Global Goals for Every Child: Progress and disparities among children in South Africa

Global goals for every child: Progress and disparities among children in South Africa

Global goals for every child: Progress and disparities among children in South Africa

Acknowledgements This publication is a follow-up to the 2011 report on South Africa’s Children: A Review of Equity and Child Rights by the South African Human Rights Commissions (SAHRC) and the United Nations Children’s Fund (UNICEF). Both draw their inspiration from UNICEF’s Progress for Children series as well as a number of notable national monitoring exercises, most prominently the country reports on the Millennium Development Goals produced by Statistics South Africa and Children Count, released annually by the Children’s Institute at the University of Cape Town.

The publication draws heavily from national surveys and administrative data, as well as international sources.

Bjorn Gelders from Development Pathways conducted the technical collation and analysis of the data, and drafted the report. Specialists from UNICEF and SAHRC provided valuable inputs and feedback at various stages.

Alejandro Grinspun from UNICEF South Africa was responsible for giving technical guidance and oversight, and for the overall management of the project.

Suggested citation: SAHRC & UNICEF, 2016. Global goals for every child: Progress and disparities among children in South Africa. Pretoria: UNICEF South Africa. © South African Human Rights Commission/United Nations Children’s Fund This publication is intended to support everybody who works in the child rights field in South Africa. All care has been taken to ensure that the information provided is correct and original sources have been indicated for reference and verification. With an identification of the South African Human Rights Commission and UNICEF as source, the document may be freely quoted, reviewed, abstracted, reproduced and translated, in part or in whole, but not for sale nor for use in conjunction with commercial purposes. Original sources should be acknowledged where indicated in the publication.

ISBN 978-0-620-72680-1 Obtainable free of charge from: South African Human Rights Commission. Website: http://www.sahrc.org.za UNICEF South Africa. Website: http://www.unicef.org/southafrica Cover photograph © UNICEF/Williams Design and typesetting Handmade Communications

Contents

Foreword 3 Overview 5 Summary report card on progress and disparities among children in South Africa 12 01 Socio-demographic profile of children

14

02 Social inclusion

22

03 Nutrition

34

04 Health and HIV

42

05 Education

52

06 Water and sanitation

62

07 Child protection

70

Technical note

76

References 78

1

Global Goals for Every Child

2

Foreword

South Africa has made significant progress in fulfilling the rights of the child since the advent of democracy in 1994. The South African Constitution boasts a legislative framework that is world renowned for its advances on the rights of children, and the State has introduced many targeted legislative and policy advancements. Some of these include the Child Support Grant, which is credited with having substantially improved the financial situation of many indigent families, thereby positively contributing to the well-being of children in South Africa.

It is, however, concerning that given all the advancements and the initiatives that have been embarked upon, a great number of children are still left behind. High levels of inequality continue to pose a serious challenge to South Africa’s expressed commitment to children’s rights. Poverty remains a lived reality for far too many of our children. By providing updated statistical information, this publication promotes the understanding of the current status of children, particularly with regard to efforts aimed at addressing children who are trapped in poverty and,

Foreword

as a result, socially excluded.

The study focusses on areas that are pertinent to children’s development. The statistical information provided here covers the important areas of social inclusion, nutrition, health, HIV, water, sanitation, education and child protection. This information will be useful not only to advocates of child rights but also to the State, as it reviews its performance in terms of the commitments made under the National Development Plan.

The report illustrates that while progress has been made as far as children’s rights are concerned, much remains to be done, especially in the poorest sections of society where children are most likely to remain trapped in poverty.

by Commissioner Lindiwe Mokate, South African Human Rights Commission

If sufficient attention is paid by the relevant authorities to addressing challenges in these areas, the lives of children in South Africa will vastly improve, in line with the goals of the National Development Plan and the United Nations’s Sustainable Development Goals.

The South African Human Rights Commission is proud to be a part of the publication of Global Goals for Every Child: Progress and Disparities among Children in South Africa. As a nation, we all have to ensure that government, which has the primary responsibility to promote and protect children’s rights, delivers on its obligations. Through its mandate, the South African Human Rights Commission continues to engage with government and other stakeholders to ensure that the rights of children are realised.

I have no doubt that this report will assist the Commission and other stakeholders in monitoring and tracking progress made towards the realisation of children’s rights in South Africa.

