Country Demographics

Abstract

Being the youngest and the fastest growing population, Africa is facing an increasing financial burden on healthcare and education expenditure. This chapter investigates the population, population growth, population density, urbanization rate, life expectancy, median age, fertility rate, gender equality, and economy of the eight sampled countries (Algeria, Côte d'Ivoire, Ghana, Kenya, Morocco, Nigeria, South Africa, and Tunisia). The aim of this chapter is to provide an overview of factors that contribute to the financial burden while influencing patients’ decisions relating to healthcare, and the performance of the healthcare system. Poverty and gender inequality in Africa negatively affect the education level, which as a result influences the healthcare system, as it constructs an obstacle for the healthcare workers to provide information to the patients, and for the patient to access preventative and medical treatments. This chapter focuses on education and gender equality in education. It investigates the school enrollment rate, drop-out age, literacy rate, and government expenditure on education.

2.1 Country Profiles

A total of eight African countries are selected as samples in this book: Algeria, Côte d’Ivoire, Ghana, Kenya, Morocco, Nigeria, South Africa, and Tunisia. Three of the countries are from North Africa, three are from West Africa, one from East Africa, and one from South Africa. The diversity in the location, culture, and economic development of the countries should provide a comprehensive profile of the African continent. North Africa has a stronger public healthcare system compared to other parts of Africa. This chapter presents the country profiles of these countries, which includes the basic demographics (life expectancy, median age, fertility rate, population distribution), economic status (GDP and GNI), gender ratio, and education system.

2.1.1 Algeria

The People’s Democratic Republic of Algeria in northern Africa has a population of 43,900,000 (World Bank, 2020) with an average life expectancy of 76.95 years (World Bank, 2020). The median age is 28.1 years (27.8 for men and 28.4 for women). The fertility rate is 2.946 (World Bank, 2020), resulting in annual population growth of 1.85% (World Bank, 2020), as shown in Fig. 2.1.

Fig. 2.1

(Data source United Nations—World Population Prospects. Map source Macrotrends)

Projected population growth in Algeria, 1960–2080

Algeria’s gross national income (GNI) per capita is $3,948.3 (World Bank 2019). Spoken languages include Arabic (official), French (lingua franca), Berber or Tamazight (official), and dialects of Kabyle Berber (Taqbaylit), Shawiya Berber (Tacawit), Mzab Berber, and Tuareg Berber (Tamahaq). The main religion is Islam (99%), with Christianity and Judaism accounting for <1% (2012 est.). The northern capital, Algiers, is the most populous city (1,977,663), followed by Boumerdas (786,499), Oran (645,984), and Tebessa (634,332) (Population Data, 2021). Most Algerians live in the northern part of the country, as the southern part is mainly a desert.

The gender ratio in Algeria fluctuates. The 2020 average was 102.10 men to 100 women, but at younger ages, there are more males than females. By age 45, the number of females surpasses that of men (Fig. 2.2).

Fig. 2.2

(Data source United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2019 Revision, Graph source Abdelkader Bouregag)

Population distribution in Algeria, by gender and age, 2019

Education in Algeria is free, starts at age six, and continues for nine consecutive years. Although mandatory, many children do not attend school, especially girls. Among girls who do attend, however, many complete secondary school and university. The government of Algeria funds a public healthcare system that is accessible and free to all Algerian citizens. This healthcare system generally favors preventative healthcare and clinics over hospitals.

