Report No. 44459-ML Mali The Demographic...
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Report No. 44459-ML Mali The Demographic Challenge June 23, 2010 Human Development, AFTHE Country Department AFCF1 Africa Region Document of the World Bank
Transcript of Report No. 44459-ML Mali The Demographic...
Report No. 44459-ML
Mali
The Demographic Challenge
June 23, 2010
Human Development, AFTHE
Country Department AFCF1
Africa Region
Document of the World Bank
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CURRENCY EQUIVALENTS
(Exchange Rate as of June 2010 - average)
Currency Unit French CFA
US$1.00 539 FCFA
Mali Government Fiscal Year
January 1 to December 31
Abbreviations and acronyms
AfDB African Development Bank
AFD French Development Agency
AIDS Acquired Immunodeficiency Syndrome
AMPPF Malian Association for the Protection and Promotion of Families
BCC Behavior Change Communication
CAREF Center for Research and Training Support
CAS Country Assistance Strategy
CEM Country Economic Memorandum
CERPOD Center for Study and Research on Population and Development
CILSS Permanent Interstate Committee for Drought Control in the Sahel
CPS Planning and Statistics Unit
CSCOM Community Health Centers
CSCRP Strategic Framework for Growth and Poverty Reduction
CSLP Strategic Framework for the Fight against Poverty
CYP Couple-years of protection
DGPP Government Population Policy Declaration
DNP National Population Directorate
DNSI Central Statistics Office
EDS Demographic and Health Survey
EDSM Demographic and Health Survey, Mali
EU European Union
FAO Food and Agriculture Organization
FCFA Franc used in the West African Francophone Community
FP/RH Family Planning/Reproductive Health
GDP Gross Domestic Product
GER Gross Enrollment Rate
HDI Human Development Index
HIV Human Immunodeficiency Virus
ICPD International Conference on Population and Development (ICPD)
IDA International Development Association
IEC Information, Education, and Communication
IMF International Monetary Fund
IMOA Accelerated Implementation Initiative
INRSP National Public Health Research Institute
INSAH Sahel Institute
IPPF International Planned Parenthood Federation
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IRD Institute for Research and Development
LDC Least Developed Countries
LSMS Living Standard Measurement Survey
MDG Millennium Development Goals
MDSSPA Ministry of Social Development, Solidarity, and the Elderly
MEN Ministry of National Education
MICS Multiple Indicator Cluster Survey
MOH Ministry of Health
N/A Not available
NGO Non-governmental Organization
NPP National Population Policy
ODA Official Development Assistance
ODHD Observatory for Sustainable Human Development
ONMOE National office of labor and employment
PCIME National Program for the Integrated Management of Childhood Illnesses
PDES Economic and Social Development Program
PRMC Cereal Market Reform Program
PRODEC Decennial Project for the Development of Education
PRODESS Program for Social and Sanitary Development
PRSP Poverty Reduction Strategy Papers
TFP Technical and Financial Partners
TFR Total Fertility Rate
RAPID Resources for the Awareness of Population Impacts on Development
RAVEC Administrative Census with Civil Registration
RGPH General Census of Population and Housing
SOMIEX Malian Import and Export Company
STD Sexually transmitted disease
UNDP United Nations Development Program
UNESCO United Nations Educational, Scientific, and Cultural Organization
UNFPA United Nations Population Fund
UNICEF United Nations Children‟s Fund
USAID United States Agency for International Development
VAT Value-added tax
WHO World Health Organization
Vice President of Africa Region: Obiageli Katryn Ezekwesili
Country Director: Habib M. Fetini
Acting Sector Director: Tahwid Nawaz
Sector Manager: Eva Jarawan
Task Team Leaders: John F. May & Boubou Cissé
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Acknowledgements
The World Bank team that undertook this study was led by John F. May (Lead Population
Specialist, AFTHE) and Boubou Cissé (Economist, Health, WBIHD). Tonia Marek (Lead
Public Health Specialist, AFTHE, Bamako Country Office) provided overall supervision of
this study. The team also benefited from the help of Haidara Ousmane Diadie (Health
Specialist, AFTHE, Bamako Country Office) and Chloë Fèvre (Consultant). Logistical
support for the study and field coordination was provided by Fatoumata Moumoune Sidibé
and Moussa Fode Sidibé (Assistants, AFMML, Bamako Country Office) and Nicole Hamon,
Language Program Assistant, AFTHE, in Washington. Nada Chaya, Consultant, AFTHE,
reviewed the entire report. Alex Ritter, Consultant, AFTHE, edited and formatted the
manuscript. Moussa Keita, Economist, served as the national consultant. Finally, the team
also benefited from the support of Jane Remme, Social Sciences Specialist.
Thomas W. Merrick, Demographer and Economist (Population Reference Bureau) and Luc
Christiaensen, Agro-Economist (EASOP, World Bank) served as peer reviewers.
The team also benefited from the input and advice of Philippe Beaugrand, Economist, Head
of Mission for Mali at the International Monetary Fund (IMF), Jean-Pierre Guengant,
Economist and Demographer, Director of the Institute for Research and Development (IRD)
in Ouagadougou, Burkina Faso (who also prepared new population projections based on the
preliminary results of the 2009 Population and Housing Census), and Hubert Balique,
Technical Adviser with the Ministry of Public Health in Niger.
Among Malian colleagues, the team wishes to thank in particular Mrs. Fatoumata Sidibé
Dicko, Director, National Population Directorate (DNP), together with all the DNP officials
and staff at the Ministry of Economy and Finanace. Other Malian experts from various
sectors have contributed to this analysis in addition to representatives from many technical
and financial partners in Bamako (French Agency for Development, UNFPA, UNDP,
UNICEF, the European Union, and USAID). The authors also wish to thank several
colleagues from the World Bank and external agencies for their input and for reviewing
several versions of this report.
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MALI
The Demographic Challenge
Contents
EXECUTIVE SUMMARY .................................................................................................... 9 INTRODUCTION................................................................................................................. 14 CHAPTER 1. THE DEMOGRAPHIC SITUATION AND ITS PROSPECTS .............. 16
Demographic data are incomplete .................................................................................. 16
The size of the population of Mali is average………………………………… ………..18
A highly rural population clustered in the South ............................................................ 20 A very young population structure ................................................................................. 21
Early age at first union and widespread polygamy…………………………… ……......25
Elements of demographic change…………………………………………… …………26
Demographic projections ................................................................................................ 28 CHAPTER 2. CONSEQUENCES OF DEMOGRAPHIC TRENDS ............................... 32
Demographic growth and human capital development ................................. ……….....32
The education sector…………………………………………………………… ………32
The health sector……………………………………………………………… ………..36
Financial needs for education and health……………………………………………….38
Population growth and population density ..................................................................... 40 Demographic growth, agriculture, and nutrition............................................................. 41 Demographic growth and urbanization ........................................................................... 44 Demographic growth and the environment..................................................................... 46 Demographic growth and health ..................................................................................... 47
CHAPTER 3. REVIVING POPULATION INTERVENTIONS……………… …..........49 Population policies pursued in Mali over the last two decades ...................................... 49 The implementation of population policies collides against a lack of national
coordination and insufficient national grounding ........................................................... 50
The revival of advocacy to put back demographic growth at the heart of public
debate………………………………………………………………………………...…52
How to define a population strategy that supports the country‟s efforts towards
development? .................................................................................................................. 53 Defining realistic objectives ................................................................................... 53 Aligning strategies .................................................................................................. 54 Repositioning family planning ................................................................................ 55 Identifying and re-energizing key actors ................................................................ 57 Coordinating the actions of the Technical and Financial Partners ....................... 59 Collecting data and initiating demographic research ............................................ 60
CONCLUSIONS ................................................................................................................... 62 ANNEX 1. SOCIO-ECONOMIC AND GEOGRAPHIC SITUATION .......................... 64
Socio-economic conditions and trends ........................................................................... 66 Structural characteristics of the economy of Mali .......................................................... 69
Strctural reforms and economic performance……………………………… . ……..…..70
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Poverty reduction strategy .............................................................................................. 72 ANNEX 2. POPULATION POLICIES IN THE WORLD AND IN SUB-SAHARAN
AFRICA ................................................................................................................................. 74
International and African approaches to population……………………… ........... ……78
Main arguments to slow down demographic growth…………………… …………...…79
Instruments of population policy………………………………………… ..................... 81
ANNEX 3. POPULATION PROJECTIONS ..................................................................... 84
Population baseline……………………………………………………… ……………..84
Fertility………………………………………………………………………………… .84
Mortality………………………………………………………………………………. . 85
International migration………………………………………………………………… .85
Results………………………………………………………………………………… ..86
ANNEX 4. SIMULATION MODEL: EDUCATION AND HEALTH ............................ 89
Assumptions, variables, and methodology………………………………………..… …89
Limits of the model………………………………………………………………….. ....92
BIBLIOGRAPHY ................................................................................................................. 94
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LIST OF FIGURES
Figure 1.1: Age pyramid of Mali, 1 January 2005 .................................................................. 22 Figure 1.2: Growth of the Malian population, 1950-2005 (thousands) .................................. 23 Figure 1.3: Crude birth rate and crude death rate, 1950-2005 (per 1,000 per year) ............... 24 Figure 1.4: Annual growth rate of Mali‟s population, 1950-2005 (percent) .......................... 25 Figure 1.5: Population projection, slow fertility decline vs. rapid fertility decline ................ 29 Figure 1.6: Mali population pyramid, by projection scenarios, 1 January 2035 .................... 30 Figure 1.7: Mali population pyramid, Low projection, 2005, 2020, and 2035 ....................... 31
Figure 2.1: Rate of change for rural and urban populations, 1955-2005 ................................ 46
Figure A.1.1: Map of Mali ...................................................................................................... 64 Figure A.1.2: Regions of Mali ................................................................................................ 65 Figure A.1.3: GDP growth rate between 2005 and 2007 ........................................................ 70 Figure A.1.4: Poverty rate and decrease in Mali‟s population growth rate, 2007-2015 ......... 73
LIST OF TABLES
Table 1.1: Demographic indicators and population strategies in Mali ................................... 16 Table 1.2: Different estimates of Mali‟s population, 2005-2008 ............................................ 19 Table 1.3: Key data for Mali, the sub-region, and large countries of sub-Saharan Africa ..... 20 Table 1.4: Population of Mali, rural and urban, and by region, 1998 and 2008 ..................... 21 Table 1.5: Fertility and mortality in Mali, its neighboring countries, and large countries of
sub-Saharan Africa, 2005........................................................................................................ 27 Table 2.1: Number of students by educational level, 2005-2035 ........................................... 33 Table 2.2: Shortage in teachers, 2005-2035 (slow fertility decline) ....................................... 35 Table 2.3: Shortage in teachers, 2005-2035 (rapid fertility decline) ...................................... 35 Table 2.4: Need for textbooks, 2005-2035 (slow fertility decline) ......................................... 36 Table 2.5: Need for textbooks, 2005-2035 (rapid fertility decline) ........................................ 36 Table 2.6: Need for health personnel, 2005-2035 (slow and rapid fertility decline .............. 37
Table 2.7: Need for new health facilities, 2005-2035 (slow and rapid fertility decline)…..... 38
Table 2.8: Education expenditures, 2005-2035 (in million of US dollars)………….……… 39
Table 2.9: Health expenditures, 2005-2035 (in millions of US dollars) ................................. 40 Table 2.10: Population density in Mali, 2005-2035 ............................................................... 41 Table 2.11: The agrarian production in Mali and in sub-Saharan Africa ............................... 42 Table 2.12: Nutrition in Mali, neighboring countries, and sub-Saharan Africa ..................... 44 Table 2.13: Rural and urban population of Mali, 2005 ........................................................... 45 Table 2.14: Reproductive health and fertility in Mali ............................................................. 47 Table A.1.1: Classification of regions according to poverty level ......................................... 68 Table A.1.2: Average annual growth rate and volatility by period ........................................ 70 Table A.3.1: Population baseline DNP/DNSI 2005 (1 January) ............................................ 84 Table A.3.2: Distribution by age of out-migrants, both sexes, 2005-2035 (percent)………. 85
Table A.3.3: Mali Population Projections, 2005-2035, High fertility .................................... 86 Table A.3.4: Mali Population Projections, 2005-2035, Low fertility ..................................... 87 Table A.4.1: School-aged groups for both sexes (in millions and percentages)..................... 93
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LIST OF BOXES
Box 1.1: Overview of demographic data in Mali ................................................................... 17 Box 2.1: The story of Djenaba ................................................................................................ 48 Box 3.1: The Malian Association for the protection and promotion of families (AMPPF) ... 58
Box A.1.1: Evolution of the economic policies framework implemented in Mali since 1980 ... 67
Box A.2.1: Poverty and fertility in sub-Saharan Africa – a literature review ........................ 76
Box A.3.1: Update on the 2009 Population and Housing Census………… ………………...88
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EXECUTIVE SUMMARY
VERY RAPID DEMOGRAPHIC GROWTH
1. Mali will experience unprecedented demographic growth given its very young
age structure and very high fertility rates. While the population density is low because of
the large surface area of the country, the terrain suitable for agriculture and grazing remains
limited. The rapid demographic growth will pose a problem in the future; estimates show
that the population of Mali is certain to double in the next 25 years even if fertility declines
quickly, while a gradual decrease in birth rates could mean a tripling of population by 2035.
This rate of demographic growth raises first and foremost the issue of human capital
development (education and health).
2. Mali’s population – estimated at 12.6 million in mid-2007 – has one of the
highest growth rates in the world. At its current level of natural growth rate (birth rate
minus death rate) the population of Mali is increasing by 3.3 percent a year and will double
in 21 years. However, high out-migration rates temper this growth; an estimated 1.2 to 2.7
million (even four million according to some estimates) Malians currently live out of the
country. Thus, according to population projections prepared for this study, the population of
Mali could grow from 11.7 million in 2005 to 27.7 million in 2035 (assuming a rapid decline
in fertility with a total fertility rate (TFR) – the average number of children born alive per
woman – of 4.0 children per woman in 2035) or to 33.9 million in 2035 (assuming a slow
decline fertility with a TFR of 6.3 children in 2035).
3. Taking migration into account, the net growth rate is estimated at approximately
3 percent a year, which will lead to a doubling of the population in 23 years (net growth
rate is calculated by adding the migration rate (in-migration minus out-migration) to the
natural growth rate (birth rate minus death rate)). Malians migrate more to neighboring
countries in the sub-region than to Europe. The HIV/AIDS epidemic will not impact this
rapid increase of the population. It is worthwhile to note that remittances from these
immigrants are a large financial inflow to Mali contributing to its economy (it is assumed
that receiving countries will continue to let in Malians in the future, a rather optimistic
assumption).
4. The strong decline in mortality – which has not been offset by a decline in fertility
– is the reason for the rapid demographic growth. The levels of infant mortality (below
age 1) and child mortality (ages 1 to 5) remain very high, but they are quickly decreasing as
shown by the Demographic and Health Surveys (EDS). At 96 deaths for every 1,000 live
births, the infant mortality rate (IMR) is for the first time under 100. However, Mali has not
yet started the fertility transition; the total fertility rate remains high at 6.6 children per
woman. This high fertility rate, the declines in infant and child mortality, and a young age
structure, are leading to Mali‟s rapid demographic growth.
5. Mali’s demographic future will be determined by its fertility levels and trends.
Very high levels of fertility and the very low levels of modern contraceptive use have
remained practically unchanged for the past 15 years. According to the 2006
Demographic and Health Survey of Mali (EDSM 2006), only 7 percent of women use a
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modern method of contraception whereas 31 percent of women have an unmet need for
family planning. Moreover, the desired level of fertility is still very high in Mali:
approximately three-fourths of women wish to have more children and about a third wish to
have one in the near future (EDSM 2006). The current conditions are thus not conducive to a
rapid drop in fertility, although the beginning of such a decline can be triggered. For
example, expanding women‟s access to contraception with well-targeted programs will not
only lead to a slowing of demographic growth but will also significantly improve the health
of women and their children.
CONSEQUENCES OF HIGH DEMOGRAPHIC GROWTH
6. To accommodate the increase in the size of the school-aged population and the
increase in school enrollment, strong efforts should be made to recruit teachers and
procure teaching material such as textbooks. The increase in numbers is dependent on the
growth of the school-aged population as well as on the rise in the real numbers of the
population attending schools (more and more parents wish to have their children in school)1.
The cumulative shortage in the number of teachers between 2005 and 2035 is projected to
range from 113,016 (rapid fertility decline assumption) to 142,122 (slow fertility decline
assumption). Additional demand would also necessitate the creation of 1,457 classes per
year, over and above the current needs, if the rate of 63 students per teacher and per class is
maintained. Over the last few years, only between 500 and 600 new classes a year were
created in elementary schools. The same reasoning can be applied to healthcare staff.
7. Between 2005 and 2035, the total expenditures for Education and Health will increase at least eight-fold (rapid fertility decline assumption) and probably eleven-fold
(slow fertility decline assumption); they will increase from US$552 million in 2005 to
US$4,864 million or US$6,171 million in 2035, respectively. Healthcare expenditures alone
will represent 19 percent of the GDP in 2035, compared to 7 percent of the GDP in 2004.
These projections assume the same level of health services coverage as in 2007.
8. The population of the city of Bamako is projected to maintain its high rate of
population growth. Bamako‟s population size increased from 89,000 inhabitants in 1950 to
1.5 million in 2007. In 2025, the city is projected to have 3.2 million inhabitants.
HOW TO INFLUENCE THE DEMOGRAPHIC VARIABLE
9. Mali’s population growth could benefit from a multisectoral strategy, with a plan
of action that would focus on the following: (i) define a multisectoral strategy; (ii) ensure a
strong political engagement and identify key actors and the leaders who could advance this
strategy; (iii) coordinate the support of technical and financial partners (TFP); and (iv)
strengthen information systems and data collection. This preliminary plan of action should
be examined and discussed with the Government of Mali and development partners.
1 The number of teaching personnel consists of fulltime teachers and of a significant proportion (approximately
30 percent) of adjunct teachers and contractors, is in constant change given the high growth of school
population.
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10. Define a multisectoral strategy. This involves:
Ensuring that all development strategies are consistent with the demographic growth
issue. The revision planned for the 2007-2011 Strategic Framework for the Fight
against Poverty (CSLP) should take into account the demographic growth issue. The
World Bank Country Assistance Strategy (CAS) for Mali already takes it into
account. World Bank project support that will take over from the Program for Social
and Sanitary Development (PRODESS) could support reproductive health and family
planning efforts. Finally, development partners should be in agreement in the areas
of population and reproductive health.
Revisiting the concepts of family planning and reproductive health. Until now,
family planning, reproductive health, and fertility management interventions
implemented in Mali have had only modest impact and use of family planning
remains minimal. As in most sub-Saharan African countries, family planning
communications campaigns in Mali most often address birth spacing, presented as
conforming to African tradition and acceptable in the Muslim community. Even in
the most conservative areas of Mali, the notion of “short birth intervals” is identified
in national languages (the term “seremuso” in Bamana, identifying women who have
short birth intervals, carries a negative connotation). In addition, the consequences of
short birth intervals on children‟s health are well-known (the term “serebana” means
the weight loss and the complications that often lead to death in children born to
mothers with short birth intervals). It is therefore important to present family
planning as an essential measure to protect the life of an infant. As such, a
message perceived negatively - by a population that it is desirous of having many
children and that lives in fear of high infant and child mortality rates (1 in 5 children
die before age 5) - will be seen as a positive solution to protect a child whose birth is
a joy to the family (“den ka di” in Bamana). In adopting modern contraceptive
methods, couples will use available tools that will allow them to “plan” their
pregnancies, following their constraints and their wishes: in replacing traditional
methods that are as common as they are ineffective (such as the fine cord “tafo”),
contraception will be as accepted by the husbands (who will be able to “find” their
spouses at the end of periods prescribed by tradition or by religion) as by the imams,
who will see that family planning is in accordance with the foundations of Islam, to
guarantee the protection of one of the main gifts of God: a child.
Helping to accelere the achievement of the first five Millennium Development Goals
(MDG): (i) eliminating extreme poverty and hunger, (ii) achieving universal primary
education, (iii) promoting gender equality and empowering women, (iv) reducing
child mortality, and (v) improving maternal health. This plan must rest on three
strategic options: (i) the improvement of the quality of care and the access to care
through strengthening community health services, (ii) the management of a large
educational program in private and public schools involving teachers in the
development of programs and of educational material to teach boys and girls about
reproductive health, and (iii) the implementation of a continuous campaign via all
available media on the health of the family (television; national, regional, and
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community radio; itinerant kotéba troupes; posters, etc.), through the engagement of
villages, community health organizations, NGOs, and other organizations. The
success of this family health campaign would greatly benefit from the support of the
Head of State. USAID and UNFPA, that finance family planning and reproductive
health programs, will be joined by most other partners.
Having selected objectives, rather than covering a wide range of activities in an
incomplete way. Meeting women’s unmet need for family planning and
reproductive health should be a priority as should making quality services available
to them. The necessary expansion of family planning and reproductive health
services will require careful consideration of gender issues. Universal education of
young girls is also a policy instrument to lower fertility, as are the empowerment of
women and the involvement of men. The adoption of a new family Code, in the
process of being finalized, will be an essential step forward, notably by raising the
legal age at marriage to 18 years. Applied correctly, this measure will have
significant impact on lowering fertility.
Putting into place a national coordination body. The implementation of a national
population, family planning and reproductive health program will require firm
institutional grounding and strong national coordination. This central body -
coordinating the implementation of all activities related to population, family
planning, and reproductive health - should have an institutional level higher than a
Ministerial department and benefit from increased attention where financial resources
are concerned. A single administrative structure will be more efficient than several
under-resourced small entities. Furthermore, the central body in charge of
population matters should be accountable to produce results according to clear
performance indicators.
11. Secure strong political engagement and identify key actors and leaders. The
trigger for fertility decline and its continued decline will only happen through the strong
engagement and involvement of Malian leaders. Moreover, it will be necessary to re-
energize key actors and to identify new leaders among those working on population, family
planning, and reproductive health. It would also be desirable for the Authorities to: (i) have
an institutional structure in charge of monitoring population issues, family planning and
reproductive health; and (ii) mobilize adequate financing (national, multi-and bi-lateral) to
develop coherent and sustainable programs throughout the country. The establishment of a
National Forum on population to address all such needs would be a welcome initiative.
12. Coordinate the support of technical and financial partners. The revival of
population activities in Mali will not be stimulated without stronger engagement and better-
coordination of technical and financial partners (TFP). It would be suitable to identify those
most capable of supporting this change and of playing the role of mentor to their Malian
colleagues (TFPs already working on this issue are USAID, UNFPA, several bilateral
agencies from the United Nations, the World Bank, and certain international NGOs).
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13. Strengthen information systems and data collection. All studies on the population
of Mali population face a lack of demographic data, despite significant efforts to collect such
data recently. In addition to the 2009 population and housing census and the anticipated
improvement of civil registration Mali could consider conducting a survey on migration,
modeled after the study on Migration and Urbanization in Western Africa in 1993. Mali also
lacks rigorous demographic analyses. A clear and precise research agenda for the future will
be necessary to shed light on yet unstudied areas, periodically update data, regularly prepare
population projections, and to support the implementation of population, family planning and
reproductive health activities in Mali.
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INTRODUCTION
1. Mali has demographic characteristics similar to most sub-Saharan African
countries, except for those of Southern Africa. The population of Mali is very young: in
1998, 46.3 percent of the population was under 15 years of age. Whereas mortality,
especially infant and child mortality, has decreased rapidly, fertility has remained high over
the past decades, equaling 6.6 children per woman on average. As a result, the rate of
demographic growth has increased significantly over the last decades. Today, the natural
population growth rate is estimated at 3.3 percent per year (it would take 21 years for the
population to double). International migration somewhat slows down this growth, and the
net population growth rate is estimated at 3 percent per year, which leads to a doubling of the
population in 23 years.
2. Mali’s demographic future will be determined by its fertility levels and trends. Changes in fertility will impact not only Mali‟s completion of the demographic transition, but
also and above all its capacity to develop its human capital (see in the second chapter of this
study). These levels of fertility, in the order of 6.6 children per woman, have not changed in
the last few decades. Moreover, the desired number of children is still very high;
approximately three-fourths of women in Mali wish to have more children, and one-third
would like to have one in the near future (EDSM 2006). Hence, it is unlikely that there will
be a quick decline in fertility. Given the very young population structure, even if fertility
started to drop in the next few years, the population of Mali would still grow at a high rate
(and a continued decrease in mortality would further increase this high rate of growth).
Thus, according to population projections prepared for this study, the population of Mali
could grow from 11.7 million in 2005 to 27.7 million in 2035 (assuming rapid fertility
decline with a total fertility rate of 4.0 in 2035) or 33.9 million in 2035 (assuming slow
fertility decline with a total fertility rate of 6.3 in 2035) (all numbers are as of the 1st of
January). According to these projections, the population of Mali will double or triple in the
course of the next 30 years, depending on the level of fertility, and will be a populous
country in West Africa.
3. Such demographic challenges alone make it difficult to reach the millennium
development goals and to win the fight against poverty. One should, however, add the
challenges of the climate and a relative scarcity of economic and natural resources which
make this demographic increase and its consequences of more concern. In the absence of
immediate action aimed at reducing the present levels of fertility, universal primary
education and complete health and vaccination coverage will be difficult to achieve, and it
will be equally difficult to significantly decrease poverty). In this context, it is the success of
the Strategic Framework of the Fight against Poverty and the achievement of the Millennium
Development Goals that are threatened.
