CE SR center for Economic and social rights fact sheet no. 6

In light of Madagascar’s appearance before the committee on Economic, social and cultural rights in May 2009 and the forthcoming possible mission of the UN special rapporteur on the right to Food to Madagascar, this fact sheet looks at the realization of the right to an adequate standard of living in Madagascar. It focuses on the rights to food, health and water and possible policy failures in these areas, with the aim of graph- Visualizing ically illustrating background information to help assess compliance of the government of Madagascar with the International covenant on Economic, social and cultural rights. This factsheet highlights some of the 2003 concluding observations on Madagascar by the committee on the rights of the child. Food security in Madagascar is precarious. The large majority of Madagascar’s peo- ple live in rural areas, with only 27 percent of the country’s population living in cities and Rights towns (EIU 2007). Most people survive as small farmers, producing for their own con- sumption (FaO 2008). But they are vulnerable to food insecurity as a result of frequent natural disasters, undiversified production and lack of access to basic infrastructure. The prevalence of undernourishment in Madagascar is higher now than it was in 1992 and is much higher than the sub-saharan african average (World Bank 2008). Levels of acute child malnutrition have risen in recent years, as have levels of income inequality, despite an overall increase in national gdP wealth. Within the country, child malnutri- tion is widespread, but varies by up to 10 percent across different regions. as this factsheet illustrates, access to improved water sources and sanitation also varies drastically by region. almost 70 percent of those in the country’s capital have access to an improved water source, while less than a quarter of people have such access in the province of . The Malagasy people face low and unequal access to safe water, sanitation and health treatment, with high child mortality rates. Yet Mad- agascar spends the lowest proportion of its budget on health, as a percentage of its gdP, compared to its southern african neighbors. Its tax base is also comparatively low and its regressive tax regime could affect its ability to realize the right to an adequate stan- dard of living for its people. This suggests possible failures of the government to give priority to the progressive realization of economic, social and cultural rights according to maximum available resources. The graphics that follow compare data that derive from the 1992 household survey and the most recent demographic household survey from 2003/2004. In the absence of more recent data, this factsheet does not reflect the outcomes of any changes in policy that may have been instituted since the sweeping gains won by the current president, Mr. of Tiako-I-Madagasikara (TIM), in national and municipal elections in 2006 and 2007. It should also be noted that in 2007, voters approved a ref- erendum to abolish the six autonomous provinces of Madagascar (see disaggregated data) which will be implemented by 2009. Madagascar fact sheet no. 6 CE SR

THE RIGHT TO FOOd “The Committee is concerned that the sur- vival and development of children in the State party continue to be threatened by Undernourishment in Madagascar, Sub-Saharan early childhood infectious diseases, diar- Figure 1 and Low-Income Countries (average), 1992–2004 rhoea and malnutrition.” (CRC Concluding Observations 2003) 41

39 40 37 38 35 Madagascar has one of the highest 35 33 levels of undernourishment

31 29.7 29.8 in Sub-Saharan Africa 29.1 % of population, average 29 Sub-Saharan Africa at least 38 percent of Madagascar’s population is 28.9 27 28.4 Madagascar undernourished, much higher than the sub-saha- 25 Low income ran african average (30 percent) and also higher 1992 1997 2004 Source: World Bank 2008 than the average for low-income countries. The prevalence of undernourishment among the Mala- gasy people is higher now than in 1992, raising seri- Children Under Height and Underweight for Age, Latest ous concerns about the priority the government Figure 2 Available Data has been giving to its commitments to realize the right to adequate food. 55 52.8 Over half of Malagasy children 50 are chronically malnourished ��.� ��.� 45 Over half of Madagascar’s children are stunted 40 for their age and over one-third are underweight Sub-Saharan Africa 36.8 (both measures of chronic malnutrition). This is 35 Madagascar also much higher than average rates of chronic 30 28.9 Low-income countries 26.8 malnutrition amongst children in sub-saharan 25 africa and across low-income countries.

