MILLENNIUM DEVELOPMENT GOALS IN LESOTHO

In September 2000, at a seminal event, all world leaders of the United Nations member states, including Lesotho adopted the United Nations Millennium Declaration. The Declaration sets out within a single framework the key challenges facing humanity, outlines a response to these challenges, establishes concrete measures for assessing performance through a set of inter-related goals on development, governance, peace, security and human rights. Now placed at the heart of the global agenda, these are called the Millennium Development Goals (MDGs). At the recent World Summit in September 2005, world leaders cast their re-commitment to the achievement of the MDGs by committing to stop doing business as usual.

The Government of Lesotho is committed to implementing the Millennium Declaration and to the systematic monitoring of the MDGs within the context of the National Vision and the Poverty Reduction Strategy processes. The MDGs form special core of the Government’s efforts to design and implement policies that can effectively combat poverty and promote human development. Lesotho, with the third highest adult prevalence rate of HIV in the world, HIV & AIDS has been singled out as the greatest obstacle to development as well as to achieving all the other MDGs and has thus been ranked as MDG 1.

The following are the Millennium Development Goals as adopted by the Government of Lesotho:
1. Combat HIV & AIDS
2. Eradicate Extreme Poverty
3. Achieve Universal Primary education
4. Promote Gender Equality and empower women
5. Reduce Child Mortality
6. Improve Maternal Health
7. Ensure Environment Sustainability
8. Develop a Global Partnership for Development

As part of its efforts towards integrating the MDGs into the planning process, a Needs Assessment was carried out in 2005 to estimate the financial and human resources required to meet the MDGs. The Needs Assessment for MDGs was linked to the costs associated with the implementation of the Poverty Reduction Strategy. Lesotho's prospects for achieving the MDGs.

1. COMBAT HIV & AIDS, MALARIA and OTHER DISEASES
The HIV and AIDS pandemic continues to undermine past efforts to improve the quality of life of the population. It has reduced human capital committed to productive activities and threatens prospects of sustainable human development. For Lesotho, it has been well acknowledged that the foremost caveat to attaining all eight MDGs is the scourge of HIV and AIDS. From 1986 when the first AIDS case was reported, HIV and AIDS prevalence trends at the population level have shown a steep increase. Projections established that a person who became 15 years old in 2000 has a 74% chance of becoming HIV positive by the time they reach the age of 50 (UNAIDS Global Report 2002). The concurrent patterns of recognized associated disease conditions such as TB and Sexually Transmitted Infections (STIs) have likewise contributed to the overall escalating morbidity and mortality patterns. National estimates produced

in 2005 in collaboration with UNAIDS/WHO place Lesotho as the country with the third highest adult HIV prevalence rate in the world. Since 2000, numerous sero-prevalence and behavioural surveys have substantiated that Lesotho’s HIV and AIDS epidemic is characteristic of the generalized HIV and AIDS epidemic within the Sub-Saharan African context.

Of the 320,000 HIV-infected people living in Lesotho, women and children are the adversely affected population groups. By the end of 2003 there were 170,000 women and 22,000 children living with HIV in Lesotho. Of note is that the new infections were predominantly among younger women and children who have been attributed to the common sexual partnerships between older more experienced men who are already likely to be HIV infected and the younger uninfected women. Currently, the adult prevalence rate is 23.2 percent (26 percent prevalence among women and 19 percent prevalence among men). Another daunting challenge is to ensure that the more than 100,000 young people below the age of 17, whom, by the end of 2003 had lost one or both parents, have access to quality education, health shelter as well as adequate nutrition. Above all, they are entitled to love and care as well as an opportunity to explore their potential as young people instead of shouldering the burden of being heads of households and caregivers.

