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Eritrea and the Millennium Development Goals: Setting the Record Straight By Simon Tesfamariam I write the following

to provide some awareness in regards to Eritrea’s overall development and progress towards reaching the Millennium Development Goals by 2015. Let us begin by first considering the remarks from a 2005 UN MDG Report on Eritrea: "It is encouraging to note that Eritrea is projected to achieve eight of the ten targets by 2015. We realize, of course, that this is no cause for celebration for three reasons. First, Eritrea is off-track in two crucial areas: (1) reduction of poverty, and (2) achievement of universal primary education. Second, the general consensus is that the MDGs, even if they were to be fully achieved, represent only the minimum benchmarks rather than the culmination of full development itself. Third, the road map to 2015 is based on crucial assumptions, including the resolution of the no-peace no-war status of the border conflict, the absence of drought, the robust performance of the economy, and the successful mobilization of resources, both domestic and international, necessary for the achievement of the MDG targets." [link] Despite the UN's many concerns, Eritrea has come a long way since then. As Overseas Development Institute explains in a 2011 report: "Eritrea is one of the few countries expected to achieve the MDGs in health, in child health in particular. Infant and child mortality rates have reduced dramatically; immunization coverage has rocketed; malaria mortality and morbidity have plummeted; and HIV prevalence has almost halved in a very short period…This can be attributed to the high prioritization of health and education and a strong commitment to development among Erit We see how, with just a little training, teachers can now spot simple problems - skin and ear infections, eyesight problems - and get children help before small problems become large. We also see teachers educating children on Life Skills, peer education, girls' health, and prevention of HIV/AIDS. And we see how good education promotes good health, and good health promotes good education.reans, as well as to innovative multisectorial approaches to health…Out of necessity, Eritreans’ experience in adapting to adverse circumstances has given them the capacity to develop innovative multi-sectorial approaches to health. In addition, community involvement has enabled improved healthseeking behaviors as well as widespread buy-in." [link] What about progress in in MDG goals outside of health care? Overall, Eritrea is now on course to meet 6 out of the 8 MDGs. Even the UN Special Rapporteur on Human Rights in Eritrea, who was rejected by the Eritrean government on the basis that she was politically appointed by group opposing the government, admitted the following about Eritrea’s developmental progress:

“With regard to the Millennium Development Goals, Eritrea is reportedly poised to meet six of the eight Goals, namely Goals 2 to 7 (regarding universal primary education, the promotion of gender equality and empowerment of women, the reduction of child mortality, improvement in maternal health, combating HIV/AIDS, malaria and other diseases, and ensuring environmental sustainability). Eritrea is not on track with regard to Goals 1 (on the eradication of extreme hunger and poverty) and 8 (developing a global partnership for development).” More specifically, the country’s progress for each of the MDGs is as follows: 1. MDG1: not achieved 2. MDG2: [link] (Note: AfDB says MDG2 might not be achieved but this was back in 2009 [link]; Dr. Mismay Gebrehiwet of the Ministry of Health said, on state TV, that Eritrea is on track. [link]) 3. MDG3: [link] 4. MDG4: [link] 5. MDG5: [link], 6. MDG6: [link, link] 7. MDG7: [link, link] 8. MDG8: not enough data to assess progress The above links provided are by no means definitive. Instead they are estimates of Eritrea’s progress in respect to the preliminary data on the 8 MDGs and we must keep in mind that there is such little reporting and international awareness about the nation that more definitive assessments are often challenging. As New African Magazine aptly pointed out in a November 2011 article, “though it has gone unreported, Eritrea is a country that may meet most of the UN Millennium Development Goals (MDGs) by 2015.” Thus, much further investigating is needed by concerned individuals and international bodies. When it comes to development in this young east African nation, it doesn’t seem to limit itself to just the MDGs as the 2005 UN MDG Report rightfully warns. It looks like Eritrea took the UN’s concerns to heart and went above and beyond expectations by significantly raising the standard of living of the Eritrean people. While the overall life expectancy in Africa has actually dropped over the last 30 years, [link] Eritrea has "continued its steep rise in life expectancy. In 2009 the average was 66 years, up from 61 years in 2000 and just 36 years in 1990." [link] Imagine that: the average Eritrean only lived until 36. Considering the quick jump to 66 years, how is it that 22 year-old Eritrea, the second youngest nation in Africa, now has the highest life expectancy in continental sub-Saharan Africa? [link] Additionally, Eritrea's immunization rates are even higher than that of Australia's and its HIV prevalence is lower than that of the U.S. [link, link] How is this possible when, as recently as 2009, a Physicians for Peace report determined that Eritrea only had 5 pediatricians and 7 surgeons serving the entire nation (a population of 4.9 million). [link] Therefore the government had to be creative, efficient, and effective to meet the citizen's needs. So what did it do until it could train and acquire the doctors necessary to fill the gap? We have often heard that "necessity is the mother of

