non-communicable diseases will put an even higher burden on the already
underfunded national health systems (WHO 2018a).
2
Poor service delivery from the public sector is another major challenge, contributing to the ineffective utilization of the scarce financial resources (Ssozi and Amlani
2015). This is possibly due to the lack of competent health workers, inadequate
incentives for qualified health professionals and broader institutional constraints
(Lange and Klasen 2017). Women often do not receive adequate maternal care
due to the barriers posed by long distances to health centres, long waiting times,
inadequate health care facilities and incompetent health professionals (Mohale et al.
2017). Similarly, major obstacles for effectively dealing with epidemics such as
HIV/AIDS, and more recently Ebola, include the limited resources for the extended
duration therapies, the high cost (or even absence) of medicine, the shortage of
medical facilities and personnel, as well as the poor health literacy, social isolation
and stigma (WHO 2018a).
1.2.4 SDG 4: Quality Education
Even though no SSA country has achieved universal enrolment in primary education, more than half of the countries have achieved enrolment rates of greater than
90% (SDG Centre for Africa 2019).
3 In fact, since 2000 most SSA countries have
achieved impressive progress towards universal access to primary education, but
progress for other Education for All (EFA) goals is slow (Africa 2030 report, 2017).
Out of the 18 countries globally that are far from achieving the quantifiable EFA
goals, 10 are located in West and Central Africa, and are characterized by very low
literacy rates mostly for male students (UNESCO 2015). More than half of the
children globally that are out-of-school live in SSA, with most of them being girls
and an estimated 50% located in conflict-affected regions (UN 2015, 2019). It is
worth mentioning that despite this impressive progress in enrolment, an estimated
88% of the children (202 million) in primary and lower secondary school age in SSA
are not proficient in reading, and 84% (193 million) are not proficient in mathematics
(the highest such levels in the world) (SDG Centre for Africa 2019).
A series of challenges pose obstacles for a more significant progress in meeting
SDG4. For example, disparities in education along the lines of gender, wealth and
location (e.g. urban vs. rural areas, developed vs. underdeveloped areas) are an
unfortunate reality, and vary widely between countries and years. For instance, in
Nigeria, enrolment in basic education dropped by 8.24% in 2015, but increased by
2 For example, the prevalence of hypertension is likely to increase in SSA by 89% between 2000 and
2025, which is much higher than the 24% projected increase for the developed world in the same
time period (WHO 2018a).
3 There are large disparities between countries. For example, there is low enrolment in countries
such as Eritrea, Djibouti, Burkina Faso, Mali and Niger (less than 70%), and very high in countries
such as Malawi, Ghana and Sierra Leone (close to 100%) (SDG Centre for Africa 2019).
14
D. Juju et al.
underfunded national health systems (WHO 2018a).
2
Poor service delivery from the public sector is another major challenge, contributing to the ineffective utilization of the scarce financial resources (Ssozi and Amlani
2015). This is possibly due to the lack of competent health workers, inadequate
incentives for qualified health professionals and broader institutional constraints
(Lange and Klasen 2017). Women often do not receive adequate maternal care
due to the barriers posed by long distances to health centres, long waiting times,
inadequate health care facilities and incompetent health professionals (Mohale et al.
2017). Similarly, major obstacles for effectively dealing with epidemics such as
HIV/AIDS, and more recently Ebola, include the limited resources for the extended
duration therapies, the high cost (or even absence) of medicine, the shortage of
medical facilities and personnel, as well as the poor health literacy, social isolation
and stigma (WHO 2018a).
1.2.4 SDG 4: Quality Education
Even though no SSA country has achieved universal enrolment in primary education, more than half of the countries have achieved enrolment rates of greater than
90% (SDG Centre for Africa 2019).
3 In fact, since 2000 most SSA countries have
achieved impressive progress towards universal access to primary education, but
progress for other Education for All (EFA) goals is slow (Africa 2030 report, 2017).
Out of the 18 countries globally that are far from achieving the quantifiable EFA
goals, 10 are located in West and Central Africa, and are characterized by very low
literacy rates mostly for male students (UNESCO 2015). More than half of the
children globally that are out-of-school live in SSA, with most of them being girls
and an estimated 50% located in conflict-affected regions (UN 2015, 2019). It is
worth mentioning that despite this impressive progress in enrolment, an estimated
88% of the children (202 million) in primary and lower secondary school age in SSA
are not proficient in reading, and 84% (193 million) are not proficient in mathematics
(the highest such levels in the world) (SDG Centre for Africa 2019).
A series of challenges pose obstacles for a more significant progress in meeting
SDG4. For example, disparities in education along the lines of gender, wealth and
location (e.g. urban vs. rural areas, developed vs. underdeveloped areas) are an
unfortunate reality, and vary widely between countries and years. For instance, in
Nigeria, enrolment in basic education dropped by 8.24% in 2015, but increased by
2 For example, the prevalence of hypertension is likely to increase in SSA by 89% between 2000 and
2025, which is much higher than the 24% projected increase for the developed world in the same
time period (WHO 2018a).
3 There are large disparities between countries. For example, there is low enrolment in countries
such as Eritrea, Djibouti, Burkina Faso, Mali and Niger (less than 70%), and very high in countries
such as Malawi, Ghana and Sierra Leone (close to 100%) (SDG Centre for Africa 2019).
14
D. Juju et al.