A/HRC/23/37 expenditures on health, education and other social services. On average, such spending is about five times the amount of debt-service payments.” 27. Nevertheless, it is also evident that conditionalities that have accompanied debt relief have exacted substantial social costs, including high unemployment and increasing poverty and inequality and have had an adverse effect on the realization of a number of basic human rights. For example, Zambia completed the HIPC Initiative in 2005 receiving a total of $6.6 billion in debt relief through the HIPC Initiative and MDRI. Although the country has used the savings from debt relief to eliminate school fees and user fees in rural health centres and to fund infrastructure projects, it remains poor with approximately 64 per cent of the population living on less than $1 a day. The country generates three-quarters of its foreign exchange earnings from copper mining. However, a privatization deal that favoured foreign companies has reduced the benefits that the country has received from this vital sector. 28. The impact of debt relief on development and on progress towards the Millennium Development Goals is even less certain. In 2011, the World Bank and IMF, while reporting that HIPCs had increased their poverty-reducing expenditure, noted that these countries “have made uneven, and in some cases, limited progress towards achieving the Millennium Development Goals.” Only a quarter of completion point HIPCs were on track to achieving Goal 1 (to eradicate extreme poverty and hunger), with progress toward Goal 5 (to improve maternal health) less certain. Moreover, only a few HIPCs were on track to attain Goal 8 (to build a global partnership for development). 29. Similarly, a recent World Health Organization and UNICEF report, covering 68 countries where more than 95 per cent of all maternal and child deaths occur, notes the limited progress towards the Millennium Development Goals.29 The report indicates that 49 of the countries surveyed were off track for achieving Goal 4 (to reduce child mortality) and Goal 5 (to improve maternal health). It is worth noting that 33 of the countries surveyed are HIPCs, including 27 post-completion point HIPCs. C. Human rights 30. According to some studies, a key benefit of savings from debt relief has been an expansion in public education and access to health care. In several countries, debt relief savings allowed governments to abolish user fees (initially introduced as a condition of IMF and World Bank adjustment lending in the 1980s and 1990s). According to World Bank estimates, in 2011, health expenditures in the 32 post-completion HIPCs rose from 5.2 per cent of GDP in the period 1995 to 2000 to 6.6 per cent in the period 2006-2009. In the field of public education, user fees have been reduced, with primary school enrolment 29 10 also Christian Barry, Barry Herman and Lydia Tomitova (eds.) for Carnegie Council, Dealing Fairly with Developing Country Debt (Malden, MA, Blackwell, 2007), p. 2; Jubilee Debt Campaign, “Debt and Public Services,” Briefing note (October 2007); Alcino Ferreira, Câmara Neto and Matías Vernengo, “Lula’s Social Policies: New Wine in Old Bottles?”, Working Paper Series 2006-07, Department of Economics, University of Utah (2006), p. 11; The New Economics Foundation, Debt relief as if justice mattered: A framework for a comprehensive approach to debt relief that works (2008) p. 11. WHO and UNICEF, Countdown to 2015, Decade report (2000-2010): Taking stock of maternal, newborn and child survival (2010), p. 1.