2. ERADICATE EXTREME POVERTY
Both internal and external factors have had either positive or negative bearing on the country’s prospects in achieving the Goals. Lesotho’s geopolitical location within the Republic of South Africa exposes it to a multitude of economic shocks beyond its control. The surge in the price of gold between 2003 and 2004, emanating from high demand by European investors resulting from a stronger Euro against the US dollar should have gone a long way in improving incomes from migrant workers in the South African mines. The potential benefits of these increases in the international price of gold were however offset by a very strong appreciation of the rand against the dollar in the same year. The price of gold, in terms of the South African rand, actually fell during the same period as a result of this appreciation. This in turn impacted negatively on the profitability of the South African mining sector, forcing it to lay off a considerable number of workers as a cost saving measure. This, as would be expected, impacted negatively on the numbers of migrant mineworkers from Lesotho, which fell from 61,424 at the end of 2003 to 56,353 at the end of 2004, and down to 50,837 by the third quarter of 2006. These developments have had a bearing on the achievement of the Millennium Development Goals. Specifically, Lesotho’s MDG 2, which seeks to reduce by half, the proportion of people who live below the poverty line by 2015, is significantly compromised. The 24 percent unemployment rate is quite distressing, and continues to be further exacerbated by the retrenchments in the mines in South Africa. Available job opportunities in the country do not adequately meet the demand. One of the key features of the poverty situation in Lesotho is the inequality with which incomes are distributed. The poorest 10 percent of the population have command of less than one percent of the total income while the same proportion of the richest command more than 50 percent of the total income. This disparity is more pronounced in the rural-urban divide, in which urban districts have significantly higher levels of income compared to the rural districts. The level of poverty and vulnerability in rural and mountainous districts is much higher than in the urban districts.

There is also a distinct gender aspect to income poverty in Lesotho. Female-headed households are generally poor compared to the male-headed households. This is mainly a reflection of socio-cultural practices. Traditionally men are providers or breadwinners and the loss of a husband in a family setup places the household in a very precarious situation. This is particularly true for those families that largely depend on the labour and income (remittances) of the husbands.

Lesotho, along with several other countries in the Sub-region, has been going through severe food shortages in the recent past resulting in unprecedented food insecurity for a vast swath of the population. The underlying causes of hunger/food insecurity remain the same. These include poverty, continued land degradation and soil erosion, recurrent weather-related disasters (droughts, frosts) emerging consequences of the HIV and AIDS pandemic and retrenchments from South African Mines.

This chronic food insecurity has serious manifestations on the nation’s children. Twenty two percent of the children under the age of five are underweight. In addition, 17 percent are stunted and 12 percent are wasted. The proportion of children underweight has increased by more than a third from 1992 to 2002. This is an indication that Lesotho’s population is becoming more food insecure. Whilst these indicators highlight the likelihood of significant chronic food insecurity problems, they should be interpreted with a degree of caution insofar as they indicate food intake (hunger), as they also capture the influence of health and care factors.
 

3. PROMOTE GENDER EQUALITY AND EMPOWER WOMEN
The Basotho society is patrilineal and patriarchal, with the man as head of the family and the sole decision maker. However, in the past, women were de facto heads of households due to excessive male labour migration to South Africa. As a result, they were responsible for agricultural production, which was the backbone of Lesotho’s economy. Women now contribute significantly to the economy of the country, and dominate the SMMEs and the garment sectors. However, discrimination against women is still a problem and is based on Customary and Common Laws enshrined in the Constitution, under which women are considered perpetual minors under guardianship of their spouses and male relatives. Nevertheless, the Government is committed to promoting gender equality as a fundamental human right.

The majority of women in Lesotho enjoy higher rates of educational attainment and literacy rates, unlike in most other countries in Africa. However, the gap between females and males is shrinking at most levels, especially at primary level where the proportion is almost one to one (MOET; 2004). In 2004, more boys than girls enrolled into primary school, with a ratio of 101.2. However, this equilibrium might be distorted by the HIV pandemic, which has been seen to affect more women than men, especially because they bear a much larger burden in caring for the sick and the increasing numbers of orphans.

Despite the relatively high education levels of women, men dominate the overwhelming majority of political and decision-making positions. While females account for 63 per cent – almost two-third – of professional, technical and related positions in the formal sector, they still lag behind in administrative and managerial positions, accounting for only 34 per cent of all decision-making positions (BoS, 1999). Another clear indication of the limited access that women have to the most influential posts in society is the low number of women represented in the National Parliament. In 1993 the National Assembly had only 3 seats occupied by female members out of the total of 60, representing 5 per cent of the total. Since then, the situation has improved significantly. In May 2002, 14 women occupied parliamentary seats out of a total of 80 seats – or 17 per cent of all members in the National Assembly. In 2004, 18 women occupied parliamentary seats out of the total of 120 seats – 15 per cent of all members in the National Assembly. Moreover, women hold 6 out of 21 cabinet posts (albeit including 2 junior portfolios), and out of 33 members of the upper house of parliament, women occupy 12 Senate seats (approximately 36 per cent).

