Published on International Journal of Agriculture & Agribusiness
Publication Date: August, 2019
Ahmed Mohammed Abrahim
College of Business and Economics, Department of Economics, Jigjiga University
Extreme poverty remains a daily reality for more than a billion people who survive on less than the basic needed for a day to day survival. Hunger and malnutrition are almost equally pervasive also more than 800 million people have too little to meet their daily energy needs.Therefore, this study was conducted to analyze pastoral households’ poverty status, determinants that could potentially affect the households’ poverty status, and to measure the intensity of poverty in Fik district. The analysis was based on household survey data gathered from 154 randomly selected households in four Kebeles based on probability proportional to size. Descriptive statistics, like mean, standard deviation, percentage and frequency distribution. Univariate analysis such as t-test and Chi-square (X2) test, FGT and binary logit regression were used to achieve the stated objectives. The survey result shows that 55.19% of the sample households live below poverty line with poverty gap and poverty severity index of 0.104 and 0.030 respectively. The binary logit model outputs show that 7 variables were significant determinants of household poverty. These were sex of the household, age of the household head, dependency ratio, family size, education level of the household head, credit and income from milk. The results generally suggest the need to improve agricultural technologies enhancing land productivity and training of farmers on land management. The findings imply that emphasis should be given to the following issues with a view to reduce poverty prevalence in the study area. Accordingly, building basic livelihood assets, improving institutional services (credit provision), and improving the market for the surplus milk, family planning programs and gender equality could provide entry points for policy making and intervention.
Keyword: Poverty, FGT, Logit, pastoral, Fik.
The population of Ethiopia is 104,834,317 as of Saturday, September 16, 2017, based on the latest United Nations estimates, equivalent to 1.39% of the total world population, with rank of number 12 in the list of countries by population. The population density in Ethiopia is 104 per Km2. And the total land area is 999,541 Km2 (385,925 sq. miles). The rural population of the country is 83,170,696which is a 79.7% of the total population (World Meters, 2017).
Ethiopia is the second most populous country in Africa is a one-party state with a planned economy. For more than a decade before 2016, Ethiopia grew at a rate between 8% and 11% annually as one of the fastest growing countries among the 188 IMF member countries. This growth was driven by government investment in infrastructure, as well as sustained progress in the agricultural and service sectors (CIA World Fact Book, 2017).
Ethiopia has the lowest level of income-inequality in Africa and one of the lowest in the world, yet despite progress toward eliminating extreme poverty, Ethiopia remains one of the poorest countries in the world, due both to rapid population growth and a low income per capita. Changes in rainfall associated with world-wide weather patterns resulted in the worst drought in 30 years in 2015-16, creating food insecurity for millions of Ethiopians (CIA World Fact Book, 2017).
The government is currently implementing the second phase of its Second Growth and Transformation Plan (GTP II), which will run from 2015/16 to 2019/20, aims to continue improvements in physical infrastructure through public investment projects and transform the country into a manufacturing hub. The overarching goal is to turn Ethiopia into a lower-middle-income country by 2025. Growth targets are comparable to those under the previous plan, with annual average GDP growth of 11%; in line with the manufacturing strategy, the industrial sector is slated to grow by an average of 20% (World Bank, 2017).
The international development community had poverty in focus for more than a decade. In “The Millennium Assembly of the United Nations” Summit (6-8 September 2000), the International Community issued a statement pronouncing the eradication of poverty as a Priority one for the millennium development goals,specifically, it set out to halve severe poverty by the year 2015 (UN, 2017).
Extreme poverty remains a daily reality for more than a billion people who survive on less than the basic needed for a day to day survival. Hunger and malnutrition are almost equally pervasive also more than 800 million people have too little to meet their daily energy needs.In recent years, many countries in Africa have experienced extraordinary recover in economic growth(Eunice Busisa, 2011).
Poverty continues to be the main challenge in developing countries, especially in Sub-Saharan Africa (SSA). Three fourths of the poor in the developing world live in rural areas, and rural poverty remains high and persistent 51 percent in SSA-while the absolute number of poor people hasincreased since 1993 (World Bank, 2008). In fact, the burden of poverty in SSA is disproportionately borne by rural dwellers and women (UNECA, 2012).