20 Malnutrition prevalence, Malnutrition prevalence, Disparities in the realization of the right height for age weight for age to food persist between Madagascar’s (% of children under 5) (% of children under 5) Source: World Bank 2008 provinces and between rich and poor. about half of all children under five living in anta- nanarivo are stunted, whereas one-third of chil- Percentage of children under-5 stunted, by province, dren in antsiranana suffer from stunting.a lthough Figure 3 2003–2004 there has been national progress in reducing rates of stunting, from 54 percent in 1992 to 47 percent in 2003/2004, the prevalence of stunted children has markedly increased in province. : 52.4 percent There are also disparities between rich and poor— : 47.8 percent 51 percent of children in the poorest 20 percent of Mahajanga: 47.6 percent families are stunted, compared with 38 percent of Toamasina: 47.3 percent children from the wealthiest 20 percent (UNdP Toliary: 40.5 percent 2008). Antsiranana: 37.1 percent

Source: DHS 2003/2004

2 center for Economic and social rights

Acute malnourishment has risen sharply Percentage of Children Under-5 Underweight for Height Figure 4 amongst Malagasy children and GDP, per capita, Madagascar 1992–2004 The rate of children under five suffering from 14 acute malnutrition (under weight for their height 950 or wasting) has risen markedly since 1992. This 12 rise began before the political and economic cri- 900 10 sis of 2002 and has not improved since, despite

the marked recovery in gdP per capita. The rise in 8 850 acute malnutrition raises serious concerns about 6

the realization of the right to adequate food of under 5) (% of children 800

Madagascar’s children. 4 wasted Malnutrition prevalence,

GDP per capita PPP (constant 2005 int’l $) PPP (constant GDP per capita 750 2 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

GDP per capita, PPP (constant 2005 int’l 2005) Malnutrition prevalence in children under-5, underweight for height: wasting

Source: World Bank 2008, DHS 1992, DHS 2003/2004

Percentage of Children Under-5 Wasted (Underweight for The rise in acute malnutrition Figure 5 suggests that Madagascar is giving Height), Madagascar and Its Neighbors, Over Time less priority to the right to food of its children than its neighbors 14 acute malnutrition, as measured by wasting, is 12

much more severe than chronic malnutrition as it 10 threatens not only the right to food and the right to 8 health, but even the right to life of the child. acute 6 malnutrition increases the likelihood of dying from 4 measles, malaria, pneumonia and diarrhea. The near tripling of acute malnutrition in Madagas- 2 car is therefore of serious concern, and stands in 0 1992/3 1999 2000/1 2003/4 2005/6 marked contrast to neighboring countries. Kenya Madagascar Tanzania Uganda Zambia Zimbabwe Source: DHS Statcompiler

Half of Madagascar’s arable land may be Figure 6 South Korea May Lease Half of Madagascar’s Arable Land leased to grow crops for South Korea In a context of high levels of chronic and acute malnutrition among Madagascar’s children, it is of

serious concern that the government of Madagas- 1.3 million hectares car has reportedly agreed to lease 1.3 million hect- may be leased by South Korea’s Remaining arable land Daewoo Logistics ares of land to a south Korean corporation which after South Korean purchase (hectares) will grow crops (corn and palm oil) for seoul using South Korean Daewoo’s workers to be brought in from . as 99-year lease of arable land (hectares) only five percent of Madagascar’s land is classified 1.65 million hectares arable land remaining as arable land, this means that 44 percent of Mad- in Malagasy hands agascar’s arable land will now be used to promote

food security in south Korea, with very little ben- Sources: World Bank 2008, Financial Times 18/11/08 efit for Madagascar (Financial Times 18/11/08).

3 Madagascar fact sheet no. 6 CE SR

THE RIGHT TO HEalTH “The Committee is deeply concerned at the high infant and under-5 mortality rates and low life expectancy in the State party.” Under-5 Mortality Rate (per 1,000 Children), by Malagasy (CRC Concluding Observations 2003) Figure 7 Province, 2003/2004

140 140.2 133.7 128.6 The right to health and to life is 120 116.5 not enjoyed equally by children

102.1 in all Madagascar’s provinces 100 children in Toliary province are almost twice as 79.6 80 likely to die before age five as children in the capi-

60 tal province of antananarivo. This may reflect a lack of investment in rural areas in access to health 40 care and other resources necessary for enjoying 20 the rights to health and to life.