4. ACHIEVE UNIVERSAL PRIMARY EDUCATION
The Government of Lesotho is committed to the provision of basic and quality education to all its people. Though enrolment in primary schools had fallen since the mid-1980s, to 76 percent in 1990 and further to 51 percent in 1999, in 2000, the Government embarked on a programme of Free Primary Education (FPE), introduced gradually over a 7-year period, beginning with Standard 1. As a result, primary enrolment increased to 69 percent in 2000 and further increased to 85 percent in 2003. In support of the programme, 184 new schools have been constructed, while 1,105 new classrooms were installed. More than 1 million textbooks and other teaching materials were supplied to 1,300 schools.

The country continues to have a higher level of primary enrolment for girls than for boys. This is unique in the developing world, where it is customary that girls are discriminated against in accessing primary schooling. In Lesotho the norm has been that boys from young ages tend to herd livestock and later in life migrate to take up work in the South African mining industry. Recently, the advantage of girls over boys in primary education seems to be narrowing.
 

5. REDUCE CHILD MORTALITY
According to Lesotho’s Demographic and Health Survey (DHS) 2004, about 12.1 percent of the total population is under 5 years of age. Like in most developing countries, Lesotho’s population structure is such that there is a proportionately larger young population. The long-term development prospects of Lesotho are intrinsically linked to the health and well being of its youngest population. Therefore, reducing the mortality rate for children is a key national objective. Retrospective analysis demonstrates that before 1995, trends in early childhood morbidity and mortality were on the decline. This pattern has been largely ascribed to the adoption of the “Health for All” Primary Health Care Strategy in 1979, which resulted in the restructuring of health care delivery to prioritise essential child health programmes, such as immunisation and nutrition. Various events have been associated with the currently observed trends in rising early childhood morbidity and mortality since 1995. These include: national reforms in neighbouring South Africa which had a direct effect on the migrant Lesotho labour force that supported their families at home; droughts that affected food production; HIV and AIDS transmission from mother to child during pregnancy and the breast-feeding period. The impact of these economic, nutritional and disease-related factors on early childhood morbidity and mortality is significant. The 2003 launch of the Prevention of Mother to Child Transmission (PMTCT) initiative and the implementation of the Integrated Management of Childhood Illnesses (IMCI) are both notable interventions to reduce childhood mortality.
 

6. IMPROVE MATERNAL HEALTH
Findings from the 2004 Lesotho Demographic Survey affirmed escalating maternal mortality trends. The maternal mortality rate (MMR) of 762 per 100,000 live births estimated from the 2004 Lesotho Demographic Survey is a huge leap from 416 per 100,000 live births estimated in the 2001 Demographic survey, and is certainly significantly higher than rates in other countries within the Southern African region. Maternal mortality rates are significantly higher in rural areas as compared to urban areas. This disparity between urban and rural is plausibly linked to the limited access to health facilities and skilled personnel in rural Lesotho. Additional contributing factors to this maternal mortality pattern are related to the prevailing economic, food production and disease conditions that have similarly impacted on childhood mortality.

Apart from care for safe delivery, maternal morbidity and mortality are also closely related to services for pre-natal care and post-natal care. In 2000, 85 percent of women aged 15-49 received antenatal care from skilled personnel at least once during pregnancy. The percentage of deliveries attended by health care providers in Lesotho stood at 60 percent in 2000, compared to 50 percent in 1993. Comparatively, adolescent women are more vulnerable to pregnancy-related complications, sexually transmitted infections and unsafe abortion and are, consequently, at greater risk of dying during pregnancy or childbirth than women in the 20 and 30 age range. When considering women aged 12-19 years, 34 percent reported having sexual intercourse and 9 per cent reported having been pregnant.

To accelerate implementation of Lesotho’s MMR reduction strategies, an assessment of Emergency Obstetric Care (EmOC) was conducted in 2005 and established that there is inadequate use of health facilities for pregnant women, and that for those pregnant women who use health facilities, there is inappropriate use. Infections, abortion- related complications, and complications with labour were found to be the top causes of direct maternal deaths.