Poverty in pastoral areas is different from the other rural households. The major roots of pastoral poverty stem from shortage of rainfall resulting water scarcity and loss of pasture, loss of land, conflict, and political marginalization (Little, McPeak, Barrett, &Kristjanson, 2008).
Generally, the determining factors of poverty are varied and complex, which needs close analysis at the grass-root level, that is, at the level of the poor pastoral households themselves. If the poor and their problems are to be identified more clearly, then they must be asked what they think and given the opportunity to express their views. Therefore, this study is expected to undertake a thorough analysis of the case among pastoral households of Fik district.
1.2 Statement of the Problem
Povertysituationis a major problem in most of the developing countries, especially in Sub-Saharan Africa. In Ethiopia, poverty have become chronic problems and significantly more widespread in rural areas than in urban (Kader H. Obsiye, 2011).
Ethiopia faced a decades of political instability and economic decline, in the late 1980s and has begun economic reform. The country is still one of the poorest countries in the world, and has an estimated 35 million people who are subjected to abject poverty; this is roughly around 44 percent of the current population. Over 12 million of these people are severely affected by food insecurity, the majority live in rural areas (Rainbow CDA, 2017).
The Somali region is a lowland region and among the poorest regions in Ethiopia that its rural population is dominated by pastoralists. A study carried out by the Ethiopian Pastoralists’ Forum Day (EPFD)in 2006 showed that the pastoral poverty that exists in these geographically semi-arid areas is described as absolute poverty characterized by lack of livestock cultivation resources, insufficiently met basic needs (food, shelter and clothes), weak social infrastructure and conflict over limited resources. Somali region is one of four regions classified as a Developing Regional State (DRS) by the Ethiopian Government. These are regions where poverty incidences are higher and social indicators lag significantly behind the national averages. In addition, the region is prone to drought, floods, disease outbreaks and inter-clan conflictsand 32.8 per cent of the population lives well below the poverty line, (UNICEF, 2016).
Pastoral livelihoods are characterized by risk and uncertainty due to fluctuating environmental conditions and occasional shocks (Scoones, 1995). Traditionally, the vagaries of the natural environment are overcome through access to and management of communal rangelands, mobility of stock, and institutions for mutual assistance. Moreover, the very features that allow pastoral production systems to work – the communal land tenure and the free mobility are often viewed as impediments to commercialization of land use, social integration, and, in a broad sense, the modernization and civilization of pastoral culture (Scott, 1998; Bonfiglioli, 1992; Baxter, 1985).
All the above mentioned poverty situations and constraints are the true highlights of rural and urban of Ethiopia, but the people in the rural areas particularly the pastoralists are dauntingly exposed to poverty which needs area focused and context specific researches to examine and investigate factors causing poverty at households and grass root level within poverty prone groups. Moreover, in Fik district contextual factors that are believed to explain the magnitudes and determining factors of poverty are not evaluated using the available methods of measurement. So far there is no such type of research conducted by the any other researcher in the study area particularly on poverty status of pastoral households. Accordingly, this study is proposed with the main aims of measuring poverty in agro pastoralist households and examining the relationship between poverty and different socio-economic characteristics of the agro-agro-pastoralist households in order to narrow the existing information gap and enhance the development actions pertaining to the betterment of the agro-pastoralists themselves.
1.3 Research Questions
This study focuses on the following key research questions.
1. What is the poverty status of the pastoral households in the sampled district study area?
2. What is the magnitude of pastoral household poverty in the study area?
3. What are the determinants of household poverty in the study area?
1.4 Objectives of the Study
The general objective of the study is to assess the determinants of poverty status of agro pastoral household of Fik district of the Ethiopian Somali Regional State.
specific objectives are:
1. To assess agro-pastoral household’s poverty status of poor and non-poor households in the study area.
2. Estimate the magnitude of agro-pastoral household’s poverty in the study area.
3. To identify determinants of agro-pastoral households poverty in the study area.
1.5 Significance of the Study
Results and findings of the study have economic and policy implication significance and expected to give detail and clear understanding of the extents and determinants of poverty among the pastoral households in the study area to help policy makers, planners and donors in the formulation of appropriate policies that aims to pastoral development, local as well as international NGOs interested in promoting pastoral development in the study area would benefit from the results and findings of the study.