2.1.2 Côte d’Ivoire

The Republic of Côte d’Ivoire is located on the southern coast of Africa along the Gulf of Guinea. It borders Guinea, Liberia, Mali, Burkina Faso, and Ghana. The population in 2020 was 26,755,519 (50.3% urban and 49.7% rural). Life expectancy is 56.6 (MICS, 2016). In 2014, Côte d’Ivoire’s General Population and Housing Census projected 6,086,255 women of childbearing age by 2018, representing an annual increase of 2.6%. The total fertility rate is 4.6 (Multiple Indicator Cluster Survey 2016), resulting in annual population growth of 2.5%. The crude birth rate per 1,000 is 35.1 (Multiple Indicator Cluster Survey 2016), and the crude death mortality rate per 1,000 is 10.2 (MICS, 2018). Its most populous city is the capital, Abidjan (4,707,404). Its least populous city is Denguélé (289,779), in northwestern Kabadougou (World Population Review, 2020). Most people in Côte d’Ivoire live in the southwestern part of the country or in the capital city.

The gender ratio of Côte d’Ivoire in 2020 was 100 males to 98 females, and the overall population skews young (Fig. 2.3).

Fig. 2.3

(Data source Banque Mondiale. Graph source Banque Mondiale)

Population distribution in Côte d’Ivoire, 2018

The education system in Côte d’Ivoire is based on the French system. It was reformed in 2015 with the introduction of universal basic education to tackle a large number of out-of-school children (about 1.45 million children in 2014) and high rates of illiteracy among adolescents and adults. Students aged 3–16 years no longer pay tuition fees for most public schools, but they still pay entrance fees and purchase their own uniforms. The basic education system extends from preschool to lower secondary school. The education system also includes private, denominational, and secular schools that operate outside the public school system.

2.1.3 Ghana

The Republic of Ghana is located in western Africa along the Gulf of Guinea, bordering Togo, Burkina Faso, and Côte d’Ivoire. It has 16 administrative regions. The official language is English. The population is 76.9% Christian, 16.4%, Muslim, and 2.6% traditional faiths (Demographic Health Survey 2014). According to the World Bank (2018), the total population is 31,072,940 (Worldometer 2020), with a life expectancy of 63.78 years (62.7 for men and 64.9 for women). The total fertility rate is 3.87, resulting in 2.2% annual population growth (World Bank 2018). The unemployment rate is 4.51% among those of working age. The GDP is US$66.98 billion. In 2017, the healthcare expenditure was approximately 3.3% of GDP or $67 per capita.

The capital of Ghana is Accra, located in the Greater Accra region, which is the second most populous in Ghana (5,055,883), followed by Ashanti region. The least populous region is the northeast.

The gender ratio of Ghana is 102.79 males to 100 females (Knoema 2020), and age distribution skews heavily toward the younger end. Men outnumber women under the age of 50, but this distribution changes with advancing age (Fig. 2.4). Ghana is currently working toward universal health coverage focusing on primary healthcare and moderate investments in other sectors, such as oncology.

Fig. 2.4

(Data source 2020 CIA World Factbook. Graph source Gilbert Gadzekpo)

Gender distribution in Ghana, by age, 2020

2.1.4 Kenya

The Republic of Kenya is located in eastern Africa along the Indian Ocean, bordering South Sudan, Ethiopia, Somalia, Uganda, and Tanzania. It is divided into 42 geographical units, referred to as counties. The official languages are English and Swahili (Kenya Law Reform Commission). The main religion is Christianity (85.5%), with only 1.8% of other religions (Index Mundi 2019). The total population is 52,573,937 with a life expectancy of 66.34 years (World Bank 2019). The total fertility rate is 3.46 births per woman (Macro Trend 2019), resulting in an annual population growth rate of 2.3% (World Bank 2019). The unemployment rate was 2.6 in 2019, which rose to 2.98 in 2020 (World Bank). GNI per capita is US$1,750 (World Bank 2019).

The capital city of Nairobi is the most populated county, with a population of 4,397,073 (Kenya 2019 Census by Kenya National Bureau of Statistics, 2019). The least populous county is Lamu, with a population of 143,920.

The gender ratio in Kenya is 98.8 males to 100 females (Statista 2019), with more males than females until about age 10, when females surpass males. The population is very young overall (Fig. 2.5).