4. The aim of this study is to examine the consequences of population growth on the
access to education and to health services as well as on economic growth and to suggest
recommendations accordingly. The demographic projections presented in this study will
help the identification and analysis of the policies that Mali needs to benefit from the
economic advantages of a drop in fertility.
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5. This study is presented in three chapters. The first chapter shows the present
situation of the population of Mali and its prospects for the future. This chapter evaluates
available demographic data, analyzes the size, geographic distribution as well as the structure
and rate of growth of the population, including international migrations. It also presents
population projections for the years 2005 to 2035, based on slow or rapid fertility decline
scenarios. Chapter two is dedicated to the future implications of these demographic trends.
It first addresses the development of human capital (demographic investment), especially in
education and health. It then examines the macro-economic consequences of demographic
growth for Mali. Finally, it briefly analyzes other consequences of the high population
growth, in terms of increasing population density, agriculture, nutrition, urbanization,
environmental degradation, and maternal and child health. The last chapter assesses the
population policies in Mali and what is needed to set into motion a decline in fertility and
presents practical recommendations.
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CHAPTER 1. THE DEMOGRAPHIC SITUATION AND ITS
PROSPECTS
1.1. This chapter analyzes the demographic data available in Mali, evaluates their
quality and identifies data gaps. It then examines the four key population components:
size, geographical distribution, age structure, and growth rate. Population growth is the
result of the demographic transition process, i.e., the transition from high birth and death
rates (in equilibrium) to low birth and death rates (in equilibrium). Fertility and mortality
levels and trends are the main determinants of demographic transition. However,
international migration can slow population growth. Fertility and mortality levels and trends
are briefly analyzed (a more detailed analysis was not possible because of incomplete data).
The chapter finally presents two sets of population projections for Mali between 2005 and
2035 based on two different sets of assumptions. The first set is based on a slow rate of
fertility decline while the second set is based on a rapid rate of fertility decline. Projections
assuming rapid fertility decline are used to examine the impact of changes on the shape of the
population age pyramid, especially the shape of the base of the pyramid. Table 1.1 lists key
demographic indicators of Mali and related population policies and poverty reduction
strategies.
Table 1.1: Demographic indicators and population strategies in Mali
Population (mid-2007) 12.6 million
Out-migration (2008) Between 1.2 and 2.7 million Malians outside
the country (estimations) (the Government
sometimes puts forward the number 4 million)
Infant mortality rate (EDSM 2006) 96 deceased per thousand live births
Infant-juvenile mortality rate (EDSM 2006) 191 deceased per thousand live births
Total fertility rate (EDSM 2006) 6.6 children per woman
Contraceptive prevalence rate (ESDM 2006) 7.0 percent (modern methods, among women
aged 15-49)
Unmet need for family planning (EDSM
2006)
31.0 percent of women aged 15-49
Natural rate of growth (from 1998 todate) 3.3 percent per year (estimation)
(doubling time: 21 years)
Net rate of growth (from 1998 todate) 3.0 percent per year (estimation)
(doubling time: 23 years)
National Policy of Population (NPP) Adopted in 1991
Revised in 2003 (Revision 1)
Advocacy on population RAPID model prepared in 1995-96
Updated in 2003
Poverty Reduction Strategy Papers (PRSP)
or Strategic Framework for the Fight
against Poverty (CSLP)
Adopted in 2001, for the years 2002-2006
(does not mention questions of population).
Revised in 2007, for the years 2007-2011
Source: Republic of Mali 2007 and the World Bank (various years).
Demographic data are incomplete
1.2. Demographic growth can be measured using data from census, demographic
surveys, and civil registration when available. For censuses, four enumerations of the
17
population have been done in Mali since its independence (1960), but data quality varies
from one census to another. For demographic surveys, many have been conducted but
available data is to be used cautiously (except for demographic and health surveys). This is
because there is not always sufficient information on the methods used (sampling frame,
sample size, response rate etc.). Civil registration is the best source of demographic
information but Mali‟s civil registration system cannot provide reliable data on births and
deaths, and less so on marriage, because the civil registration is incomplete.
Box 1.1: Overview of demographic data in Mali
Population and housing censuses:
1976, 1987, 1998 and 2009 (the data of the 2009 RGPH are still being tabulated).
Quality: Good.
Demographic and health surveys:
1987, 1995-96, 2001 and 2006.
Quality: Good.
No MICS surveys.
Civil registry:
Quality: Incomplete (An Administrative Census with Civil Registration (RAVEC) has been
undertaken in 2009).
Data on internal and external migrations:
Quality: Incomplete.
Source: Authors (compiled from various sources).
1.3. The demographic data available for Mali are incomplete and unreliable and
therefore allows for only a general overview of the country’s demographic situation. The complete data on the structure of the population by age and sex come from the 1998
census but more recent data should be available soon; a census was conducted in 2009 but
the results remain preliminary as they have not been completely tabulated yet (see Box
A.3.1). Recent and reliable data on fertility and mortality (particularly on fertility) are
available from demographic surveys (the last one was conducted in 2006). Data on
migration, both internal and international, is of poor quality. Finally, civil registration data
are incomplete, but there is an effort to try and improve them. Despite their deficiencies, the
demographic data available in Mali are agreed upon by the country and the sub-region. For
example, the Center for Study and Research on Population and Development (CERPOD)
published at different times (especially in 2001) socio-economic and demographic indicators
for Mali which have been approved by international experts and their technical and financial
partners (TFP).
1.4. The first modern census in Mali was organized in 1976, followed by the 1987,
1998 and 2009 censuses. These modern censuses are of acceptable quality and do not seem
to have significant under-counting. In the absence of reliable data from the civil registry,
annual intercensal data are obtained by extrapolating from the latest available census. This
implies that the margin of error gradually increases as one gets farther from the date of the
original census.
18
1.5. Civil registry statistics are fragmented and incomplete. In Mali as in other parts
of sub-Saharan Africa, urban areas (cities) are better covered than rural areas (villages), and
births are better recorded than deaths. The improvement of the civil registry requires a
strengthening of the legal and judicial systems since vital statistics are derived from the
administrative system. For the time being, the Government of Mali plans to strengthen the
state of the civil registry because of the Administrative Census with Civil Status Registration
(RAVEC) which will complement the RGPH.
1.6. The statistics on internal and international migration are incomplete. There is
not much information on internal and international migration. Internal migration is gauged
through specific questions in the census and/or some socio-economic surveys. On the other
hand, international migration is very poorly documented. This represents a considerable gap
because of the significance of migration to Mali, especially international migration. The
most reliable data seem to be those obtained by inference and recently published by the
World Bank (World Bank 2008) (see section “Elements of the demographic change” later in
this chapter).
1.7. Mali has demographic surveys that provide reliable data on it natural
population growth (fertility and mortality). Mali has organized, among others, four
demographic and health surveys (EDSM) which were conducted in 1987, 1995-96, 2001, and
2006. The last survey is currently in its second level of analysis. These are the most reliable
demographic data currently available in Mali and allow us to monitor natural population
growth (fertility and mortality) trends during the past twenty years, especially infant and
child mortality trends. Finally, Mali does not have a Multiple Indicator Cluster Survey
(MICS) survey type (see www.childinfo.org).
The size of the population of Mali is average
1.8. During the past fifty years, the population of Mali has increased considerably
and at an ever-increasing rate. Different estimates show that before 1960, the annual
population growth rate was about 1.9 percent. In 1970-75, it grew to 2.3 percent a year and
reached 3 percent a year between 2000 and 2005 (this is the net population growth rate).
This rapidly increasing population growth rate can be attributed to a high decreases in
mortality and to constant fertility that has practically not changed for decades.
1.9. In mid-June 2007, the population of Mali was estimated at 12.6 million people. The first key component of a population is its size. This element is important because it
allows the estimation of population density and the gauging of the economic, political, and
even military potential of a country.
1.10. However, one does not know with certainty the real size of the Malian
population. As mentioned, a census was conducted in 2009 but its results are preliminary as
data tabulation remains underway. For this study, one uses the results of the census that
precedes the 2009 census and which dates back to 1998. Hence, the current population is
estimated using past fertility, mortality, and international migration trends. As noted earlier
in this chapter, the farther one gets from the date of the original census (in this case 1998) the
less reliable the extrapolations. The population estimates of Mali vary according to the
different sources (see Table 1.2).
19
Table 1.2: Different estimates of Mali’s population, 2005-2008
Year
DNP
&
DNSI
Population
Reference
Bureau
World
Bank
U.N. Pop. Division
2006 Revision
(Medium Variant)
2005 (1 January) 11,732,420
2005 (30 June) 11,908,406 13,500,000 11,611,000 2006 (30 June) 12,265,658 13,905,000 11,959,330
2007 (30 June) 12,633,628 12,300,000 14,322,150 12,318,110
2008 (30 June) 13,012,637 12,669,000 14,751,815 12,687,653
Notes: Estimates are listed in bold and projections in italics.
Projections are based on a net population growth rate of 3 percent per year.
Sources: National Population Directorate, Bamako, Mali; Population Reference Bureau,
Washington, DC; World Bank; and United Nations Population Division.
1.11. Mali has an average population size compared to the sub-region and to large
countries in sub-Saharan Africa. However, compared to its direct neighbors (not counting
Algeria because it is located North of the Sahara), Mali is relatively populous; its population
size is almost as big as Niger‟s and only lags behind that of Côte d‟Ivoire (see Table 1.3,
2005 data).
20
Table 1.3: Key data for Mali, the sub-region, and large countries of sub-Saharan Africa
Population
2005
(millions)
Surface area
(thousands of
km²)
Density
(persons per
km²)
Gross domestic
product per
capita (USD)
Mali and countries in the
sub-region:
Mali
Algeria
Niger
Burkina Faso
Guinea
Senegal
Côte d‟Ivoire
Mauritania
Large countries in sub-
Saharan Africa:
Nigeria
Ethiopia
Dem. Rep. of Congo
Sub-Saharan Africa
13.5
33.0
14.0
13.2
9.4
11.7
18.2
3.1
131.5
71.3
57.5
743.0
1,240
2,382
1,267
274
246
197
322
1,026
924
1,104
2,345
24,265
11
14
11
48
38
61
57
3
144
71
25
31
380
2,730
240
400
420
700
870
580
560
160
120
746
Source: World Bank Development Indicators (2007).
A highly rural population clustered in the South
1.12. The population of Mali is mainly concentrated in the South of the country as
well as along the Niger River. The spatial or geographical distribution of a population is
another key component of any population study. This variable has important implications for
the socio-economic development of a country and could determine investment priorities
According to the 1998 census, close to 90 percent of the Malian population lived in the 5
regions in the South of the country. If the Mopti area is excluded, four regions in the
Southwest were home to three-fourths of the population of Mali. The most populated areas
were those of Koulikoro (where the capital Bamako is located), Segou, and Sikasso: these
regions together sheltered 60 percent of the population of Mali. On the other hand, the desert
regions of the North, namely Tombouctou, Gao, and Kidal, were home to less than 10
percent of the total population (see Table 1.4). It can be assumed that these trends have not
drastically changed since the 1998 census, although urbanization has accelerated. The
numbers for 2008 are derived from population projections prepared by the National
Population Directorate (DNP) but these projections do not take into account internal
migration, which explains why the distribution among the regions remains identical.
21
Table 1.4: Population of Mali, rural and urban, and by region, 1998 and 2008
Regions Population 1998 Population 2008 (1 January)
Thousands Percent Thousands Percent
Urban 2,633.40 26.8 4,313.24 34.0
Rural 7,177.50 73.2 8,399.42 66.0
Bamako 1,016.30 10.4 1,316.88 10.4
Kayes 1,374.30 14.0 1,780.80 14.0
Koulikoro 1,570.50 16.0 2,035.01 16.0
Sikasso 1,782.10 18.2 2,309.26 18.2
Ségou 1,675.40 17.1 2,170.87 17.1
Mopti 1,478.50 15.1 1,915.80 15.1
Tombouctou 476.80 4.9 617.82 4.9
Gao 394.60 4.0 511.31 4.0
Kidal 42.40 0.4 54.92 0.4
Total pop. 9,810.90 100.0 12,712.67 100.0
Sources: Sahel Institute, Demographic and socio-economic indicators of
Mali 2001, Bamako: INSAH, 2001 and DNP.
1.13. Population distribution by urban and rural areas shows the acceleration of
urbanization in Mali. Malians are moving to urban areas. The share of the rural population
has strongly decreased since 1975 where it hovered around 84 percent of the total population.
In the 1998 census, the rural population was estimated at 73.2 percent. Finally, on the 1st of
January 2008, it was estimated that 66.1 percent of the population of Mali was rural. Thus,
within 30 years the rural population has declined by about 20 percentage points (UN 2007).
The capital Bamako was home to more than 10 percent of the total population of the country
in 1998 (see table 1.4). All these trends should be confirmed by the results of the new census
of the population that was conducted in 2009. This urban concentration is a consequence of
the natural population increase in the cities and of rural exodus. Unfortunately, the data on
internal migration in Mali are incomplete and do not allow the identification of the migratory
movements between regions or between rural and urban areas.
A very young population structure
1.14. The population structure of Mali by age and sex - almost perfectly pyramid shaped - shows how young the Malian population is. The population structure of a
country by age and sex is probably the most important dimension of socio-economic
development. This structure determines the training needs of the human capital and shows
the need to train an ever-growing number at the base of the pyramid if the fertility remains
high (see Chapter 2). The age and sex structure in Mali is typical of the populations of
countries that have not yet effectively started their fertility transition (meaning the decline
from high to low fertility). The Mali population pyramid has a very wide base since a large
share of the population is among young age groups. According to the 1998 Mali census, 46.3
percent of the population was under 15 years of age, 50.2 percent of the population was
between the ages of 15 and 65, and 3.5 percent was over 65 years old (Sahel Institute 2001).
22
However, there is a slight indentation in the pyramid for young adults aged between 20 and
50 years - especially among men who are the left side of the pyramid - which can probably
be explained by the out-migration of males in these age groups (see Figure 1.1)2.
Figure 1.1: Age pyramid of Mali, 1 January 2005
Source: DNP/DNSI.
1.15. The number of young people aged 10 to 24 years was 3.5 million in 2005,
approximately 30 percent of the Malian population. It is the decisions that these young
people will take as to the number of children they want to have and when to have them
(timing of fertility) that will determine the size of the Malian population in the twenty-first
century. If adequately trained and if jobs are available to them, these young adults entering
the job market for the first time will be additional labor force that will contribute to more
rapid economic development. This will be possible only if adequate plans for human capital
formation are implemented (see Chapter 2).
1.16. This young population structure results in a dependency ratio. The dependency
ratio is defined by the number of dependants in the population (people under 15 years of age
and those older than 65) divided by the number of working age people (i.e., people 15 to 64
years of age). In Mali, there were 113 dependents for 100 working age adults in 2005.
Among the dependents, approximately 92 percent were under 15 years of age, and around 8
percent above 65. The dependency ratio shows the level of the economic and social burden
borne by the active population and the level of economic dependence. However, this is only
an approximation, since all working age people are not necessarily working, and all people
categorized as dependents are not necessarily dependents.
1.17. Women slightly outnumber men in Mali – 100 women per 98 men in 2005. The
sex ratio at birth is 105 boys for 100 girls, same as worldwide sex ratio at birth. While males
outnumber females at birth, most populations have more females than males since male
2 All population pyramids in this study show the numbers in absolute value.
Population (in thousands)
4,000 2,000 0 2,000 4,000
0-4
10-14
20-24
30-34
40-44
50-54
60-64
70-74
80-84
Age
Males Females
23
mortality is higher than female mortality. In Mali, the out-migration of men contributes to
women outnumbering men.
1.18. The Malian population has almost quadrupled in a little over half a century: it
grew from almost 3.3 million in 1950 to 12.6 million people in mid-2007 (see Fig.1.2). In
addition to the size, geographical distribution, and the age structure of a population, the
growth rate of a population has important implications for the economy of a country and the
living conditions of its inhabitants. Population growth determines the strategy that a country
has to adopt in order to satisfy the demand for social services and to build its human capital
while minimizing the pressure on public resources. The strategy used will have influence on
the human development as well as on poverty reduction.
Figure 1.2 : Growth of the Malian population, 1950-2005 (thousands)
Source: United Nations, 2006 World Population Prospects.
1.19. The considerable growth of Mali’s population is the result of a rapid decrease in
mortality rates and unchanging high fertility rates. The decrease in mortality - especially
infant (below age 1) and child (between 1 and 5 years) mortality - is due to gains in life
expectancy resulting from improved health services and sanitary conditions. Vaccination
campaigns, the fight against malaria (e.g., insecticide treated mosquito nets), nutrition
programs (e.g., vitamin supplementation), and oral rehydration therapy for young children
are examples of interventions that contributed to improved health. On the other hand,
fertility levels remain very high. The total fertility rate (TFR) - estimated at an average 6.6
children per woman in 2006 - has remained practically unchanged over the past 15 years and
the levels of modern contraceptive use have remained very low.
1.20. Crude birth and death rates have followed different trends over the past fifty
years. The crude birth rate (the annual number of births for 1000 people) has remained high
and practically unchanged between 1950 and 2005, in the order of more than 50 births per
thousand per year. The crude death rate, on the other hand, was almost halved over the same
period and went from over 30 to almost 15 deaths per thousand per year (see Figure 1.3).
Declines in mortality have not been coupled with declines in fertility.
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
1950 1960 1970 1980 1990 2000 2005
Year
Po
pu
lati
on
(in
th
ou
san
ds
)
24
Figure 1.3: Crude birth rate and crude death rate, 1950-2005 (per 1,000 per year)
Source: United Nations, 2006 World Population Prospects.
1.21. The population of Mali was increasing by more than 2 percent a year in 1970,
while it is presently increasing at the rate of 3.3 percent a year. The annual natural
growth rate is the difference between crude birth rates and the crude death rate. A growth
rate of 3.3 percent a year implies a doubling of the population in about 21 years. The
population growth rate increased between 1950 and 1970 but remained under 2 percent a
year. It stabilized at around 2.2 percent a year between 1970 and 1985, then started
increasing at a faster pace. It reached the peak level of 3.3 percent a year that is currently
observed (United Nations, World Population Prospects 2006) (see Figure 1.4). However,
negative net migration rate (because of the strong out-migration) brings down the natural
population growth rate of 3.3 percent to a net population growth rate of about 3 percent a
year. At this rate of net rate of growth, one can safely predict that the population will double
in 23 years (by 2032).
0
10
20
30
40
50
60
1950- 1955
1955- 1960
1960- 1965
1965- 1970
1970- 1975
1975- 1980
1980- 1985
1985- 1990
1990- 1995
1995- 2000
2000- 2005
Interval Years
Cru
de
bir
th a
nd d
ea
th r
ate
Crude brith rate Crude death rate
25
Figure 1.4: Annual growth rate of Mali’s population, 1950-2005 (percent)
Source: United Nations, 2006 World Population Prospects.
Early age at first union and widespread polygamy
1.22. Women in Mali enter into union3 at a very early age. Among women aged 25-49,
close to one quarter (23 percent) were already in union at the age of 15. Moreover, two-
thirds of women were in union at the age of 18 and almost all women (95 percent) were in
union at the age of 25, according to the 2006 demographic and health survey (EDSM 2006).
Men enter into union at a much higher age than women: at age 22, while most women have
already entered into union (90 percent), only 23 percent of men have. Looking at the age at
first union is important because of the close relationship between age of first entry into union
and the beginning of exposure to fertility. The median age of entry at first union for women
is 16.6 and has practically not changed for a generation. For men, the median age at first
entry into union is 25.8 and appears to be decreasing: it is 27.9 years among men aged 45-49,
but 24.1 years among those aged 25-29.
1.23. The biggest differences in the first age at union are related to the level of
education. The age at first union of women increases as the level of education increases:
from 16.4 years among women with no education, to 17.1 among women with primary
education, to 20.3 years among women with secondary or higher level of education,
according to the EDSM 2006. For men, too, the age at first union increase with increasing
level of education. Age at first union is lower in rural areas (16.3 years) than in urban areas
(17.3 years). Women in Bamako marry later (18.1 years) than women in other cities (16.8
years). For men, as for women, entry into first union is higher in urban (27.9 years) than in
rural areas (25.1 years). Household income has less influence on the age at first union of
women. Men in richer households tend to enter into union at a higher age.
3 The term “union” applies to all people who are married or cohabiting (with one partner for women and with
one or more partners for men), be it civil, religious, customary, consensual or common law union.
0
0.5
1
1.5
2
2.5
3
3.5
1950- 1955
1955- 1960
1960- 1965
1965- 1970
1970- 1975
1975- 1980
1980- 1985
1985- 1990
1990- 1995
1995- 2000
2000- 2005
Years
Po
ula
tio
n g
row
th r
ate
(%
)
26
1.24. In Mali, polygamous unions are widespread and affect 40 percent of women in
union. In comparison, 28 percent of men in union are in a polygamous union. Among
women in a polygamous union, 7 percent have two or more co-spouses, according to the
2006 Demographic and Health Survey (EDSM 2006). At the age 45-49, more than half of
women in union (55 percent) are in a polygamous union.
1.25. The practice of polygamy is more widespread in rural than in urban areas (45
percent and 27 percent, respectively) and disproportionately affects women with lower
levels of education. The proportion of women living in a polygamous union is 42 percent
among women with no education, 30 percent among women with primary education, and 19
percent among women with secondary or higher level education, according to the EDSM
2006. In term of economic status, the proportion of polygamous women decreases as the
household income increases; the proportion is 25 percent in the richest quintile compared to
46 percent in poorest one. Among men, however, polygamy does not vary significantly with
the household income and seems to be most widespread among the middle class.
Elements of demographic change
1.26. Mali still has to start its fertility transition, namely a decrease in fertility. The
demographic transition is the gradual shift from high levels of births and deaths (in
equilibrium) to low levels of births and deaths (in equilibrium). The demographic transition
usually begins with the decrease in mortality, which is the first phase of the transition
process. However, that drop, which has already started in Mali, has not been followed by a
drop in fertility.
1.27. The rate of infant and child mortality remains very high in Mali and should
continue dropping in the future, which will lead to a higher population growth rate if
fertility does not drop or drops slowly. The crude death rate started dropping around 1950,
and this trend should remain steady in the future. The levels of infant and child mortality
remain high in Mali, but they have started to drop significantly. Improvements in mortality
can be further improved by expanding education, nutrition, and public health services.
1.28. The infant mortality rate was estimated at 96 per 1,000 live births in 2004
compared to 125 per 1,000 live births in 1994, according to the 2006 Demographic and
Health Survey (EDSM 2006). The child mortality rate was estimated at 191 per 1,000 live
births in 2004, compared to 242 in 1994 (EDSM 2006). There is a gap between the level of
infant mortality and child mortality in Mali, Niger and Burkina Faso. This could be due to an
under-registration of infant deaths, or to a weakness of the National Program for the
Integrated Management of Childhood Illnesses (PCIME) that targets children over 1 year old,
or due to a combination of the two.
1.29. Data available on the levels of adult mortality are incomplete. However, Mali
does not have a serious HIV/AIDS epidemic. The last demographic and health survey of
2006 found a prevalence of HIV-1 or HIV 2 of 1.3 percent for people of both sexes aged 15
to 49 year. This rate is 1.2 percent for HIV-1. HIV prevalence is higher among women than
among men and higher in urban areas than in rural areas (1.3 percent and 0.9 percent
respectively). Bamako has the highest prevalence in the country, with 1.9 percent of people
infected and 2.2 percent of men aged between 30 and 34 infected. Among women, the
27
highest prevalence, 1.9 percent, is among women aged between 25-29 years (EDSM 2006).
HIV prevalence remains weak in Mali compared to other countries of sub-Saharan Africa.
Table 1.5: Fertility and Mortality in Mali, its neighboring countries, and large countries of sub-
Saharan Africa, 2005
Life
expectancy
(both
sexes)
(years)
Infant
mortality
rate (per 1,000
live births)
Child
mortality rate
(per 1,000
live births)
Total
fertility rate
(births per
woman)
Contraceptive
prevalence,
all methods
(percent of
women
aged 15-49)
Mali and neighboring
countries: Mali Algeria Niger Burkina Faso Guinea Senegal Ivory Coast Mauritania Large countries of
sub-Saharan Africa: Nigeria Ethiopia Dem. Rep. of Congo Sub-Saharan Africa
49 72 40 48 54 56 46 54
44 43 44 47
(*) 96 34
(*) 81 96 97 61
118 78
100
80 129
97
(*) 191 39
(*) 198 191 160 119 195 125
194 127 205 163
(*) 6.6 2.4
(*) 7.1 5.9 5.6 4.9 4.7 5.6
5.5 5.3 6.7 5.3
(*) 8 57
(*) 11 14
7 11
.. 8
13 15 31 23
Sources: (*) 2006 Demographic and Health Surveys, otherwise 2006 World Bank Development Indicators.
1.30. Mali’s fertility and mortality indicators do not compare favorably with those of
its neighboring countries, or of large countries in sub-Saharan Africa (see Table 1.5).