3

Global Goals for Every Child

4

Overview

Overview

This report presents an analysis of progress and disparities among children in South Africa. Data show significant progress during the past two decades in areas such as child poverty, child survival, mother-to-child transmission of HIV and primary school attendance, among others. These are impressive achievements, but they are only part of the story. Stark gaps in opportunity – between rich and poor households, urban and rural communities, Black African and White children – perpetuate intergenerational cycles of deprivation. Disadvantages based on gender, disability and other markers persist.

The structure of the report builds on the 2030 Agenda for Sustainable Development and the new Sustainable Development Goals (SDGs) adopted by world leaders in September 2015. It groups together child-related SDG goals and targets into six clusters: social inclusion, nutrition, health and HIV, water and sanitation, education and child protection. It uses selected indicators from the global indicator framework for which data are available to highlight critical gaps and challenges for children in South Africa. Data are derived from the latest nationally representative household surveys, such as Statistics South Africa’s General Household Survey (GHS) and the Southern Africa Labour and Development Research Unit’s (SALDRU’s) National Income Dynamics Study (NIDS), census, administrative data from government departments and agencies, and United Nations inter-agency estimates.

Today there are 19.7 million children under the age of 18 in South Africa. The experience of childhood is increasingly urban. In fact, over 55 per cent of children live in cities and towns. Migration is an important demographic process in shaping the distribution of the population. Nearly one in 10 children nationwide, and one in five in Gauteng, have migrated from another province. Fluid caregiving arrangements are another common feature of childhoods in South Africa. Only one in three children live with both their biological parents and one in six has lost a parent. Population projections indicate that the overall number of children in the country is reaching its peak and will start to decline gradually. The proportion of children in the total population will go down from 36 per cent today to 29 per cent in 2035.

5

Global Goals for Every Child

Social inclusion End poverty, promote decent work and economic growth, and reduce inequality The SDGs call for an end to poverty in all its manifestations, including extreme poverty, over the next 15 years. All people everywhere, including the poorest and most vulnerable, should enjoy a basic standard of living and social protection benefits. South Africa has made important progress and succeeded in nearly halving the share of children living below the food poverty line since 2003. However, almost seven out of 10 children are living in households below the upper-bound poverty line, which takes into account both food and non-food needs. Stark disparities persist between different population groups and across geographic locations, with child deprivations still heavily concentrated in the areas where the former homelands of the apartheid era used to be. Poverty also varies depending on a child’s living arrangements: those who live in households headed by women or without coresident parents are poorer than other children.

Child poverty could have been worse if the country had not made such impressive progress in fulfilling children’s rights to social security. Today, 12 million children are receiving the Child Support Grant, 470,000 children are supported by the Foster Child Grant (of whom three in every four live with their grandparents or other relatives), and 130,000 children with severe disabilities are benefiting from the Care Dependency Grant. The existence of barriers to accessing child grants, however, remains a concern. For instance, an estimated 18 per cent of eligible children are not receiving the Child Support Grant. Uptake rates are especially low among eligible young children under age 1 and among those living in urban formal areas.

The goal on economic growth and employment calls for a global strategy to ensure decent work and opportunities for young people. Poverty and unemployment are inextricably linked, with over 60 per cent of South Africa’s poorest children not having any working adults at home. As children themselves

6

1

move into adulthood, many are also disconnected from the labour market and opportunities that promote employability. Nationwide, one in three young people aged 15–24 years are neither in employment nor in education or training. Racial inequalities remain pronounced, while youth with disabilities are nearly twice as likely to be inactive and not engaged in learning compared with their non-disabled peers.

The level of income inequality remains among the highest in the world. Reducing it will not be possible in the absence of inclusive growth. For the poorest 40 per cent of the population, the growth of household income has been lower than the national average. A different, more inclusive pattern of economic growth will be needed to redistribute income and wealth, reduce disparities and lift poor South Africans out of poverty.

48%

2

3

1 in 3

young people are neither in employment, nor education, nor training

48%

reduction in the share of children below the food poverty line SINCE 2003

Overview

Nutrition End hunger, achieve food security and improved nutrition The SDGs call for ending hunger and all forms of malnutrition, and achieving sustainable food production by 2030. The aim is to ensure that everyone everywhere has enough good-quality food to lead a healthy life. In South Africa, the share of children experiencing hunger because of a lack of food has declined considerably, from an estimated 30 per cent in 2002 to 12 per cent in 2014. The decline was particularly pronounced in the Eastern Cape and Mpumalanga.