Fig. 2.5

(Data source 2020 CIA World Factbook. Graph source Beatrice Birir)

Gender distribution in Kenya, by age

The government provides free primary and secondary education. Entrance into secondary school is granted by passing a national exam and obtaining the Kenyan Certificate of Primary Education. As a result, more than four-fifths of Kenyans are literate, which is extraordinarily high for sub-Saharan Africa.

2.1.5 Morocco

The Kingdom of Morocco in north Africa is home to 37,344,795 people (World Bank 2021). The average life expectancy is 77 years (World Bank 2019), with a total median age of 29.3 (World Bank 2018). The fertility rate is 2.42 (World Bank 2020), resulting in a population growth rate of 1.22% (World Bank, 2019). The GNI per capita is US $7,680 (World Bank 2019). Languages spoken include Arabic (official), Tamazight (official Berber language), Tachelhit, Tarifit, and French (often the language of business, government, and diplomacy). The capital of Morocco is Rabat, but the most populous city is Casablanca (3,359,818 people as of 2014). Both cities are in northwestern Morocco, further from the desert and closer to the Atlantic Ocean (Fig. 2.6).

Fig. 2.6

(Data source United Nations International Children's Emergency Fund, Graph source United Nations International Children's Emergency Fund)

Projected gender distribution of Morocco, 2015–2050

2.1.6 Nigeria

The Federal Republic of Nigeria is in western Africa on the Gulf of Guinea, bordering Niger, Chad, Cameroon, and Benin. It has 36 states plus the Federal Capital Territory. The official language is English. The population is almost equally split, 51.5% Muslim and 46.9% Christian, with 1.6% traditional faiths (Central Intelligence Agency World Factbook 2019). It is the most populous country in Africa with about 208.8 million people (Worldometer 2021), 52% of whom live in urban areas. Life expectancy is 54 years (53 for men and 55 for women).

The fertility rate is 5.4 (World Bank 2018), resulting in a population growth rate of 2.6 (Worldometer 2018). The median age is 18. The GDP is $442.98 million, and the GDP per capita is US$2,150 (International Monetary Fund 2020). GNI per capita is US$5,190 PPP, and the minimum wage is 30,000 Naira (US$78.95). In 2019, 40% of the population lived in poverty. The capital of Nigeria is Abuja, located in the Federal Capital Territory. The most populous city, however, is Lagos, as it provides more economic opportunities. The least populous is Bayelsa. Kano and Lagos are Nigeria’s most populous states. The gender ratio is 100 males to 97.24 females (2019), with more males than females at younger ages; however, by age 40, the number of women surpasses that of men (Fig. 2.7).

Fig. 2.7

(Data source 2020 CIA World Factbook. Graph source Ademola Olokun)

Gender distribution in Nigeria, by age, 2019

2.1.7 South Africa

South Africa, officially known as the Republic of South Africa, is located at the southernmost region of the African continent. The recorded population is 59,810,579 as of March 2021, with a life expectancy of 64.38 years. The fertility rate was 2.41 births per woman in 2018, resulting in annual population growth of 1.28% (World Bank, 2018). GNI per capita is US$12,670 PPP. The official languages are IsiZulu (23.16%), IsiXhosa (16.33%), Afrikaans (13.78%), English (9.80%), Sepedi (9.29%), Setswana (8.16%), Sesotho (7.76%), Xitsonga (4.59%), SiSwati (2.55%), Tshivenda (2.45%), and IsiNdebele (2.14%). The main religion is Christianity (86%), and others include 5.4% African religions (e.g. ancestral, tribal, and animist), 5.2% atheist, 1.9% Islamic, and 1.5% other (Central Intelligence Agency 2015). The most populated province is Gauteng, where 15 million people live. The Northern Cape is the least populated with 1 million people.

The gender ratio of South Africa is 97.09 males to 100 females. There are more males than females at younger ages, however, by the age of 40, the number of females bypasses that of males (Fig. 2.8).