According to the international data, life expectancy at birth is low in Mali. However, the
National Population Directorate (DNP) has calculated a higher estimate of life expectancy at
birth: 58.5 years for men and 59.3 for women (this number may be too high). Mali‟s fertility
level of fertility is higher than that of its neighbors, except for Niger and for the average of
sub-Saharan Africa. The total fertility rate – the average number of children that a woman
will bear during her life if the present conditions are maintained – was estimated to be 6.6 in
2006 in Mali (EDSM 2006). The use of modern methods of contraception remains poor at
7.0 percent of women in union, and has increased only slightly since 2001 (EDSM 2006).
1.31. International migration slows the natural population growth of Mali, but
reliable data are lacking. In 2005, the total number of Malian migrants living outside the
country was estimated between 1.2 and 2.7 million people, the equivalent of 10 and 23
percent of people residing in the country, respectively. Malian authorities (Ministry of
Malians Abroad and African Integration, and High Council for Malians Living Abroad)
estimate that 4 million Malians live abroad, equal to 34 percent of the population living in
28
Mali (Transtec 2006).4 These Malian migrants live mainly in (by decreasing order of the size
of the Malian communities abroad): Côte d‟Ivoire, Burkina Faso, Nigeria, France, Niger,
Gabon, Senegal, Gambia, the Republic of Congo and Mauritania (World Bank 2008: 155).
The National Population Directorate (DNP) estimates a negative net migration of
approximately 50,000 Malians per year, of which two-thirds are men and the remaining third
are women. The unrest in Côte d‟Ivoire may have triggered a migration back to Mali. On the
other hand, Mali welcomes immigrants, but in much smaller numbers: the number of
immigrants was estimated at less than 50,000 people in all in 2005 as well (World Bank
2008: 155).
Demographic projections
1.32. The demographic projections5 for Mali suggest that the population that was 11.7
millions in 2005 could more than double or triple by 2035 depending on its future
fertility trends. The projections make the best use of the available data which are, as
already noted, incomplete. The component method was used for making the projections, and
the projection methodology, along with the main results, is explained in Annex 3. The same
mortality and international migration assumptions are used for the two scenarios considered
for this study, while two different fertility assumptions are considered: slow fertility decline
and rapid fertility decline. In the slow fertility decline scenario, fertility decreases from 6.6
to 6.3 children per woman between 2005 and 2035, and in the rapid fertility decline scenario,
fertility decreases from 6.6 to 4.0 children per woman in 2035. The level of mortality is too
optimistic (life expectancy at birth too high), but the purpose of the projections is to compare
the effects of the two different fertility trends. So, the first projection scenario could be
qualified as one of no intervention while the second projection scenario as a proactive one
based on effective programs to reduce fertility. In many countries, fertility decline was
achieved the education of girls, increased access to modern contraception methods, and the
implementation of legal reforms (namely age at first marriage). In some instances, gender
policies have been added to these interventions to ensure more equality between men and
women and greater autonomy of women in matters of reproduction.
1.33. According to the two projection scenarios considered, the population of Mali
would grow from 11.7 million in 2005 to 27.7 million in 2035 (rapid fertility decline:
TFR=4.0 in 2035) or 33.9 million in 2035 (slow fertility decline: TFR=6.3 in 2035) (all
numbers are as of the 1st of January). The population would reach 25.8 million in 2035 if the
fertility dropped to 3.3 in 2035. It would reach 23.7 million if the fertility dropped to 2.4 in
2035. The results of the first two projections are presented in Figure 1.5.
4 The percentages are calculated based on the estimates of the National Population Directorate for the Malian
population at the beginning of 2005, which was of the order of 11.7 million.
5 The new population projections that have been prepared with the preliminary data of the 2009 Population and
Housing Census are not much different from the results of the projections used in this report (see Box A.3.1).
29
Figure 1.5: Population projections, slow fertility decline vs. rapid fertility decline
Source: Authors’ calculations.
1.34. Beyond population size, the most important factor is the change in the
population age structure, especially at the base of the population pyramid, due to
fertility declines. If fertility remains constant or if it declines only slightly, the age structure
will stay practically the same. However, a decline in fertility changes the population pyramid
by gradually stabilizing the number of births, i.e. stabilizing the number of people who enter
the base of the pyramid. This change in the age structure will lead to a change in the
dependency ratio which will improve in the case of a drop in fertility. Hence, the
dependency ratio will change from 1.13 to 1.05 in the case of a slow fertility decline from 6.6
to 6.3 children per woman (high fertility scenario), but drops from 1.13 to 0.79 in case of a
slow fertility decline from 6.6 to 4.0 children per woman in 2035 (low fertility scenario).
The population pyramid in 2035 illustrates three scenarios brought about by different fertility
trends (see Figure 1.6).
0
5
10
15
20
25
30
35
40
2005 2010 2015 2020 2025 2030 2035
Years
Slow fertility decline Rapid fertility decline
Po
pu
lati
on
to
tale
(m
illio
ns)
30
Figure 1.6: Mali population pyramid, by projection scenarios, 1 January 2035
Source: Authors‟ calculations.
1.35. An even faster drop in fertility to 3.0 (relatively low fertility) or 2.1 (replacement
fertility) children per woman in 2035-40 will make the shape of the base of the age
pyramid more rectangular. A TFR of 2.1 children per woman is considered the
replacement level of generations (depending on the conditions of mortality in the country).
Furthermore, this faster drop in fertility will further lower the dependency ratio to 0.7
(TFR=3.0) and 0.61 (TFR=2.1) respectively in 2035 (see Figure 1.6). The projection
methodology is explained in Annex 3.
Population (in thousands)
4,000 2,000 0 2,000 4,000
0-4
10-14
20-24
30-34
40-44
50-54
60-64
70-74
80-84 A
ge
Males Females
Very low projection Low projection High projection
31
Figure 1.7: Mali population pyramid, Low projection, 2005, 2020, and 2035
Source: Authors’ calculations.
1.36. The next chapter will examine the implications of the changes in the age
structure, resulting from a drop in fertility, on human capital development in Mali in
the areas of education and health (using the first two population projections presented,
slow and rapid fertility decline). It will also examine other consequences of demographic
growth in Mali.
Population (in thousands)
4,000 2,000 0 2,000 4,000
0-4
10-14
20-24
30-34
40-44
50-54
60-64
70-74
80-84
Ag
e
Males Females
2005 2020 2035
32
CHAPTER 2. CONSEQUENCES OF DEMOGRAPHIC TRENDS
2.1. This chapter examines the implications of the fast demographic growth in Mali
on human capital development in the areas of education and health. The chapter also
examines the implications of demographic growth on population density, agriculture,
nutrition, urbanization, the environment and finally the health of the population, particularly
maternal and child health.
2.2. First, the chapter examines the impact of demographic growth on human
capital development through a model of the education and health sector. The fast
growth in numbers means, from a strictly financial perspective, a higher cost for the
education and health systems, because of the added burden of “demographic investments” – a
term used to denote all necessary expenses needed to develop human capital or, in other
words, the future work force. These demographic investments are crucial because they
determine the future economic growth and subsequently the standard of living. With respect
to national income, these investments are more difficult to secure when the population is
growing rapidly, as is the case in Mali.
2.3. The other analyses presented in this chapter are shorter, because they will be
addressed in-depth in future studies. In effect, the Government of Mali wishes to conduct
a study to gauge the impact of demographic growth on agriculture. This work will be
included in the implementation framework of the Economic and Social Development
Program (PDES). It will be led by the National Population Directorate (DNP) with the
support of the World Bank. Furthermore, the World Bank anticipates undertaking an
analysis of urbanization in Mali, which will consider the impact of the demographic growth.
Demographic growth and human capital development
2.4. The departure point for the analysis presented here is a simulation model that
estimates the consequences of population growth on education and health systems, in
quantitative terms (means, personnel, and budget). For example, the trends in educational
and health coverage rates will be analyzed based on two population growth scenarios: slow
fertility decline with a total fertility rate (TFR) of 6.3 children per woman in 2035, and rapid
fertility decline with a TFR of 4.0 children per woman in 2035. To do this, a certain number
of national level indicators will be included: reports on population and infrastructure
(educational and health, including hospital beds) and population and staffing reports
(teachers, nurses, midwives, and doctors). Annex 4 presents the model, the variables, the
assumptions used and their limits.
The education sector
2.5. The rapid population growth in Mali results in a high level of demand for
schooling. According to the two demographic projections scenarios (slow fertility decline
and rapid fertility decline), the school age and school attending population at each
33
educational level in Mali will grow significantly in the coming years6 (see Table 2.1). In the
current context of Mali, this demand will intensify further because of rapid urbanization, the
relative success of awareness creation among Malian parents of the importance of educating
all their children, and the greater access for women to income-generating activities that take
place outside the home and therefore a higher level of education.
Table 2.1: Number of students by educational level, 2005-2035
2005 2010 2015 2020 2025 2030 2035
Preschool Slow decline 32,844 38,808 46,424 56,084 68,040 82,516 100,128 Rapid decline 32,844 38,444 45,136 53,060 62,076 71,848 82,236
Basic 1
Slow decline 566,559 669,438 800,814 967,449 1,173,690 1,423,401 1,727,208 Rapid decline 566,559 663,159 778,596 915,285 1,070,811 1,239,378 1,418,571
Basic 2
Slow decline 287,385 339,570 406,210 490,735 595,350 722,015 876,120 Rapid decline 287,385 336,385 394,940 464,275 543,165 628,670 719,565
Secondary Slow decline 49,266 58,212 69,636 84,126 102,060 123,774 150,192 Rapid decline 49,266 57,666 67,704 79,590 93,114 107,772 123,354
Technical and professional Slow decline 40,820 48,233 57,698 69,704 84,564 102,556 124,445 Rapid decline 40,820 47,780 56,098 65,946 77,152 89,297 102,208
Higher Education Slow decline 33,548 39,640 47,419 57,286 69,498 84,284 102,274 Rapid decline 33,548 39,268 46,103 54,197 63,406 73,388 83,998
Non-Formal
Slow decline 20,000 23,632 28,269 34,152 41,432 50,247 60,972 Rapid decline 20,000 23,410 27,485 32,310 37,801 43,751 50,077
Source: Authors’ calculations.
2.6. Practically negligible in the 1960s, the number of children who are sent to
preschool7 will grow rapidly between now and 2035. Children aged 3 to 6 make up an
important age group because of the elevated fertility level. According to the two projection
scenarios, these children will make up at least 14 percent of the total population8 in the
coming decades. The number of preschool children is projected to rise from 32,844 in 2005
to 56,084 in 2020 and 100,128 in 2035 (assuming low fertility decline and maintaining the
6 The structure of the Malian education system consists in six formal levels of instruction: preschool (2/3 years),
basic education of 1st cycle (6 years, previously called primary school), basic education of 2nd
cycle (3 years,
previously called secondary school), general secondary education (3 years, also called secondary/high
school/lycee), technical and professional education (lasting from 2 to 4 years) and, higher education.
7 Data available for this sub-sector are incomplete. The private sector has been expanding since it started in
1990 and has an increasing capacity to enroll more students.
8 Authors‟ calculations based on DNP data.
34
current enrollment rate of 6 percent9). These numbers could, however, rise to 508,500 with
an enrollment rate aimed of 15 percent. This shows an increase in the current numbers by at
least threefold to a maximum of 14 times. This trend does not change significantly under the
rapid fertility decline that assumes an average of 4.0 children per women in 2035.
2.7. The trend in basic education is equally important and does not show much
change. 853,944 students attended basic public education in 2005, of which 566,559
attended the basic cycle 1 level (66.3 percent) and 287,385 attended the basic cycle 2 level
(33.7 percent). The number of students enrolled in basic education will rise by 150 percent
between 2005 and 2035 (rapid fertility decline) or by 205 percent (low fertility decline),
going from 853,944 students to 2,138,140 and 2,603,328 students, respectively. This rise is
equivalent to an annual average rate of growth10
of 3.8 percent (slow fertility decline) to 3.1
percent (rapid fertility decline). The pace of growth in enrollment in the basic cycle 1 level is
higher than that in the basic cycle 2 level. Despite this significant growth in the number of
students, the goal of universal primary education will still not be achieved.
2.8. A look at the growth in the number of those enrolled at the secondary,
technical, and professional levels shows an equally rapid growth in the coming decades.
This growth is mainly due to enrollment at secondary level. The number of secondary
students will increase 2.5 times (rapid fertility decline) or threefold (slow fertility decline)
between 2005 and 2035. Between 2005 and 2035, this growth corresponds to an increase of
more than 75,000 students (rapid fertility decline) or of 100,000 students (slow fertility
decline). During the same period, the total number of students enrolled at the technical and
professional levels will increase from 40,820 to 102,208 (rapid fertility decline) or 124,445
(slow fertility decline). In the same way, projections indicate that Mali will see a significant
increase in higher education enrollment numbers which will more than double in 20 years
compared to 2005 enrollment.
2.9. To accommodate the growing school age and school enrolled population
described above, significant efforts will be necessary in terms of recruitment of teachers
and procurement of instructional materials (textbooks). Tables 2.2 and 2.3 show the
projected need for teachers due to the growth in the size of school enrollment11
. The increase
in school enrollment depends on the growth in school-age population as well as on the
growth in school enrollment (more and more parents want to send their children to school).
These two factors increase the size of school enrollment and, as a result, the need for
additional teachers12
and additional classrooms. In total, the shortage in teaching personnel,
9 Coverage of children aged 3-5 years is still very limited, in the order of 6 percent in 2005. This coverage is
essentially urban and mostly benefits privileged populations in the Malian context.
10
The annual average growth rate is the value of growth (positive or negative) measured over many years, then
scaled to one year.
11
The school population, differentiated by levels and types of education, form the base for the projection of
needs.
12
The number of teaching personnel, consisting of fulltime teachers/permanent teachers and of a sizable
proportion (about 30 percent) of adjunct teachers and contractors, is in constant change given the high growth of
school population.
35
all levels combined, is estimated at 113,016 in 2035 (rapid fertility decline) and 142,122
(slow fertility decline). Therefore, 83,354 school education teachers (basic and secondary
levels) will need to be recruited between 2005 and 2035. Finally, the response to the
additional demand created by the average annual demographic growth in Mali - maintaining
the rate of 63 students per teacher and per class - will necessitate finding 1,457 teachers and
classes a year, in addition to the current needs. Yet, over the last few years, only between
500 and 600 new classes a year were created in elementary schools. These teaching
personnel needs projections take into account the political will to improve teacher-student
ratio especially in higher education, primarily to lower the elevated failure rates in the first
university cycle.
Table 2.2: Shortage in teachers, 2005-2035 (slow fertility decline)
2005 2010 2015 2020 2025 2030 2035 Total
Preschool 29 88 619 1,039 1,559 2,188 2,954 8,476
Basic 1 180 1,813 3,898 6,543 9,817 13,781 18,243 154,275
Basic 2 125 1,259 2,708 4,546 6,820 9,573 12,924 37,955
Secondary 43 432 928 1,558 2,338 3,282 4,431 13,012
Tech/Prof 62 628 1,351 2,267 3,402 4,775 6,446 18,931
Higher Ed. 11 113 242 407 610 857 1,157 3,397
Non-formal 20 202 433 728 1,092 1,532 2,069 6,076
Total 470 4,734 8,323 13,971 20,961 29,424 48,224 142,122
Table 2.3: Shortage in teachers, 2005-2035 (rapid fertility decline)
2005 2010 2015 2020 2025 2030 2035 Total
Preschool 29 272 563 908 1,300 1,724 2,176 6,979
Basic 1 180 1,713 3,546 5,715 8,184 10,860 13,704 43,901
Basic 2 125 940 2,213 3,720 5,434 7,294 9,270 28,999
Secondary 43 408 844 1,361 1,949 2,587 3,264 10,457
Tech/Prof 62 594 1,229 1,980 2,836 3,763 4,748 15,212
Higher Ed. 11 84 198 333 486 653 830 2,595
Non-formal 20 191 394 636 910 1,208 1,524 4,882
Total 470 4,202 8,987 14,653 21,100 28,088 35,516 113,016
2.10. Concerning the need for teaching material, Tables 2.4 and 2.5 show the
projected need for textbooks between 2005 and 2035 (slow and rapid fertility declines). The growth of school population size translates into a dire shortage of textbooks, and, as a
result, into a continual and sharp decrease in the textbook-student ratio.
36
Table 2.4: Need for textbooks, 2005-2035 (slow fertility decline)
2005 2010 2015 2020 2025 2030 2035 Total
Preschool 6,422 19,404 23,212 28,042 34,020 41,258 50,064 212,422
Basic 1 188,853 223,146 266,938 322,483 391,230 474,467 575,736 2,442,853
Basic 2 57,477 67,914 80,913 98,147 119,070 144,403 175,224 743,148
Secondary 4,927 5,821 6,964 8,413 10,206 12,377 15,019 63,727
Tech/Prof 4,082 4,823 5,770 6,970 8,456 10,256 12,444 52,801
Higher Ed. 1,118 1,321 1,581 1,910 2,317 2,809 3,409 14,465
Non-formal 6,667 7,877 9,423 11,384 13,811 16,749 20,324 86,235
Total 279,546 330,306 394,801 477,349 579,110 702,319 852,220 3,615,651
Table 2.5: Need for textbooks, 2005-2035 (rapid fertility decline)
2005 2010 2015 2020 2025 2030 2035 Total
Preschool 6,422 19,222 22,677 26,530 31,038 35,924 41,118 182,931
Basic 1 188,853 221,053 260,783 305,095 356,937 413,126 472,857 2,218,704
Basic 2 57,477 67,277 79,369 92,855 108,633 125,734 143,913 675,258
Secondary 4,927 5,767 6,803 7,959 9,311 10,777 12,335 57,879
Tech/Prof 4,082 4,778 5,638 6,595 7,715 8,930 10,221 47,959
Higher Ed. 1,118 1,309 1,545 1,807 2,114 2,446 2,800 13,139
Non-formal 6,667 7,803 9,206 10,770 12,600 14,584 16,692 78,322
Total 279,546 327,209 386,019 451,611 528,348 611,521 699,936 3,274,190
The health sector
2.11. The health sector is also confronted by the demographic challenge. Population
growth, no matter what the scenario (slow or rapid fertility decline), has a negative effect on
the availability of human resources and health facilities. This effect of population growth on
Mali‟s health sector13
is illustrated through three major parameters – medical personnel,
health facilities, and health expenditures.
2.12. At the national level, ratios seem satisfying or almost satisfying, compared with
current national and international standards. However, if Bamako (the capital) is
excluded, the ratios (health personnel/population) fall to 46 percent (doctors), 37 percent
(nurses), and 40 percent (midwives). Thus, large gaps remain in the availability of human
resources in the health sector. The poorest regions suffer from these gaps, because, health
13
The Malian public health system is organized under a pyramid form at three levels: the central level
(corresponding to services and directorates), the intermediary level (corresponding to the regions), and the
operational level (corresponding to the health district). The health care delivery structure includes, from the
base to the top of the pyramid: community health centers at the first level; referral health centers and regional
hospitals at the second level; and, finally, national hospitals, a national dentistry center and specialized centers
at the third level.
37
personnel are generally unwilling to practice in disadvantaged areas where the prospects for
additional remuneration are not very attractive.
2.13. Table 2.6 shows projected needs14
for doctors, nurses, and midwives based on
current standards in Mali a well as the two assumptions of slow and rapid fertility
decline. To maintain the current ratios of medical personnel per number of inhabitants,
health personnel numbers should increase from 4,596 workers in 2005 to at least 6,438
workers in 2035 (rapid fertility decline) or 8,841 workers (slow fertility decline), which
would correspond to a 40 and 90 percent growth respectively. Auxiliary and community
health workers that will take over from local authorities, and for which the exact number is
not known by the central level, should be added to the above numbers.
Table 2.6: Need for health personnel, 2005-2035 (slow and rapid fertility decline)
2005 2010 2015 2020 2025 2030 2035 Total
Slow fertility decline
Doctors - 155 260 329 408 494 601 2,247
Nurses - 385 643 816 1,010 1,222 1,487 5,563
Midwives - 71 119 151 187 227 276 1,031
Rapid fertility decline
Doctors - 143 228 270 307 333 354 1,635
Nurses - 354 565 669 761 825 877 4,051
Midwives - 66 105 124 141 153 163 752
Current production capacity
Doctors15
11316
Nurses 30217
Midwives 3018
Source: Authors’ calculations.
2.14. Mali will have a shortage in medical personnel in 2010 of no less than 143
doctors, 354 nurses, and 66 midwives. These gaps will widen in the coming years,
according to both the slow or rapid fertility decline assumptions, corresponding to a need of
55 to 75 doctors per year, 135 to 185 nurses, and 25 to 34 midwives in the course of
upcoming decades. Currently, the national system for training health personnel (see Table
14
This reflects the growth of numbers recorded in the public sector.
15
Data for 2004/2005; see page 54 of « Etude sur les ressources humaines du secteur de la santé au Mali » by
Y.A. Berthé and H. Balique, 2004, 60 pages, Ministère de la santé du Mali et Ministère des affaires étrangères
de la République française; these numbers are probably under-estimations because they do not take into account
the annual number of graduates from other schools in the center of the country.
16
Data for 2004/2005; see page 54 of « Etude sur les ressources humaines du secteur de la santé au Mali » by
Y.A. Berthé et H. Balique, 2004, 60 pages, Ministère de la santé du Mali et Ministère des affaires étrangères de
la République française.
17
Numbers given in the report cited above by Berthé and Balique on pages 56 and 57; these numbers are
probably under-estimations because they do not take into account the annual number of graduates from other
schools in the center of the country.
18
Numbers given in the report by Berthé and Balique on pages 56 and 57.
38
2.6) is not capable of responding to these additional needs. Mali will need almost six times
its present capacity of schools for physician training to circumvent the anticipated shortage in
2035; it should also multiply by 4 the capacity of schools for training nurses and by 9 that of
schools for training midwives19
.
2.15. Demographic growth translates into a crucial need for new health infrastructure (see Table 2.7). For each fertility assumption, the need for new facilities will be very
important, notably for first level health facilities (Community Health Centers). Generally,
the projections of need for new facilities show a relative mismatch between population
growth and the growth in health facilities at all levels of health care delivery (first, second,
and third levels). The result of this mismatch is the decline in health coverage for the Malian
population (in quality and quantity).
Table 2.7: Need for new health facilities, 2005-2035 (slow and rapid fertility decline)
2005 2010 2015 2020 2025 2030 2035
Slow Fertility Decline
Comm health centers 388 601 873 1.218 1,645 2,162 2,791
District hospitals 19 33 52 75 103 137 179
Regional hospitals - 1 2 4 6 9 12
National hospitals - 1 1 2 2 2 3
Pharmacies/Warehouses - 47 115 201 308 437 594
Private health clinics - 53 133 234 360 512 697
Rapid Fertility Decline
Comm health centers 388 588 827 1,110 1,432 1,781 2,152
District hospitals 19 33 48 67 89 112 137
Regional hospitals - 1 2 3 5 7 9
National hospitals - 1 1 2 2 2 2
Pharmacies/Warehouses - 43 103 174 254 342 434
Private health clinics - 49 119 202 297 400 509
Source: Authors’ calculations.
2.16. According to WHO (World Health Organization) standards the number of
doctors should increase by 12 to 15 times in 2035. Even if this target is reached the
problem of the availability of human resources in the health sector will not be resolved. The
poorest regions will continue to lack medical personnel for curative, infant and maternal care,
whereas Bamako will have an abundance of such personnel.
Financial needs for education and health
2.17. The rapid population growth in Mali places a heavy burden on the country’s
public finances, especially when economic development does not keep up with population
increase. Rapid population growth requires a growth in capital if the standard of living is to
be maintained; and this growth in capital – also known as demographic investment – soaks
up a significant fraction of domestic production. It leads to a decrease in resources that could
19
The standards used here are subject to change following the adoption of new policies for human resources.
39
improve the lives of the population, insofar as resources taken up by these kinds of capital
investments are subtracted from the production of consumer goods.
2.18. Tables 2.8 and 2.9 show projections of health and education expenditures in
Mali between 2005 and 2035. The total education and health expenditures will rise globally
by almost nine times (rapid fertility decline) to eleven times (slow fertility decline) between
2005 and 2035; the expenditures will thus go from $552 million ($174 million for education
and $378 million for health) to $4,864 million or $6,171 million, respectively.
Table 2.8: Education expenditures, 2005-2035 (in million of US dollars)
2005 2010 2015 2020 2025 2030 2035
Slow fertility decline Preschool 3 6 12 20 31 46 67
Basic 1 33 60 100 158 240 353 507
Basic 2 38 74 127 203 311 459 663
Secondary 29 49 80 124 186 272 388
Technical and Professional 42 78 132 210 320 471 678
Higher Education 28 43 64 95 137 195 274
Non-formal education 1 4 7 12 20 30 44
Total 174 313 521 822 1,245 1,825 2,621
Rapid fertility decline Preschool 3 43 51 62 75 91 111
Basic 1 33 58 94 143 208 288 388
Basic 2 38 72 119 183 268 374 505
Secondary 29 48 76 113 162 223 299
Technical and Professional 42 76 124 190 276 384 517
Higher Education 28 42 61 87 121 163 214
Non-formal education 1 3 7 11 17 24 33
Total 174 341 532 790 1,126 1,547 2,066
Source: Authors’ calculations.