0 Antananarivo Fianarantsoa Antsiranana Toamasina Mahajanga Toliary

Source: DHS 2003/04

Mortality Gap for Children Under-5 between Rich and Figure 8 Children from poor families are Poor, Madagascar and its Neighbors more likely to die before age five than children from rich families Number of deaths per 1,000 live births, top (on left) and bottom (on right) quintiles This graph shows Madagascar has the largest gap Madagascar 49.4 141.8 in mortality rates between children from rich and

Zambia 92.4 191.7 poor families compared to other southern african countries. The poorest 20 percent of Madagascar’s Mozambique 108 196 children (with a mortality rate of 142 out of 1,000 Uganda 108 172 live births) are almost three times as likely to die Kenya 91 149 as children from wealthy families (who have a Tanzania 93 137 mortality rate of 49 out of 1,000).

Zimbabwe 57 72

50 75 100 125 150 175 200

Source: WHO 2008

Percentage Births Attended by Skilled Health The right to health of women has Figure 9 Professionals by Province less priority now than in 1992 There has been a significant fall in the coverage of 80% D������� reproductive health services, with a fall in all but 70% D������� one province of the proportion of births attended 60% D������� D������� D������� by skilled health professionals between 1992 and 50% 2003/4. 40% 30% 20% 10% 0% Toamasina Toliary Fianarantsoa Mahajanga Antsiranana Antananarivo

1992 2003/2004

Source: DHS 1992, 2003/04

4 center for Economic and social rights

Percentage of Children Who Showed Vaccination Card, “The Committee also remains concerned Figure 10 by Region that health services in the local areas con- tinue to lack adequate resources (both 70% D������� financial and human) and that health D������� D������� 60% D������� D������� coverage is declining.” (CRC Concluding 50% Observations 2003) 40%

30%

The right to health of children may also be 20%

affected by falling vaccination coverage 10%

The proportion of children with vaccination cards in 0% each province has also fallen, suggesting lower rates Mahajanga Toamasina Toliary Fianarantsoa Antsiranana Antananarivo of vaccination coverage. This may suggest a lower 1992 2003/2004 Source: DHS 1992, 2003/04 priority and levels of resources for the realization of the right to health of Madagascar’s children.

Treatment for malaria has fallen, even Malaria Treatment and GDP per capita, Madagascar Figure 11 when more resources may be available 2000–2004 Malaria accounts for 20 percent of deaths for Mal- 900 65 agasy children under five years of age (UNIcEF 880 60 2008). Nevertheless, the rate of treatment more 860 than halved between 2000 and 2004, continuing 840 55 820 to fall in the years following the economic upturn. 50 This raises concerns about government efforts to 800 45 realize the right to health to the maximum of avail- 780 760 able resources. 40 740 35 720 (% of children under age 5 with fever) (% of children

GDP per capita PPP (constant 2005 int’l $) PPP (constant GDP per capita 700 30 Children with fever receiving antimalarial drugs receiving with fever Children 2000 2001 2002 2003 2004

GDP per capita, PPP (constant 2005 int’l 2005) Children with fever receiving antimalarial drugs (% of children under age 5 with fever)

Source: World Bank 2008

Insufficient allocation of resources for Public Health Expenditure as % of GDP Figure 12 the realization of the right to health 2005, Madagascar and its Neighbors compared with its neighbors in southern africa,

Madagascar spends the lowest amount on the Zimbabwe 3.6

health sector as a percentage of its gdP. This South Africa 3.6

ratio is a reflection of government commitment to Tanzania 2.9

providing healthcare, demonstrating the level of Zambia 2.7

resources the Malagasy government will invest in Mozambique 2.7

the realization of this right. This low ratio suggests Kenya 2.1

a weak commitment to the realization of the right Uganda 2.0

to health. Madagascar 2.0

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Source: World Bank 2008

5 Madagascar fact sheet no. 6 CE SR

THE RIGHT TO WaTER “Concern is also expressed at …the poor state of sanitation and the insufficient access to safe drinking water, especially Percentage of Population with Access to Improved Water in rural areas.” (CRC Concluding Obser- Figure 13 and Sanitation by Malagasy Province, 2003/2004 vations 2003)

