Report on the Economic and Social Conditions in Southern Africa,2000

SUBREGIONAL DEVELOPMENT CENTRE FOR SOUTHERN AFRICA (ECA/SRDC-SA)

IV. SOCIAL SITUATION

Health

A proper analysis of health conditions in Southern Africa needs to take into consideration the historical, social and economic context of the sub-region. While on average Southern African citizens appear to have better access to health services than other sub-regions within the continent, there is, however, wide variation within the countries.

Generally, health conditions in Southern Africa did not improve much during the period under review. The health sector was characterized by a high outbreak of transmissible diseases. The prevalence rate of HIV/AIDS in the sub-region is estimated to be as high as one in five people, or 20 per cent, in some countries. This makes the pandemic the single largest threat to development in the sub-region. Furthermore, the generally high levels of poverty, unemployment and poor health infrastructure impact negatively on the health status of the population

Lack of access to safe drinking water and sanitation, especially during the rainy season, increases outbreaks of waterborne diseases and aggravates the already poor health conditions. Angola has the lowest percentage of population with access to safe water and sanitation in the sub-region. Those with access to safe water and sanitation was estimated at 31 and 38 per cent, respectively. On the other hand, nearly 100 per cent of the people in Mauritius had access to safe water and sanitation, followed by Zimbabwe with 77 and 66 per cent, respectively.

In order to address issues to improve the status of health in the sub-region, the SADC Council of Ministers approved the Health Policy Framework and Priority Programs in September 1998. These address five priority concerns, namely HIV/AIDS, communicable diseases, especially TB and malaria, standardization of health information system, resource mobilization and reproductive health. Furthermore, in order to improve coordination, the SADC Health Protocol was signed by the Heads of State Summit in Maputo in 1999.

Other major developments recorded in the sector during the period under review include the formulation of a multisectoral program to combat the HIV/AIDS pandemic. In this respect, a SADC HIV/AIDS Strategic Framework and Program of Action, which covers seven identified SADC Sectors, was finalized for implementation by the end of 2000.

A major challenge facing the member States remains, however, the formulation, implementation and monitoring of appropriate programs at the national level. Mobilizing resources for the programs is another challenge. In this respect, partnerships with relevant organizations including WHO, FAO, UNICEF, developed countries and international organizations involved in health related activities in the subregion should be encouraged.

The relatively higher prevalence of HIV/AIDS in Southern African countries is well documented. Globally and regionally, the Southern African countries are comparatively the most affected by the scourge. Member States in the region view it as a major development challenge of the 21st Century, which presents serious constraints to economic, social, cultural and political development of the sub-region. For example, the infection rates are 1 in 3 for Botswana, 1 in 5 for South Africa, and 1 in 4 for Zimbabwe. Based on UNAIDS figures on HIV prevalence rate among 15 to 49 years age group, Zambia for instance in 1998 was at 20 per cent, Botswana 36 per cent, Swaziland 25 per cent, Zimbabwe 25 per cent, Lesotho 24 per cent, South Africa 20 per cent, Namibia 20 per cent, and Malawi 16 per cent.

A recent survey by UNAIDS estimates a total of about 12 million people living with HIV/AIDS in 12 countries of Southern Africa at the end of 1999, out of which 6,384,000 were women, and 892,500 were children. During the same period in these countries, the cumulative number of deaths from AIDS was estimated at 973,700. The total number of AIDS related orphans reached 4,652,500 (Table 5).

TABLE 5
REPORT ON SOUTHERN AFRICA HIV/AIDS EPIDEMIC, JUNE 2000

HIV/AIDS Estimates
	1. People living with HIV/AIDS, end 1999					2. AIDS Orphans	3.AIDS deaths, 1999	4. Population 1999
Country	Adults and Children	Adults (15-49)	Adult e (%)	Women (15-49)	Children (0-14)	Orphans, cumulative	Adults and Children	Total (000)	Adult (000)
Angola	160000	150000	2.78	82000	7900	98000	15000	12497	5389
Botswana	290000	280000	35.8	150000	3000	22000	5600	5945	27330
Lesotho	240000	240000	23.57	130000	8200	3500	16000	2108	998
Malawi	800000	760000	15.96	420000	40000	390000	70000	10674	4733
Mauritius	---	500	0.08	---	---	---	---	1149	647
Mozambique	1200000	1100000	13.22	630000	520000	310000	98000	19222	8607
Namibia	160000	150000	19.54	85000	6600	67000	18000	1689	790
South Africa	4200000	4100000	19.94	2300000	95000	420000	250000	39796	20630
Swaziland	130000	1200000	25.25	67000	3800	12000	7100	981	480
Zambia	870000	830000	19.95	450000	40000	650000	99000	8974	4137
Zimbabwe	1500000	1400000	25.06	800000	56000	900000	160000	11509	5771
Total	11950000	11430500		6384000	892500	4652500	973700	197750	116144