invention" and as such, Eritrea took on many innovative means of providing health care to the masses. The trick, it seems, was to do it their way and on their own terms without the all-tocommon interference of NGOs, the IMF, or other somewhat paternalistic institutions that aren't truly beholden to the Eritrean people. One example of the Eritrea's creative approach to health care has been documented in a World Bank video, One Childhood, that illustrates how multisectorial collaboration between different ministries can meet the population's health goals: http://youtu.be/19yIGjH3joE The description of the documentary on the World Bank website reads as follows: “One Childhood tells the story of how one small nation supports the development of its children throughout their childhood through the seamless linking of early child development and school health programs, delivered in even the most inaccessible communities, by a strong partnership between the education and health teams ….We see how, with just a little training, teachers can now spot simple problems - skin and ear infections, eyesight problems - and get children help before small problems become large. We also see teachers educating children on Life Skills, peer education, girls' health, and prevention of HIV/AIDS. And we see how good education promotes good health, and good health promotes good education.” We can also see tremendous progress in respect to eradicating malaria, the leading cause of death in the developing world. Since independence in 1991, Eritrea has employed unique and cost-effective approaches to reducing malaria prevalence and mortality. While most subSaharan African nations failed in their efforts to use insecticide treated nets (ITNs) to lower infection rates, Eritrea made use of those same ITNs to virtually wipe out malaria across the country. [link] Around the continent, national governments were distributing the nets but found that few of their citizens were actually using them. In Eritrea, however, they employed Africa's only national-scale ITN intervention (as of 2008) and promoted the use of free ITNs through widespread community campaigns and innovative "health facilities" that allowed them to surpass the Abuja Target for usage levels in risk areas. [link, link] One research paper reflects on the nation’s success and concludes that the "'Abuja Declaration targets for the Roll Back Malaria initiative were met on schedule because the government had set even higher targets for itself." [link] Though Eritrea is among the poorest countries in the world it has emerged as "one of the leading countries in the African Region that demonstrated that malaria can be controlled with a limited resource environment." [link] Furthermore, according to the UNICEF representative in Eritrea, “Most of the millions of children that die due to controllable diseases every year worldwide are Africans. Africa has a long way to go; and Eritrea is an example that shows through organized effort a lot could be done.” [link] So what about the whole lack of doctors issue? Well, it turns out Eritrea established the Orotta School of Medicine in 2004 and an accompanying School of Dentistry back in 2007. The problem, as the government quickly learned, was that Eritrean medical graduates had to undergo residency training outside Eritrea and would often avoid returning as a result of better

economic opportunities outside the country (in line with the Henry-Todaro model of migration). That’s why there were so few pediatricians, surgeons, and other specialists and sub-specialists. So what did the government do in response? Under the leadership of the late Health Minister, Saleh Meki, they started a partnership with George Washington University to start a postgraduate program at the medical school in 2008. [link] The plan was to provide specialty training for the few existing general practitioners and future medical school graduates. Unlike medical partnerships in many-developing nations, characterized by dependency and lasting indefinite periods, this partnership was a clean in-and-out operation that lasted just two years. [link] In the 5 year period following the establishment of the post-graduate program, the medical school trained 15 pediatricians, 5 gynecologists, and 5 surgeons, with an additional 4 residents are still under training. [link] Furthermore, the dean of the medical school explains that, "Within nine years, the Orotta School of Medicine has succeeded in training 176 doctors while the Orotta School of Dental Medicine shall graduate 24 dentists in 2014. At present, there are 311 medical and 80 dental students pursuing their education." [link] But it takes more than physicians. In this regard, the nation established health colleges and schools of associate nursing in the cities of Barentu, Ginda and Mendefera, which have trained 1,800 nurses, 2,700 associate nurses and 905 technicians. [link] Since we're on the topic of education, which is the focus of MDG2, let us assess Eritrea's progress in this respect. The Eritrean government invests a surprising “45 percent of its annual budget on schooling as one of the main tools for human resource development.” [link] On account of increased primary and secondary education Eritrea has rapidly increased literacy rates from 41% in 1991 to 80% in 2013 with a goal of reaching 85% by 2015. [link] The "Adult Education Program" has also been key to growth in literacy by providing language education in not only one but eight languages primarily found outside of the capital (imagine that!). [link] In 1991 there were only 25 centers providing literacy training but by 2011 there were more than 800, representing a growth of 3200%. [link] Literacy is largely the product of basic education but how about more? What about tertiary education and beyond? Well, following the 1998-2000 war with Ethiopia, the government produced a white paper assessing the state of healthcare in the nation and decided that it wanted to expand tertiary education. [link] The reasons for this were primarily on the basis of meeting developmental goals by training a skilled work force. Unfortunately, there was only one university for 4 million citizens so in 2003, the government opened 7 new colleges and institutes to expand higher education. [link] Instead of expanding the only university into a mega-university where knowledge is highly concentrated among a few selected elite that come from primarily urban centers, the government decided to pursue a policy of equitable access and quality of education. [link] Therefore the institutes and colleges were dispersed in all regions of the nation and situated in places that would make them most effective (eg. marine college by the sea, agricultural college in a fertile region, etc.). The government plans to expand these institutes and colleges into universities providing quaternary education as resources and conditions permit. [link] And contrary to the rumors, All education from primary to quaternary is free. Thus, in light of Eritrea's success and emerging research on tertiary education in Africa,