100% 90% The right to water is not being enjoyed 80% 70% equally by Malagasies across the provinces Madagascar’s urban population living in the capi- 60% tal of antananarivo has much higher levels of 50% access to safe water and sanitation than the rest 40% 30% of the country. antananarivo residents are nearly 20% three times as likely to have access to safe drink- 10% ing water as resident of and 0% more than seven times as likely to have access to � Antananarivo� Mahajanga� Toliary� Antsiranana� Fianarantsoa� Toamasina improved sanitation. Improved Water Access Improved Sanitation Access These wide disparities reflect the difference in Source: DHS 2003/2004 infrastructure and investment in the urban capital area and the rest of the country. While urban-rural Percentage of Rural Population with Access to Improved Figure 14 Water Source, Sub-Saharan Africa, 2006 disparities are common worldwide, these dispari- ties raise concern about Madagascar’s efforts to

Mauritius ensure equality in enjoying the basic human right Botswana Namibia to water. Sao Tome & Principe South Africa People living in rural areas of Madagascar Gambia, The Lesotho have access to safe water at rates well Malawi below averages in Sub-Saharan Africa Zimbabwe Ghana More than 73 percent of Madagascar’s population Burundi Burkina Faso live in rural areas, but only 36 percent of them have Côte d’Ivoire Senegal access to safe water (World Bank 2008). Mada- Sudan gascar’s rural population has much lower access Rwanda Uganda to safe water than people living in rural areas in Guinea Benin other countries across sub-saharan africa. This Eritrea Mauritania suggests that efforts to meet the needs of those Liberia living in rural areas have been inadequate. Central Afr. Rep. Swaziland Kenya Mali Cameroon Gabon Guinea-Bissau Tanzania Equatorial Guinea Zambia Chad Togo Angola ���������� 36% Congo, Rep. Niger Sierra Leone Ethiopia Nigeria Congo, Dem. Rep. Mozambique Somalia 0% 20% 40% 60% 80% 100%

Source: World Bank 2008

6 center for Economic and social rights

POvERTy and InEqualITy

The majority of Malagasies Population Living Below $1 per day (%), Sub-Saharan live on less than $1 a day Figure 15 Africa, Latest Available Data almost two-thirds of Malagasies live on less than Nigeria $1 a day, making it difficult for them to meet the Central Afr. Rep. Zambia minimum calorie requirements and basic non-food ���������� 61% Niger needs. This is one of the highest rates of poverty in Rwanda Gambia sub-saharan africa. Tanzania Sierra Leone Zimbabwe Burundi Increased national wealth has not Swaziland Ghana trickled down to all Malagasies Lesotho Mozambique This graph shows that although national income Mali Namibia (in terms of gdP per capita) has risen, this has Benin Botswana been accompanied by rising inequality. (This is Burkina Faso Mauritania measured in Fig. 16 by the gini Index, a measure Ethiopia Kenya of inequality of wealth or income where a higher Malawi Cameroon percentage indicates greater inequality.) This sug- Senegal Côte d’Ivoire gests that the benefits of growth and development South Africa have been unevenly spread. It also and raises con- 0% 20% 40% 60% 80%

cerns about Madagascar’s commitment to use Source: UNDP 2007/2008 the maximum of available resources to ensure progressive realization and equal enjoyment of economic and social rights. Figure 16 Gini Index and GDP per capita, Madagascar 1993–2001

Tax policies reflect a weak 890 49 880 commitment to fulfilling the right 47 to an adequate standard of living 870 45 Tax policies are an essential means of generating 860 the resources needed to realize the equal right 850 43

of all members of the population to an adequate 840 41 Gini Index standard of living. Madagascar, however, in com- 830 39 parison with its neighbors (for which data was 820

available) has the lowest rates of income taxes as 810 37 GDP per capita PPP (constant 2005 intl $) PPP (constant GDP per capita a percentage of its revenue and as a percentage of 1993 1994 1995 1996 1997 1998 1999 2000 2001 its total taxes. In addition, industries in the export- GDP per capita, PPP (constant 2005 int’l 2005) Gini Index processing zones (EPZ), have been excused from Source: World Bank 2008 most taxation (EIU 2008). This suggests a regres- sive system of taxation with indirect, consumption Taxes on Income, Profits and Capital Gains (% of taxes as the main income source for the govern- Figure 17 Revenue), Madagascar and Its Neighbors, 2006* ment’s budget, placing a disproportionate burden on the poor. South Africa 55.8 44.2

