Eritrea is Africa's newest independent country, having formally
achieved its independence from Ethiopia in May 1993. Three
decades of fighting to achieve that independence have left
Eritreans with a devastated infrastructure, but a strong
commitment to rebuild their country economically and politically.
Evidence of this dedication abounds. Among Eritrea's economic
recovery goals are complete rehabilitation of the strategic port
facility at Massawa (one of very few in the region); rebuilding
the railway system; and the transition to a market economy.
Among the political goals are development of a democratic
constitution; and, one of the most delicate issues in the region,
demobilization and reintegration of ex-combatants. Eritrea is a
solid example of an emerging civil society and self-reliant
determination. U.S. assistance to Eritrea supports U.S.
interests by promoting economic recovery and growth, and
democratic governance to underpin national stability in an
historically volatile region. Eritrea's two deep water ports and
shipping lanes in the Red Sea are of strategic importance in the
Mideast and Horn of Africa regional contexts, and are principal
life lines for humanitarian assistance to the Horn region where
this past year, famine threatened 25 million people.
The Development Challenge.
Eritrea's severe poverty has been exacerbated by decades of war.
By African standards, Eritrea's health and nutrition indicators
are poor. Infant mortality is 135 deaths per 1,000 and under-
five mortality is 203 deaths per 1,000. Life expectancy is
approximately 46 years. Population growth rates of 2.7% to 3%
are high. Eritreans suffer from preventable diseases such as
malaria, diarrhea and acute respiratory infections. Compounding
these problems, health facilities are damaged or non-existent in
many areas. Most Eritreans depend on agriculture for their
survival, but Eritrea's location in the erratic Sahelian rainfall
zone makes food security a paramount concern. Food security in
Eritrea is also constrained by a lack of processing facilities
and marketing systems, and poor transportation infrastructure.
Potential for rapid rehabilitation and development in Eritrea is
high. The country was once the most industrialized in Africa and
has the legacy of a hard-working labor force and good public and
private management. Its location at the crossroad of the Middle
East and Africa is advantageous to trade. Eritreans are united
in their commitment to rebuild their country. A careful steward
of limited resources, the Government of Eritrea (GOE) is
committed to the principles of an open-market economy and has
made impressive progress in this area. Recognizing that a
healthy, productive population is its strongest resource, the GOE
has entered into partnership with USAID to strengthen the health
sector and increase access to basic health services. With USAID
assistance, the GOE is also taking steps to address two of the
most sensitive issues in the region, the transition from military
to civilian rule and the demobilization of ex-combatants and
their families.
Strategic Objectives (SOs).
USAID is focusing on the priority area of encouraging broad-based
economic growth. Increasing the use of primary health-care and
family planning is the principal initiative in support of
economic growth. Additional economic policy and capacity
building, demobilization, and refugee reintegration activities
also support broad-based economic growth. A democracy and
governance activity will begin in FY 1995. In addition, an
upcoming analysis of the food security situation will help define
a second SO in support of the achievement of food security.
ENCOURAGING BROAD-BASED ECONOMIC GROWTH ($ 7,072,802)
SO 1. Increased use of enhanced primary health-care and family
planning services ($ 3,232,802 of which $459,000 is for
Stabilizing Population Growth).
To rekindle Eritrea's economic development and promote broad-
based growth, it is essential to raise the physical well-being
and productivity of Eritrea's population. Eritrean women and
children suffer from high morbidity and mortality rates due to
preventable causes such as diarrheal diseases, malaria, acute
respiratory infections and closely-spaced pregnancies.
Contraceptive prevalence is less than 1%, and the total fertility
rate is 6.8 children per woman. Without family planning,
Eritrea's population will double in 23 years.
The existing health-care delivery system cannot address these
problems due to a dearth of trained personnel and a severely
damaged and deteriorated infrastructure. By strengthening the
core set of health-care management systems (e.g. financial
controls and planning, supervision, and training), and by
selected infrastructure improvement, effective health-care
delivery can be achieved and sustained. By improving the health
profile of its population, Eritrea strengthens its most valuable
resource and enhances its economic development.