2.19. The financial impact to cover human resources needs, and run new and old
health facilities will be significant (see Table 2.9 below). Health expenditures will increase
from US $378 million in 2005 to US $3,550 million in 2035 (slow fertility decline). Total
health expenditures will represent 19 percent of the GDP in 2035, compared with 7 percent in
2004 (the most recent year for which reliable data on health expenditures are available).
According to the rapid decline in fertility, the increase in public expenditures for health will
nevertheless remain substantial, representing around up to 15 percent of the GDP in 2035. In
2004, the total health expenditures of Mali represented less than 5 percent of the GDP and
the Ministry of Health‟s budget is less than 2 percent of the GDP; it can be deduced that in
the coming years the Government and the people of Mali will need to make significant
efforts in order to finance health expenditures20
.
20
The health system in Mali gets its financing from four main sources: households (60%) through the cost
recovery, the state budget (22%), external partners (15%), the NGOs and the private sector (3%).
40
Table 2.9: Health expenditures, 2005-2035 (in millions of US dollars)
2005 2010 2015 2020 2025 2030 2035
Slow fertility decline
Capital costs 96 235 404 649 993 1,467 2,117
Operating costs 282 359 467 614 813 1,078 1,433
Total expenditures 378 594 871 1,263 1,807 2,545 3,550
GDP in millions of US$ 5,359 11,452 12,643 13,959 15,412 17,016 18,787
Capital costs % of GDP 1.79 2.05 3.20 4.65 6.45 8.62 11.27
Operating costs % of GDP 5.3 3.1 3.7 4.4 5.3 6.3 7.6
Total expenditure % of GDP 7.1 5.2 6.9 9.0 11.7 15.0 18.9
Rapid fertility decline
Capital costs 96 229 380 586 855 1,194 1,612
Operating costs 282 356 455 583 746 945 1,186
Total expenditures 378 584 834 1,169 1,601 2,139 2,798
GDP in millions of US$ 5,359 11,452 12,643 13,959 15,412 17,016 18,787
Capital costs % of GDP 1.79 2.00 3.00 4.19 5.55 7.02 8.58
Operating costs % of GDP 5.3 3.1 3.6 4.2 4.8 5.6 6.3
Total expenditure % of GDP 7.1 5.1 6.6 8.4 10.4 12.6 14.9
Source: Authors’ calculations.
2.20. Rapid population growth causes a decrease in resources available to improve the
standard of living for children. A country like Mali, with high birthrates and rapidly
declining mortality rates, has to devote its resources to the construction of schools, health
facilities, and other social services the population needs, knowing that the funds invested in
these projects are indispensable but are not immediately productive.
2.21. Financial resources are not easily available. The funds necessary for development,
if they are not generated from savings on the revenue, have to come from loans. Yet, the
daily needs of a large Malian family leave few opportunities for saving money, be it for the
household or the entire nation. This is one of the reasons why the Government reaches out to
foreign investors or gets foreign international loans. Thus, rapid population growth impedes
economic development in two ways: first, a disproportionate share of available capital is used
for social rather than economic needs; second, the formation of capital is itself restricted
because the increase in production has to be used to provide for the population surplus,
improve the standard of living and free up a surplus to be reinvested to improve economic
performance.
Population growth and population density
2.22. The population density in Mali is low; it was estimated at 11 people per square
kilometer in 2005. Density, or the size of the population compared to the surface area of the
country, is an indicator of demographic pressure. By looking at population density and at the
technological development of a country, one can try to estimate the impact of population
pressure on the economic system, especially for societies that are heavily dependent on
agriculture, as it is the case in Mali. The low population density of Mali (11 inhabitants per
square kilometer in 2005) is due to the huge area of the country, which is 1,250,000 square
kilometers. For the sake of comparison, the density of the population in Mali is
41
approximately three times lower than the average density in sub-Saharan Africa. However,
the low density of the Malian population hides important regional differences because the
country encompasses huge desert areas. Population density is lower in the desert zones in the
north of the country, but much higher in the southwest of Mali, as well as along the Niger
River and in the basin of the Senegal River.
2.23. In sub-Saharan Africa, the population density computed for fertile or agrarian
land is much higher than that computed for the country as a whole. In the case of Mali
and for the year 2000, the population density related to usable land is 255 inhabitants per
square kilometer, instead of 10 inhabitants per square kilometer for the country as a whole.
For the sake of comparison and according to the same criteria (density related to arable land)
and for the same year, Mauritania shows 529 inhabitants per square kilometer of usable land
instead of 3 for the country as a whole, Senegal 391 instead of 48, and Somalia 817 instead
of 14 (Tabutin and Schoumaker 2004).
Table 2.10: Population density in Mali, 2005-2035
2005 2010 2015 2020 2025 2030 2035
Slow fertility decline
Pop per total area 9 11 13 15 18 22 27
Pop per fertile land 241 279 328 393 474 574 695
Rapid fertility decline
Pop per total area 9 11 12 14 17 19 22
Pop per fertile land 241 276 319 371 432 498 568
Source: DNP, Tabutin and Schoumaker 2004, and calculations by the authors.
2.24. The strong demographic growth in Mali will lead to a strong increase in
population density. Table 2.10 shows the results of the population increase for global
densities and the densities that concern arable land. These calculations were obtained by
extrapolation while taking into account the two scenarios of demographic projections used in
this study (these scenarios are, as indicated before, differentiated by a slow decline and a
rapid fertility decline). However, the numbers in Table 2.10 have to be looked at cautiously.
First, the baseline population as of January 1st, 2005 is the one given by the National
Population Directorate (DNP): it differs from the one used by Tabutin and Schoumaker
(2004), which translates into a slightly lower density in 2005 for arable lands than the one
suggested in 2000 by these authors. Moreover, in the calculations shown here, the area of
arable lands has been kept constant between 2005 and 2035. The estimate is that in 2005, the
arable lands and the ones permanently cultivated represented approximately 48,000 square
km or 3.9 percent of the total area of the country. However, Mali has a strong agricultural
potential and could, no doubt, increase the area of arable land in the future (these were
estimated at 1.7 percent of the total area of the country in 1990; see World Bank 2007: 127).
Such an increase in arable land would lead, if it happens, to a density decrease on good land,
but remains heavily dependent on the level of investments which should be considerable.
Demographic growth, agriculture, and nutrition
2.25. Mali has an economy that is strongly tied to agriculture. Population growth could
help increase the agricultural production as long as the necessary investments and techniques
42
are made available (Boserupian scenario). However, the rapid demographic growth could,
on the contrary, create additional pressure for the agricultural production and food
consumption (Malthusian scenario).
2.26. The average rate of change in the food production has slightly decreased in Mali,
even though that rate has remained higher than the rate of population change. The rate
of change in food production has been 4.9 percent on average for the span of time between
1979-1981 to 1990-92, and 3.5 percent for the period from 1993-95 to 2001-03 whereas the
average growth rate for the population was estimated at 2.5 percent and 2.8 percent for the
same periods, respectively.
Table 2.11: The agrarian production in Mali and in sub-Saharan Africa
1990-92 2002-04
Farmland (percentage of the surface area)
Mali 26.3 32.4
Sub-Saharan Africa 43.4 44.1
Production Index (1999-2001 = 100)
Mali 73.8 107.4
Sub-Saharan Africa 75.9 103.9
Food Production Index (1999-2001 = 100)
Mali 78.6 105.8
Sub-Saharan Africa 77.6 105.1
Farming productivity (value added by laborer, in $US 2000)
Mali 204.0 227.0
Sub-Saharan Africa 314.0 337.0
Source: World Bank 2007.
2.27. Arable land makes up approximately a third of the area of Mali, but it is
estimated that only about 12 percent are used to this day for permanent and temporary
agriculture (see table 2.11) according to the estimations of the Food and Agriculture
Organization (FAO) and of the World Bank (World Bank 2007). The development of the
arable land still available could therefore decrease demographic pressure (FAO 2005).
However, the model Resources for the Awareness of Population Impacts on Development
(RAPID) of 2003 estimated that if the level of fertility stayed at its level of 2000, the area per
inhabitant that could be cultivated would change from 0.21 hectare per inhabitant in 2000 to
0.09 hectare per inhabitant in 2025 (RAPID model 2003). Here again, it is important to
stress that this is an extrapolation based on a constant denominator (in other terms, no
increase in the arable land is expected).
2.28. Farm production is the main source of food availability in Mali, and the largest part of food production is channeled towards home consumption. Agricultural
production has increased in Mali for the last 15 years (despite the decline observed over the
period of 1993-95 to 2001-03) and the productivity has also improved in that sector. After
many problems due to drought in the 1970s and 1980s, food production has managed to
satisfy the national demand since 1986. The agricultural production has become more
diversified with the increase of the fruit and vegetable production thanks to the increase of
market gardening. This evolution has allowed a wider consumption of fruits and vegetables,
43
which has helped improve nutrition. However, socio-economic and regional inequalities
remain at the level of food and nutritional safety (FAO 2005).
2.29. The rainfall and vulnerability of the region to weather conditions have an effect
on the agricultural production and contribute to the problem of food insecurity. Rain
cultures (mostly for home consumption) dominate Malian agriculture, and crops are fragile
and hard to predict (FAO 2005). Agricultural production has already largely suffered from
the drought (particularly, as mentioned earlier, in the 1970s and 1980s) and remains
vulnerable to weather variations. Indeed, there are risks of drought, erosion, devastating
rains and excessive use of the soil. These risk factors concerning agricultural production
present a considerable problem for the population of Mali, because securing food is more
difficult when demographic pressure is strong and rapidly increasing. The weather is also a
problem for industrial cultures on which the economy of Mali depends. Among these is
cotton, which represented 40 percent of exportation revenues in 2005. Traditional livestock
farming (fowl, cattle etc.) is the main activity in the North of Mali. Despite its sensitivity to
the climactic changes, it represents 20 percent of national GDP (FAO 2005).
2.30. However, nutrition has not seen fundamental changes since the 1990 period of
1990-92: neither caloric value nor consumption elements have changed in a significant
manner. The daily individual energetic dietary consumption was at 2220 calories for the
1990-92 period and of at 2230 calories for the years 2001-03. Dietary consumption of
protein did not change and consisted of 63 grams per person and per day for the two periods
mentioned. Fat consumption remained relatively stable between 1990-92 and 2001-03 and
was estimated at 49 grams and 46 grams respectively. Starchy foods are a staple in the
Malian diet: since 1990, starches have represented 73 percent of the food consumption (FAO
2005).
2.31. The level of malnutrition remains very high in Mali. The prevalence of
malnutrition21
in Mali is practically the same as the average for sub-Saharan Africa and did
not improve since 1992-1994 when its prevalence was 29 percent (World Bank 2007b). The
total number of people suffering from malnutrition has increased; 2.7 million men and
women in Mali were suffering from malnutrition during the period 1990-92, whereas there
were 3.5 million during 2001-2003 (FAO 2005).
21
Malnutrition is calculated by comparing weight to age.
44
Table 2.12: Nutrition in Mali, neighboring countries, and sub-Saharan Africa
Prevalence of
malnutrition
(percent)
2002-2004
Prevalence of child
malnutrition
(percent of children under 5)
2000-2005
Wasting Stunting
Underweight
newborns
(percent of births)
2000-2005
Mali
Algeria
Burkina Faso
Côte d‟Ivoire
Guinea
Mauritania
Niger
Senegal
Sub-Saharan
Africa
29
4
15
13
24
10
32
20
30
33.2
10.4
37.7
17.2
32.7
31.8
40.1
22.7
29.6
38.2
19.1
38.7
..
..
34.5
39.7
25.4
39.2
14.4
7.0
19.0
17.0
16.0
..
13.0
18.0
14.0
Source: World Bank 2007b.
2.32. The number of underweight newborns in Mali is alarming. With 14.4 percent of
newborns in Mali being underweight, the percentage of these births is close to the average for
sub-Saharan Africa which is of 14 percent (World Bank 2007b). The prevalence of child
malnutrition in Mali – both wasting (acute malnutrition)22
and stunting (chronic
malnutrition)23
– is similar to the average in sub-Saharan Africa but is much higher than
most of its neighboring countries, except for Burkina Faso and Niger. According to the
World Health Organization, access to drinking water and health facilities is a factor with
serious repercussions on children‟s health in Mali (WHO 2004). The numbers above show
Mali‟s challenges with nutrition and food security which are linked to food availability which
itself is a function of agricultural production and population growth (see Table 2.12).
Demographic growth and urbanization
2.33. Urbanization is a major global phenomenon including Mali. The United Nations
estimates that the urban population will make up 47.4 percent of the world population by
2030 compared to 30.5 percent in 2005 (United Nations 2007; World Bank 2007b).
2.34. Although the rural population outnumbers the urban population in Mali, the
rate of urbanization is rapidly increasing, mainly because of internal migration. The
rural population is still the majority and was estimated at 69.5 percent of the total population
in 2005, although it has strongly declined since 1950 when it made up 91.5 percent of the
population. In 2050, the United Nations estimates that only 37.7 percent of the population
will still be living in a rural area in Mali (United Nations 2007).
22
Wasting is due to acute malnutrition and is calculated by comparing height to weight.
23
Stunting is due to malnutrition and is calculated by comparing height to age.
45
Table 2.13: Rural and urban population in Mali, 2005
Percent of total
population
Rate of change
(average percent)
1990-2005
Population size
(millions)
Rural population Urban population
69.5
30.5
2.2
4.7
9.4
4.1
Total population 13.5
Source: World Bank 2007b.
2.35. The growth rate of the urban population was already very high in 1955,
estimated at 4.6 percent and remains high: it is estimated to be 4.8 percent in 2005. The
growth of the rural population, on the other hand, has remained relatively stable since 1955,
changing between 1.6 percent and 2.3 percent and estimated at 2.1 percent in 2005. Even if
rural and urban growth rates in Mali remain relatively stable, the differential level of change
shows that the population is becoming more urban with time. The reason for that is that the
same growth rate is being applied to a population that is becoming larger in size every year –
a snow ball effect (see Table 2.13 and Fig. 2.1).
2.36. The population of the city of Bamako will explode. It went from 89,000
inhabitants in 1950 to 1.5 millions in 2007. Bamako will have 3.2 million inhabitants in
2025. It is projected that the population of Bamako will represent 36 percent of the urban
population and 16 percent of the total population of Mali in 2025 (United Nations 2007).
2.37. The rapid urbanization of Mali will have important repercussions on the
population distribution and will necessitate the implementation of adequate policies and
investments related mostly to infrastructure, sanitation, housing and schooling.
However, the greatest challenge for the urban environment will be to ensure employment
opportunities for the young people who will enter the labor market.
Figure 2.1: Rate of change in rural and urban populations, 1955-2005
Source: United Nations 2007.
0
1
2
3
4
5
6
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
2005
Year
Rural
Urban
Ra
te o
f c
ha
ng
e (
perc
en
t)
46
Demographic growth and the environment
2.38. The weather is a basic factor for an economy dependent on the primary sector,
and Mali is particularly vulnerable in that respect. Economic discrepancies at the
regional level are linked to the climate and to geographic conditions. The majority of the
economic activity is located in irrigated regions irrigated along the Niger River. On the other
hand, the areas north of the country (Gao, Kidal, and Tombouctou) that are the most arid
regions suffer from a lack of basic infrastructure and have lower revenues.
2.39. Mali uses mostly surface irrigation while sprinkling and drip irrigation are
limited. Approximately 566,000 hectares are irrigated, whereas the land that could be
irrigated is estimated to be 2,200,000 hectares. Among the land already irrigated, around
60,000 hectares have been abandoned because of a drop in the water level of the river and
because of technical or institutional difficulties (for instance, land preparation and/or lack of
financing) (www.fao.org; see Aquastat 2005).
2.40. Sanitary conditions and access to water and sanitary conditions have improved
in Mali. Access to an improved source of water has gone from 34 percent of the population
in 1990 to 50 percent in 2004. Access to better sanitary installations went from 36 percent in
1990 to 46 percent in 2004. Despite these positive developments, water and sanitary
conditions remain problematic as evidenced by the high prevalence of diarrhea in children,
chronic malnutrition and frequent cholera epidemics (WHO 2007). Water and sanitary
conditions have an important impact on health, essentially by way of food. In 2007, 70
percent of the population had access to drinking water. However, the inequalities between
urban and rural areas remain significant, with access rates of 76 percent and 35 percent,
respectively (www.fao.org; see Aquastat 2005).
2.41. Conservation or degradation of the environment is one of the key factors for
agricultural production and food security in the long term. In general, statistics
regarding forest management, aquiculture, and the environment are lacking in Mali.
Demographic growth will probably have serious repercussions on the environment because
the agricultural capacity of the land will be used to it fullest to ensure the food secure. A
decrease in soil fertility in certain areas is already a problem for agricultural production;
certain lands that were previously suitable for irrigation have already been abandoned
(www.fao.org; see Aquastat 2005).
2.42. The demand for fuel wood, one of the basic energy sources in Mali, will keep on
increasing if the high level of fertility stays the same. The demand for fuel wood reached
9,129 million tons in 2002. It will increase to 19,871 million tons in 2022. This is equivalent
to a forest area of 3,784,981 hectares or 2.2 times the cleared area in 2002. Over the period
2002 to 2022, the country will destroy a forested area of 13,255 million hectares. Natural
forests will not be able to satisfy the demand for fuel wood (Republic of Mali 2003a: 25). Of
note is that the forested areas in Mali have decreased from 11.5 percent of the total area of
the country in 1990 to 10.3 percent in 2005. The same statistics for the whole of sub-Saharan
Africa for the same years are 29.2 percent and 26.5 percent, respectively (World Bank 2007:
127-128).
47
Demographic growth and health
2.43. Mali has not really started its fertility transition. However, as noted in Chapter 1,
infant and child mortality rates have significantly decreased, even if they are still very high.
This decrease in mortality should continue, not only to ensure the survival of more children
but above all so that couples in Mali will understand the implications of this decline and
modify their reproductive behavior in the future. A higher child survival rate, especially for
those under age 5, should motivate couples to adjust their fertility. Indeed, it will no longer
be necessary for them to have many children to make sure that some of them survive.
2.44. Mali’s reproductive health and fertility indicators have shortcomings (see Table
2.14). The total fertility rate of 6.6 children per woman in Mali is very high. The
contraceptive prevalence for modern methods is very low, in the order of 7.0 percent per
married woman (15-49 years old), and the unmet need for contraception remain high at 31.2
percent for that same age group (EDSM 2006). The maternal mortality ratio is equally high:
it is estimated to be 464 deaths per 100,000 live births in 2006, but is lower than 921 deaths
per 100,000 live births for the sub-Saharan region on the whole (World Bank 2007: 19-20).
The assistance of a trained professional during delivery is also rare; they are present at 49
percent of the total number of deliveries (EDSM 2006). Births assisted by traditional birth
attendants and by family or friends are common in rural regions (53.1 percent in 2001) and
among women with little to no education. On the contrary, births assisted by traditional birth
attendants are not common in urban areas and among women who have a higher level of
education (EDSM 2001). Still, in 2001, 16 percent of deliveries were without any help,
especially for women over 35 years old (21 percent), for women who already have many
children (21 percent for the sixth child and over), in rural regions (19 percent), and among
women with little to no education (18 percent) (EDSM 2001). Finally, the results of the new
demographic and health survey of 2006 (EDSM 2006) do not show much progress regarding
these indicators.
Table 2.14: Reproductive health and fertility in Mali
Total fertility rate
(number of children per woman), 2006
6.6
Adolescent Fertility Rate (per 1,000 women aged 15-19), 2005
197
Unmet need for contraception (percentage of married women aged 15-49), 2000-05
31.2
Contraceptive prevalence, modern methods (percentage of married women aged 15-49), 2000-05
7.0
Delivery assisted by a trained professional (percent of total), 2005
49
Maternal mortality ratio (per 100,000 live births), 2006
464
Source: World Bank 2007b.
48
2.45. High fertility rates present a risk for the health of mother and child. A body of
research has shown the link between a lower level of fertility and better health outcomes.
These links are reviewed in the new RAPID model. Specifically, maternal and child health
improves when births do not happen too early or too late, are not too close and are not too
many. The decline in fertility, especially the one forecast under the rapid fertility decline
scenario in this study, will therefore be beneficial to the health of the mothers and their
children. A faster drop in fertility will further improve the maternal, child health and
reproductive health indicators. It is important to note that part of the improvement in these
indicators will be due to declines in mortality (infant, child, and maternal), not only to a
decline in fertility.
2.46. As a conclusion is the testimony of Djenaba, a young Malian girl who would
have wished to start her reproductive life later and have longer intervals between the
births of her children. This testimony, in Box 2.1, shows the gap that exists in Mali
between the discourse on reproduction that is agreed upon and the deep desires of the people
concerned. This testimony will call the attention of all the decision-makers and actors in
Mali‟s development. It will move them to put in place needed programs to meet the
aspirations of the population and of women in particular. Past and future interventions will
be examined in the last part of this report.
Box 2.1: The story of Djenaba
In a village in Mali, a predominantly Sunni nation, I met Djenaba. She was sixteen or seventeen
– she didn‟t know which – and the mother of two. The new baby, a girl, tugged at her breast as
we spoke. Djenaba said she was happy to have just one year between births, if that was Allah‟s
will. And when I asked her how many children she wanted to have in all, she replied quietly,
eyes down: “As many as I can.” A more nuanced answer surfaced as I pressed on with the
interview, asking her about the health of her children, the circumstances of their births, and how
she had met their father. Her parents had arranged the marriage, she said, but the wedding hadn‟t
actually taken place until after the birth of her son when she was fourteen or fifteen. Suddenly
her composure and her voice both shifted, and she confessed that she wished she could have
waited to become a mother. Around the world, 80 million times a year, other women learn, as
she had, that they are pregnant and wish, as she had, that they were not. Djenaba had heard of the
contraceptive pill, and she understood its appeal.
“You take it, and you don‟t get pregnant,” said this cultural descendent of the Axial Age. “You
stop taking it, and you have children.” She wished she could wait now, at least three years,
before becoming pregnant. She wondered where she could find some of these pills, because she
did not want many more children, and none any time soon.
“It is too hard,” she said. “We don‟t have any wealth.”
Excerpt from Engelman, R. (2008). More. Population, Nature, and What Women Want.
Washington, DC: Island Press, p. 139.
49
CHAPTER 3. REVIVING POPULATION INTERVENTIONS
3.1. This chapter first examines Mali’s experience in matters of population policies
by identifying the programs currently underway and by examining their impact. This
chapter also explores ways to improve the effectiveness of the National Policy of Population
(PNP), Revision 1. Reviving population, family planning, and reproductive health
interventions would involve dealing with several different issues. These issues are presented
here in order of priority, although several of them overlap. Additionally, given the
importance of these issues, several activities proposed will have to be conducted at the same
time.
3.2. To re-energize population interventions, Mali should first equip itself with a
very high-level institution to re-launch advocacy and coordinate programs. Mali should
also choose key interventions and translate them into concrete, programmatic, and
measurable actions with performance indicators. It is also necessary to coordinate all
development strategies in relation to the demographic variable. It is particularly important to
re-position family planning and to have national coverage for services. Clearly, to
accomplish this, it will be necessary to identify and reinvigorate key actors from Mali, who
will need to be supported by their development partners. All these actions should be
accompanied by an effort to collect and analyze new demographic data, with a clear research
agenda.
Population policies pursued in Mali over the last two decades
3.3. Since 1991, Mali has had a National Population Policy, which was revised in
2003 and will be examined here. It is founded on six cardinal principles: (i) the right to
economic, social, physical, intellectual, moral, and cultural development, (ii) equal rights for
men and women, protection by the State for mothers, children, elderly people, and disabled
people, (iii) respect of the fundamental rights of children (survival, protection, development
and participation), (iv) respect for the right of individuals and couples to freely decide on the
number of children they want, (v) the acknowledgement of interrelations between population
and sustainable development, and (vi) respect for Mali‟s commitments concerning population
in national and international plans (Republic of Mali 2003a: 38-39).
3.4. The 1991 NPP version listed control of demographic growth as its first priority.
This goal of ˝contributing to the gradual control of fertility˝ ranked third in the NPP
Revision 1. The first objective of the new NPP is to contribute to the rise of the level of
schooling and functional literacy, particularly of young girls and women. The second
objective relates to reducing maternal and infant and child mortality, and improving the
population health, especially reproductive health. The other objectives (fourth and those
following) relate to gender equality, children‟s rights, recognition of elderly people, the
balanced spatial distribution of the population, recognition of international migration, and the
population and environment equilibrium. Two NPP objectives aim to improve conditions for
the implementation of the policies through strengthening institutional capacity for planning
and management as well as better decentralization of coordination. The last objective is to
50
“engage the support of the people, the commitment of the decision-makers and the partners
towards the goals of the National Population Policy” (Republic of Mali 2003a:40).