the African Development Fund chose to sponsor Eritrea's efforts. In a 2010 report on Eritrean higher education, they state the following: "There is now considerable evidence-based literature that a large pool of workers with tertiary education is a prerequisite for attracting foreign investment and technologicallybased industry that can transform the economic structure of a low-income economy….The project will therefore support the building of the capacity of [Eritrea’s] seven higher education institutions to produce the required skilled workforce. Furthermore, with this kind of support certain key sectors, such as agriculture and mining, will be rejuvenated to contribute to accelerated economic growth and reduction of poverty." [link] A question frequently asked by external observers is, why did the government focus on technical colleges and institutes instead of internationally accredited universities? It all has to do with the government’s national developmental plan. As important as a class on "Sexuality in Scandinavia" may be in understanding human society and the world, Eritrea is more concerned with addressing its existential crisis by meeting the basic needs of a society ravaged by war. Providing classes like "Applied Modern Irrigation Techniques" make much more sense in the near term. Institutes and technical colleges provide more of these classes because they’re focused on specialized education for industrialization that promotes self-reliance, which in turn promotes nation building—it’s all about nation building. In a 2013 report on progress in higher education in Eritrea, the Norwegian Agency for Quality Assurance in Education indicated that, “As a result of [educational] reform, the number of students in higher education institutions has increased from around 5,000 students attending classes at the University of Asmara in 2004 to approximately 17,000 students in 2012 attending higher education programs at the new colleges.” [link] That represents a growth of 340% in a span of 8 years. As the institutions of higher education continue to grow, the government plans to expand them into universities. [link] In light of Eritrea's success and emerging research on tertiary education in Africa, the African Development Fund has chosen to sponsor Eritrea's efforts. In a 2010 report on Eritrean higher education, they state the following: "Economies increasingly need a more sophisticated labor force equipped with competencies, knowledge, and workplace skills that cannot be developed only in primary school or in secondary school programs. There is now considerable evidence-based literature that a large pool of workers with tertiary education is a prerequisite for attracting foreign investment and technologically-based industry that can transform the economic structure of a low-income economy….The project will therefore support the building of the capacity of the country’s seven higher education institutions to produce the required skilled workforce. Furthermore, with this kind of support certain key sectors, such as agriculture and mining, will be rejuvenated to contribute to accelerated economic growth and reduction of poverty." [link] Thus, Eritrea has achieved major developmental advances across many sectors of society, putting it on track to meet 6 of the 8 MDGs. With Eritrea's recent economic boom, achieving

MDG1 is also in the realm of possibility. [link] Entire papers can be written on the reasons for Eritrea's recent economic successes but suffice it say that the following factors have been contributing factors in development and the alleviation of poverty (MDG1): principled focus on self-reliance, shunning of unnecessary aid packages with onerous preconditions, limiting international NGO interference, developing the domestic economy, focusing on infrastructure development via dirigist policies, conducting business via equal partnership, developing a culture of good and clean governance, developing strong national mining laws, etc. On account of my limited time, I will save writing about these topics for another time. However, the point is that Eritrea has made major gains in the last 22 years and is one of few developing countries on track to meet most, if not all, of the MDGs. To the surprise of many, it has done this in the face of Ethiopian occupation of its land, repeated attacks by Ethiopia, illegal UN sanctions, no USAID (the only country in Africa to kick them out), recurrent droughts (only country in the Horn of Africa without famine over last 3 years), hostile campaigns to isolate the country, and intermittent regional conflicts. Although major change has been taking place in the country for the last decade, some keen observers are now realizing that Eritrea is that cusp of a major changes in the near term. [link] The hope is that fellow Africans will pay attention to this underreported nation's progress. Eritrea just might be model for future African development.