Zambia 42.4 57.6

Kenya 37.6 62.4

Uganda 27.1 72.9

MADAGASCAR 18.6 81.4

Income, profits and capital gains taxes Other taxes (including sales tax)

* Kenya 2005 Source: World Bank 2008

7 Madagascar fact sheet no. 6 CE SR

References Committee on the Rights of the Child (CRC). concluding Observations: Madagascar 27/10/2003. dHS 1992. Madagascar: standard demographic and Health survey. central Bureau of statistics. dHS 2003/2004. Madagascar: standard demographic and Health survey. central Bureau of statistics. dHS 2008. demographic and Health survey sTaTcompiler. www.statcompiler.com CE SR Economist Intelligence unit. country Profile 2007 and Main report and country report september 2008. www.eiu.com Board Members FaO Country Profile. agriculture and consumer Protection department. republic of Madagascar country Profile 2008. www.fao.org/ag/agn/nutrition/mdg_en.stm Victor Abramovich, Inter-American Commission on Human Rights Financial Times, november 18, 2008. “Land Leased to secure crops for south Korea” Philip Alston (Chairperson), www.ft.com/cms/s/0/98a81b9c-b59f-11dd-ab71-0000779fd18c.html New York University School of Law Linda Cassano (Treasurer), undP 2007/2008. United Nations development Programme. statistics of the Human Commonwealth Bank of development report 2007/2008. www.hdr.undp.org/en/statistics Sakiko Fukuda-Parr, unICEF 2008. “countdown to 2015: Maternal, Newborn and child survival.” 2008 report. The New School, New York Richard Goldstone, www.countdown2015mnch.org/documents/2008report/2008countdown2015 Harvard Law School fullreport.pdf Chris Jochnick, Oxfam America World Health Organization (WHO). WHO statistical Informational system (WHOsIs) Jose Maria Maravall, 2008. www.who.int/whosis Juan March Institute, Madrid Alicia Ely Yamin, Harvard Law School World Bank 2008. World development Indicators. www.worldbank.org

Acting Executive Director: Ignacio Saiz about This Fact Sheet Series This series is intended to contribute to the ongoing monitoring work of UN and other inter- governmental human rights mechanisms to monitor governments’ compliance with their eco- About CESR nomic, social and cultural rights obligations. It is also intended to contribute to strengthening The Center for Economic and Social the monitoring and advocacy capabilities of national and international NgOs. drawing on the Rights (CESR) was established in 1993 with the mission to work for the recog- latest available socioeconomic data, the country fact sheets display, analyze and interpret nition and enforcement of economic, selected human development indicators in the light of three key dimensions of governments’ social and cultural rights as a power- economic and social rights obligations. ful tool for promoting social justice and human dignity. CESR exposes violations Firstly, indicators such as maternal mortality or primary completion rates are used to of economic, social and cultural rights assess the extent to which the population is deprived of minimum essential levels of the through an interdisciplinary combination of legal and socio-economic analysis. right to health, education, food and other economic and social rights. secondly, data tracking CESR advocates for changes to economic progress over time can help to assess whether a state is complying with its obligation to real- and social policy at the international, ize rights progressively according to maximum available resources. comparisons within the national and local levels so as to ensure these comply with international human same region provide a useful benchmark of what has been achieved in countries with similar rights standards. resources. Finally, data disaggregated by gender, ethnicity, geographical location and socio- Fuencarral, 158-1ºA economic status is used to identify disparities and assess progress in eliminating discrimina- 28010 Madrid, Spain tion and unequal enjoyment of these rights. Tel: +34 91 448 3971 Fax: +34 91 448 3980 The fact sheets are not meant to give a comprehensive picture, nor provide conclusive 162 Montague Street, 3rd Floor evidence, of a country’s compliance with these obligations. rather, they flag some possible Brooklyn, NY 11201, USA concerns which arise when development statistics are analyzed and visualized graphically in Tel: +1 718 237-9145 Fax: +1 718 237-9147 light of international human rights standards.

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