3.5. The NPP version 2003 draws lessons from the poor results of the 1991 policy
and adopts a more pragmatic approach in` advocating the spacing of births and not
their limitation. Ten years after the implementation of the 1991 policy, whose goal was to
cut back the TFR from 6.77 children per woman to 4 children per woman by 2020, the level
of fertility in Mali had not changed. The NPP 2003 version changes direction and focuses
instead, not on reducing fertility, but on improving the quality and standard of living, and,
incidentally, on controlling population growth. This is what transpires from a more thorough
look at the foundations and ten objectives of the NPP. The first principle of the document,
incorporated in the foundation of the NPP, proclaims the primacy of human resources as a
development factor and affirms that “the population constitutes the greatest wealth of the
Nation” (Republic of Mali 2003a: 36). This can reinforce the traditional belief according to
which demographic growth in Mali, far from being a factor inhibiting access to economic
development and well-being, is seen as an engine producing wealth.
3.6. The NPP version 2003 gives no quantified framework as to the future evolution
of demographic trends. There is no clear expression of an intention to reduce the fertility
level, which is the main cause for rapid population growth. The reduction of fertility levels is
seen mostly in terms of increasing modern contraception use and of raising the age at first
marriage among young girls24
. However, increasing the prevalence of contraceptive use and
raising the age of marriage is mostly to improve maternal and child health rather than a
demographic concern. Besides, the NPP targets relating to certain general objectives were
not quantified, which would have facilitated monitoring of progress and modifying, if
necessary, the least effective strategies. This is the case, for example, of the balanced
population distribution, of international migration, and population and environment
equilibrium that were not quantified. Finally, no deadline in the short-, medium-, or long-
term is set for the improvement of the demographic indicators relating to the trends in the
economic system of the country.
The implementation of population policies collides against a lack of national
coordination and insufficient national grounding
3.7. At the present, Mali does not have a unique body to coordinate population
interventions. Population, family planning, and reproductive health activities are
disorganized and relatively low-profile. Although many are intervening in these issues, their
actions are of varying importance and, in the end, not very visible. The activities are
24
The two objectives are to raise the rate of modern contraception use (from 8 percent in 2001 to 30 percent in
2025) and the age of marriage for young girls (up to 18). Reaching these two objectives will require much
effort. Only 7.0 percent of women use modern contraceptives (EDSM 2006: 67). Fifty five percent of women
in a relationship do not intend to use modern contraception and Malian women tend to marry at a very early
age. The median age for first marriages among women between the ages of 25 and 49 is estimated to be 16.6
years. This median age jhs not practically changed from one generation to another, swinging between 16.5 and
16.7 years. There is neither a significant decrease over the generations in the number of early marriages (19
percent among women aged 45 to 49 versus 25 percent among women aged 20 to 24; see EDSM 2006: 84-85).
51
dependent on funding, often external funding, and are rarely for the long-term. Thus, Mali
finds itself in a fragmented and “stop-and-go” logic. No program has real national coverage.
It is not surprising that the results are equally fragmented and modest.
3.8. The skills and expertise in population matters are fragmented in Mali’s public
sector. The Central Statistics Office (DNSI) in the Ministry of Economics, Industry, and
Commerce is responsible for the collection of demographic data. The National Population
Directorate (DNP), which is linked to the same Ministry, is responsible for the analysis and
use of the data. However, the DNP is not very visible, nor is it endowed with considerable
means or strong political support. Moreover, it deals with certain population issues at the
Central Statistics Office. The Ministry of Social Development, Solidarity, and Senior
Citizens (MDSSPA) also deal with some population issues. Finally, the Center for Applied
Research on Population and Development (CERPOD), that provided reliable demographic
data to the nine States belonging to the Permanent Interstate Committee for Drought Control
in the Sahel (CILSS), is undergoing a serious financial crisis and is not doing all its mandate.
Nevertheless, a new research office, the Center for Support for Research and Training
(CAREF), provides certain research operations in terms of population and reproductive
health.
3.9. The implementation of a national population, family planning, and
reproductive health program will require a high level of institutional grounding and
strong national coordination. In order to carry more weight, this central agency should be
connected to an institutional level much higher than a ministerial department. The agency
should coordinate the implementation of all activities relating to population, family planning,
and reproductive health issues. A single administrative organization - connected to a
University (which will encourage intellectual stimulation)25
, the media, and the private sector
- would certainly be more effective than small entities, generally deprived of the minimum
necessary human and financial resources, sharing responsibility for this matter.
3.10. Population, family planning, and reproductive health activities should be
accompanied by an effective monitoring and evaluation system, with precise and clear
performance indicators. This is one of the greatest challenges that Mali must address if it
hopes to equip itself with an effective population, family planning, and reproductive health
program. There should be clear distinctions between inputs, outputs, and outcomes, and to
differentiate between process indicators and outcome indicators. In addition, the central
structure in charge of population should be held accountable for the outcomes; this has been
one of Mali‟s weaknesses for too long, which partly explains the weak results obtained.
3.11. This central structure in charge of population issues should also benefit from
greater allocation of financial resources. The experience of the last ten years has shown
that the lack of human and financial resources affects the viability of programs, and thus the
degree of motivation of those in charge of population, family planning, and reproductive
health issues.
25
For example, the University could organize scientific days on the theme of population in Mali, addressing the
problem from different angles.
52
The revival of advocacy to put back demographic growth at the heart of public debate
3.12. As of yet, Mali has no true realization of the stakes related to demographic
growth. There is weak public will to invest in population activities on a large scale and
for the long-term. About fifteen years ago, the Malian authorities appeared to be more
conscious of the importance of the demographic stakes in development. First of all, a
National Population Policy (NPP) was prepared for Mali in 1991. It reflected the concern of
controlling population growth (first priority of the DNP) and, above all, balancing population
growth with economic resources. Following that in the middle of the 1990s, RAPID
(Resources for the analysis of population and its impact on development) was prepared under
the aegis of the Planning and Statistics Unit (CPS) in the Ministry of Health (MOH). Then,
several Malian promoters in the public sector were trying to alert the authorities of the
importance of facing the demographic challenge for the development of Mali. Efforts were
made likewise in the areas of reproductive health and family planning. From 1999 to 2006,
PRODESS (the government‟s Health and Social Development Program) contributed to
making available reproductive health services through the strengthening of the health system.
IDA‟s support for this program planned «to accelerate the country’s transition towards
slower demographic growth» (the project‟s development goal). However, the indicators of
PRODESS specific to population (be it the Total Fertility Rate or contraceptive prevalence)
were ambitious and changed very little throughout the project. Yet, the contribution of
PRODESS in the strengthening of the health system itself should not be underestimated. It
should eventually allow for advances in matters of family planning and reproductive health.
3.13. It seems that the enthusiasm and initial impetus for taking population issues into
account have somewhat decreased. Thus, the ambitious NPP plans (National Population
Policy) in 1991 were diluted in the 2003 version of the NPP. Furthermore, the Poverty
Reduction Strategy Papers (PRSP) for the years 2002-2006 did not really take population
issues and fertility decline into account. Advocacy on population and reproductive health
issues, with a particular focus on family planning, remains weak in Mali. Advocacy is the
promotion of convincing beliefs by people who are themselves convinced in order to
persuade others so that political and individual decisions will be modified; it must not be
confused with information, education, and communication (IEC) campaigns, or behavior
change communication campaigns (BCC) aiming at changing behavior. Quality advocacy
must combine political and media visibility with credible scientific and technical expertise.
It also has to be well-targeted and well-directed to key groups whose support one wants to
obtain and/or whose behavior one wishes to modify. This will lead to the renouncing of
broad and vague themes that are known as “population and development” or “reproductive
health,” which do not put particular focus on family planning. It is necessary to note that
advocacy needs to be done on a continuous basis, because it is important to give constant
reminders of key and mobilizing population, family planning, and reproductive health
messages by updating them with available new data (for example, from the EDSM 2006).
Only an effective and continuous advocacy will rally the attention of Malian decision-makers
and their partners in development.
3.14. In Mali, it seems that certain people in charge of population advocacy are not
themselves sufficiently convinced of the strong messages they should be circulating.
This weak backing for social change and this limited engagement are obstacles to win over
53
others to support the cause. Furthermore, advocacy efforts are conducted only on a small
scale and in piecemeal according to available funding. What is needed is a large scale
advocacy campaign, planned for the long term and systematically targeting all key people
and groups. Priority attention must be paid to the parliament, religious and opinion leaders,
journalists, and traditional chiefs without forgetting civil society.
3.15. Nevertheless, efforts have been made in Mali to re-energize the political dialogue
on matters of population and reproductive health. A new RAPID model was prepared in
Mali by the Ministry of Health (MOH) in 2003, with the technical and financial support of
POLICY/USAID. This new model has already been introduced to numerous Malian
decision-makers. The conclusions of the model are covered in a short, accompanying
brochure (Republic of Mali, 2003b). The POLICY project also worked with religious leaders
and prepared an advocacy tool concerning Islam and family planning. It will be useful to
complete the RAPID model with data intended for religious leaders and some sections taking
up arguments on the formation of human capital and the macro-economic situation, as shown
in the present study. It would be suitable to use this kind of advocacy tool to further sensitize
the Malian leadership including the highest authorities of the State. A media campaign on
questions of population should also be organized.
How to define a population strategy that supports the country’s efforts towards
development?
3.16. Choices of population interventions are delicate and dependent on several
dimensions – cultural, societal, religious, and political. Only Mali, its leaders and
population are capable of making these fundamental decisions. The consequences of the
choices will have a social and economic impact that the leadership should accept vis-à-vis the
Malian population and development partners.
3.17. The goal of the following directions is to provide the leaders in Mali with ways of
thinking about a realistic population strategy oriented towards the sustainable
development of Mali.
Defining realistic objectives
3.18. The best population strategy would retain relatively limited objectives but at the
national scale, rather than cover a wide range of activities in an incomplete manner.
The National Population Policy (NPP) Revision 1 seems difficult to implement in its present
form because of the high number of priorities. Drafting a shorter (ten pages maximum) and
more operational Declaration of Population Policy should be considered, which would make
its focus lowering of fertility levels and the three or four methods needed to achieve this.
These key interventions will be the provision of quality family planning services; the
launching of advocacy, IEC and BCC campaigns; the expansion girls‟ education; and, lastly,
the improvement of the autonomy of women by means of legal reforms. Other documents of
NPP implementation and follow-up can then be re-examined in the light of the Declaration of
Population Policy.
54
3.19. Meeting women’s family planning and reproductive health needs should
undergo a constant and massive effort to make quality services available. The
Government of Mali adhered to Cairo‟s program of action, adopted at the International
Conference on Population and Development (ICPD) in September 1994. This program
stresses “the right of men and women to be informed and to have access to safe, effective,
affordable and acceptable methods of family planning of their choice.” Moreover, men and
women should be free to discuss with their partners their wishes regarding reproduction, to
negotiate protection (concerning HIV/AIDS), and to have information about the advantages
and disadvantages of specific contraceptive methods. According to EDSM 2006, the
contraceptive methods principally used in Mali are birth control pills, injectables, condoms,
and the lactational amenorrhea method. Three key axes could be considered in order to
restart the family planning and reproductive health program: exclusive breastfeeding (which
will reinforce nutritional security), the effective enforcement of the law concerning age at
first marriage, and the increase of modern contraception at the rate of 1 percentage point per
year (Guengant and May 2002).
3.20. To expand family planning and reproductive health services it is imperative to
take gender issues into account. The legal and economic autonomy of women, their power
to decide, in short, their right to family planning and reproductive health make up the
preliminary and indispensable conditions for any progress in this area. The same is true for
girls‟ education, which is a fundamental variable for attitude and behavior change in fertility
matters. Men should also be involved in these programs in order to contribute to changing
their decisions concerning reproduction. Moreover, it would be suitable to test pilot
approaches to advance the gender agenda, for example, micro-credit systems for women,
accompanied by messages and actions concerning family planning and reproductive health.
Another approach that needs testing is that of “competence in matters of population” on the
community level (meaning creating awareness in communities and giving them tools with
which to act). Legal and regulatory reforms (for example, the effective application of the law
concerning first age at marriage) should also accompany this process. Certain interventions
(girls‟ education and raising the age of marriage) could be encouraged by conditional cash
transfers.
Aligning strategies
3.21. The planned revision of the Poverty Reduction Strategy Papers (PSRP-II), also
called the Strategic Framework for the Fight against Poverty (CSLP), which covers the
years 2007-2011, should take the demographic variable into greater account. In
particular, PSRP-II should integrate the results from new population projections which are
being done with the support the POLICY/USAID project. This revision is important because
the PSRP-II is the key instrument that will allow the attainment of the Millennium
Development Goals (MDG).
3.22. The World Bank’s Country Assistance Strategy (CAS) for Mali also takes the
demographic variable into account. The upcoming Country Economic Memorandum as
well as the sectoral studies of the World Bank should dedicate a larger space to these
questions (this is anticipated in the study on urbanization planned by the World Bank).
55
Finally, specific questions about population could be introduced in the qualitative studies on
poverty.
3.23. Development partners should also speak with one voice about population and
reproductive health issues. Actually, only USAID and the UNFPA seem to be making
these issues a central concern of their programs in Mali. Coordination between development
partners should be strengthened, in order to exchange information and align strategies in
population matters. To this effect, the monthly meetings of donors could be used to make
specific communications about population, family planning, and reproductive health. A
common front of development partners would help improve the political dialogue with the
Government in this domain. It would also be useful to frequently remind the Malian
leadership of the importance of these population issues and their implications for the future
of the country.
Repositioning family planning
3.24. Up-to-now, the activities conducted in Mali in the areas of family planning,
reproductive health, and fertility control had modest impact. The data collected from
demographic and health surveys in Mali led in 1987, 1995-96, 2001, and 2006 allowed for
the measurement of the low level of fertility control among Malian couples. These
investigations also provided better information on the opinions of women and men
concerning the ideal family size, the contraceptive needs of couples for the spacing and
limiting of births.
3.25. The degree of family planning by populations is still minimal when considering
the very high fertility level. Only 19 percent of married women and 9 percent of married
men do not want more children. These proportions vary depending on the parity attained,
place of residence, as well as education level. Limiting family size does not seem to be a real
concern in Mali until after the sixth child, and then to women only. Beneath this threshold,
women still hope to bear more children, without taking into account the birth interval (two
years) necessary for the physiological recovery of the mother after birth or the sanitary
problems caused by the sudden weaning of the child, provoked by the start of a new
pregnancy a few months after the most recent birth. In the absence of effective awareness
campaigns, a rapid reduction of fertility indicators cannot be expected, given these attitudes
as well as the low educational level of women of childbearing age. This should lead to
questioning the demand for services as well as the implementation modalities of IEC and
BCC national campaigns.
3.26. The concept of family planning should be revisited. From this point of view, the
comprehensive approach to reproductive health, adopted at the 1994 Cairo Conference, was
doubtless too large for many countries in sub-Saharan Africa confronted with a multiplicity
of problems. In these countries, the adoption of a comprehensive approach to reproductive
health could be considered as a luxury, since the major public health issues are the ones
posed by the consequences of the number of births - always early, numerous, insufficiently
spaced, and too late in a woman‟s life - and thus by the consequence of a lack of even partial
control of fertility by women. It can therefore say that the adoption of a comprehensive
approach to reproductive health pushes family planning, which is nonetheless a priority
56
within this agenda, to the side. The Cairo agenda emphasized other problems that are
certainly important, but are not necessarily a priority in the context of concerned countries, to
the detriment of family planning. In the case of Mali, one example illustrates this situation.
In numerous national fora, the problem of couples‟ sterility has been put forth; but this
problem, which indeed presents a personal tragedy to the affected couples, only concerns a
low percentage of the Malian population. In reality, family planning is relevant to close to
three-quarters of Malian couples, so that they can decide freely on the number of children
they hope to raise, nourish, and educate properly.
3.27. In Mali, like in most sub-Saharan African countries, raising family planning
awareness most often relates to the spacing of births, presented as being in adherence
with African tradition and perfectly acceptable to the Muslim community. The
limitation of births is frequently seen as fundamentally wrong because it is outside tradition.
Even in the most conservative zones of Mali, the concept of “closely spaced pregnancies” is
perfectly identified in the national languages (the term “seremuso” in Bamana, describing
women who have closely spaced pregnancies, has a negative connotation). In addition, the
consequences of closely spaced pregnancies on children‟s health are well-known (the term
“serebana” is the expression for weight loss and complications that often lead to death in
children born of mothers who have closely spaced pregnancies). It is also important to
present family planning as an essential measure to protect the life of the infant. In this way, a
message perceived negatively by a population - that still lives in such fear of high infant and
child mortality rate (1 in 5 children die before age 5) and that it is desirous of having many
children - will be seen as a positive solution to protect a child whose birth is a joy to the
whole family (“den ka di” in Bamana). In adopting modern contraceptive methods, couples
will use tools that will permit them to “plan” their pregnancies following their constraints and
their wishes; in replacing traditional methods that are as common as they are ineffective
(such as the fine cord “tafo”), modern contraception will be accepted by husbands (who will
be able to “find” their spouses at the end of time periods fixed by tradition) and by imams
(who will see that family planning is in accordance with the foundations of the religion) to
guarantee the protection of one of the principal gifts from God - a child.
3.28. The debate today is not about how not to collide with the sensibilities of certain
social pro-birth strata. It is about the free choice of women and men to procreate, as
well as the availability and accessibility of reproductive health and family planning
services. Just meeting the unmet need family planning raises contraceptive prevalence by 70
percent (Feyisetan and Casterline 2000: 100-109). Nevertheless, despite many
announcements and promises, contraception is still far from being largely available in Mali
(Engelman 2008: 100).
3.29. The institutional grounding of family planning/reproductive health (FP/RH) also
deserves particular attention. Today, FP/RH questions are diluted among other dimensions
of public health. The subject‟s importance should lead to its revival by way of a strong
political engagement and a careful monitoring by development partners. In fact, there has
been a repositioning of family planning, undertaken by USAID and UNFPA. USAID has
already supported several family planning campaigns in Mali.
57
3.30. Alternative strategies to make family planning services available should also be
explored, whether they involve community-based distribution or social marketing. In
the past, these approaches have known considerable success in Mali, but they were not
pursued consistently, either because of a lack of interest on the part of political decision-
makers or for lack of funding. Social marketing of condoms contributes to the fight against
the HIV/AIDS epidemic and sexually transmitted diseases. It is necessary to develop
awareness and behavior change communication campaigns regarding not only HIV/AIDS
prevention but reproduction as well.
3.31. Certain development partners, including USAID and FNUAP, are financing
family planning and reproductive health programs, but the biggest challenge will be the
scaling up of these programs. An important tool will be the next funding from IDA at
PRODESS 2. While the objective of this new project is, in theory, health sector reform, it is
desirable that it prioritizes a few issues, including reproductive health and family planning.
In particular, the new project should support service delivery outreach strategies. In this
light, the project should allow the generalization of successful experiences in Mali (for
example, community-based distribution and social marketing of contraceptives). Moreover,
the project could help the funding of contraceptives themselves, in order to assure
contraceptive security. Finally, it should support the collection of reliable indicators for
program monitoring and evaluation, notably through special enquiries and service statistics,
whose results should be brought together with the couple-years of protection (CYP) statistics
and survey data.
Identifying and re-energizing key actors
3.32. A large number of Malian actors intervene in population, family planning, and
reproductive health matters. These are agents in state departments (National Population
Directorate, Central Statistics Office, and medical and paramedical professionals of the
Ministry of Health); from specialized NGOs and associations like AMPPF (see Box 3.1);
family planning and reproductive health professionals in the private sector; academics in
related fields (medicine, geography, demography, sociology, agronomy, etc.); religious and
opinion leaders; traditional and community chiefs; and communities and local groups.
58
Box 3.1: The Malian Association for the protection and promotion of families (AMPPF)
Within the specialized Malian NGOs, the Malian Association for the protection and
promotion of families (AMPPF) remains to this day the most active one in the field. Created in 1972,
it receives financial support from diverse sources, including the International Planned Parenthood
Federation (IPPF) and the principal development partners in Mali (Canada, France, Switzerland,
Norway, the Netherlands, Germany, USAID, WHO, UNICEF, UNDP, UNFPA, etc.).
The AMPPF intervenes in the areas of reproductive health and the improvement of the
economic status of women and children. It has created branches offering services for family planning
and maternal and child health services, including the fight against sexually transmitted diseases and
HIV/AIDS, and providing guidance and education for youth for whom the principal mission is to
prevent STDs and HIV/AIDS, unwanted pregnancy, unsafe abortions and early age at first sex
(CERPOD 1999); detecting STDs and helping to treat confirmed cases; providing confidential
consultations for unwanted pregnancies; and guaranteeing low-cost availability of modern
contraceptives. Hence, AMPPF works to better space births, and prevent STDs and HIV infections.
It also supports women and young people through revenue-generating activities. Its interventions
take place in 6 of the 9 regions of Mali (Kayes, Koulikoro, Sikasso, Ségou, Mopti and the District of
Bamako) and extension to the other regions is planned.
Nevertheless, the AMPPF faces several problems, among which a few can be named: (i)
difficulties in physically extending welcome centers to respond to the unmet needs of the population;
(ii) insufficiency of human resources: only about 40 salaried and 300 non-salaried community agents
are working to meet the Association‟s objectives; (iii) lack of logistical means; (iv) the lack of
sustainable activities: financing usually lasts only two years; and (v) difficulties accessing public
funding. For example, the Association is solicited by the Government for the development of policies
and research funding, but once funding is obtained, the Association is no longer consulted.
Sources: Information collected by authors.
3.33. It will be necessary to identify new leaders among all these actors and within the
Malian society in general, and to re-energize present key actors. These actors should
work under adequate supervision, receive proper payment (a fundamental problem), and have
access to modern methods of work (computers, Internet, transportation facilities, etc.). All
actors should move from a culture of project management to a culture of activism for social
change. This assumes that they are themselves convinced of the topics they will defend.
Periodic travel for study to similar countries in terms of socio-economic, religious, and
cultural conditions is an effective way to train staff on population, family planning, and
reproductive health issues.
3.34. The onset of the fertility decline and the continuation of this decrease cannot
occur without a strong commitment and the concrete involvement of the Malian
leadership. The leadership should engage itself politically for health reasons and the
Government should equip itself with a new, high-performance institutional organization in
charge of population, family planning, and reproductive health. It would also be suitable to
mobilize adequate funding, whether national, multilateral, or bilateral, to set up well-aligned,
long-term and nationally scaled-up programs. The organization of a national Forum on
59
population issues to deal with all these aspects seems to be a good mechanism to make a
fresh start on population and reproductive health issues.
3.35. The revival of population activities in Mali will not happen without greater
engagement of the Technical and Financial Partners (TFPs). The Government of Mali
benefits from the support of numerous TFPs. Among these, it would be suitable to identify
those that would be most capable of supporting this change and to play the role of mentor for
their Malian colleagues. Thus, there will be some chance of creating a new situation with
respect to population, family planning, and reproductive health matters in Mali.
Coordinating the actions of the Technical and Financial Partners
3.36. Concerning population issues, the most important TFPs in Mali are USAID,
UNFPA, several bilateral agencies of the United Nations, the World Bank, and certain
international NGOs. Key Malian actors have been working with these development
partners for a while in most areas related to population, family planning, and reproductive
health.
3.37. These development partners provide technical and financial support to
practically all areas of population intervention. Good examples are the United Nations
Development Programme (UNDP) and USAID for the collection of the data (General Census
of Population and Housing & Administrative Census with Civil Registration (RAVEC) &
Demographic and Health Surveys, respectively). Particularly the UNFPA and USAID
support family planning and reproductive health activities, including contraceptive security.
In addition, UNFPA also supports the collection and analysis of demographic data, training
in these areas, and the gender activities related to population. UNICEF concerns itself with
the well-being of women and children in supporting activities related to the spacing of births,
maternal and infant health, and promotion of the status of women, as well as respect for the
rights of children. In supporting vaccination programs, UNICEF also contributes to the
reduction of infant and child mortality. This agency has also placed nutritional security
among its main priorities. The WHO and the World Bank are participating in the
improvement of the health conditions and are helping to the strengthening of health systems.
Finally, the World Bank lends its support to the Government of Mali for the development of
the Poverty Reduction Strategy document (PSRP-II).
3.38. Most other development agencies in Mali contribute indirectly to the general
objectives related to population, be it support for girls‟ education or the construction of
health or educational infrastructures. It is necessary to mention the European Union (EU)
and the French agency developpement (AFD) which give budgetary support and/or titular
help to projects reinforcing numerous development sectors in Mali (education, infrastructure,
agriculture, sanitation, etc.). Numerous bilateral agencies of cooperation are present in Mali,
coming from European countries, the United States (through the USAID mission in
Bamako), and from Canada, among others. Numerous NGOs and national and foreign
associations are active as well in the country, even if they are having difficulties in terms of
human and financial resources that compromise the implementation of planned activities.
60
3.39. All TFP interventions in matters of population need to be coordinated. The cells
of coordination created by development partners generally succeed in avoiding double
financing for one activity. However, they rarely manage to harmonize their actions in
sectors. Therefore, it is essential to reinforce them, under the aegis of the central
coordination structure, in integrating not only all stakeholders in the area of population, but
also in making sure that intervention areas, target populations, and types of activities to be
conducted are collegially determined, defined, and harmonized. This will allow avoiding
concentrating actions in certain areas while others do not benefit at all, and, most
importantly, to maximize the impact of efforts accomplished jointly.
3.40. There is still a long way to go to reach the objectives to reduce fertility. It is
useful to remember that several activities analyzed in this report overlap. Although the
different areas of intervention were presented in this chapter in a sequential manner and in
priority, it will be imperative to deal with some of these issues simultaneously, given the
urgency of addressing population issues in Mali.