7. ENSURE ENVIRONMENT SUSTAINABILITY
The most tangible feature of Lesotho’s environmental degradation is the extensive soil erosion, with gullies (or dongas) and surface sheet erosion being wide-spread. This is not only attributable to natural factors, such as the rugged mountainous terrain, ‘erodible’ soils and erratic rainfall, but also to structural factors: overstocking and overgrazing of rangelands, poor agricultural practices, such as mono-cropping, biomass removal, and road construction in environmentally sensitive areas such as wetlands. This is exacerbated by population growth, which is putting pressure on arable land, reducing average land holdings, and increasing landlessness. Poverty is also encouraging the use of inappropriate farming methods, the removal of shrubs, as well as the use of cow dung as sources of fuel. During the 1990s, the number of formal conservation areas in Lesotho increased from two to seven, but an exceedingly small percentage of land area (0.4 percent) remains protected. In addition to these gazetted areas, Lesotho also has ‘sustainable use’ areas, which occupy 6.9 percent of total land area and include the maboella regime and Range Management Areas, which are grazing schemes designed to promote the sustainable use of rangelands.

Significant progress has been witnessed in the area of water and sanitation. In 1996, an estimated 38 percent of Lesotho’s population did not have access to safe drinking water, with most of the population located in the rural areas. These led to increased challenge in improving water coverage on scattered small and remote highlands rural communities that are, in most cases, inaccessible. During the late 1990s, there were discernible improvements in access at the national level, and by 2000 only 23 percent were without access to safe drinking water. This further improved to 21 percent in 2002. In 2000, 10 percent of the urban population had no access, compared to 26 percent of the rural population. The overall gains between 1996 and 2000 appear exclusively attributable to better coverage in rural areas. Improved rural access is predominantly the result of the introduction of community standpipes, and protected wells/ springs, to a more limited extent. In 2003 focus was on existing water systems to improve their functionality, and rehabilitation of the old system that has been overgrown by the population.

Inadequate sanitation is associated with a range of diseases, including diarrhoeal diseases and typhoid. While 77 percent of households in Lesotho lacked access to adequate sanitation in 1987, impressive progress was made by 1995, with lack of access dramatically reducing to 48 percent. The number of households gaining access to adequate sanitation had more than doubled in the intervening period. Despite these remarkable gains, a slight worsening occurred in the late 1990s.
Access to improved sanitation in urban households was almost four times the level found in rural areas in 1987. By 1995, the sanitation target for urban households had been attained and remained around the desired level, despite the downward trend in the late 1990s. Although access to sanitation improved significantly for rural households and kept pace with the rate of progress required to fulfill the 2015 target marginally, less than two-thirds of rural households remain unserviced. In an effort to address the situation, the Ministry of Natural Resources has taken the initiative to implement water programmes concurrently with sanitation programmes, starting with 3 districts in the 1990s, and subsequently in all districts in 2004. The downturn between 1995 and 2001 appears predominantly attributable to urban areas, and is a reflection of the rapidly increasing urban population and uncontrolled urban sprawl, which makes it difficult to provide essential services.
 

8. DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT
Effective progress towards the achievement of the MDGs will, to a large extent, be dependent on a flourishing international partnership. For Lesotho to develop a global partnership for development, the improvement of financial management and restructuring of government revenues and expenditures is crucial as well as adjusting to the reduced levels of revenues from Southern African Customs Union revenue pool. The Government, in collaboration with development partners, is implementing the Public Sector Improvement and Reform Programme (PSIRP), the initial phase of which will cover improvement of the financial management, decentralization process and public service reform. The programme involves bilateral and multilateral agencies. Other measures which will contribute towards the attainment of this MDG include promoting sustainable investment and trade strategies, building on current preferential arrangements; diversifying exports away from a heavy reliance on garments and promoting exports to other SADC markets and the European Union. Diversification is critical to reduce economic dependency; mobilizing additional grant resources, and strengthening effectiveness and coordination of overseas development assistance. In addition, there will be a need to strengthen strategic economic relations with South Africa, to exploit the proximity of Lesotho to the largest and most advanced economy on the African continent, harmonizing tax systems, licensing, customs procedures, and regulatory frameworks.

Tapping international best practices in key strategic areas such as: Public Private Partnerships, Information and Communication Technology, tourism development, HIV and AIDS. The Government is exploring public-private partnerships with IFC as an option of replacing the existing referral hospital (Queen Elizabeth II Hospital). This will include strengthening national capacities to provide an enabling environment for private sector growth and strengthen linkages between FDI and the local economy, to maximise backward linkages and impact on sustainable human development. Government, together with development partners are planning to set up a unit that would gather and provide relevant information about business regulations in Lesotho. Due to complex business licensing procedures, Government will shift to registration system with areas identified as outside of private business activity. With regards to linkages between SMMEs and large-scale industry, it will work with industry groups to improve small business training and work with banks to improve SMME access to credit.