Fig. 2.8

(Data source United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2019 Revision. Graph source Funani Mpande)

Population distribution in South Africa, 2020 estimates

2.1.8 Tunisia

The Republic of Tunisia is located in the northernmost region of the African continent. Tunisia is the 30th most populous country in Africa, with an estimated population of 11,746,695 as of 2020. Tunisians live about 77 years (World Bank, 2020). The fertility rate is 2.2 births per woman (2019), and the population growth rate is 1.06% annually.

The GNI per capita is US$10,850 PPP. Annual GDP is US$38.797 billion, and GDP per capita is US$3,317 (World Bank 2019). The poverty rate was 15.2% in 2015. Healthcare expenditure is 7.3% of GDP (World Bank 2018). The official languages are Arabic, French, and Berber. The main religion is Christianity (98%), with small numbers of people practicing Islam and Judaism. Tunisia’s most populous governorate in Tunis also serves as the capital. The least populous governorate is Tozeur.

The gender ratio is 100 males to 102 females (2020). Women slightly dominate the population with life expectancies of 79 and 75 for men (Fig. 2.9).

Fig. 2.9

(Data source National Institute of Statistics (Tunisia). Graph source Ademola Olokun)

Population in Tunisia, by age, 2020 estimates

2.2 Population and Urbanization

Africa has the fastest growing population in the world, with a 2.7% annual growth rate, which is more than twice as fast as southern Asia (1.2%) and Latin America (0.9%). Around 16.9% (1.228 billion) of the world’s population (7,633 billion) lives in Africa, and the number is expected to increase to over 1.8 billion by 2030 (Fig. 2.10).

Fig. 2.10

(Data source World Bank. Graph source The author)

Population in the eight studied African countries, 2018

Globally, the average population density is 25 people per km². Most countries studied in this report have experienced increases in population density that greatly exceed the global average, according to data collected in 2018. The below-average increase in Algeria alone, as shown in Fig. 2.11, may be due to its large desert area (Economist 2020).^{1 2} This growth, as illustrated in Fig. 2.12, can be seen as a positive sign, as increased population density can indicate urbanization, rising living standards, and better quality of life.

Fig. 2.11

(Data source World Bank. Graph source The author)

Population density in the eight studied African countries, 2018

Fig. 2.12

(Data source World Bank. Graph source The author)

Annual population growth in the eight studied African countries, 2000–2018

The age range in Africa’s population skews significantly young (Fig. 2.13).³ By 2035, its population is projected to be the youngest in the world, and the ratio of working-age individuals to non-working-age individuals will increase. Another economic advantage of a younger population, compared to many developed countries such as Japan and EU countries, is reduced healthcare concerns. However, the large share of children and young adults below age 29 means that governments will face large healthcare and education expenditures. It is thus important to prepare youths with job skills and to create jobs for people as they reach working age.

Fig. 2.13

(Data source World Bank. Graph source The author)

Average ages in the eight studied African countries, compared to the world and EU, 2018

Some countries, mostly in western and central Africa, are experiencing demographic transitions, with shifts from high birth and death rates to older and more stable populations characterized by lower birth rates and higher life expectancies. This demographic dividend process occurs when the share of working-age people increases, thus creating an economic boost. Expansion of the labor force also can increase production capacity, as well as savings and investment. However, this transition can be jeopardized if fertility rates remain high and life expectancy increases, as is the case in many sub-Saharan African countries. For example, Nigeria is on the verge of such a demographic transition. It has the highest fertility rate (5.4) and population growth rate among all countries in this report, yet its life expectancy (54.3) is the lowest. Life expectancy at birth reflects overall mortality across all age groups. It has steadily risen by 26 years, from 38 in 1950 to 64 in 2021 (Fig. 2.14). The difference in life expectancy between men and women also has widened and is expected to continue widening as deaths from HIV/AIDS decrease.

