A/HRC/42/38/Add.1 for infectious/transmissible diseases (HIV/AIDS, sexually transmitted infections and tuberculosis, among others), including antiretroviral treatment, which is now available in all municipalities of the country; and integrated management of childhood illness. All pregnant women have free access to sexual and reproductive health services, which includes a prenatal HIV test and antenatal and postnatal care. The basic package also includes free screening for breast, cervical and prostate cancer. 32. The Special Rapporteur considers it encouraging that the above-mentioned key indicators for the country have improved. However, in Cabo Verde in 2015 there were 0.79 physicians per 1,000 people. The World Health Organization (WHO) estimates that fewer than 2.3 health workers (physicians, nurses and midwives) per 1,000 people would be insufficient to achieve coverage of primary health-care needs. In addition, the Special Rapporteur received reports that there is a lack of qualified medical specialists in some areas, which further jeopardizes access to necessary health care. The total expenditure on health as a percentage of the gross domestic product is about 4.8 per cent, 22 and the Special Rapporteur notes with concern that this figure is also below that recommended by WHO. 33. The Special Rapporteur was also informed that there was a solid legislative basis for regulating health care, but that there were issues with regard to implementation and that readjustment was necessary in order to reflect the domestic reality. Concerns were raised with regard to tertiary health care for the inhabitants of most islands, since there were only two referral hospitals in the country. The Special Rapporteur hopes that the upcoming decentralization process will be instrumental in restructuring the health-care system and will allow the system to better answer the needs of the communities, in particular in remote and rural areas. He noted concerns raised about the lack of training of medical personnel with regard to attending to persons living with HIV/AIDS, who continue to face stigmatization in the health-care system and a lack of confidentiality relating to their status. Other health-related concerns are noted in the sections of the present report on the situations of women and persons with disabilities. D. Education 34. In the Special Rapporteur’s view, equal access to quality education is both a right in itself and a precondition for the fulfilment of the right to development. The net enrolment rate in primary school was 95.88 per cent in 2017 (92.53 for girls and 99.16 for boys). 23 About 52 per cent of the pupils in secondary education in 2017 were girls. The literacy rate for young people aged 15 to 24 years was 98 per cent in 2013, and there is parity among young women and men.24 However, general literacy rates in the country are estimated at 92.5 per cent among men and 82.5 per cent among women. 25 35. The extension of preschool to cover all children from 4 to 6 years of age is in process, aimed at reducing economic and social disparities in education, including for children with special education needs. Although 86 per cent of children, on equal terms for boys and girls, already attend preschool, children from poor households are twice as likely not to have access to preschool education. When they attend, they are more likely to have access to preschools of low quality. 26 The Special Rapporteur is further concerned that families living under or close to the poverty line cannot bear the costs for school supplies and transportation to an educational establishment, nor cover the tuition fees for secondary education; therefore, the right to development of children from such families is not ensured. 36. All stakeholders with whom the Special Rapporteur met during his visit agree on the extreme importance of education for the development of the country, and this view is reflected in all of the country’s strategic planning instruments. The Special Rapporteur 22 23 24 25 26 See www.who.int/countries/cpv/en/. See https://data.worldbank.org/indicator/SE.PRM.ENRR?end=2017&locations= CV&start=1971&view=chart. CRC/C/CPV/2, para. 127. SDG Cabo Verde, p. 8. A/HRC/WG.6/30/CPV/1, para. 37. 9