needs to incorporate a strategy that employs a economic, environmental and social solution, something that is much easier said than done. Some major ways that this could be achieved is rural development, improving agricultural technology, providing more social protection, improving energy access, instituting markets and credit and supporting small/medium sized businesses. It won’t be a quick or easy process but it is necessary to help improve the health of the people in Sub-Saharan Africa. Malaria, Tuberculosis, unsafe water conditions and other detrimental health concerns still exist, but as long as Africa continues to work on the MDGs they will continue to see lower infant mortality rates, higher education, lower poverty rate, and other improved determinants of health.
Sources
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http://www.wfp.org/countries/ghan
http://www.undp.org/content/dam/rba/docs/Reports/MDG%20Report%202015_ENG.pdf
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http://www.worldbank.org/en/news/feature/2015/06/15/giving-new-life-to-farms-in-ebola-hit-countries
http://mirror.unhabitat.org/content.asp?cid=2289&catid=462&typeid=24&subMenuId=0
http://www.wfp.org/countries/ghan