1.6 Scope/ limitation of the study
It is the nature of any type of research to have some scope and limitations. So, as to the scope of this study it was conducted only in Fik district of Erer Zone in Ethiopian Somali Regional State (ESRS); the study was covered four Kebeles of the district from which a representative number of agro-pastoral households were selected. Moreover, the study has some limitations in terms of time, logistics and budget as well as lack of well-documented record.
2. LITERATURE REVIEW
2.1 Definitions, concepts and types of pastoralism
2.1.1 Definitionsand concepts of pastoralism
There has not been a consensus over the definition of pastoralism but the most dominant definition is an economic activity involving the care of herds of domesticated livestock, also notes that pastoralism is “the use of extensive grazing in rangelands for livestock production” which is widely practiced in the dry land areas of the world.Pastoralism is a livelihood strategy and a system of mobile livestock production that makes wide-ranging use of grazing lands in arid and semi-arid environment that doesn’t uphold sustainable crop cultivation (YohannesAberra and MahmmudAbdulahi, 2015).
According to Oxfam (2008) defines Pastoralism as “the finely-honed symbolic relationship between the local ecology, domesticated livestock and people in high variable conditions” and represents a form that manages the natural resources and the ecology between pasture, water, livestock and people (WISP, 2006). However, the exact definition of the term pastoralism depends on the nature of the unique pastoral societies being studied.
2.2Ethiopian Pastoral Policies and Strategies
In the Federal Democratic Republic of Ethiopia (FDRE)pastoralism is one of the fundamental socio-economic classifications in which livestock husbandry in open grazing areas characterizes the key means of survival. Ethiopia’s arid or semi-arid pastoral lands, the majority of pastoralists live in the four regional states of Somali, Afar, Oromia and Southern Nations, pastoralist areas mark Ethiopia’s border with neighboring countries(YohannesAberra and MahmmudAbdulahi, 2015).
Ethiopian government considered the area ofpastoral as areas of special problems which need special measures appropriate tolocal conditions (Solomon Desta, 2006).The 1995 constitution is the first in incorporated the issues of pastoralists for the first time in the country. It also formed a department in the Ministry of Federal Affairs which coordinates and facilitates development in pastoral areas and set up Pastoralist Affairs Standing Committee (PASC) in the parliament which oversees pastoral development activities in the country. Regional offices in charge of pastoral development have been established in regions where pastoralism is an important production system. Different from the previous two regimes the current government has attempted to incorporate pastoral development in its national development plans 2000-2004 and 2005-2009 five year plans (Mohammed Yimer, 2015).
The government set a national policy and strategies to direct development efforts in the pastoral areas of Ethiopia. It has made a stride in considering the need to develop the pastoral area and to give some development direction that triggers improvement of the livelihood of pastoralists. It also has made certain shift in the thinking of pastoral development from its predecessors.It looks like it has made a departure from its predecessors in a sense thatit is focusing more on the poor livestock holders (i.e., pastoralists) and poverty reduction than the livestock themselves (Solomon Desta, 2006).
The current Ethiopian constitution also provides pastoralists to receive fair prices for their products that would lead to improvement in their conditions of life. These are some of the articles in the constitution which specifically reflect position of the government regarding pastoralist interest. In its short-medium development policy the government admits the importance of investing in pastoralism to improve the food security situation of pastoralists. It also acknowledges the usefulness of the traditional pastoral knowledge to manage pastoral resources, however in its long term policy it advocates for sedenterization of pastoralists based on development of irrigation. There is a need for more and open dialogue among the policy makers, development facilitators, researchers, pastoral advocacy groups and the pastoral households to bring to the surface implications and appropriateness of the government long term policy of pastoral sedenterization. The government has to move and admit unambiguously that Pastoralism as a viable way of life for the environment it is being practiced as crop cultivation is in the high moisture are (Solomon Desta, 2006).
Nowadays, according to Solomon Desta, (2006) even organizations that have been operating in pastoral areashave begun to question the impact of their development interventions.More studies are revealing that pastoral systems in Ethiopia which have been functioning well for centuries and which have provided livelihood to people are becoming unstable and less reliable to sustain pastoral livelihoods. The pastoral areas are currently being characterized by increasing instability, food insecurity, decreasing income, increasingpoverty, a decline in adherence to social mores and environmental degradation. Most alarming of all is the decline in the ratio of livestock to people. The human population is increasing while the livestock population fluctuates as it is periodically affected by drought and feed shortages all these in one way or the other is possibly influence the poverty conditions of the pastoral households in the pastoral communities in general.