The disproportionately high level and impact of the pandemic on women and children has also been recognized and documented. Estimated HIV prevalence among females in the age group 15-24 years is around 18 per cent, compared to 8 per cent for males. Some of the factors, which place women and the girl-child at greater risk to HIV/AIDS than men include:

It is no accident, therefore, that during the mid-decade review of Beijing + 5 organized by the Economic Commission for Africa in November 1999, HIV/AIDS pandemic was highlighted as a major hindrance in the implementation of the recommendations of the Dakar and Beijing Platforms for Action.

Since the scourge and impact of HIV/AIDS cuts across national borders and is a cross-cutting issue in the entire development sectors of society, SADC Ministers adopted the SADCHIV/AIDS Strategic Framework and Program 2000-2004, which aims at decentralizing HIV/AIDS responses to all the development sectors in SADC countries.

The African Consensus and Plan of Action: Leadership to Overcome HIV/AIDS, adopted at the African Development Forum 2000 in Addis Ababa, Ethiopia, offers hope in the fight against HIV/AIDS in Africa if implemented fully and without delay. The Consensus and Plan of Action stress the importance of leadership at personal, community, national and regional levels as key in reducing the devastating effect and impact of HIV/AIDS. It equally recognizes the importance of international partnership in reducing the disease.

It is clear that countries in the subregion have, at national level, been concerned with the loss of active people in all economic and social sectors. Many countries have developed programs and policies to deal with HIV/AIDS and others have already put in place the necessary structures to coordinate activities. Such efforts need to be strengthened. The African Consensus and Plan of Action should give impetus to accelerating the effectiveness of community, national and regional programs on HIV/AIDS.

The following action is recommended in the countries in order to improve the health status of their people:

Southern African countries recognize the importance of education as a vehicle for successfully competing in the global economy. Over the past few years, many countries adopted international conventions on educational development and undertook policy reform measures, which put emphasis on, inter-alia, universal basic education. As a result, many countries have achieved net enrolment rates (NER) of 80-100 per cent in primary education (see Table 6). However, this contrasts starkly with enrolment at both secondary and tertiary levels, which still remain significantly low, ranging from 1.5 to 53.3 per cent. In most countries, less than 50 per cent of students in primary education progress to secondary school level, while, on average, less than 1 per cent of students in secondary education progress to higher education and training. Member States, however, are making efforts in widening access to education at all levels.

In addition, member States have adopted programs to increase the enrolment rates of girls compared to boys, particularly in Malawi and Zambia. Malawi is implementing the Girls' Attainment in Basic Literary and Education (GABLE) while Zambia is implementing a Program for the Advancement of Girl Child Education (PAGE). These efforts demand more resources if they are to have a dent on improvement of the status of the girl child and women and empower them to contribute more effectively to socio-economic development.

Despite efforts to provide Education for All by the year 2000, at the dawn of the twenty first century only a few countries are close to achieving this goal. As in other African countries, deteriorating economic conditions, unsustainable debt and high population growth rates have hindered expansion and improvements in education. In addition, efforts to improve quality in the education system in Southern Africa are being undermined by a number of factors including high pupil teacher ratios, high classroom ratios, high proportion of unqualified teachers and inadequate textbooks and instruction materials. Very few countries meet the international standard of maximum 34 pupil-to- teacher ratio. This situation is even worse when only trained teachers are taken into consideration.

Further efforts to implement the SADC Protocol on Education and Training towards the attainment of universal education by 2005 are required. In Namibia, for example, government indicated that it is committed to universal education, which features compulsory primary education. Considerable progress has been made to increase enrolment in primary schools, although high dropout rates remain a major cause of concern. On the other hand, Swaziland is reported to have almost achieved access to primary education. Mozambique expects to achieve universal primary education by 2006.

Many countries have realized the need for education to reflect vocational needs to enhance employability and capacity for further training of school leavers. This is being done, for example, in Botswana, Lesotho, Swaziland and Zambia. Furthermore, during the period under review, Southern African member States continued to re-orient activities to improve education and training systems in the sub-region and an implementation plan was put in place for the operationalization of the SADC Protocol on Education and Training.

Member States, in their further efforts in improving education, should continue to pay attention to:

The four areas of action identified in Harare Program of Action of the Decade of Education in Africa - 1992-2006, which are equity and access to education; quality, relevance and effectiveness of education; complementary learning modalities; and capacity building.

Issues on education as reflected in the United Nations Special Initiative on Africa (UNSIA).

