Eritrea’s Participation at the High-Level Political Forum on Sustainable Development (Part III)

Note: This is the third article in a multi-part series reviewing Eritrea’s participation at the 2022 High-Level Political Forum and the country’s presentation of its Voluntary National Review re­port. Part III highlights some of the progress achieved on Sustain­able Development Goals 3 (good health and well-being) and 13 (climate action).

In September 2000, world lead­ers came together at the UN to adopt the Millennium Declara­tion, committing their nations to a global partnership on develop­ment and setting out a series of time-bound targets – with a dead­line of 2015 – that would become known as the Millennium De­velopment Goals (MDGs). The MDGs were succeeded by the Sustainable Development Goals (SDGs), a collection of 17 com­prehensive, closely interconnect­ed goals, further broken down into 169 targets, designed to be a, “blueprint to achieve a better and more sustainable future for all.”

Eritrea was one of the few countries that entered the SDGs period having achieved most of the health-related MDGs. (Many of those goals were achieved con­siderably earlier than the 2015 MDG target date.) Its experienc­es and achievements during the MDGs period have offered a va­riety of lessons and a foundation to drive forward with momentum.

Notwithstanding myriad chal­lenges, including external ag­gression, a difficult regional geo­political context characterized by conflict and instability, a long period under illegal, unjust sanc­tions, and a spate of hostile fi­nancial and economic restrictions and coercive measures, great strides have been achieved in several areas in recent years. Er­itrea’s achievements, particularly within its challenging context, are impressive and offer impor­tant insights for other countries operating in resource constrained environments. Below, progress for SDGs 3 and 13 is highlighted.

Eritrea’s national health pol­icy aims to maximize the health and well-being of all citizens at all ages and seeks to ensure eq­uity and access to essential health services, utilizing primary health care as a key strategy and consis­tent with universal health cov­erage (UHC) principles. Since 2016 a wide set of interventions have been implemented to ex­pand access and improve care for all, and progress is being reg­istered towards achievement of UHC. Health services are heavily subsidized, with patients required to make only nominal payments (which are wholly waived in cases of financial need). Many essential health services are pro­vided completely free of charge, while all patients with certain chronic diseases and other disor­ders are provided with free care and prescribed medications.

Accessibility, the expansion of health infrastructure, and human resource development have been areas of major focus, with the country constructing and reno­vating many health facilities, as well as considerably increasing the number of doctors and health professionals. There are now 335 health facilities distributed across the country (comprising hospitals, health centres, health stations, and clinics) – a nearly fourfold increase from 1991, while the number of doctors has been increased from 100 in 1997 to 291 by 2021. Across the same period, the number of dentists rose from 6 to 59, nurses from 625 to 1,474, assistant nurses from 1,220 to 2,918, dental thera­pists from 11 to 165, pharmacists and pharmacy technicians from 97 to 486, laboratory technicians from 99 to 517, radiologists from 28 to 132, physiotherapy techni­cians from 6 to 140, and special­ized doctors from 5 to 74.

Distribution is also being im­proved, with more health workers now serving in rural and hard-to-reach areas. Approximately 80 percent of the population lives within a 10 km radius of a health facility and 70 percent within a 5 km radius, representing major improvements from just a few de­cades ago.

Considerable progress has been made in improving reproductive, maternal, newborn, child, and adolescent health. The maternal mortality ratio dropped from 998 per 100,000 live births in 1990 to 228 in 2015, and 184 in 2019 – an overall reduction of 82 percent. The proportion of deliveries by skilled health workers has risen to 71 percent, the percentage of pregnant women attending at least one antenatal care visit has increased to 98 percent, and more mothers and newborns are now receiving postnatal care within two days of childbirth. Also, be­tween 1990 and 2020, the neo­natal mortality rate was reduced by 49 percent, from 35 deaths per 1,000 live births to 18, while the under-five mortality rate was reduced by 75 percent, from 153 to 39. The average annual rate of reduction for under-five mor­tality between 1990 and 2020 is estimated at 4.5 percent – among the fastest in the world.

At present, neonatal mortal­ity accounts for about 43 percent of under-five deaths and 60 per­cent of infant deaths, suggesting that continued reductions will be largely contingent upon further improvements in neonatal mor­tality. Importantly, plans are in place to begin providing more ho­listic and comprehensive health care for children based on inte­grated management of neonatal and childhood illnesses in com­munities and facilities around the country, as well as improving the quality of care in the peripartum period by strengthening health worker skills in early essential newborn care and scaling up ac­cess to neonatal intensive care.