Fig. 2.14

(Data source World Bank. Graph source The author)

Life expectancy in the eight studied countries, compared to the world and EU

A subregional variation on the continent indicates that the average life expectancy for northern African countries rose by more than 50% from 1960 to 2011, compared to 10% or less in almost all southern African countries. Eastern Africa had the most rapid increase in life expectancy, whereas southern Africa experienced declines due to HIV/AIDS (Fig. 2.15).

Fig. 2.15

Life expectancies in Africa, 1950–2010, adapted from AfDBm (2011)

2.3 Fertility Rate and Gender

Fertility rate refers to the number of children born to each woman if she lives to the end of her childbearing years. If the fertility rate reaches 2.1, the replacement level, the population will exactly replace itself from one generation to the next. The global fertility rate is 2.4. In 2018, the EU average fertility rate was 1.6. All eight countries in this study have a fertility rate that exceeds the replacement rate, and five exceed the global average. Fertility rates often decreases as urbanization and income increases and child mortality decreases.⁴ Developed countries tend to have lower fertility rates but much higher life expectancies.

The fertility rate may indicate the gender equality of a country. Historically, husbands make decisions for their families in most traditional African societies, and wives care for the children. The burden of fertility thus falls almost exclusively on women. In Nigeria, for example, women tend to have many children to prevent their husbands from divorcing them. High fertility rates in these countries become closely tied to women’s low societal status.⁵ Reducing the fertility rate could be interpreted as an increase in gender equality because it would indicate that women are less restricted by their domestic roles as housewives and mothers and are gaining autonomy.

Women’s autonomy is significant to the healthcare system. Being viewed as an individual, rather than solely as a mother, gives women a better chance at education and job training, more control over their own bodies, and the power to make fertility-related decisions. Women also would be more likely to seek healthcare, such as breast and cervical cancer screening and HIV treatment, and to increase their physical activity level, which would in turn reduce fertility and maternal mortality rates (Fig. 2.16).

Fig. 2.16

(Data source World Bank. Graph source The author)

Fertility rates in Africa, 2018

2.4 Economy

The healthcare system in the African region is weak compared to many developed countries. It is underfunded, overstretched, and understaffed. The underlying reason for the current poor state of health is the failure to alleviate extreme poverty.⁶ Overseas aid and debt relief are not sufficient to address core issues in the African healthcare system. Most of this aid goes to general budget support and is lost to inefficiencies in the system. For example, relief funds aimed at healthcare are spent on expensive tertiary hospitals that do not reach most people seeking medical help. Diseases like HIV/AIDS rely heavily on primary care rather than tertiary care. Furthermore, foreign aid from traditional international donors to Africa is declining. Therefore, African countries will need to shift their focus to greater domestic ownership of health systems and the involvement of new international aid players.

According to Health in Africa over the Next 50 Years, published by the African Development Bank Group in 2013, even though the overall wealth of Africa has increased, the poorest sectors of the population remain out of reach of the healthcare system due to governance and income inequality. Weak institutions make some governments vulnerable to corruption and conflict. Thus, although the poverty level has declined from 9% since 1995, 47% of Africa's population (excluding northern Africa) still earns $1.25 or less a day.

All eight countries studied in this report had an annual GDP lower than the average annual GDP of low-income countries in 2018. However, all had a higher GDP per capita than the average low-income country, especially South Africa (Figs. 2.17 and 2.18). For example, the local currency in Ghana has consistently depreciated (GHC 5.74 to US$1), and it has experienced relatively low economic growth (1.6% increase between 2018 and 2019). Increased public debt and government expenditures continue to generate negative fiscal and trade balances.

Fig. 2.17

(Data source World Bank. Graph source The author)

GDP (USD) in the eight studied countries, 2018 estimates

Fig. 2.18

(Data source World Bank. Graph source The author)

GDP per capita in the eight studied countries

2.5 Education and Gender

Education and healthcare have a bidirectional relationship, each playing an important and direct role in the other. Higher education typically leads to higher income, which means more options for investing in healthcare, more knowledge about medicine, greater self-awareness and emotional regulation, and better physical fitness. Lack of education in developing countries can lead to poor health, unequal gender roles, child labor, poverty, and so on.

