By Kean Smith, 7 April
Originally published on the Centre for African Justice, Peace & Human Rights website, 7 April, 2021
The theme of World Health Day 2021 is “[b]uilding a fairer and healthier world”. This theme encompasses Goals 3 and 10 of the United Nations Sustainable Development Goals (UN SDGs). The United Nations Sustainable Development Goal 3 is to ensure healthy lives and promote well-being for all at all ages[i] and Goal 10 is to reduce inequality within and among countries (see infographics for these goals below).[ii] The UN SDGs that were adopted in September, 2015 by Heads of State and Government and High Representatives comprise of 17 Sustainable Goals and 169 targets which were designed to be comprehensive, far-reaching and people centred.[iii] In the remainder of this article, I will share some insights into the challenges people living in rural communities face with accessing health services and education.
Impact of very low income
All over the world, some people struggle to make ends meet with little daily income, have poorer housing conditions and education, fewer employment opportunities, experience greater gender inequality, and have little or no access to safe environments, clean water and air, food security and health services. This leads to unnecessary suffering, avoidable illness, and in some cases premature death. Ultimately these consequences of little daily income harm both our societies and economies.[iv]. For example, in 2019, “… 34% of rural schools had a basic hygiene service and 41% had no hygiene service.”[v]. The lack of such hygiene service results in increased risk of contracting and spreading viruses and bacteria that cause COVID-19, Ebola and Diarrhea.
Poverty in rural areas
While global progress in poverty reduction has been remarkable, poverty is still far from eradicated. The proportion of the global population living in extreme poverty (living below $1.90 a day in terms of the 2011 purchasing power parity) fell from 36 per cent in 1990 to 10 per cent in 2015, yet 736.7 million people still lived in extreme poverty in 2015.[vi]
Based on the international poverty line of $1.90 a day, the share of rural inhabitants in developing countries that live in extreme poverty is three times higher than the share of those living in urban areas. When considering moderate poverty, over 46 per cent of the global rural population is poor, compared with approximately 16 per cent of the global urban population.
In least developed countries, a significant majority of the poor live in rural areas. Based on national poverty lines, more than 80 per cent of the poor live in rural areas in Afghanistan, Lesotho, Madagascar, Myanmar, the Niger, Nepal and Zambia.[vii]
Challenges accessing health services
Poor people living in rural areas face greater challenges than their urban counterparts in obtaining access to health services, in particular in developing countries. Rural areas have fewer and less adequate primary care services, weaker referral systems, insufficient numbers of experienced and qualified health professionals, including doctors and nurses, poorer working conditions for public health workers, inadequate social security, deficient laboratory networks and underdeveloped intersectoral action in support of health, which together undermine the health of the rural poor.[viii]
The Ebola virus disease outbreak in western Africa highlighted how an epidemic can proliferate rapidly and pose huge problems in the absence of a strong health system capable of a rapid an integrated response. The outbreak began in Guinea in December 2013 but soon spread into neighbouring Libera and Sierra Leone. By early August 2014, Ebola was declared an international public emergency.
At the time the outbreak began, the capacity of the health systems in Guinea, Liberia and Sierra Leone was limited. Several health-system functions that are generally considered essential were not performing well and this hampered the development of a suitable and timely response to the outbreak. There were inadequate numbers of qualified health workers. Infrastructure, logistics, health information, surveillance, governance and drug supply systems were weak. The organization and management of health services was sub-optimal.
Government health expenditure was low whereas private expenditure – mostly in the form of direct out-of-pocket payments for health services – was relatively high.[ix] In 2017, only around one third to half of the global population was covered by essential health services. The proportion of the population spending more than 10 per cent of its household budget on out-of-pocket payment for health services increased continuously, from 9.4 to 12.7 per cent (927 million persons), between 2000 and 2015. This resulted in nearly 90 million persons being pushed into extreme poverty owing to out-of-pocket medical expenses.[x]
Challenges accessing education
In the past 50 years schooling has expanded dramatically. Years of schooling completed by the average adult in developing countries more than tripled between 1950 and 2021 – from 2 to 7.2 years. Previously marginalised groups, especially girls, are now much more likely to start primary school; however, the likelihood of completing school remain low in some countries. Exclusion due to poverty, gender, ethnicity, disability and location persists. In sub-Saharan Africa, poor rural girls are seven times less likely than non-poor urban boys to complete school, and less than 1 in 20 of these girls is on track to complete secondary school. Other barriers include a lack of accessible facilities and inclusive education for students with disabilities.[xi]
Sustainable Development Goal 3 infographic[xii]
Low educational attainment levels, coupled with scant opportunities to acquire job-specific skills and on-the-job training, continue to constrain job opportunities for many rural people seeking productive work.[xiii] Additionally, rural transport and roads have an important role in facilitating access to essential services, including education and health, as well as to markets and income-generating opportunities.[xiv]
In 2019, less than one half of primary and lower secondary schools in sub-Saharan Africa had access to electricity, the Internet, computers and basic handwashing facilities, key basic services and facilities necessary to ensure a safe and effective learning environment for all students.