Through sustained implemen­tation of high-impact interven­tions and a well-coordinated multi-sectoral approach, notable success has been achieved in halting the spread of HIV and sustaining a decline in preva­lence and incidence. From 2005 to 2020, HIV prevalence declined from 1.1 percent to 0.6 percent, while the incidence rate declined from 0.43 per 1,000 population to 0.1. Across the same period, AIDS-related deaths fell from 1,400 to 270. Importantly, HIV testing is nearly universal among pregnant women (around 95 per­cent), and the mother to child transmission rate is estimated to be 1.8 percent. Between 2003 and 2020, the percentage of pregnant women testing positive declined from 2.5 to 0.2, while positive tests dropped from 4.3 to 0.3 among those in the general popu­lation voluntarily seeking testing. These notable measures of prog­ress position Eritrea to apply for validation and ultimately certifi­cation of elimination of mother-to-child transmission of HIV.

The country is also transition­ing from pre-elimination towards elimination of malaria, and there have been major inroads against tuberculosis, hepatitis B, and ne­glected tropical diseases. Addi­tionally, tremendous strides have been made with regard to nation­al vaccination. The proportion of the target population covered by all vaccines included in the Na­tional Immunization Programme is nearly universal, with more than 95 percent of children fully immunized for their age. According to the United Nations Statistics Division, life expectan­cy at birth has shown improve­ment, rising from 49.6 years in 1990 to 65.1 in 2016 and 67.1 years in 2021.

Notable improvements are be­ing made in expanding access to safe, clean water. Through signif­icant investments and a range of interventions, nationwide access to clean water is approximately 85 percent, whereas it was 13 percent in 1991. Importantly, the rural-urban gap is steadily being bridged, with access to water in urban areas rising from 30 per­cent to 92 percent and in rural areas from 7 percent to above 70 percent.

In terms of SDG 13, Eritrea has signed and ratified a number of international climate change agreements and instruments. As well, the Ministry of Land, Water and Environment, working close­ly with other ministries, offices, and stakeholders, has prepared and submitted a range of climate change- and biodiversity-related reporting documents to interna­tional bodies. Eritrea continues to undertake climate change miti­gation and adaptation actions, focusing on the areas of energy, industry, transport, forestry, and waste.

Annual greenhouse gas emis­sions remain relatively low and there are only small fluctuations per year. In 2018, GHG emis­sions were approximately 6.396 megatons of carbon dioxide equivalent (Mt CO2 eq.), about a 20.17 percent increase from 2000 emissions and a slight de­crease of 0.37 percent from 2015 emissions. Renewable energy is being prioritized, while steps are actively being taken to improve energy efficiency and promote clean alternatives in transport, manufacturing, and household consumption. A number of proj­ects are also in place to conserve, restore, and enhance natural ar­eas, including regular nationwide afforestation campaigns involv­ing the participation of communi­ties, students, and youth groups, as well as water and soil conser­vation programs.

In order to achieve a climate-resilient future, Eritrea is work­ing towards the development of renewable energy and efficiency improvement in all sectors, par­ticularly in energy production, transmission, distribution, and consumption, as well as in trans­port, manufacturing, and house­hold energy consumption. Con­currently, an array of adaptation and mitigation efforts are also un­derway, including the expansion of irrigation schemes, and con­struction of terraces, dams, and ponds. There are plans for desali­nation of sea water for domestic and economic sectors, while de­graded land is being restored and rehabilitated. Households and communities, especially those in at-risk areas, receive support with adaptation strategies and technologies, helping to reduce vulnerability, strengthen resilien­cy, and secure livelihoods.

Eritrea is vulnerable to sev­eral natural hazards, including recurrent droughts, flooding and storms, high winds, locust swarms, and volcanic activity. National responses to and man­agement involve a comprehen­sive approach. The Ministry of Defence, along with different levels of government and ad­ministration, and various other partners work collaboratively to mobilize resources, coordinate activities, and assist communities to both prepare and recover.

Education is locally regarded as a strong foundation for sustain­able development and recognized as a critical component in build­ing a more just, peaceful society and world. Global Citizenship Education and Education for Sustainable Development and many of their core themes are mainstreamed and tightly inte­grated within different aspects of the national education system, including in national education policies and guidelines, teacher education, curricula, and student assessment.