2.5.1 Literacy Rate

Literacy refers to the ability to read and write and has been shown to be complementary to health services. The cost of increasing the literacy rate, particularly education expenditure, outweighs the cost of mortality and reduces direct healthcare costs. Patients who are literate can act on health information and better advocate for their individual, family, and community health. The general literacy rate also affects the health literacy rate, which is the degree to which people can access, understand, appraise, and communicate information to engage with the demands of different health contexts and promote and maintain good health across the life course.⁷ Being health literate implies an increased ability to take responsibility for one’s health and to adhere to treatment. However, low literacy is not always associated with low health literacy. People who cannot read but have excellent verbal communication skills can still acquire knowledge and understanding from medical providers, just as people with high overall literacy may fail to interpret certain medical information. Nevertheless, people with low health literacy generally have less access to healthcare, higher medical costs, and increased emergency care visits and hospital admissions. It is, therefore, crucial to present and communicate health-related information in an accessible way. Due to data limitations, this report will not look at health literacy directly but instead draw conclusions based on overall literacy data.

According to the World Bank, Côte d’Ivoire had the lowest literacy rate in 2018 among the eight studied countries, with only 47% of the population aged 15 and older able to read and write. Nigeria ranked second lowest (62%), then Ghana (79%), Algeria (81%), and Kenya (82%). In South Africa, 87% of the adult population aged 15 or older was considered literate in 2017. Literacy rates vary by region, gender, and income quartile. For example, the highest literacy rates in Nigeria were registered in the southern regions of the country, where 89% of males and 81% of females were considered literate in 2018. The southern zones of Nigeria also reflect the smallest gender discrepancies in literacy: female literacy in Nigeria is among the highest in western Africa. The primarily Muslim northern region has lower rates because most Muslim students pursue Islamic education after completing some elementary education.

In most of the studied countries, fewer women than men are literate. The Ministry of Education reported 60 million Nigerians (~30%) as illiterate in 2017, 60% of whom were female. In South Africa, women with lower incomes than men also have lower literacy rates. Literacy is directly proportional to income in other countries as well. In Nigeria, the literacy rate in urban areas (80.2%) is much larger than that in rural areas (47.45%), as shown in Fig. 2.19.

Fig. 2.19

(Data source World Bank. Graph source The author)

Literacy rate in Nigeria, by area and gender, 2018

In South Africa, literacy also has a direct proportional relationship to the income quintile. As income increases, so does literacy among all genders (Fig. 2.20).

Fig. 2.20

(Data source World Bank. Graph source The author)

Literacy among people aged 15 years and older, by gender and by monthly per capita income quintile, 2018

In 2017, Ghana introduced a free senior high school policy to eliminate some of the financial burdens parents face in educating their children. Ghana’s literacy rate has since increased to 79.04%. The literacy rate of Tunisia, as measured by the percentage of people aged 15 and above who can read and write was around 79.04% in 2014. Literacy among males has decreased since 2012, but literacy among females has continued to increase (Fig. 2.21).

Fig. 2.21

(Data source World Bank. Graph source The author)

Literacy rate in Tunisia, 2007–2014

2.5.2 School Enrollment and Gender Disparity

Individuals with higher levels of education tend to have higher incomes and are more likely to consume preventative medical care, purchase healthy food, and exercise regularly. Their employers also may offer health insurance, paid leave, and retirement plans.⁸ However, school enrollment in African countries is complicated. In 2012, only about half of the children in sub-Saharan Africa attended school, mainly due to barriers caused by poverty. UNICEF has identified 13 barriers to education in developing countries, including direct and indirect costs; lack of national budgets for education, health, and nutrition; and local attitudes and traditions.⁹ These barriers affect girls, children with disabilities, ethnic minorities, and poor and rural children most acutely.