However, disadvantages based on location, wealth, race, gender and other markers persist. Reported child hunger ranges from a low of 4 per cent in Limpopo to a high of 19 per cent in KwaZulu-Natal, and is more than twenty times higher among the poorest children compared to the least poor. Children in female-headed households are nearly twice as likely to experience hunger as those living in male-headed households.

Despite gradual progress chronic undernutrition, or stunted growth, still affects over one in five children under the age of 5 across the country and 28 per cent of the poorest children. Left unaddressed at that point, chronic undernutrition can affect cognitive development, leading to learning difficulties and poor health in adolescence and adulthood. Undernutrition co-exists with overweight, leading to a double burden of malnutrition. Overall, around 14 per cent of young children under 5 are overweight. Rates of overweight increase rapidly with age, especially among girls: 29 per cent of females aged 15–19 years are overweight or obese—three times as many as males of the same age. The existence of micronutrient deficiencies among children and women is another concern. A quarter of women of reproductive age are anaemic, a condition that impairs health and well-being and increases the risk of maternal and neonatal adverse outcomes.

The incidence of low birthweight remains relatively high, affecting for instance almost one in every five newborns in the Northern Cape.

2012

2014

CHILDREN SUFFERING FROM HUNGER DECLINED FROM

30% TO 12%

IN 2002

IN 2014

1 in 5

CHILDREN UNDER AGE 5 HAVE STUNTED GROWTH

7

Global Goals for Every Child

Health & HIV Ensure healthy lives and promote wellbeing for all at all ages The goal on health aims to address risks across the life cycle by improving reproductive, maternal and child health; ending the epidemics of major communicable diseases; reducing non-communicable and environmental diseases; achieving universal health coverage; and ensuring access to safe, affordable and effective medicines and vaccines for all. In South Africa, the number of women who died each year due to complications of pregnancy and childbirth increased between 1995 and 2015, from 62 deaths to 138 deaths per 100,000 live births, according to United Nations inter-agency estimates. The country, however, started reversing the trend of rising maternal mortality during the last five years. The mortality rate of children under 5 fell by 46 per cent since 2005, but progress needs to accelerate to meet global and national targets. Most child and maternal deaths can be prevented, as evidenced by the huge disparities between different provinces and population groups. For instance, compared with a White child, a Black African child is almost five times more likely to die before his or her first birthday.

South Africa continues to have the largest HIV and AIDS epidemic of any country in the world. Nearly 30 per cent of pregnant women and an estimated 235,000 children under the age of 15 are living with HIV. Adolescent girls and young women are disproportionately vulnerable and at high risk. The country is making important strides though in addressing the epidemic.

New HIV infections among children are declining at an impressive rate, largely due to scaled-up efforts to prevent mother-to-child transmission. The prevalence of HIV among children appears to be decreasing in all provinces, except in KwaZulu-Natal. Access to treatment is growing: nearly three-quarters of children living with HIV are now receiving antiretroviral therapy, up from 33 per cent in 2010.

The SDGs call for universal access to sexual and reproductive health-care services. Nationwide, less

8

than half of women of reproductive age are using modern contraceptive methods to prevent unplanned pregnancies. One in seven adolescent girls aged 15–19 years have already given birth, pointing to a need for strengthening access to reproductive health information and care. Rates of adolescent pregnancy are especially high in both urban and rural informal areas and among girls from the poorest households.

33% 74%

CHILDREN living with hiv receiving antiretrovirals

districts achieving the national immunisation target

10

OUT OF

52

10

IN 2010 IN 2015

Overview

Water and Sanitation Ensure availability and sustainable management of water and sanitation for all The goal on water and sanitation continues unfinished development business, aiming for universal and equitable access, with special attention to the needs of women and girls and vulnerable people. Overall, South Africa has already attained high coverage of the use of improved drinking water sources, with well over 90 per cent of the population having access to water piped into their premises or other improved sources. Despite this accomplishment, troubling disparities persist by wealth and between provinces. For instance, almost one in five of the poorest children live in households that still rely on rivers, streams and other unimproved sources for their drinking water. Access to piped water is especially problematic in the mountainous areas of Eastern Cape and KwaZulu-Natal.