Activities. Funds for health-care and family planning
activities were first obligated in September 1994. Therefore,
activities described below are in early stages. Improvements in
health-care delivery will be achieved by increasing availability
and access, quality, and awareness and demand. Availability of
and access to health-care will be expanded through training
health-care personnel at all levels; creating opportunities for
greater private sector participation; and infrastructure
improvements. The quality of health-care will be improved
through modernizing the training offered at health-care training
schools; developing standardized protocols for laboratory tests
and treatments; improving supervision; and upgrading
laboratories. The awareness of and demand for essential health
and family planning services will be based on improvements in the
Ministry of Health and the Family Planning Association of Eritrea
and selected health-oriented non-governmental organizations
(NGOs); community outreach programs; and targeted programs to
educate policy makers and opinion leaders about health and
population issues.
Related Activities. USAID's specialized assistance for the GOE's
demobilization efforts also supports this SO. Those ex-
combatants who served in paramedical capacities are being trained
with the aim of upgrading their skills to both meet the need for
better trained health-care personnel and to provide employment
opportunities for ex-combatants.
All public and private sector planning in Eritrea is constrained
by the almost total lack of information. Under this SO, USAID
will contribute to the information base through supporting the
development of a health information system, which includes
conducting the first nationwide demographic health and nutrition
survey.
Indicators. USAID indicators for measuring progress toward
achieving this objective are a: (1) decrease in maternal, infant
and child mortality rates; and a (2) decrease in the fertility
rate. Numerical goals will be set based on initial data to be
gathered during the first year of the program.
Feasibility and Cost-effectiveness. In order to expand the
economy, Eritrea must have a reliable pool of workers with access
to basic health-care services. Over the next five years, the
activities described under the SO will assist in the
rehabilitation of the health-care delivery system. The SO will
also support the development of cost recovery mechanisms and
increased participation of health-care
oriented NGOs and the private sector in order to augment the
resources and services of the public sector.
Progress in 1993-1994. Funds were obligated under this SO in
September 1994. Progress has been limited to logistical start-up
activities.
Donor Coordination. USAID has initiated dialogue with other
donors in the health sector and has involved a number of them,
including UNICEF, in the design of activities. Many donors are
currently shifting from ad hoc emergency assistance to
formulating development assistance programs. USAID's is the
first major health sector bilateral activity in Eritrea.
Interest shown by other donors augurs well for additional donor
investment in the sector.
Constraints. A steadily growing economy is needed for Eritrea to
meet the recurrent costs of a health-care system over the long
run. Eritrea's relatively open and diversified economy, compared
to other Sub-Saharan African countries, expanded by nearly seven
percent in 1991 and 1992. However, poor agricultural performance
slowed output growth in 1992/1993, delaying the ability of the
GOE to fully assume its recurrent cost burdens.
Cross-cutting Issues.
Economic Policy and Capacity Building ($1,500,000). The GOE is
embarking on an ambitious economic reform program, transforming
it from a state-controlled economy to one dominated by the
private sector. USAID provides technical assistance, commodities
and training in areas such as privatization, public sector
enterprise, establishment of a financial sector and transition to
a democratically elected government.
Food Security ($2,360,000 of which $2,340,000 is for Economic
Growth and $20,000 is for Protecting the Environment). Food
insecurity has been identified as perhaps the greatest challenge
facing the countries of the Greater Horn of Africa, of which
Eritrea is a member. Food insecurity is both a cause and effect
of economic and political instability in the region. The Greater
Horn of Africa Initiative (GHAI) has been undertaken to deal with
the issue of food security on a regional basis. The goal of the
GHAI will be to build an enabling environment in which the
population of the region will be able to achieve continuous food
security with diminishing donor assistance. The GOE views food
security as one of its key objectives in the agricultural sector.
USAID plans to conduct an analysis of food security in Eritrea.
Among the topics to be considered in the analysis are the
constraints to food security and the environmental impact of food
insecurity. The analysis will guide development of a second
strategic objective. This strategic objective will focus on
improvements in food security.
PROVIDING HUMANITARIAN ASSISTANCE ($4,060,000).
P.L. 480 Title II resources will continue to address food
security issues with a focus on food for work activities which
will contribute to the critical area of infrastructure
development.
BUILDING DEMOCRACY ($ 2,071,802).
In addition to the activities described above, USAID will support
democratic governance and popular participation in five areas:
developing a democratic constitution; strengthening local
government capacity to create an enabling environment for popular
participation; supporting civic education; creating the
foundations for educational public media and independent private
media; and improving the capacity of local courts to administer
justice fairly and competently.
Other Donor Resource Flows.
In 1993, the United States provided approximately 5% of all
bilateral assistance provided to Eritrea. Leading bilateral
donors are Italy, Germany, Sweden, Denmark and Norway.