Since last year, the closure of schools to slow the spread of COVID-19 is having an adverse impact on learning outcomes and the social and behaviourial development of children and young people. It has affected more than 90 per cent of the world’s student population, 1.5 billion children and young people. Although remote learning is provided to many students, children and young people in vulnerable and disadvantaged communities, such as those living in remote areas, in extreme poverty, fragile states and refugee camps, do not have the same access thereto. The digital divide is expected to widen existing gaps in equality with regard to education.[xv]
Conclusion
About 8 in 10 people worldwide who lack access to basic drinking water services live in rural areas, as do 7 out of 10 people lacking basic sanitation services. [xvi]
Access to adequate health services and education are necessary for the development and improvement of live in rural communities. Low income and proximity from urban areas are two factors that may lead to inadequate and poor delivery of services.
More broadly, it is the inequality of the provision of services that negatively impacts residents of rural areas. Not only do many residents earn little money and are unable to afford health services and education, these services may be limited and far distances from their homes. If we build a fairer world, then people who live in rural areas will benefit from improved services like health and education.
Sustainable Development Goal 10 infographic[xvii]
[i] United Nations Department of Economic and Social Affairs. (n.d.). United Nations Department of Economic and Social Affairs. Https://Sdgs.Un.Org/Goals/Goal3. Retrieved March 28, 2021, from https://sdgs.un.org/goals/goal3
[ii] United Nations Department of Economic and Social Affairs. (n.d.). United Nations Department of Economic and Social Affairs. Https://Sdgs.Un.Org/Goals/Goal10. Retrieved March 28, 2021, from https://sdgs.un.org/goals/goal10
[iii] United Nations Department of Economic and Social Affairs. (n.d.-a). Transforming our world: the 2030 Agenda for Sustainable Development. United Nations Department of Economic and Social Affairs Sustainable Development. Retrieved March 28, 2021, from https://sdgs.un.org/2030agenda
[iv] World Health Organization. (n.d.). World Health Day 2021. Retrieved March 26, 2021, from https://www.who.int/campaigns/world-health-day/2021
[v] World Health Organization & United Nations Children’s Fund. (2020). Progress on Drinking Water, Sanitation and Hygiene in Schools: Special Focus on COVID-19. United Nations Children’s Fund (UNICEF) and World Health Organization (WHO). https://washdata.org/sites/default/files/2020-08/jmp-2020-wash-schools.pdf
[vi] United Nations General Assembly. (2020, July). Eradicating rural poverty to implement the 2030 Agenda for Sustainable Development. https://undocs.org/A/75/189
[vii] United Nations General Assembly. (2020, July). Eradicating rural poverty to implement the 2030 Agenda for Sustainable Development. https://undocs.org/A/75/189
[viii] United Nations General Assembly. (2020, July). Eradicating rural poverty to implement the 2030 Agenda for Sustainable Development. https://undocs.org/A/75/189
[ix] Kieny, M., Evans, D. B., Schmets, G., & Kadandale, S. (2014). Health-system resilience: reflections on the Ebola crisis in western Africa. Organisation Mondiale de La Sante. https://www.who.int/bulletin/volumes/92/12/14-149278.pdf
[x] United Nations Economic and Social Council. (2020, April). Progress towards the Sustainable Development Goals. https://undocs.org/en/E/2020/57
[xi] United Nations General Assembly. (2020, July). Eradicating rural poverty to implement the 2030 Agenda for Sustainable Development. https://undocs.org/A/75/189
[xii] United Nations: Department of Economic and Social Affairs. (n.d.). Department of Economic and Social Affairs: Sustainable Development. Retrieved March 30, 2021, from https://sdgs.un.org/goals/goal3
[xiii] United Nations General Assembly. (2020, July). Eradicating rural poverty to implement the 2030 Agenda for Sustainable Development. https://undocs.org/A/75/189
[xiv] United Nations General Assembly. (2020, July). Eradicating rural poverty to implement the 2030 Agenda for Sustainable Development. https://undocs.org/A/75/189
[xv] United Nations Economic and Social Council. (2020, April). Progress towards the Sustainable Development Goals. https://undocs.org/en/E/2020/57
[xvi] United Nations General Assembly. (2020, July). Eradicating rural poverty to implement the 2030 Agenda for Sustainable Development. https://undocs.org/A/75/189
[xvii] United Nations: Department of Economic and Social Affairs. (n.d.). Department of Economic and Social Affairs: Sustainable Development. Retrieved March 30, 2021, from https://sdgs.un.org/goals/goal10