Collecting data and initiating demographic research
3.41. This study faced the problem of gaps in demographic data in Mali. In particular,
there was deficiency in data on civil registration, internal migration, and, above all,
international migration. Additionally, the most recent census done in Mali is old, dating back
to 1998. Only the demographic and health surveys, that are quite reliable, will allow us to
gauge demographic trends, particularly fertility and infant and child mortality (see Chapter
1).
3.42. However, in the last few years, considerable efforts were made in the area of
demographic data-gathering. Mali has just completed a demographic and health survey
(2006). Mali is also preparing the on-the-ground phase of a General Population and Housing
Census (RGPH), planned for 2009. This last operation will be completed by an effort to
improve the quality of Malian civil registration; entitled the Administrative Census with Civil
Registration (RAVEC), it will also be conducted in 2009. The first step in acknowledging
population issues is to be able to correctly measure demographic trends. It is, therefore,
urgent to complete RGPH and RAVEC with the least possible delay. In addition, Mali must
plan to lead a survey on migration following the model of the 1993 investigation on
Migration and Urbanization in West Africa (which was led by the Institute of Sahel at the
CILSS). This survey would help get a better grasp on internal and international migratory
movement.
3.43. Mali also lacks rigorous demographic analysis. A precise research agenda will be
necessary in order to point out the areas not yet covered, periodically update data, regularly
prepare demographic projections, and, above all, support the revival of activities related to
population and reproductive health. First of all, new population projections at the regional
and national levels should be prepared using the results of the new census. It will also be
necessary to prepare projections for different key sectors, including education and health.
These new population projections will help update the Poverty Reduction Strategy document
(PSRP-II). Moreover, the results of the recent demographic and health survey (2006) should
be used to conduct an analysis of the proximate determinants of fertility (Bongaarts model).
61
An examination of the proximate determinants of fertility will allow us to calculate practical
population projections (instead of the trend method currently used), as well as to choose key
interventions and policy instruments. It is equally necessary to model the trends in the
HIV/AIDS pandemic, following different epidemiological factors. Finally, there is a striking
lack of anthropological and qualitative studies on, for example, the determinants of fertility,
the makeup of families, the social and cultural burdens on the reproductive life of women,
and personal experiences of the HIV/AIDS pandemic. All these analyses should lead to clear
and practical program recommendations, particularly in what concerns policy instruments to
set in motion a decline in fertility.
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CONCLUSIONS
1. Population in Mali is one of the key elements in the socio-economic development of
the country. In order to reach the Millennium Development Goals, namely those related to
the formation of human capital and the improvement of maternal and child health, Mali will
have to slow down the pace of population growth. A rapid demographic growth
unaccompanied by a rise in resources accentuates the difficulties faced by public policies in
matters of poverty reduction. Indeed, by increasing the number of vulnerable and dependent
people, the demographic pressure has as a direct consequence the division of already
insufficient resources to satisfy the socio-economic needs of the population. A slowing down
of the rapid demographic growth in Mali would have positive impact on human capital
formation, on the economy, and on maternal and child health. First, a slower demographic
growth would translate into a decrease – relative to productive adults – in the number of
youth. These youth would then be more able to benefit from available education and health
resources. Furthermore, slowing demographic growth would relieve the pressure of large
numbers on public finances, on the agriculture and land, on the environment, and on natural
resources, especially water. Finally, lower fertility would be the answer to some of the hopes
of Malian women, illustrated by the elevated rate of unmet need for family planning. As it is,
Malian women wish to space out their pregnancies, but have neither the information nor the
autonomy, and much less the means to do it. A lower fertility would also have positive
effects on their health and that of their children.
2. Thus, it has become urgent to act on the strong demographic growth and the best
way to slow it is to act on fertility, especially since the decrease in infant and child
mortality is going to continue and may further increase population growth. By acting on
fertility, it would be possible to improve health indicators as well as the survival of mothers
and children. While acting on the demographic variable, it would also be important to
restore a balance between population and resources in such a way as to satisfy the social
demand for education and health and the needs in demographic investment (human capital).
These would have important implications for the Government‟s maneuvering space in fiscal
matters and the macro-economic balance of the country. Finally, the “demographic
dividend” (a drop in fertility and in dependency rates followed by a growth in the labor force
and an acceleration of the economic growth) could contribute – if it can be captured – to a
drop in poverty levels and achieve the Millennium Development Goals (MDG).
3. This effort on the demographic variable should be multisectoral as matters of
population are cross-cutting. It would also require political will and steadiness of action
because it should be a long-term effort. Considering the urgency, it would be necessary to
take simultaneous actions. First, it would be important to establish a high level institution to
deal with population issues. Then, the Strategic Framework for the Fight against Poverty
(CSLP) should be revised to take into full account the demographic variable. It would be
important to re-awaken the Malian leaders regarding population and reproductive health
issues. World Bank support to the project that would take over from the Program for Social
and Sanitary Development (PRODESS) would have to shoulder the efforts as far as
reproductive health and family planning are concerned. Finally, it would be suitable to deal
63
with gender issues, legal reforms, and girls‟ education which are at the heart of the problems
of demographic behavior change. All these actions are indispensable for Mali to be able to
finally start its fertility transition.
4. The effectiveness of the endeavors to slow down demographic growth will rely in a
large part on the level of attention that the Malian authorities will devote to the
problems of population. The Government of Mali could decide to embrace the challenge
fully, as other countries have done, including Islamic countries such as Bangladesh, Egypt,
Indonesia, Iran, Morocco, and Tunisia and, in sub-Saharan Africa, Ghana and Kenya. In this
case, fertility would start to decline, in other words, the transition from traditional levels of
fertility to more controlled levels. The dependency ratios would then improve. With time,
Mali would have the possibility to improve its human capital due to better quality of
demographic investments. It would also be able to better satisfy social needs, namely in
schools and health facilities.
5. On the other hand, the Government can keep considering that the present
demographic growth is a minor problem, which might strongly limit the progress
already achieved in the areas of education and health as well as in meeting social needs for
schools, health facilities, housing, jobs, etc., and the revamping of current services, which are
often run-down, and the improvement of their quality.
6. The first objective of this study was to shed light on the debate over these
fundamental choices by providing relevant information based on data and available
studies. All the elements in this report highlight the importance and urgency of a determined
and effective effort to reduce the current demographic growth and, especially, to slow down
fertility.
7. However, the choices in this matter are delicate and depend on many
considerations – cultural, social and religious – and are, after all, eminently political. Only Mali, its leaders, and its population can make these fundamental, even vital, choices.
But the consequences of the choices that will be made, or not, on the subject will have an
economic and social impact for which the national leadership will have to bear responsibility
toward the Malian population as well as toward development partners.
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ANNEX 1. SOCIO-ECONOMIC AND GEOGRAPHIC SITUATION
This Annex presents the main characteristics of the geographical and socio-economic
situation of Mali. In particular, it analyses the structure of its economy, the reforms that
have been instituted, recent macro-economic performance and prospects for the future,
including the Poverty Reduction Strategy.
Mali is one of the largest countries in West Africa. It extends from the Sudan-Sahel
strip to the Sahara desert. It is a landlocked country of 1,248,574 square kilometers, and
shares 7,420 kilometers of border with seven neighboring states: Algeria to the northeast,
Niger to the East, Burkina Faso to the southeast, Ivory Coast and Guinea to the South, and
finally, Senegal and Mauritania to the West (see Figure A.1.1). Mali has no access to the sea.
The ports of Dakar and Abidjan, that Mali uses for most of its international traffic, are
approximately 1,200 km away from Bamako (Turner 2005: 1111-15).
Figure A.1.1: Map of Mali
Source: Wikipedia 2007.
The subtropical arid climate and global warming make the country vulnerable to
droughts. Rainfall is hard to predict, and there is little of it all throughout Mali, although the
southwest of the country gets more rain. Heat, the harmattan wind (common during the dry
season), recurring droughts, and occasional flooding of the Niger River are constant natural
threats linked to the geography and to the climate of the country. On the other hand,
deforestation, desertification, soil erosion, and the inadequate water supply of water create
serious environmental problems that arose more recently. These problems are magnified by
the rapid demographic growth.
65
Mali is divided into three natural geographic zones: the arid Saharan North, the semi-
arid Sahel center, and the Sudanese South good for agriculture (figure A.1.2 shows the
regions of Mali). With a flat terrain for a great part of the country, the plateaus in the North
are sand covered, rugged hills are in most of the northeast and a Sudanese type savannah
dominates in the South. The water system relies mainly on river basins that are catchments
of two rivers, the Senegal and the Niger, both located in the southern part of the country and
originating in the Fouta-Djalon in Guinea. They also guarantee an important part of the
transportation. However, these rivers do not flow in a regular way: the Niger is proper for
navigation six months of the year, between July and January. It curves along a long loop of
about 1,700 km and branches at its summit into multiple arms forming a real “interior delta”.
Its tributaries drain the southeast and the northeast of the country. This area occupies 50,000
square km of the territory which is approximately 4 percent of the total area of the country.
The Niger River plays an important part in the economy, the development and the spatial
distribution of the country. It is the main river in Mali as well as an essential element of its
geography and its agricultural potential. A small part in the western area of the territory is
irrigated by the Senegal River. These two rivers and their tributaries allow the country to
have a hydro-electric potential.
Figure A.1.2: Regions of Mali
Source: Wikipedia 2007.
Because the desert makes up a large part of the territory, the population of Mali is
concentrated in the southwestern part of the country. Approximately 90 percent of the
population resides in the southern provinces where the weather is less arid and life conditions
less harsh. The north of the country is inhabited by nomads.
The biggest part of the population of Mali, or 69 percent of the total population, lives in
rural areas (Population Reference Bureau 2007). The population density, which is quite
variable, varies from 90 inhabitants per square km. in the central delta of Niger to less than 5
inhabitants per square km. in the Saharan area in the North.
66
Many ethnic groups make up the Malian population: the Mandé (Bambara, Malinkés and
Soninkés) represent 50 percent of the total population; followed by the Peuhls or Foulanis
(17 percent); people of Burkinabè origin, either Gur or Mandé (12 percent); Touaregs and
Maures (10 percent); Songhai (6 percent); and finally other ethnic groups (5 percent). Ethnic
tension remains between the Touregs and the Songhais. The Bambara, mainly farmers, live
in the central part of Mali. The Malinké live mostly in the regions of Bafoulabé, Kita, and
Bamako. The Peuhls (Fulanis), semi-sedentary breeders, are everywhere in the country, but
mostly in the area of Mopti. The Songhai, farmers, fishermen, and traders live along the
Niger river and on the islands in the delta of the river. Finally, the Touareg nomads are
mostly in the north of the country.
Socio-economic conditions and trends
Mali is one of the poorest countries in the world with a poverty incidence that has
remained for a decade at 56 percent of the population, according to a report in the 2007
CSCRP magazine. It belongs to the Least Developed Countries (LDC) and, according to the
2006 Human Development Report, ranks 173rd
over 177 countries with a Human
Development Index (HDI) of 0.380. Mali‟s human development indicators point to a
difficult socio-economic situation: a life expectancy at birth estimated at 58.5 years (this
estimate may be too high); health coverage estimated at 78 percent within a 15 km radius of
minimal care dispensaries; access to drinking water for only 70 percent of the population
according to the same report; a gross school enrollment ratio of 77 percent; and a literacy rate
of only 32 percent.
A series of reforms transformed the economy, which was state-controlled in the 1970s,
into an economy that is much more open to the private sector. However, the different
policies implemented as well as the important reforms efforts agreed upon with the Bretton
Woods institutions (see Box A.1.1) have not succeeded in decreasing poverty in a significant
manner.
Poverty affects the Malian population immensely, thus jeopardizing the realization of
its economic and social rights. This poverty is an essentially rural phenomenon, with over
90 percent of poor households residing in the countryside of Mali and eighty percent of rich
households residing in an urban setting. Except for the district of Bamako, poverty has
increased tremendously in almost all areas of Mali (see Table A.1.1) where more than half
the population lives below the poverty threshold. It is more flagrant in the areas of Zone 1,
with at least three people out of four living below poverty level. These four regions - where
three-fifths of the population lives - include approximately four-fifths of the poor in Mali.
The incidence (P0), the depth (P1), and the severity (P2) of poverty are always more
pronounced in rural areas.
67
Box A.1.1: Evolution of the economic policies framework implemented in Mali since 1980
1980–1987: Launch of reforms targeting the market economy
• Liberalization of the cereal market in the context of the Cereal Market Reform Program
(PRMC).
• Progressive loss of the monopoly held by the Malian Society for Import and Export
(SOMIEX) in foreign trade.
• Improvements in public resources management: budgetary nomenclature reform, hiring
freezes in the public sector, and putting limits on the expenditures of certain Ministries.
• Launching of the privatization program of public companies (tile factory SOBRIMA
and tannery TAMALI).
• Restructuring of the Development Bank of Mali and of Air Mali.
1988–1993 : Expanding the reforms
• Liberalization of all prices (except those of hydrocarbons) between 1988 and 1990.
• Elimination of the monopoly on hiring of the National office of labor and employment
(ONMOE).
• Labor Code revision.
• Updating the Commerce Code.
• Liquidation of SOMIEX in 1988.
• Liberalization of exterior commerce, with the elimination of import and export permits.
• Simplification and rationalization of customs tariffs.
• Replacement of the tax on goods and services by a value-added tax (VAT).
1994–2004 : Consolidation and continuation of reforms begun
• Liberalization of all prices, including those of hydrocarbons.
• Creation of commercial and administrative courts in Kayes, Bamako et Mopti.
• Establishment of a single office to deal with all procedures of exterior commerce.
• Creation of a center to deal with procedures of businesses and the restructuring of the
Chamber of Commerce and Industry.
• Creation of an Office for the supervision of large companies that have turnovers of
more than 2 million FCFA.
• Reduction of the list of products exempted from the VAT.
• Global income tax reform.
• Better management of public resources.
Source: Compiled by the authors.
68
Table A.1.1: Classification of regions according to poverty level
Regions by
poverty
level26
Percent of
total
population
Percent of
people living
below the
poverty
threshold
(P0 or
incidence of
poverty)
Percent of
poor people
living below
the poverty
threshold
(P1 or depth
of poverty)
Percent of the
total number
of poor in Mali
living in this
region
(P2 or severity
of poverty)
Human
development
index
(HDI)
Zone 1 66.3 79.0 37.7 79.0 0.311 Mopti 14.9 88.6 40.9 20.9 0.780 Sikasso 18.4 82.7 41.6 23.8 0.308 Koulikoro 16.0 74.9 39.6 15.4 0.317 Ségou 17.0 70.4 28.9 18.9 0.288 Zone 2 22.9 46.9 16.2 17.0 0.319 Tombouctou 4.5 60.8 17.6 4.4 0.259 Kayes 14.0 50.1 19.4 11.0 0.340 Gao/Kidal 4.4 22.9 5.0 1.6 0.315 Zone 3 10.8 23.9 6.2 4.0 0.588 Bamako 10.8 23.9 6.2 4.0 0,588 Total (Mali) 100.0 69.0 31.0 N/A 0.380
Source: ODHD 2007, UNDP, World Bank and Authors’ calculations.
After years of stagnation, the educational coverage has improved greatly, especially
within the last five years. Progress is ongoing under the direction of the National Ministry
of Education (MOE), which is implementing its Ten-Year Program for the Development of
Education (PRODEC 2000-2010) in collaboration with funders within the framework of the
Accelerated Implementation Initiative (IMOA). The gross enrollment rate (GER) at the
primary level in schools has increased from 47.7 percent in 1996/1997 to 69 percent in
2004/05. Despite this result, the GER for the primary level remains among the lowest rates in
West Africa and is 10 percentage points lower than the regional average. Besides, the quality
of education is poor, and disparities are still great. Evaluations have shown that the
completion rates are low and that the quality of the education is inadequate. This poor
quality of education is in one art due to the lack of good teachers and in another part due to
the priority given to quantitative objectives to the detriment of qualitative ones.
Despite major improvements in the course of the last ten years, the progress in health
still has mixed results, and the country is still behind its health target in the Millennium
Development Goals (MDG). Maternal and child health indicators remain at worrisome
levels, with the rural populations shouldering the heaviest toll as far as mortality and
morbidity are concerned. The rates for infant and child mortality are among the highest in
sub-Saharan Africa, well above the numbers of the neighboring countries with Niger
26
Mali is comprised of 8 administrative regions: Gao, Kayes, Kidal, Koulikoro, Mopti, Ségou, Sikasso and
Tombouctou in addition to the district of the capital Bamako. The administrative capitals of the regions have
the same name as the region in which they are situated. Three of these regions - Tombouctou, Kidal and Gao -
are situated in the Sahara Desert. The five other regions, where farming and economic potential is much higher,
are thus the most populated regions of the country.
69
excepted. The indicators for nutritional status are among the worst in Africa. The total
fertility rate (TFR) that remains well above the regional average (6.6 children per woman in
2006 versus 5.1 for the sub-region) and is one of the factors that explain the high level of
mortality and morbidity among women and children.
Despite improvements of different social indicators, Mali will probably not reach the
MDGs. The recent Country Economic Memorandum (CEM) notes that Mali is not presently
capable of attaining the MDG targets and that, for this prospect to change, an exhaustive and
forward-looking public investment program is a necessity in the main sectors. The
Government has already started implementing a Political Action Program aiming at
achieving the MDGs. However, given its present financial resources, the country is not
capable of financing the investment programs needed; as a result, significant foreign aid is a
necessity.
The first generation of the Strategic framework for the Fight against Poverty (CSLP
2002-2006) remains the only frame of reference on development policy in Mali in the
medium-term. After its recent evaluation, it appeared that the intended objectives of the
2002-2006 CSLP have not been reached, namely the objective to reduce poverty by a
quarter25
. This low level recorded for poverty reduction was in part explained by the
difficulty in controlling demographic growth.
Structural characteristics of the economy of Mali
Mali is a landlocked country and its economy relies on the primary sector. Its urban part
is dominated by an informal sector. However, Mali has considerable natural resources and
those that are most mined are gold, phosphates, kaolinite, salt, and limestone. Other natural
resources that are not all exploited include granite, gypsum, bauxite, iron ore, tin, manganese,
and copper. The hydro-electric potential of the country has already been mentioned above.
The economy of Mali is still dominated by activities related to agriculture, breeding,
and fishing. Agriculture represents 40 percent of the gross domestic product (GDP),
three-quarters of the export revenues and four-fifths of employment. Agricultural
production is mainly reliant on traditional food commodities (rice, millet and sorghum) and
cotton is the most common cash crop, especially in the South. Malian agriculture is mostly
an extensive culture that relies on human labor and is not very productive. It is performed by
small farmers who sell only 15 to 20 percent of their production; the percentage varies
considerably depending on precipitation. Furthermore, cotton profitability follows world
markets fluctuations. In the North, livestock breeding is an important part of livelihood. The
economic activity is limited mostly to the area irrigated by the Niger River, and the industrial
activity is clustered around agricultural activities.
Out-migration is a very important source of income. Mali also depends on foreign aid.
It is vulnerable to fluctuations in the price of cotton (its main export) in the
international market.
25
2006 study of the implementation of the CSLP, June 2007.
70
Structural reforms and economic performance
A succession of reforms has changed the state economy of the 1970s into an economy
that is much more open to the private sector. Thus, economic growth has improved since
1994 after a period of contraction in the 1980s marked by an average growth rate of -1.2
percent between 1980 and 1986 (see Table A.1.2 and Figure A.1.3). Between 1987 and
1993, the economic growth of Mali was at 3 percent. After the devaluation in 1994,
economic growth in Mali progressed strongly to reach the present rate of 5.4 percent in 2006
(World Bank 2006, 2007; United Nations 2007). A stabilization of the economy
accompanied the strong economic growth of the last 15 years as shown by more regular rates
of growth. Moreover, the economic growth per capita was 3.3 percent per year on average,
with a population growth rate between 2.4 and 2.7 percent during the same period (World
Bank 2006). The Gross Domestic Product (GDP) per capita went from US$240 in 1994 to
US$380 in 2004, an average annual increase of 4 percent. These improvements at the
beginning of the 1990s can be attributed to the restoration of the political, social, and macro-
economic stability by way of effective structural and economical reforms (World Bank
2007).
Table A.1.2 : Average annual growth rate and volatility by period
Growth in
GDP
Growth in
GDP per capita
Standard
Deviation
Coefficient of
variation
1980-1986 -1.2 -3.6 7.0 5.6
1987-1993 3.0 0.3 5.3 1.7
1994-2004 5.7 3.3 3.1 0.5
Source: Calculations by World Bank services.
The economy of Mali remains fragile because it is dependent on weather conditions, on
the terms of trade, and on changes in world markets (for example, the recent increase
in food prices). Despite significant progress made, the socio-economic development
remains hampered by the dependency of the animal and agricultural production on rainfall,
the budding development of the industrial sector, the importance of the informal sector, the
slow development of human resources, and the degradation of the natural resources.
Moreover, Mali depends on the ports of the neighboring countries for its imports and its
administrative capacities remain weak. The economy relies mainly on the exportation of
three products from the primary sector (gold, cotton and livestock products) (World Bank
2007). Agriculture is the most important sector of the economy in Mali the growth of this
sector particularly affects the poorest populations.
GDP growth declined between 2005 and 2007, slowing down gains to Mali’s economy
(see Figure A.1.3). The global economic situation was less satisfying worldwide in 2007
than it had been in 2006. Forecast initially at 1.5 percent, the GDP growth finally came out
at 3.2 percent (following the publication of the final results of the agricultural campaign
2007/2008), whereas it was at 5.3 percent in 2006.
Figure A.1.3: GDP growth rate between 2005 and 2007
71
6.1
5.3
3.2
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
2005 2006 2007
GDP growth rate
Source: DNSI.
The growth rate of agriculture is low, estimated at a level of 2.6 percent, and has slowed
down since the devaluation of 1994 (the average rate was 3.5 percent for the period 1987-
1993). This slowing down and the actual weakness of that sector are worrisome because
low-income households depend on it for their livelihood. The growth of this sector, which
represented annually only 20 percent of GDP growth for that period, essentially came from
the farming of rice and cotton. In fact, while rice and cotton represent only 20 percent of the
agricultural value added, they have an average annual growth rate of 7 and 4.5 percent,
respectively. The other important crops, namely cereal and livestock which represent 35
percent and 28 percent of the agriculture value added respectively, have slightly increased
with a rate of 1.6 percent for the cereals and 2.9 percent for livestock (World Bank 2006).
Overall, even if the economic situation has improved since 1994, the agricultural sector of
the economy, on which the poorest populations depend, is suffering a worrisome slowdown.
The sectors of industry and services have contributed considerably to the Malian
economic growth. The share of industry and services is relatively small compared to
agriculture as far as employment is concerned. However, by representing 40 percent of GDP
growth, these sectors are the ones that mostly sustained this growth between 1994 and 2004.
Mining, especially gold, has enormously contributed to the economic growth since the
devaluation of 1994. With an annual average growth of 21 percent, gold mining has
expanded rapidly. Other economic activities, such as transportation, storage, and
communication services, have also seen a rapid growth, whereas the transformation
industries have not seen a marked change. This suggests that the economic development has
been limited during this time, despite the progress achieved in economic growth (World
Bank 2006).
72
The business climate in Mali is still not viewed as satisfactory by international organizations. According to World Bank data (www.doingbusiness.org), the Malian
economy is still not attractive enough for entrepreneurs and investors. In 2006, Mali was
ranked 146 over 155 countries for business climate. It ranks 143rd
in relation to the ease of
starting a business and 123rd
for the ease to obtain the needed authorizations. Mali is 147th
regarding the ease to hire and fire and 135th
as far as ease to obtain loans.
Finally, money transfers from migrants are a very important contribution to the
economy of Mali. A recent study from the African Development Bank (AfDB) puts an
estimate of approximately 11 percent of the gross domestic product (GDP). These transfers
from migrants represent around 80 percent of the transfers by way of official development
assistance (ODA) (African Development Bank 2007). However, these numbers have to be
considered cautiously. First, the total number of Malian migrants abroad is difficult to
evaluate, as mentioned in Chapter 1. Second, a significant part of migrant transfers are
informal and, therefore, not accounted for in statistics.
Poverty reduction strategy
The Poverty Reduction Strategy Paper (PSRP) of Mali is from 2002. It is based on the
interim document for poverty reduction strategy (PSRP-I) of 2000 presented at the
International Development Association (IDA) and at the International Monetary Fund (IMF).
The PSRP is the result of a participatory process at the regional and national level, with the
contribution of many groups composed from the Government, the civil society, the private
sector and Technical and Financial Partners (TFPs) or development partners.
Three major priorities have been suggested in the PSRP: (1) institutional development,
better governance, and better participation; (2) human development and strengthening
access to basic social services; and (3) infrastructure development and of the assistance
to productive key sectors. The main objective is to reduce poverty by achieving an annual
growth rate of 7 percent and by creating at least 10,000 jobs per year in sectors other than in
formal agriculture (PSRP of Mali 2002; World Bank 2008). Indeed, the PSRP highlights the
importance of economic growth as a prerequisite condition for poverty reduction. However,
more recent World Bank and IMF evaluations, and the evaluation of the progress of the
implementation of broad document guidelines, underline that the method by which growth
could be increased has yet to be determined (World Bank 2006). However, the simulations
achieved according to a macroeconomic model show that, under the hypothesis of an
elasticity of -0.5 in poverty-consumption growth, a decrease in the population growth rate of
0.1 percent per year from 2007 to 2015 would lead to a decrease in the poverty rate by 1.3
percentage points in 2015 compared to the baseline scenario. Poverty would decrease by 2.3
percentage points in 2015 compared to the baseline scenario with an elasticity of -1 (see
Figure A.1.4).
