However, the quality of education remains largely poor on the continent.159 Among the major factors are teachers who are poorly trained, poorly paid and lacking in motivation.160 High pupil drop-out rates owing to poverty and demand for child labour, and social problems like teenage pregnancy, pose serious challenges.161 The above causes of death in sub-Saharan Africa reflect its developmental limitations. The prominence of HIV, respiratory conditions, malaria, diarrhoea and childbirth issues suggest that a great many lives could be saved through improved living conditions, better health services and education. For comparison, it is worth noting that HIV, the leading cause of death in Africa, accounts for only 2.8% of deaths globally, 1.4% in South East Asia, 1% in Europe, and is absent from the top twenty causes of death in the WHO‘s other regions. These issues are extensively addressed in the CRRs, focusing mainly on the strategies and institutions deployed to deal with them. The CRRs note that despite progress in making healthcare available to the population significant challenges remain. The Nigeria CRR lists a number of problems that are by and large applicable to other countries too: poor implementation of healthcare programmes, unsatisfactory facilities, inadequate health insurance coverage, differentials in health coverage between urban and rural areas, and traditional and religious beliefs that work against modern healthcare practices.155 A key problem – repeated in several CRRs – is the shortage of medical personnel, a vital contributing factor being emigration.156 Doctors have readily marketable skills and are highly mobile; they can escape unsatisfactory working conditions by moving to a different country relatively easily.157 Better pay, enhanced career opportunities and better working conditions, not to mention active recruitment, are powerful ‗pull factors‘.158 Education Education in Africa has seen a great deal of progress in terms of access. This represents a significant achievement. It raises hopes for enhancing Africa‘s human capital, with the social and economic benefits that this implies. Overall, the trends are positive. Ever larger numbers and proportions of children on the continent are in school. The gains at the primary school level are particularly impressive, while those at the secondary and tertiary level – although noticeable – are more modest. 155 156 157 158 Nigeria CRR, p. 291. Ghana CRR, p. 102; Lesotho CRR, p. 175; Zambia CRR, pp. 253-255; Uganda CRR, p. 254. Vidal P, The Emigration of Health-Care Workers: Malawi‟s Recurring Challenges (Migration Policy Institute, 21 October 2015). Kissick K, „The “Brain Drain”: Migration of Healthcare Workers out of sub-Saharan Africa‟, undated, http://med.stanford.edu/schoolhealtheval/f iles/KissickBrainDrainFactSheetFinal.pdf. 159 160 161 41 Algeria CRR, p. 267; Nigeria CRR, p. 287; Tanzania CRR, pp. 230-232; Ghana CRR, p. 112. Tanzania, p. 230-232, Lesotho, p. 198, Zambia, p. 250, 252, Ethiopia, p. 238, Benin, p. 260-262, 264, 281 Benin CRR, pp. 264, 281.