The Social Progress Index¹⁰ (Fig. 2.22) measures the capacity of a society to meet the environmental and social needs of its citizens through various indicators, such as basic human needs (nutrition, sanitation, shelter, and personal safety), wellbeing (education, health, technology access, and environmental quality), and opportunities (personal rights, freedom and choice, inclusiveness, and access to advanced education).

Fig. 2.22

(Data source Social Progress Index, 2020. Graph source The author)

Social Progress Index, 2020

According to the index, five of the eight studied countries (Algeria, Côte d’Ivoire, Nigeria, Morocco, and Tunisia) rated poorly for educating women, and three of those (Morocco, Côte d'Ivoire, and Tunisia) also rated low in gender parity in secondary school, indicating the alarming lack of school attendance and participation among girls, and Côte d'Ivoire rated low in access to knowledge in general.

Algeria has the highest social index due to its high primary and secondary school enrollment. It provides free and mandatory nine years of education to children from age six. According to 2018 data, fewer girls were enrolled in primary and middle school, but more girls than boys were enrolled in advanced education. Although not investigated in this paper, the graph indicates that more boys drop out of school after completing middle school (Figs. 2.23 and 2.24).

Fig. 2.23

(Data source World Bank. Graph source The author)

Literacy and education in Algeria, by gender

Fig. 2.24

(Data source World Bank. Graph source The author)

Education level in Algeria, by gender, 2018

In Côte d’Ivoire, the difference in school enrollment in urban and rural areas is more evident. Preschools and students in urban areas outnumber those in rural areas, as urban residents have enough money to send their children to school and less time to take care of them when they are at work (Figs. 2.25 and 2.26). To balance the proportion of students across zones, the government has taken actions to bring schools to remote areas of the country.

Fig. 2.25

(Data source World Bank. Graph source Fofana Daouda)

Preschool attendance (left) and primary school attendance (right) in Côte d’Ivoire, by gender

Fig. 2.26

(Data source World Bank. Graph source Fofana Daouda)

Proportion of students in preschool (left) and primary school (right) in Côte d’Ivoire, rural and urban

Ghana introduced the Education Reform Program in 1987 and the Free Compulsory Universal Basic Education Program in 1996 requiring six years of primary education followed by three years of secondary school, three years of senior high education, and four years of tertiary education. These two programs have contributed immensely to the country’s basic education achievements (Fig. 2.27).

Fig. 2.27

(Data source World Bank. Graph source The author)

Education in Ghana, 2019

The national educational system of Kenya consists of three main levels: eight years of compulsory primary education beginning at age six, four years of secondary school, and four years of higher education. This “8-4-4” education system, which started in 1985, is being replaced by Kenya’s new 2-6-6-3 (2-6-3-3-3) curriculum, which includes two years of pre-primary, six years of primary, three years of junior secondary, three years of senior secondary, and at least three years of higher education. See Fig. 2.28.

Fig. 28

(Data source Kenya National Bureau of Statistics. Graph source Beatrice Birir)

Number of children enrolled in Kenyan education system, by level

In Nigeria, the gross enrollment rate in elementary schools was 68.3% in 2018. The northwestern and southwestern states have the highest enrollment rates (70.3% for boys and 73% for girls). The gross enrollment rate in middle schools in Nigeria is 54.4%, with the highest numbers in the southeastern states (52.5% for boys and 59.8% for girls). Figures 2.29 and 2.30 illustrate these statistics.