The linkages of education to employment demands with particular emphasis on vocational preparation for employment in the informal sector.

The education needs for women and the girl child as a way to empower them to play greater roles in socio-economic development.

Cost sharing and partnership in education reform programs; those who cannot afford to pay for education in cost sharing programs should be assisted through specific programs for the vulnerable groups.

The introduction of Information, Communication and Technology (ICT) training at an early stage as ICT would enhance the education and learning process essential for accelerated socio-economic development.

Migration issues in Southern Africa have their historical background to colonial history in the development of the sub-region with a strong dependence on South Africa. Thus, labor migration has had significant implications for Southern Africa member States. Labor migration attracted a lot of attention during the late 70s and led to a Conference on Migratory Labor in Southern Africa in April 1978 in Lusaka, Zambia, under the auspices of the United Nations Economic Commission for Africa. Currently the International Organization for Migration (IOM) is working with SADC on migration related issues.

Some countries in the past relied heavily on remittances from migrant workers employed in South Africa. Over time South Africa has tended to reduce their number to ensure use of South African labor. Both legal and illegal (irregular or undocumented) migration has been of concern, particularly in South Africa. According to South African Government, Ministry of Home Affairs, 96,515 undocumented/illegal migrants were deported in 1996 to different countries in the sub-region. In 1999, some 160,000 illegal immigrants were deported.

Since independence, South Africa has experienced emigration of persons with skilled labor while there has been a significant flow of skilled labor into the country from other SADC member States as well as from outside the subregion. There has also been skilled labor moving from other Southern African countries to Botswana and Namibia. Both of these countries currently consider that the levels of immigration are too high.

Gender issues related to labor migration in Southern Africa have not been given much attention. There is need to mainstream gender issues into migration, labor and employment programs.

Labor migration in Southern Africa, with special reference to South Africa, is currently raising issues of human rights of migrants who in some cases are reported not to be adequately protected according to international conventions. Some countries have not even ratified some conventions on migrant labor.

SADC formulated a draft Protocol on Free Movement of Persons within SADC in 1995. The draft was changed in 1997 into a draft Protocol on Facilitation of Movement of Persons in SADC. The revised drafts were considered by the SADC Summit in 1998 and 1999 and further refinements are still required.

In 2000, member States continued to address major employment and labor challenges facing the sub-region by making efforts to put in place appropriate economic and social policies to tackle the problem of declining employment opportunities, low levels of productivity and increased social insecurity and poverty levels. Particular attention was paid to the problem of combating child labor through the observation and implementation of new standards on the most intolerable forms of child labor.

Most of the strategies and policies to address problems of increasing unemployment levels are integral components of programs to reduce poverty in many countries in the subregion. Preparation of Poverty Reduction Strategy Papers (PRSPs) has become a condition for member States in order to access debt relief for poverty reduction programs funding. These include establishment of targets on poverty reduction. In Mozambique, for example, the Government has set a target of reducing absolute poverty level from 70 per cent in 2000 to less than 50 per cent in 2010, while in Zambia the target is to reduce poverty from 73 per cent in the late 1990s to 50 per cent by 2004.

The demographic pressure of youthful population aggravates the unemployment and poverty levels where economic and social conditions are continually getting worse. Moreover, the education system does not adequately prepare the youth that come out of the school system to find gainful employment and contribute to socio-economic development. To address this problem, the policy reforms in some countries promote micro and small-scale enterprises with special focus on self-employment of the youth, women and related retrenched workers. In Zambia, for example, a program called Technical Education, Vocational and Entrepreneurship (TEVET) is being implemented. It focuses on training and capacity building to meet the needs of the informal sector.

Lack of time series data makes it difficult to assess progress over time in the employment situation. Nevertheless, recent country reports prepared for a number of follow-up meetings to international and regional conferences provide some indications on the employment and unemployment situation in some member States. These indicate a decline in formal sector employment as a result of the economic restructuring process and constraints being experienced by most member States. In addition, member States had continued to face urban unemployment and declining wages, particularly in the public sector.

The member States in Southern Africa need to continue addressing the sensitive issues of migration, labor and employment collectively and individually towards the development of the subregion as a whole as well as benefiting the countries concerned. In doing so, there is need for member States to work towards:

Country	Total NER (%)	NER Boys (%)	NER Girls (%)	Public Expenditure on Education as % of GNP
Angola	39	49	31	…
Botswana	96	95	97	8.5
Lesotho	67	62	72	4.8
Malawi	83	83	83	…
Mauritius	99	98	99	…
Mozambique	36	40	32	…
Namibia	95	93	98	8.7
South Africa	94	95	93	7.1
Swaziland	80	79	80	6.8
Zambia	81	85	77	2.6
Zimbabwe	86	…	…	…