73
Figure A.1.4: Poverty rate and decrease in Mali’s population growth rate, 2007-2015
Source: Authors’ calculations.
A new PSRP, the PSRP-II, has been validated by the Government (see Chapter 3, paragraph
3.21). On the institutional level, a technical entity of the Strategic framework of the fight
against poverty, the CSLP, coordinates the implementation of poverty reduction
interventions.
45.0
50.0
55.0
60.0
65.0
70.0
2007 2008 2009 2010 2011 2012 2013 2014 2015
Population growth is constant at 3% (elasticity = -0.5)
Dropping population rate by 0.1% each year starting in 2007 up to 2015 (elasticity = -0.5)
Population growth is constant at 3% (elasticity = -1.0)
Dropping population rate by 0.1% each year starting in 2007 up to 2015 (elasticity = -1.0)
74
ANNEX 2: POPULATION POLICIES IN THE WORLD AND IN SUB-
SAHARAN AFRICA
Population issues seem to have disappeared from the international agenda for
development. The reduction of population growth has been one of the most important
development issues in the 1960s and 1970s. By then, crucial population programs had been
implemented in Asia and Latin America. They helped decrease population growth in these
two regions by 2.5 percent a year in the 1960s and by 1.2 percent a year nowadays.
Conversely, the absence of interest shown by the leadership and the elites in sub-Saharan
Africa translated into a very tardy adoption of population programs that are weak and
inefficient. Consequently, demographic growth in sub-Saharan Africa remained around 2.3
percent a year for the last 50 years, except for southern Africa (which only represents 7
percent of the Sub-Saharan population). Because of the success achieved by the programs
implemented in Asia and Latin America, international concern moved on to other “urgent”
matters, such as the HIV/AIDS epidemic, humanitarian crisis situations, and good
governance. The recent concerns about climate change and food shortage have further
marginalized the demographic dimensions in the discussion on development in Sub-Saharan
Africa.
The extreme youth of the African population – 2 out of 3 Sub-Saharans are less than 25
years old – and the sustained strong fertility translate into a continued demographic
growth in that part of the world despite the HIV/AIDS epidemic. In mid-2007, the
population of sub-Saharan African was estimated at 788 million people, or 12 percent of the
world population. By 2050, this ratio is projected to increase to 18 percent and the
population of sub-Saharan Africa is projected to reach 1.8 billion inhabitants (Population
Reference Bureau 2007). This assumes that every African woman would have only 2.5
children on average compared to 5.5 today, according to the projections of 2006 of the
United Nations. Indeed, these projections rely on the assumption of a rapid fertility decline
which is far from being achieved, except in southern Africa. Higher population numbers, as
much as two billion inhabitants and maybe more, could be reached in sub-Saharan Africa if
fertility were to decrease at a slower pace (Guengant, 2007).
For many decades now, experts have debated the existence of a relationship between
demographic growth and economic development. The “pessimists,” often referred to as
Malthusians, have maintained that rapid population growth, and thus a strong fertility,
prevented or at least slowed down economic development. This perception was used as a
justification for the general funding of family planning policies and programs in the 1960s
and 1970s. Inversely, the “optimists,” sometimes referred to as Boserupians (in memory of
Ester Boserup who had taken the opposite views of Thomas Robert Malthus), insisted that
the size of a population and its rapid growth were agents of economic prosperity since
demographic pressure would be conducive to innovations and would increase the size of the
market (May 2005: 834). The followers of both schools of thought have been able to find
research studies that support their respective theses.
The new perspective in this old debate has come from East Asia and from a more in-
depth look at the role of the demographic variable in what has been called the Asian
“economic miracle” (Birdsall et al. 2001). Indeed, the controversies had so far ignored a
75
vital demographic component, namely population distribution by age group. Because
individual economic behaviors change according to a person‟s age, changes in the age
structure can have a significant influence on economic outcomes. Countries with a high
proportion of young people in a dependent situation see an important part of their resources
devoted to them while often reducing other investments, which can slow down economic
growth. On the other hand, countries in which a higher proportion of the population is of
working and saving age, thanks to a rapid fertility decline, will often see an acceleration of
income growth. This effect is known as the “demographic dividend.” The combined effect
of this “demographic dividend” and of effective policies in other sectors can stimulate
economic growth. The main point here is that a drop in fertility leads to a new age
distribution, a decrease in the number of young dependents and a relative increase in the size
of the workforce of productive population. All these elements could lead to a virtuous circle
of investment in human capital and economic development (World Bank 2007).
Poverty and high fertility are frequently associated in the literature devoted to
demography and development (Birdsall et al. 2001). Sub-Saharan Africa, where high
poverty incidence and the highest fertility rates are side-by-side, represents these relations at
the macro level (country). These relations have been recently synthesized by Eastwood and
Lipton (2001). At the micro level, as previously outlined by different authors (Schoumaker
and Tabutin 1999; Birdsall 1980), poor women often have higher fertility. This is practically
always the case in countries in fertility transition. However, the relationships are generally
less clear in societies with high fertility where slightly lower fertility levels have been
reported among the poor (Schoumaker and Tabutin 1999). Box A.2.1 summarizes the
situation in sub-Saharan Africa.
Finally, it should be noted that the term “population” encompasses two large areas, the
macro-demographic aspects and those that relate to reproductive health. The levels and
trends of births, deaths, and migratory fluctuations determine demographic growth and the
age structure (age pyramid). These events often have an impact on economic growth as well
as on other sectors of development such as education, labor and protection of the
environment. The size of the population, its growth rate, and its distribution are closely
correlated with the social and economic development prospects. Besides, reproductive,
maternal, and sexual health and related health services are part of the population theme
(World Bank 2007:1). This study on Mali looked at the two sides of the population theme,
namely macro-demographic aspects and reproductive health issues.
76
Box A.2.1: Poverty and fertility in sub-Saharan Africa – a literature review
The relationship between poverty and fertility
For sub-Saharan Africa, the literature on the subject is sparse. In a review of the literature on
relationship between poverty and fertility, about fifty relationships between these two variables in the
countries of the South were noted in 32 studies (Schoumacker and Tabutin). Only six studies related
to sub-Saharan Africa. Despite their small number, these empirical studies point to a diversity in the
relationships between standard of living and fertility. There was no relationship between these two
variables in Botswana in the 1970s (Chernichovsky 1984), a slightly positive relationship in Sierra
Leone for the same period (Ketkar 1979), a slightly negative relationship in Burkina Faso in the
1990s (Langani 1997) and in a city in south Sudan in the 1980s (Cohen and House 1994), an
inverted-J relationship between standard of living and fertility in rural Cameroon in the 1980s
(Noumbissi and Sanderson 1998), and clearly relationships in certain contexts, such as the urban
Cameroon in the 1980s (Noumbissi and Sanderson 1998) and in South Africa in the 1990s
(Schoumaker 1999).
Nowadays, many studies allow us to complete this picture. Using demographic and health surveys,
the World Bank has produced a series of demographic and health indicators by standard of living
quintile from 22 countries of sub-Saharan Africa (Gwatkin, Rutstein et al. 2000). These new results,
dating back to the 1990s, indicate that in most countries fertility decreases significantly with the
standard of living. A recent study by Talnan and Vimard (2003) on Côte d‟Ivoire goes in this
direction. These authors measured a negative relationship between the standard of living of
households and fertility (current and cumulative) with data from the EDS survey of 1994, a
relationship that remains controlling of different socio-economic variables. On the other hand,
Ainsworth (1989) measured a slightly positive relationship between standard of living and fertility
among women with no education, using data from the Living Standard Measurement Survey (LSMS)
of Côte d‟Ivoire. Finally, Mencarini and Dovandri (2002) show a negative relationship between the
standard of living and cumulative fertility in rural Botswana and in rural South Africa in surveys
conducted in several villages in the 1990s.
There is, therefore, a diversity of relationships in various contexts and time frames but it seems that
the relationship between standard of living and fertility is now more on the negative side, meaning
that fertility among the poor is higher. However, it is difficult to make comparisons and
generalizations stemming from these studies because of several factors: (1) the diversity of the
populations on which these studies are based (rural or national, all women or women without
education, etc.), (2) the diversity of fertility indicators (cumulative or current) and of the standard of
living (income, expenses, composite indicators), and (3) the fact that standard of living categories are
defined differently in various studies.
The explanatory approaches: a brief overview
How can the relationship between poverty and fertility be explained? These associations can reflect
different types of causal relationships: (1) the effects of poverty on fertility, (2) the effects of fertility
on poverty, and (3) the influence of common factors on poverty and fertility (Birdsall and Griffin
1988; Eloundou-Enyegue 1998; Merrick 2001). Besides, these relationships imply different
explanatory mechanisms of which only a brief synthesis is proposed here (for more details, see for
example Birdsall 1994, Desai 1992, Eloudou-Enyegue 1998, Lipton 1983, Lockwood 1997 and
Schoumaker 1998).
In the case of positive relationships, i.e. the ones where fertility increases slightly with the standard of
77
living, explanations focus primarily on the lower reproductive capacity of the poor (sterility, higher
intra uterine mortality), of more frequent interruption of unions (widowhood, divorce), and of longer
periods of post-partum infertility because of longer periods of breastfeeding and abstinence (Birdsall
1980, Lipton 1983, Lipton 1999).
The negative relationships, the ones where the poor have a higher fertility, have received more
attention. The explanation frequently relies on the idea that high fertility would be an economic
rationale to poverty (Lipton1999). Simply put, poverty is accompanied by a higher demand for
children, which can be explained by the benefits generated by children being superior to their cost.
Old age security and children‟s labor are two of the benefits often mentioned regarding numerous
offspring. These views are echoed in the theory of Caldwell on inter-generational flows (Caldwell
1982), and many authors refer to it under different forms (Birdsall 1994 and Birdsall and Griffin
1988, Cain 1981). These benefits would come at low cost because of a low investment in the
“quality” of children (schooling and health) and an outsourcing of the costs in many ways (having
someone else taking care of the children, gender inequity, intergenerational cost transfer) (Merrick
2001). Measuring of the economic costs and benefits of children during the lifecycle of parenting is a
difficult, especially in the African context, and it is not surprising that little empirical research has
been conducted on the question of the economic justifications of high fertility (Stecklov 1999).
Even if they are not incompatible, the economic approach to fertility is often contrary to the cultural
approach or, more broadly, on approaches based on the diffusion of values, ideas, and technologies.
To simplify, high fertility among the poor would not reflect their economic rationality, but would be
more justified by the fact that the idea of fertility control or information on contraceptive methods are
not well-diffused among the poor and/or that contraceptive methods are not accessible to them.
According to this approach, fertility among the poor would drop but with some delay, and would not
necessitate an improvement in people‟s standard of living (Birdsall 1980, Cleland 1994).
Other variables (mortality, education, place of residence) interfere in this relationship between
standard of living and fertility as well. A higher mortality rate among the poor would have the effect
of increasing their fertility in many ways, particularly by replacement and insurance effects (Heer
1983). High fertility among the poor could also be partially explained by the connection between
poverty and education, poor women being less educated in general (Birdsall and Griffin 1988).
Finally, the concentration of poverty in rural areas could partially explain these relationships, fertility
being generally lower in the city (Shapiro and Tambashe 2003). If the effects of poverty on fertility
are the most often studied in the literature, opposing influences can also explain in part the
associations between high fertility and poverty. On this subject, many patterns have been described.
The effect of early and repeated pregnancies as hampering the accumulation of mother‟s human
capita (schooling, professional experience) is one of them. The intergenerational transfer of poverty in
families with high fertility is another one (Eloundou-Enyegue 1998).
Source: Litterature review by the authors.
After this synopsis, this Annex tries to answer two questions: should there be an intervention
on demographic variables in sub-Saharan Africa? And what are the tools that should be used
for a population policy? First, it presents a short historic review of the international approach
in matters of population policy as well as the attitude of the African leaders on the subject.
Then, it examines the main arguments to slow demographic growth. Finally, it tries to
identify population policy instruments implemented through public policy, private sector
interventions, or a combination of those two.
78
International and African approaches on population
The approaches concerning population have noticeably changed in the last decades. In
1990, Finkle and Crane established a typology of the different kinds of interventions (Finkle
and Crane 1990). For the period between 1965 and 1974, these authors talk about a policy of
“population control.” At that time, governments were trying to slow demographic growth by
launching family planning programs. In the second era, that of “planning of the demographic
variable” which covers the period from 1974 to 1981, fertility was considered in the broader
context of development planning objectives. Finally, from 1981 to 1994, these two authors
identified a time of “pluralist competition” in matters of population policy, characterized by
the emergence of many spheres of influence (most often international or at least
transnational) representing different agendas. This time period continued well beyond the
International Conference on Population and Development (ICPD) held in Cairo in 1994.
Nowadays, however, a new chapter seems to be opening, with a renewed consideration for
macro-demographic variables and their implications in the formation of human capital as
well as for economic development.
For a long time sub-Saharan governments remained reluctant to act on demographic
growth, particularly on fertility. In Latin America and in Asia, effective family planning
programs to slow down demographic growth were started as early as the 1960s and 1970s.
Nothing of this sort has yet happened in sub-Saharan Africa, except in the countries of
southern Africa which represent only 7 percent of the total population of sub-Saharan Africa
(Population Reference Bureau 2007). The African leaders and elites have long considered
that the “population subject” (meaning demographic growth and, therefore, high fertility)
were not one of the development priorities. They have, therefore, in turn invoked the vast
areas of Africa, the low population density, the availability of natural resources, and even the
supposed under-population of the continent. Some argue that because of the latter, some
African populations are prevented from reaching a critical mass which is needed for an
economic take-off. This is the thesis of the narrowness of the African markets. Others find a
relative advantage to countries that have big populations (Collier 2007: 72). Others also
consider that rapid population growth helps to hold down labor costs and makes it more
competitive.
Furthermore, historic, geopolitical, and even ethical considerations are sometimes
invoked by African leaders to justify their decision not to intervene regarding the
demographic variable. The population drain inflicted by slavery and colonization, although
sometimes exaggerated, is still, if only unconsciously, present in people‟s minds. Many
African leaders still associate the strength of their countries with the number of its
inhabitants, following the old saying of Jean Bodin (1530-1596): “the only power is
manpower.” Some leaders even consider that interventions aiming at slowing demographic
growth are culturally imperialist, forced on them from the outside against the wishes of the
population, and even immoral because they defy religious norms.
Nevertheless, one can oppose most traditional arguments justifying the laissez-faire
attitude with strong arguments justifying the interventions for a slowing of the
demographic growth. Hence, as far as human capital formation is concerned, one could
suggest an updating of the old saying of Bodin by adding that “the only wealth is an educated
79
man.” One could give numbers of population density on arable or cultivable lands which are
much higher than the density on the area overall (see Chapter 2). From a religious point of
view, one could mention the compatibility of Islam and family planning. One could finally
underline that the arguments on reproductive health, as formulated during the ICPD in Cairo
in September 1994, are in the same spirit as the Millennium Development Goals (MDGs),
even if reproductive health is not explicitly brought up by the latter (Campbell-White et al.
2006).
Little by little, African leaders and the elites are starting to revisit their stance on
demographic growth. More and more decision-makers and actors on the continent wish to
re-examine the implications of a strong demographic growth on development, whether the
arguments made are related to the formation of human capital and a decrease in poverty, to
the protection of the physical environment, or to the health of mothers and children. They
also wish to promote specific interventions to slow down the growth that they find too
speedy. A symbolic example of this new state of mind is the recent position adopted by
President Yoweri Museveni of Uganda who, in March 2008, declared that fertility was too
high in his country. According to him, this situation is detrimental to the health of women in
Uganda, namely where maternal mortality is concerned. Another striking example was the
firm position a few years ago of former President Marc Ravalomanana of Madagascar in
favor of lowering fertility and the increase in the use of modern contraception. In his
opinion, only the latter could contribute to reduce the high number of induced abortions in
the country.
Main arguments to slow down demographic growth
In sub-Saharan Africa, three key arguments can be put forth for intervening in the area
of demographic variables, especially on fertility and for slowing down demographic
growth. They are the formation of human capital and some macro-economic arguments, the
protection of the natural habitat and the ecosystems, and finally, the improvement of health
and gender equality. To illustrate these arguments for Mali, data from the model Resources
for the Awareness of Population Impacts on Development (RAPID) that was prepared for the
country in 2003 will be used, as well as the results of the model on education and health
presented in Chapter 2.
The first reason to intervene in the area of demographic variables and fertility is to
facilitate the formation of human capital. The desire to have numerous offspring finds all
its significance in agro-pastoral societies, where a child‟s cost is very low because of the
early age at which the child starts work and of the low qualifications necessary to accomplish
the production activities. Such is not the case in the modern economic world where entry
into the labor force demands a longer and more costly training for parents and society.
Under these conditions, human resources become of value only after having acquired
qualifications that are specific and useful for society as a whole. The determining factor is
no longer the increase in quantities of human resources due to high levels of fertility, but the
development of the quality of these human resources through access to education, healthcare,
and decent life conditions. Nowadays, the gradual shift of production conditions makes
numerous descendants unnecessary; on the contrary, it is preferable to have a limited number
80
of children who are well-educated, well-trained, qualified, and capable of performing the
necessary tasks in an economy where productivity is high.
The very fast demographic growth and the influx of very large numbers of youths into
the school and health market increases the social demand for these services in, as shown
in Chapter 2. Numerous groups of young people require more schools and more teachers,
more health centers with their staff and infrastructure. Hence, a strong demographic increase
will not ensure what Alfred Sauvy (1898-1990) used to call “demographic investments.” If
fertility is kept at its present level, it would imply a strong increase in the number of children
in school at the elementary level: the numbers would go from 1.7 million in 2000 to 4 million
in 2025 (model RAPID 2003). Then, education for all becomes out of reach and the
Millennium Development Goals could quickly become an unattainable dream. In turn, and
seen in Chapter 2 as well, these demographic investments have consequences on the fiscal
sphere of the country (room for fiscal action). In other words, how can the demographic
investment be financed: through taxes, budget deficit, or by national or international
borrowing? What other budget items should one sacrifice to get to it? How to assure the
macro-economic stability of the country? Other purely economic considerations should also
be taken into account. Thus, the decline of demographic growth could increase, at the
margin, the income per capita (World Bank 2005).
The economic miracle of East Asia highlighted the role that demographic trends plays
in the economic growth of these countries (Birdsall et al. 2001), although one should be
cautious about comparing the Asian and sub-Saharan situation. Recent studies attribute up to
more than one-third of the economic growth in the Asian countries to demographic changes.
These changes are: a strong fertility decline, followed by a favorable change in dependency
rates (the number of working age adults compared to the number of children), and of a
relative increase of the working age population compared to the rest of the population. This
working age population, relatively bigger, has contributed, mostly by itself, to the expansion
of the economy. The phenomenon has been called the “demographic dividend,” the dividend
being a substantial increase in economic growth resulting from a drop in fertility through the
mechanisms described above. To these arguments, one can add the drop in poverty levels
that can be accelerated due to a faster drop in fertility. The studies conducted among
households show that it is mostly the most deprived quintiles that are affected by the
consequences of high fertility.
The second reason to intervene in the areas of demographic variables and fertility has
to do with the protection of the natural environment in which the population lives. It is
about preserving ecosystem and the protection of the environment (land erosion and
deforestation) and of alleviating the demographic pressure on land tenure (arable land per
capita). Food security, dependent on the agricultural production as well as on access to
drinking water, as well as traditional sources of energy (fuel wood) are often considered as
usually grouped in the category as well. Because the Malian economy is mainly based on
agriculture, it is imperative to prevent soil erosion, to stop deforestation, and to maintain food
production threatened by desertification and drought. With such limitations, maintaining food
security becomes a challenge when demographic growth is very fast. Moreover, the strong
demographic pressure can create conflicts that may lead to security problems. Bitter fights
81
for available resources may spark among young, unemployed people, when there is unbridled
demographic growth.
The third reason for intervening on demographic variables and fertility is the desire to
improve the indicators for health and gender equality. The vicious cycle of high
mortality and high fertility does not bode well for the fast improvement of health conditions
of mothers and children. Therefore, an essential argument for intervention in the area of
fertility and population is undoubtedly the improvement of health conditions. In order to
achieve that, it is important to secure the survival of children, especially those under 5 years
of age by, among other things, birth spacing. It was estimated that more than 900,000
cumulative infant deaths could be avoided in Mali by the year 2025 by only increasing
contraception use (RAPID model 2003). Mothers should be assured of an acceptable risk
level to lead a reproductive life that agrees with their wishes. Many African women in urban
and rural areas wish to have access to family planning services. This is shown in the high
numbers of unmet need recorded in demographic and health surveys. In Mali, 31.2 percent
of women between the ages of 15 to 49 years wish to have access to services to space or limit
births, but do not have access to these services because of cultural or religious barriers, or
because of male bias (EDSM 2006). Moreover, the services offered are of poor quality. A
better access of women to family planning services would allow for a decrease in high levels
of maternal mortality. Less engulfed by their motherly duties, women could play a more
active part in the economy, which would increase their integration into society.
Many developing countries, especially in Asia and Latin America, as well as Islamic
countries, have adopted proactive policies in the domain of population and reduction of
fertility. Effective planning programs were started in the 1960s and mostly in the 1970s in
many countries of Asia, Latin America, and North Africa (Ross and Robinson 2007). In
Tunisia, for instance, under the helm of President Habib Bourguiba (1903-2000), a daring
and visionary program for the education of females, family planning, and legal reform was
implemented as early as 1961. At that time, fertility in Tunisia was, clearly higher than what
it is today in most sub-Saharan countries (currently the average is 5.5 children in sub-Saharan
Africa). Fertility is at replacement level now in Tunisia, in the order of 2.1 children per
woman. There are numerous examples of other countries, including Islamic ones, which
have decided to act on demographic variables, and especially on fertility. Iran at the end of
the 1980s is often cited as an example. There, profound socio-economic changes coupled
with a vast agrarian reform triggered the beginning of a drop in fertility that was closely
followed by an expansion of the family planning program (Ladier-Fouladi 2003). The clergy
later supported the action of the Government directed at male awareness regarding
responsible parenting, which strongly accelerated the fertility transition (May 2005: 839).
All these changes have not only allowed the slowing-down of the high demographic growth
in these countries, but have also started a real contraception revolution that has helped
improve the health of women and children.
Instruments of population policy
The main priority of population policies in the developing countries where these policies
have been implemented has been to put in place interventions to decrease fertility. As
82
discussed, the rapid decrease in mortality levels is the main factor for demographic growth.
Moreover, this decrease is looked upon as a indisputable improvement or a so-called “public
good.” It is wished for and sought after by all actors and beneficiaries. Therefore, the only
available means to restore balance of decreasing mortality is to complete the demographic
transition and initiate a drop in fertility.
The determinants of fertility are biological and behavioral (proximate determinants) as
well as socio-economic and cultural (intermediate determinants). Many factors contribute
to a decrease in fertility. The proximate determinants include age at the first marriage,
breastfeeding, contraception use, sterility, and induced abortions. Intermediate determinants
include foremost female education level of women, a fundamental variable. Participation of
women in the labor force should also be listed, although the relationship between women‟s
work and fertility is not always well defined. Finally, the importance of the status of women
should be emphasized, which, by and large, determines their choice in reproduction matters.
Furthermore, the improvement of health conditions and of mortality levels, especially infant
and child mortality, can also contribute to a reduction in fertility.
The challenge of any population policy lies in the ability to transform these different
factors into effective programs and actions, or to identify the policy instruments needed
to decrease fertility (World Bank 1984). Three elements are fundamental to interventions
related to fertility: girls „education, access to modern contraception, and legal reforms (such
as a higher age at first marriage). Other determinants play an important role in fertility
decline, such as the status of women in society (gender issues) and economic opportunities
for women. The latter contribute to the autonomy of women and strengthen women‟s
decision-making in matters of reproduction. Actions on these other determinants support the
priority interventions of education, reproductive health, and the legal status of women.
Finally, the experience of other countries (such as Kenya) has shown that improving the
health system is often a necessary condition, albeit not always sufficient for subsequent
decreases in fertility.
Interventions in matters of fertility are increasingly designed through a multisectoral
lens. Many national population policy documents have been adopted in sub-Saharan Africa
since the 1980s. Mali is no exception and adopted in 1991 (revised in 2003) a multisectoral
national population policy referred to later on. Sometimes, the demographic variable is dealt
within the more general framework of poverty reduction strategy documents. Finally, certain
countries have decided to put to use policies and health programs to provide needed family
planning and reproductive health services.