Fig. 2.29

(Data source World Bank. Graph source The author)

Gross enrollment in elementary school in Nigeria, by zone and gender, 2018

Fig. 2.30

(Data source World Bank. Graph source The author)

Gross enrollment in lower secondary school in Nigeria, by zone and gender, 2018

South Africa has struggled to provide quality and affordable education. It is one of the few countries studied in this report that does not offer any free education. Primary school enrollment rates are much lower than in the other seven studied countries. School attendance varies by province and gender. In Gauteng, more boys than girls attend grades 10–12, but boys drop out more often than girls in both primary and secondary school. Most adults in South Africa have not completed grade 12, and less than 20% of the population has any schooling beyond grade 12 (Figs. 2.31 and 2.32).

Fig. 2.31

(Data source Department of Statistics South Africa. Graph source Funani Mpande)

School attendance in South Africa, grades 10–12, by gender and province, 2018

Fig. 2.32

(Data source Department of Statistics South Africa. Graph source Funani Mpande)

Education level of South Africans aged 18 and older, 2018

In 2017, science, engineering, and technology were the most pursued (29.2%) major fields of study at public higher education institutions, and humanities and social sciences were the least pursued (22.3%) in South Africa. Among graduates of these institutions, most were women, though many men pursued science, engineering, and technology fields of study.

In Tunisia, the education system is built on the French model, as it was a French protectorate before gaining independence. The education system comprises early childhood (preschool for ages 3–6), basic (six years of primary plus three years of lower secondary), upper secondary (four years of pre-university education), and higher education (three years for a bachelor’s, two more years for a master’s; and up to five more years for a doctoral degree). It incorporated Arabic teachings into primary and secondary education, though French remains the language of university-level instruction and is mandatory for students in years 6–16. The Tunisian government has a goal to integrate information and communications technology at all levels of education, and these efforts are supported by organizations like Microsoft, Apple, and the World Bank.

2.5.3 Education Expenditure

Funding for education in Nigeria is low, with only 5.68% of the 2021 budget allocated to the education sector, far below the 15–20% benchmark set by UNESCO (Fig. 2.33).

Fig. 2.33

(Data source World Bank. Graph source The author)

Budget allocation to education in Nigeria, 2021

The last year of recorded data for public spending on education in Tunisia was 2015, indicating only 6.6% of the GDP allocated for education (Fig. 2.34).

Fig. 2.34

(Data source World Bank. Graph source The author)

Public spending on education as a percentage of GDP in Tunisia, 2002–2014

2.6 Summary

Africa has the youngest and fastest growing population in the world. Although this population structure will eventually be advantageous as the proportion of working-age people increases, current governments and families are facing huge financial burdens due to health and education expenditures. Life expectancy in Africa is also far below the average of developed countries (79 years for males and 82 years for females in 2020, analyzed by Statista), and maternal and infant deaths remain high. As these countries continue to undergo demographic transitions, child and infant mortality are important areas for research. The higher-than-average fertility rate in Africa has declined in recent years, indicating improved gender equality. Theoretically, gender equality could help predict the burden of certain diseases, as well as fertility, infant mortality, and maternal mortality rates. Understanding these outcomes could identify ways to give women a better chance at receiving education and individual incomes.

Poverty and gender inequality in Africa negatively affect the literacy rate, which in turn affects the healthcare system. As previously mentioned, less than half (47%) of people in Côte d’Ivoire are literate, which can be an obstacle when providing information to patients. Applying technological advances, such as video and photos, could improve the accessibility of this information. Although many countries are trying to at least partially subsidize primary school, coverage is inconsistent. Children increasingly drop out of school as they age. The decline in the number of female students is especially alarming because it leads to fewer career opportunities, limited income, and less access to preventive and medical treatment such as screening for HIV and cancer. Providing long-term and stable education to women is thus crucial.

The lack of students in higher education means a scarcity of professionals in the healthcare sector. Even among students who attend medical school, many choose to study and work overseas or change careers upon graduation. This “brain drain” worsens the challenges the healthcare system is facing and enlarges the gap in healthcare resources between urban and rural areas. Education coverage and gender equality in education should improve in the future as governments become more aware of the situation and create plans and policies to support it. However, considering the lack of financial capacity in most countries, there is a long way to go.