2.3 Poverty: Concepts, Causes, Measures and Indicators
Poverty is the inability to attain a minimum level of standard of living (World Bank, 1990). This definition considers income and expenditure per capita to be adequate yardsticks for measuring welfare. The definition is used to determine who fall below or above the minimum standard of living and classify them as poor or non-poorrespectively.
In general, poverty has a multi-dimensional facet and is not characterized only by incomestatus of households or per capita food production but also by other non-monetary socialdimensions. It is characterized by inadequate food and calorie intake and lack of access tohealth, nutrition, education, domestic water supply, and sanitation. Thus, poverty in generalcan be defined as to include all dimensions of the hardship people face in different incomeand employment categories (World Bank, 2000).
According to the most recent estimates in 2013, there are 767 million people or 10.7 percent of the world populations were estimated to be living below the International Poverty Line (IPL) of $1.90 per person per day. Since 2000 Ethiopia was one of the highest poverty rates in the world, and the country has seen a 33 percent reduction in the share population living in poverty, this progress has been underpinned by strong and sustained economic growth averaging 10.9 percent annually (World Bank, 2014).
There are two broad concepts that have emerged: that of absolute poverty and that of relative poverty:
Absolute poverty refers to the set of resources a person must acquire in order to maintain a “minimum standard of living”, whereas relative poverty is concerned with how well-off an individual is with respect to others in the same society. In theory, therefore, while an absolute poverty line is a measure that could, adjusting for price fluxes, remains stable over time, a relative poverty line is one that could be expected to shift with the overall standard of living in a given society (WDR, 2007).
Relative poverty reflects the difference in the level of living between the top and bottom strata of society (ISSER, 1993). According to MEDaC (1999), a relative poverty line is usually set at an arbitrarily selection fraction of the average income or expenditure in a country. So, the relative poor are defined as those people whose mean expenditure per annum falls below the two-third of the national average expenditure per AE; and varies with the level of average income in the country (MEDaC, 1999; FAO, 2001;GossayeAssefa, 2008).
According to the World Bank 1990,poverty has many dimensions extending beyond the low level of income. The first dimension is material deprivation (lack of opportunity), which is measured by the concept of income or consumption. The second dimension is low achievement in education and health (low capabilities). The third and the fourth dimensions of poverty are vulnerability (exposure to risk or low level of security) and voicelessness (powerlessness), respectively (World Bank, 2000). Accordingly, the World Bank defines poverty as “the inability to attain a minimal standard of living” and distinguishes it frominequality, which “refers to the relative living standards across the whole society” (World Bank, 1990). Similarly, World Book of Encyclopedia defines poverty as the lack of enough income and resources to live adequately by community standards, and it emphasizes that these standards and definitions of poverty vary according to place and time.
a. Causes of Poverty
According to the World Bank 2001, one route investigating the causes of poverty is to examine dimensions by poor people: lack of income and assets to attain basic necessities (food, shelter, clothing, and acceptable levels of health and education), sense of voicelessness and powerlessness in the institutions of state and society, and vulnerability to adverse shocks (World Development Report, 2001).
– Lack of income and assets: to identify with the determinants of poverty in all its dimensions, it helps to think in terms of people’s assets, the returns to productivity of these assets, and the volatility of returns. These assets are of several kinds: Human assets (capacity for basic labor, skills, and good health), Natural assets (land, water), Physical assets (access to infrastructure), financial assets (savings and access to credit), and Social assets (networks of contacts and reciprocal obligations that can be called on in time of need, and political influence over resources).
– Powerlessnessand voicelessness: those significantly depressed feel actually their lack of voice, power and independence. This helplessness subjects them to the rudeness, humiliation, shame, inhumane treatment, and exploitations at the hands of the institutions of state and society. Absence of the rule of law, lack of protection against violence, extortion and intimidation, and lack of civility and predictability in interactions which public officialsall these places a large burden on poor people, also international sanctions, War and violence are the primary causes of poverty.