More recently, a new wave of population policy statements is emerging. The best
example is from Niger which is the first sub-Saharan African country to adopt, in February
2007, a Government Declaration on Population Policy (DGPP). This brief document
suggests four population program priorities: an advocacy and awareness campaign; an
information, education and communication (IEC) program for behavior change; improving
access to reproductive health services (in the context of birth spacing); and finally, holding
couple accountable as well as encouraging the economic advancement of women. Moreover,
three concrete key interventions are suggested to impact on fertility: increasing contraceptive
83
prevalence (modern methods) by 1 percentage point per year; increasing the minimum age
for marriage; and prolonging exclusive breast feeding (Republic of Niger 2007). These last
measures are taken straight from the “Call to action” scenario of the 2005 population
projections for Niger that cover the period of 2005 to 2050 (Republic of Niger 2005). It is
important to note that the suggested measures take into account women‟s rights, allow to
promote better maternal and child health, and help attain the macro-demographic objectives
of the DGPP. The Cairo Conference (ICPD) of 1994 focused on the reproductive health and
rights of individuals (United Nations, 1995). This new approach has been adopted by the
sub-Saharan African countries, Mali included.
Nowadays, the debate focuses mainly on the level of “multisectoriality” of population
policies. In other words, should a population policy include all development sectors or only
the most important ones? The initial population policies in sub-Saharan Africa included
most development sectors as seen during the period of “planning for the demographic
variable,” described by Finkle and Crane (1990). However, because too many priorities were
set forth, the main objective of the policies – a decrease in fertility – became quite diluted.
On the whole, population policies in sub-Saharan Africa have been rather ineffective. The
current trend, however, is to favor interventions in key sectors that can bring change. It is
mostly in the areas of girls‟ education, access to modern contraception, legal reforms, and
gender equity. The implementation of these new policies has to be more proactive and
driven by a strong commitment from the highest level of decision-making in the country.
In conclusion, any population policy should in principle make sure that the
demographic factor is not a constraint to the formation of human capital, poverty
reduction, economic growth, and the safeguard of the ecosystem. It is not about forcing
certain demographic behaviors on countries, but that, on the contrary, they should induce
these countries to make the appropriate choices that are compatible with their development
needs. In this sense, the Government Declaration on Population Policy (DGPP) of Niger
manages to combine the commitments of the Cairo Conference with macro-demographic
objectives. The implementation of population policies requires firm and well-defined
objectives, such as that concerning fertility decline. Public authorities also have to make sure
that the health standards of their population are improving.
.
84
ANNEX 3: POPULATION PROJECTIONS
This Annex presents the assumptions and results of population projections. The two
population projections used in this report mostly use demographic data available in Mali
which are incomplete. The method used is the component method, and the software used is
Spectrum (Futures Group International). The assumptions for mortality and international
migration are the same for the two projections, in which the only difference is in fertility
levels. Fertility levels are either in slow decline from 6.6 to 6.3 children per woman between
2005 and 2035, or in rapid decline, in which case they reach 4.0 children per woman in 2035.
Therefore, the first projection scenario can be considered as a “laissez-faire” situation and the
second scenario as a proactive one, built on effective programs to reduce fertility.
Population baseline
The population size given by the National Population Directorate (DNP) on the 1st of January
2005, and shown as an age pyramid in Figure 1.1, is used. It is the result of a projection of
the 1998 population census data and is shown in Table A.3.1.
Table A.3.1: Population baseline DNP/DNSI 2005 (1 January)
Age Group Males Females Total
0-4 1,180,525 1,139,124 2,319,649
5-9 934,949 910,055 1,845,004
10-14 815,632 774,616 1,590,248
15-19 568,484 537,467 1,105,951
20-24 417,476 416,270 833,746
25-29 326,507 394,736 721,243
30-34 266,846 350,999 617,845
35-39 242,309 297,945 540,254
40-44 215,961 249,904 465,865
45-49 188,970 203,469 392,439
50-54 163,151 166,390 329,541
55-59 138,069 136,063 274,132
60-64 112,338 108,982 221,320
65-69 95,291 93,230 188,521
70-74 68,200 67,443 135,643
75-79 39,505 41,845 81,350
80+ 33,954 35,715 69,669
Total 5,808,167 5,924,253 11,732,420
Source: Authors’ calculations.
Fertility
The total fertility rate (TFR) is estimated at 6.6 children per woman for the period extending
from 2000-2005 (EDSM 2006). In the high variant, the fertility declines very slowly,
dropping from 6.6 to 6.3 children per woman in 2035 (TFR = 6.25 for the period extending
from 2035-2040). In the low variant, the TFR changes from 6.6 to 4.0 children per woman
by 2035 (TFR = 3.8 for the period 2035-2040). A rather low variant brings the TFR to 3.3 in
2035 (TFR = 3.0 for the period 2035-2040). Finally a very low variant speeds up even more
85
the drop in fertility, which goes to 2.4 children in 2035 (TFR = 2.1 for the period 2035-
2040). These last two scenarios have been used to show the effect of a fertility decline on the
base of the age pyramid. Fertility rates by age use the model life-table of the United Nations
for sub-Saharan Africa. The sex ratio at birth is of 105 boys for 100 girls from 2005 to 2035.
Mortality
The initial level of mortality used by the National Population Directorate (DNP) is probably
overly optimistic, but the aim of population projections is to compare the effect of two
different fertility trends. In 2005, life expectancy at birth was estimated to be 59.3 years for
men and 60.1 for women. This life expectancy improves to 68.3 years for men and 69.1
years for women in 2035. The model life-table used is the one from the United Nations,
South Asia model (it was the only kind of table that allowed the reconciliation of a relatively
high life expectancy with the level of infant mortality found during the EDSM survey of
2006, which was of 96 deaths for every thousand live births).
International migration
Data are provided by the DNP. The number of out-migrants per year varies from 38,000 in
2005 to 25,300 in 2035. For women, it is estimated that there were 16,600 emigrants per
year in 2005 and 11,100 in 2035. The age structure of out-migrants is the same for both
sexes. A migratory age structure for Ethiopia was used because it is also a country with
significant out-migration. The out-migrants age structure is presented in Table A.3.2.
Table A.3.2: Distribution by age of out-migrants, both sexes, 2005-2035 (percent)
Age Group Percent
0-4 3.0
5-9 5.6
10-14 8.9
15-19 11.3
20-24 11.4
25-29 12.1
30-34 9.7
35-39 9.5
40-44 7.2
45-49 5.4
50-54 4.8
55-59 2.9
60-64 3.1
65-69 5.1
70-74 0.0
75-79 0.0
80+ 0.0
Total 100.0
Sources: Authors’ calculations.
86
Results
The results of the two main population projections are presented in Tables A.3.3 and A.3.4.
Table A.3.3: Mali Population Projections, 2005-2035, High fertility
2005 2010 2015 2020 2025 2030 2035
Fertility (UN SSA)
Total Fertility Rate 6.58 6.53 6.48 6.43 6.38 6.33 6.28
Gross reproductive rate 3.21 3.19 3.16 3.14 3.11 3.09 3.06
Net reproductive rate 2.65 2.67 2.70 2.72 2.74 2.76 2.77
Average maternal age 28.2 28.2 28.2 28.2 28.1 28.1 28.1
Child/woman ratio 0.95 0.85 0.87 0.89 0.92 0.91 0.90
Mortality (Table: UN South Asia)
Life expectancy (Males) 59.3 60.8 62.3 63.8 65.3 66.8 68.3
Life expectancy (Females) 60.1 61.6 63.1 64.6 66.1 67.6 69.1
Life expectancy (Both sexes) 59.7 61.2 62.7 64.2 65.7 67.2 68.7
Infant mortality rate 92.7 86.1 79.6 73.2 66.9 60.9 54.9
Under five mortality rate 138.6 127.2 116.0 104.9 94.4 84.7 75.0
Migration
Male Migration (in thousands) -38.0 -34.4 -30.8 -27.1 -25.3 -25.3 -25.3
Female Migration (in thousands) -16.6 -15.0 -13.4 -11.9 -11.1 -11.1 -11.1
Total Migration (in thousands) -54.6 -49.4 -44.2 -39.0 -36.4 -36.4 -36.4
Population Growth Rate
Crude birth rate (per 1,000 people) 43.6 44.8 46.4 47.5 46.9 45.8 45.1
Crude death rate (per 1,000 people) 12.1 10.9 10.0 9.0 8.0 7.0 6.2
Natural Population Growth Rate (%) 3.15 3.39 3.65 3.85 3.89 3.88 3.89
Net Population Growth Rate (%) 2.69 3.03 3.37 3.65 3.73 3.75 3.78
Doubling time 26.1 23.2 20.9 19.4 18.9 18.9 18.7
Births and deaths
Births (annual, in thousands) 510 610 740 910 1,080 1,280 1,530
Deaths (annual, in thousands) 140 150 160 170 180 200 210
Population size and age structure
Total population (in millions) 11.73 13.57 15.98 19.13 23.09 27.94 33.85
Male population (in millions) 5.81 6.71 7.91 9.49 11.51 13.98 17.01
Female population (in millions) 5.92 6.86 8.08 9.64 11.59 13.96 16.84
Percent 0-4 19.78 18.39 19.13 19.80 19.94 19.72 19.54
Percent 5-14 29.29 29.88 28.98 28.08 28.83 29.35 29.30
Percent 15-49 39.86 41.52 42.44 43.38 43.12 43.32 43.98
Percent 15-64 46.88 48.11 48.66 49.21 48.54 48.39 48.74
Percent 65+ 4.05 3.62 3.23 2.91 2.69 2.54 2.42
Percent female 15-49 41.36 42.77 43.47 44.05 43.35 43.25 43.87
Sex ratio 98.06 97.70 97.90 98.50 99.32 100.18 101.00
Dependency ratio 1.13 1.08 1.06 1.03 1.06 1.07 1.05
Median age 15 16 16 16 16 15 16
Source: Authors’ calculations.
87
Table A.3.4: Mali Population Projections, 2005-2035, Low fertility
2005 2010 2015 2020 2025 2030 2035
Fertility (UN SSA)
Total Fertility Rate 6.40 6.00 5.60 5.20 4.80 4.40 4.00
Gross reproductive rate 3.12 2.93 2.73 2.54 2.34 2.15 1.95
Net reproductive rate 2.58 2.46 2.33 2.20 2.06 1.92 1.77
Average maternal age 28.1 27.9 27.9 27.9 27.9 28.0 28.1
Child/woman ratio 0.95 0.80 0.78 0.75 0.72 0.66 0.59
Mortality (Table: UN South Asia)
Life expectancy (Males) 59.3 60.8 62.3 63.8 65.3 66.8 68.3
Life expectancy (Females) 60.1 61.6 63.1 64.6 66.1 67.6 69.1
Life expectancy (Both sexes) 59.7 61.2 62.7 64.2 65.7 67.2 68.7
Infant mortality rate 92.7 86.1 79.6 73.2 66.9 60.9 54.9
Under five mortality rate 138.6 127.2 116.0 104.9 94.4 84.7 75.0
Migration
Male Migration (in thousands) -38.0 -34.4 -30.8 -27.1 -25.3 -25.3 -25.3
Female Migration (in thousands) -16.6 -15.0 -13.4 -11.9 -11.1 -11.1 -11.1
Total Migration (in thousands) -54.6 -49.4 -44.2 -39.0 -36.4 -36.4 -36.4
Population Growth Rate
Crude birth rate (per 1,000 people) 42.6 42.1 41.8 41.1 38.6 35.4 32.4
Crude death rate (per 1,000 people) 12.0 10.6 9.6 8.5 7.5 6.6 5.8
Natural Population Growth Rate (%) 3.05 3.14 3.22 3.25 3.11 2.88 2.65
Net Population Growth Rate (%) 2.59 2.78 2.94 3.04 2.94 2.73 2.52
Doubling time 27.1 25.3 23.9 23.2 24.0 25.8 27.8
Births and deaths
Births (annual, in thousands) 499.3 565.2 649.3 743.3 811.8 857.3 895.8
Deaths (annual, in thousands) 141.2 142.8 148.7 154.6 157.9 160.1 161.8
Population size and age structure
Total population (in millions) 11.73 13.44 15.53 18.08 21.03 24.25 27.66
Male population (in millions) 5.81 6.64 7.68 8.96 10.45 12.09 13.83
Female population (in millions) 5.92 6.80 7.86 9.13 10.59 12.16 13.84
Percent 0-4 19.78 17.58 17.63 17.59 17.00 15.92 14.78
Percent 5-14 29.29 30.18 28.98 27.27 27.36 27.20 26.33
Percent 15-49 39.86 41.93 43.66 45.89 46.74 48.11 50.10
Percent 15-64 46.88 48.58 50.06 52.06 52.69 53.95 55.93
Percent 65+ 4.05 3.66 3.33 3.08 2.95 2.93 2.96
Percent female 15-49 41.36 43.17 44.68 46.51 46.86 47.88 49.79
Sex ratio 98.06 97.62 97.68 98.10 98.71 99.35 99.95
Dependency ratio 1.13 1.06 1.00 0.92 0.90 0.85 0.79
Median age 15 16 16 17 18 18 19
Source: Authors’ calculations.
88
Box A.3.1: Update on the 2009 Population and Housing Census
Mali conducted its 4th Population and Housing Census (RGPH) in April 2009. The preliminary
results of the RGPH 2009 have been released in early 2010, in the form of a tally of the population by
sex, along with the number of households (“ménages”). These figures have been provided for the
entire country, the eight regions, and the city of Bamako, as well as disaggregated to the level of
“cercles” and communes. However, no census age and sex structure has been released yet, as these
will require a complete tabulation of the census results (which is underway) and probably the
smoothing of the crude census data by age and sex.
When compared to the results of the previous census, the preliminary results of the 2009 census
indicate that the Malian population has grown between 1998 and 2009 at the very rapid net rate of 3.6
percent per year. This net rate of growth is higher than the net rate of growth of 3.0 percent that was
used in this study. This high rate of net growth could be explained by various factors, namely a better
census enumeration, the return of Malian emigrants to Mali (or at least the fact that potential
emigrants did not leave Mali because of the situation in the neighboring countries), a sharp decrease
in mortality, and/or the persistent high level of fertility. Actually, the reason for the high net rate of
population growth could be a combination of these four causal factors. Evidently, more analysis will
be necessary.
New cohort-component population projections have been prepared by Dr. Jean-Pierre Guengant.
They are based on the preliminary 2009 Census results and were calculated with the updated Version
3.46 of the Spectrum Model of the Futures Group International. For these new projections, the
projection base-population has been adjusted upward to take into account the preliminary tally of the
2009 Census. Fairly similar assumptions have been used with respect to mortality, fertility, and
international migration. However, the fertility assumptions of these new projections are no longer
normative, i.e., based on the extrapolation of past trends in the country or in neighboring countries.
On the contrary, the new fertility assumptions are policy-driven, i.e., based on the results of proposed
interventions and programs (for example, based on annual percentage point increases of the
contraceptive prevalence rate, using the Bongaarts model of the proximate determinants of fertility).
The results of these new population projections are fairly similar to those that have been used in this
report and that are presented in this Annex. The new high fertility projection gives a total population
of 29.2 million in 2030, as compared to 28.0 million in the report. However, the new low fertility
projection yields a total population of 26.9 million, as compared to 24.3 million in the report.
89
ANNEX 4: SIMULATION MODEL: EDUCATION AND HEALTH
The simulation model covers the health and education sectors. The model is simple and
minimizes the need for data while incorporating key variables for health and education
policies. It is a series of spreadsheets that allow the estimation, year by year, of the potential
consequences of a population increase on the education and health systems in quantitative
terms (means, staffing and budget) under the assumptions of a low or rapid decline of the
total fertility rate (TFR) in Mali (TFR = 6.3 or TFR = 4.0 in 2035).
All these spreadsheets have the same structure. They include two parts: the first lines (on top
of the spreadsheets) list the variables that could be selected based on real characteristics or on
planned modifications (this part is called “parametric”), and the following lines give the
calculated results. A table is created for each of the assumptions chosen and for each
teaching level (in the case of education). These are simple spreadsheets with a perfectly
transparent construction that can be used by decision makers to examine other variants than
the ones initially chosen.
The parametric part of all these tables include general data that allow us to estimate the
population targeted for the specific activity, year by year, and also the usage rate of the
offering, as considered after discussion of the forecasts with the authorities (DNP or CPS of
the sectorial ministries) and the real cost to produce the said activities. That is where the
specificities of each scenario are brought in.
The general data include, on one hand, demographic variables, and, on the other, the rate of
usage (or of attendance) or the gross enrollment rate (GER), some ratios, as well as the
projected impact of the population increase on these rates and ratios.
The cost parameters include the average cost and the production cost of the activity. As
mentioned earlier, these costs are obtained with the advice from experts, through research by
the authors, or by using scattered data gleaned in the available documentation.
For each simulation model, the result section is obtained by multiplying the variables.
Assumptions, variables, and methodology
The model starts off using existing resources, as they were in 2005, assumes them as
constants all through the simulation exercise, and does not try to modify the current
operations of the education and health systems. The pyramidal organization of both systems
and the operations of the administrations in charge of them remain constant. Likewise, the
behavior of the people that drive the two systems is supposed to remain unchanged, be it on
the side of the demand for services or the supply of services (with all the inefficiencies).
Thus, the model generates a kind of marginal cost.
The parametric section of the sectorial models includes many variables, including:
- Demographic variables, showing the population size between 2010 and 2035
according to different projection scenarios: for the Education model, the population
90
has been regrouped by age group depending on the level of education (preschool,
elementary, secondary, and adult population; see Table A.4.1).
- The standards for human resources in the areas of education and health respectively,
according to World Health Organization‟s (WHO) and UNESCO‟s recommendations
and towards which any health or education system should evolve;
- Population ratios by type of health providers, teachers, and educators as observed in
the health and education systems.
- Population ratios for health facilities as they exist in the current health system.
Briefly, the national hospital map27
indicates that the population size for a district
hospital should vary between 150,000 to 300,000 inhabitants. The Declaration for a
sectorial health policy in Mali, which was adopted in 1990, specifies in turn that
5,000 to 10,000 inhabitants are required for the establishment of a front-line
community health center (called CSCOM in Mali). As for regional and national
hospitals, the health policy documents remain vague as to the required population
size. However, since the national hospital map states that a health region
“corresponds in principle to the size of an administrative region,” and there are nine
health regions for six regional hospitals, one can suppose that, for a population of 12
million, the size of the population for a regional hospital is two million. The
estimation made is justified also by the fact that different studies on Mali have shown
that the catchment area of a health facility rarely goes beyond the limits of the
administrative district where this facility is based. National hospitals are excepted
because they are the last resort of the health system – their catchment area is the
population of the whole country.
- The “existing infra-structure” variable that retraces the number of each type of school
and health facility. The available statistics have been compared, and the most reliable
have been kept after discussions with the people in charge of the health and education
system.
- Construction and equipment cost of a new school or health facility: the values of this
variable are derived from discussions with the people in charge of the health and
education systems paired with a documentary review. However, it bears saying that
getting these orders of magnitude was difficult because, for example, there is no
standard hospital type and investments often depend on the coverage provided by a
development partner. The orders of magnitude used here have, no doubt, an effect on
the simulation model.
- Operating costs by type of structure: in this instance and, as much as possible, data
from national health accounts28
from the year 2004 and from national education
accounts from 2005 - being the most recent years available – are used. The orders of
magnitude given by national accounts were divided by the number of each type of
structure.
27
Republic of Mali, La carte hospitalière nationale du Mali, 2003-2007, Bamako: Ministère de la Santé, 2002,
page 7.
28
Birama Djan Diakité, Kafing Diarra and Moussa Keita, Les comptes nationaux de la santé 1999-2004,
INRSP, 97 pages (October 2006 version).
91
- The macro-economic indicators for education and health: the orders of magnitude by
the two national accounts mentioned above as well as by the expenditures standards
recommended by the WHO (and the objectives of education for all) have been used.
The “results” section is the combination of many variables of the model. In the model,
several themes have become clear. Some of them are cited below:
- Human resources needs according to the above mentioned standards (Education for
All) obtained by multiplying, first the total population by the standards for agent per
inhabitant, and then, multiplying by the rate of retiring people (estimated to be 2
percent a year).
- Human resources needs according to current ratios, as observed in the health and
education system; these needs are calculated in the same way as above.
- The real needs of the education and health systems, obtained by subtracting the
staffing needs according to recommended standards and staffing needs according to
the ratio of agents per inhabitant as observed in the present health and education
systems.
- The needs in new infrastructure, obtained by calculating the difference between the
total number of needed infrastructure and the number of existing infrastructure.
- Investments (construction and equipments) in new infrastructure: orders of
magnitude are obtained by multiplying, on one hand, the number of new
infrastructure by the unit cost of construction and equipment, and, on the other hand,
by multiplying the product of the first multiplication by the inflation rate. It is
important to remember here that the national hospital map gives population ratios for
health equipment. For instance, the plan is for a district hospital bed per 4,000
inhabitants, a regional hospital bed per 7,500 inhabitants, and a national hospital bed
per 10,000 inhabitants. Other ratios are given for heavy equipment. However, these
ratios are not usable in the context of this study. Indeed, as far as a hospital bed is
concerned, the hospital plan defines it as “the base unit of hospital service; it is not
only a box spring and a mattress, but a whole that encompasses the physical bed as
well as an environment made of technical staff and human competence.” The
problem with this definition of a hospital bed in the national plan is to define what is
meant by technical equipments and human competence. For instance, since technical
equipment is not defined in a way that allows attaching a price tag to it, one cannot
form a hypothesis on the subject. Instead of these ratios from the national hospital
plan, preference has been given to the orders of magnitude given by the technical
services of the Health Ministry, which include construction cost as well as equipment
cost.
- Annual operating costs: orders of magnitude are obtained by multiplying the number
of total infra-structures (existing and new) by the annual unit cost of operation and by
the inflation rate; and
- Education and health expenditures: the orders of magnitude are the result of the
multiplication of the total population by the inflation rate and by the appropriate
variable from the cluster of “macro-economic indicators on education and/or health.”
92
Limits of the model
National plans for schools and hospitals ought to be revised every 5 years. Accordingly, the
national plans for schools and hospitals for the period 2003-2007 should have been revised,
but that was not the case in Mali. It is therefore practically impossible to know what the
evolution of the school and hospital plans will be in the next 5 coming years, and much less
in the next 25 years. As a result, the constructed simulation model generates estimations that
can stray away from what the Malian authorities could decide later on in health and
education matters.
Furthermore, the present national hospital plan for the period from 2003-2007 included the
creation a new national hospital in Bamako, the creation of two new regional hospitals (with
one in Sikasso and one in Mopti) as well as the creation of two new health districts in the
area of Sikasso. But none of these has materialized so far. This is probably due to a delay in
the execution of the plan. The simulation model cannot forecast such delays.
Finally, in the context of decentralization, the creation of new administrative regions is
planned. In this new context, it is difficult to predict the evolution of the education and
health systems and, more particularly, the evolution of the school and hospital plan. It is still
not known whether the fact of over-imposing the organization of health and education to the
administrative organization of the country will remain current. What is known is that the
decision making power belongs to the territorial authorities and it is not farfetched to find
that some are competing to have new health and education infrastructure, given the large
disparities that exist to this day. However, it is impossible to predict the number of new
infrastructures that will be created in this new atmosphere or political environment.
Therefore, the simulation model will give estimations only on the basis of the considered
assumptions.
93
Table A.4.1: School-aged groups for both sexes (in millions and percentages)
2005 2010 2015 2020 2025 2030 2035
Slow fertility decline (TFR = 6.3 in 2035)
Total Population Number 11.73 13.57 15.98 19.13 23.09 27.94 33.85
Group 3-6 years Number 1.65 1.87 2.16 2.67 3.30 3.98 4.77
% total pop 14.1 13.8 13.5 14.0 14.3 14.2 14.1
Group 7-12 years
Number 2.07 2.43 2.77 3.20 3.97 4.91 5.93
% total pop 17.6 17.9 17.3 16.7 17.2 17.6 17.5
Group 13-15 years Number 0.85 1.02 1.22 1.36 1.62 2.01 2.49
% total pop 7.2 7.5 7.6 7.1 7.0 7.2 7.4
Group 16-18 years Number 0.66 0.94 1.06 1.32 1.41 1.75 2.19
% total pop 5.6 6.9 6.6 6.9 6.1 6.3 6.5
Group 19-26 years Number 1.32 1.68 2.32 2.78 3.31 3.76 4.54
% total pop 11.3 12.4 14.5 14.5 14.3 13.5 13.4
Rapid fertility decline (TFR = 4.0 in 2035)
Total Population Number 11.73 13.44 15.53 18.08 21.03 24.25 27.66
Group 3-6 years
Number 1.65 1.83 1.99 2.32 2.68 2.95 3.15
% total pop 14.1 13.6 12.8 12.8 12.7 12.2 11.4
Group 7-12 years
Number 2.07 2.43 2.71 2.95 3.45 3.97 4.38
% total pop 17.6 18.1 17.5 16.3 16.4 16.4 15.8
Group 13-15 years
Number 0.85 1.02 1.22 1.32 1.48 1.73 2.00
% total pop 7.20 7.60 7.90 7.30 7.00 7.10 7.20
Group 16-18 years
Number 0.66 0.94 1.06 1.32 1.34 1.57 1.84
% total pop 5.60 7.60 6.80 7.30 6.40 6.50 6.70
Group 19-26 years
Number 1.32 1.68 2.32 2.78 3.29 3.58 4.07
% total pop 11.30 12.50 14.90 15.40 15.60 14.80 14.70
Source: Authors’ calculations.
94
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