– Vulnerability to adverse shocks: vulnerability is a regular companion of human deprivations, given the circumstances of the poor and the near-poor. Poor live and farm on marginal lands with uncertain rainfall. They are at higher risk disease such as malaria and tuberculosis. They are at risk of arbitrary arrest and ill treatment at the hands of local authorities. And they-women in particular–are at risk of being socially excluded and victims of violence and crime.
b. Measurement and determinant of Poverty
There is no a single measure of poverty and all choices have their strengths and weaknesses, thecombinations of measures yield relatively more reliable results. The measures of povertyunderlie a fundamental concept of the poverty lines.
The poverty threshold, poverty limit or poverty line is the minimum level of incomedeemed adequate in a particular country. Poverty lines are the starting point of every point of poor analysis. They are usually based on incomeand consumption data. The proportion of the population below the poverty line provides a quickindication of the scope of the problem. Poverty line is a tool for measuring acceptable levelknown as the poverty line (World Bank, 1992). It is true that there exists certain level of clearexactly what levels are for any given individual poverty lines. In most communities, whatconstitutes “poverty” goes beyond the attainment of the absolute minimum needed for survival.
Poverty line is defined individually by the society concerned according to its income distribution.Thepoverty line is a measure that separates the poor from the non-poor, those whose incomes (consumptions) fall below the line are poor and those above are non-poor. According to theWorld bank Groupin 2016the poverty line is estimated using purchasing power parity (PPP) exchange rateswhich seek to make comparable the purchasing power of US$1.90 in different countries at different times (World Bank, 2016).
Poverty line can be set in relative or absolute terms. Relative poverty refers to the position of anindividual or household compared with the average income in the community, society, group or country. That means relative poverty varies with the level of the average income.Absolute poverty refers to the position of an individual or household in relation to a poverty linewhose real value is fixed over time. An absolute poverty line is based on the cost of a minimumconsumption basket, based on food necessary for a recommended calorie intake. The povertyline is then augmented by an allowance for non-food needs, consistent with the consumption ofthe poor (World Bank, 2002).
It is important to identify the poor and desirable to measure the intensity of their poverty. Thus, the measurement of poverty involves two distinct problems: (1) specification of the poverty line, the income level below which one is considered to be poor, and (2) construction of an index to measure the intensity of poverty suffered by those whose income is below that line. Since the publication of Sen’s (1976) article on the axiomatic approach to the measurement of poverty, several indices of poverty have been developed. The indices use three poverty indicators: the percentage of poor, the aggregate poverty gap and the distribution of income among the poor.
2.4 Poverty Reduction efforts in Ethiopia
Poverty is an outcome of more than economic process. It is an outcome of economic, social, and political processes that interact with and reinforce each other in a way that can worsen or ease the deprivation poor people face every day. To attack poverty requires promoting opportunity, facilitating environment, and enhancing security-with actions at the local, national, and global levels. Making progress on all three fronts can generate the dynamics for sustainable poverty reduction (World Bank, 2001). However, actual priorities and action need to be worked out in each country’s economic, regional, structural, and cultural context-indeed, each community’s and households.
According to the World Bank report in 2015, Ethiopia is making significant gains in eradicating poverty. In the last decade, the country has reduced poverty by 33 percent, and increased life expectancy each year, to 63 years in 2011 (World Bank, 2015). In line with the IMF and World Bank guidelines, the Ethiopian Poverty Reduction Strategy Paper (PRSP) sets out the country’s comprehensive long-term plan to reduce poverty (FDRE, 2000). The preparation of the full PRSP named as Sustainable Development and Poverty Reduction Program (SDPRP) was finalized in August 2002. The program was the guiding document, the core objective of this strategy paper was to reduce poverty and ensure food security through rapid economic growth, which was expected to be achieved via free market economic system. It particularly focused on reducing rural poverty and increasing the income earning capacity of the poor through its highly publicized Agriculture Development Led Industrialization (ADLI) strategy (Tassew, 2004).
PRSP was a government driven national strategy to reduce poverty, developed in consultation with civil society and other stakeholders. More recently, the HIPC (Highly Indebted Poor Countries) initiative has been designed to deal with the debt problem. There are criteria set for a country to be eligible for services that back-up HIPC. The Bretton Woods Institutions give debt relief on condition that the resource relieved from debt is spent on poverty-oriented sectors such as health and education. The condition is in order to check whether the debt relief has been channeling to poverty reduction schemes, thus preparation of PRSP was put as conditionality for qualifying the debt relief (MoFED, 2002).
The Ethiopian PRSP, which is Sustainable Development and Poverty Reduction Program (SDPRP), has been built on four building blocks. These are ADLI, Justice and Civil Service Reform, Decentralization and Empowerment and Capacity Building. To this effect, the Ethiopian government has been taking various measures aimed at combating poverty. Among others the New Coalition for Food Security, Productive Safety net Program is usually a component or a continuation of the New Coalition. In addition, “Plan for Accelerated and Sustained Development to End Poverty” (PASDEP) spanning the five year period 2005 – 2010 were the core government’s poverty reduction strategies designed to improve the lives of the poor people, taking a holistic view putting the growth agenda at the center of its poverty reduction endeavor, and aimed to reduce the total poverty head count and food poverty from 39 and 38 percent in 2004/05 to 29 and 28 percent by 2009/10 respectively (MoFED – PASDEP, 2006).
Ethiopia formally embarked on anti-poverty reduction strategy in 2002 and the government put its objectives and policies in its poverty reduction strategy paper Ethiopia: Sustainable Development and Poverty Reduction Program- which assesses the poverty situation in the country, the sources and constraints to economic growth, and outlines measures to address them (FDRE, 2002). This was followed by a revised policy plan to accelerate and sustainable development to end poverty (PASDEP) (FDRE, 2006).
The revised policy stance recognizes the importance of non-agricultural sector in promoting overall growth and in addressing pressing poverty problems. Ethiopia undertook yet another ambitious economic plan within the framework of poverty reduction strategy. The Growth and Transformation Plan I (GTP-I) operational for 2010/11 to 2014/15 and envisaged a rapid economic growth and structural transformation with emphasis on industrial development (MoFED, 2010). The core of the strategy was to achieve an average annual real GDP growth rate of 10 to 14 percent per annum with an estimated cost ofUS$ 57 billion. The country has had no shortage of lofty and unrealistic plans in the past and yet all of them failed to address the fundamental problem of the economy(Abu GirmaMoges, 2013). And yet the government has also prepared and get approved the second GTP (GTP II) and started to implement it.
2.5 Review of Empirical Studies on Poverty
As poverty is the worst kind of social and material deprivation alleviating poverty is certainly one of the primary ways of ensuring social justice. Moreover, not only economic growth contributes to poverty alleviation, but also poverty alleviation itself is an important prerequisite for economic efficiency and growth. Economic growth does not necessarily mean poverty reduction, as far as there is unequal distribution of resources and unbalanced growth in the public and private sectors. Design of poverty reduction strategies requires however, an understanding of poverty, identifying who the poor are, the distribution, the dynamics and the causes of poverty. Designing appropriate poverty reduction strategies are important not only from cost-effectiveness considerations but also increasing their efficiency in reducing poverty .The analysis of determinants of poverty can provide meaningful insight about various poverty generating factors and the relevance of various policies, such as the feasibility of using targeting devices (Fitsum, 2003).
Stefan and Pramila Krishnan (1998) a survey in seven villages located in the regions Amhara, Oromiya and the Southern Ethiopian People’s Association. The study collected consumption, asset and income data on about 450 households,revealed that households with substantial human and physical capital, and better access to roads and town both have lower poverty levels and are more likely to become better off over a period of time. Human capital and access to roads and towns also reduce fluctuations in poverty across the seasons. The study was used in logit model and also reported that the households with better physical capital, in terms of land and oxen, had lower poverty levels and experienced larger poverty declines.
(Dercon, 1999, 2000; Mekonnen et al., 2002) the survey was conducted in 15 areas of the country with 1477 householdsshowed that household level studies in Ethiopia have identified some of the determinants of poverty; the survey used the logit model and has shown that ownership of assets such as oxen is associated with a lower chance of falling into poverty in rural areas. In rural areas, the type of crops that farmers grow such as coffee, chat, the cereal crop andteffhave a lower chance of falling into poverty. In addition, households with large household size and higher dependency ratios and households headed by females are associated with higher incidence of poverty.
On the other hand, Dercon (1999) found that access to infrastructure, education and land ownership is an important variable explaining the movement of households out of poverty.
The results also indicate that more female household heads and older people stay poor or experienced greater poverty compared to male and younger people. Dercon (2000) also revealed that there were signs of consumption poverty reduction and rapid improvement in primary enrolment rates. The results also suggest improvement in primary health care delivery.