The country has made modest progress in improving access to sanitation, increasing the share of the population that uses improved facilities, such as flush toilets or ventilated pit latrines, from about half in 1990 to two-thirds of the population in 2015. Disparities by wealth persist, nonetheless: the poorest children are one third less likely to have access to an improved sanitation facility than are children in the wealthiest households.

Over the same period, open defecation rates declined from an estimated 14 per cent to 4 per cent.

Again, the data reveal pronounced disparities, with the poorest and those living in rural and more remote areas least likely to use an improved sanitation facility.

For example, in 13 municipalities, more than a quarter of children live in households still practising open defecation. Meanwhile, 29 per cent of schools in the country, and 55 per cent of schools in the Eastern Cape, only have an unimproved pit or no sanitation facilities at all.

1

9

OVER

9 IN 10

PEOPLE HAVE ACCESS TO IMPROVED DRINKING WATER

29%

of schools have an unimproved pit or no toilet facilities at all

9

Global Goals for Every Child

Education Ensure inclusive and equitable quality education for all The SDG on education addresses access to learning opportunities and the quality of schooling. It adds early childhood learning to the global development agenda and aims to ensure that education is accessible to all children, whether girl, boy, living with a disability or in a vulnerable situation.

South Africa has made notable progress in expanding children’s access to early childhood development and learning. The share of children under age 5 attending day-care or educational facilities outside their homes has grown from 7 per cent in 2002 to 50 per cent in 2014. Today, nine out of 10 pupils participate in some form of pre-primary education or the reception year programme (Grade R) before starting primary school. Still, disparities by wealth persist, with the poorest children being far less likely to be exposed to stimulation activities outside the home.

Children’s access to primary education is near universal in all provinces and the number of children not in school has declined by one third since the early 2000s, but secondary school attendance is lagging behind. More than one in 10 pupils who are meant to be in secondary school are still attending primary school because they entered school late or repeated grades.

The likelihood of repeating the same grade decreases the better off a child’s household is.

Improving the quality of education remains a major challenge, and many children face serious learning difficulties. Data from national assessments indicate that less than 50 per cent of children who reach Grade 9 adequately master their home language, while nearly all fail to meet learning standards in mathematics.

Large disparities persist in access to and completion of schooling, especially by wealth and disability status.

For instance, youths with disabilities are on average less than half as likely to have completed secondary schooling as their non-disabled peers. There are also large differences in the availability of education facilities between the country’s provinces.

10

820 000

2002

2014

530 000

NUMBER OF OUT-OF-SCHOOL CHILDREN

GRADE 3

65% GRADE 6

35% 3

65%

6 9

35% 3%

GRADE 9

3%

% OF PUPILS ACHIEVING ACCEPTABLE PROFICIENCY IN MATHs

Overview

Child protection Promote peace, justice and gender equality Violence threatens the lives and futures of children and shreds the social fabric of communities. Elevating protection against violence – including abuse, exploitation and trafficking – on the international agenda is one of the great achievements of the SDGs. Many children in South Africa have witnessed or experienced violence in their homes, schools and communities. Maltreatment and abuse of children is widespread.

Adolescence is a time of heightened risk, including the risk of death due to interpersonal violence. In a recent survey, one in three children aged 15–17 years reported having experienced some form of sexual abuse in their lifetime. Boys and girls are equally vulnerable to sexual abuse, although the types of abuse they experience tend to be different. The widespread fear of crime, moreover, restricts children’s physical mobility and social interactions outside their homes.

Registering children at birth is the first step towards securing recognition before the law and safeguarding individual rights and access to justice and social services. South Africa is well on track to achieve universal coverage of birth registration: 95 per cent of children under 5 have a birth certificate.

Birth registration rates are only slightly lower among children from the poorest households. Good progress has also been made in improving the timeliness of registration. Today, over three-quarters of recorded births are registered within the year of birth.

1 IN 3

ADOLESCENTS HAVE EXPERIENCED SOME FORM OF SEXUAL ABUSE IN THEIR LIFETIME

95%

OF CHILDREN UNDER 5 HAVE A BIRTH CERTIFICATE

11

Free State

Gauteng

KwaZuluNatal

Limpopo

Mpumalanga

North West

Northern Cape

Western Cape

Province Eastern Cape

Summary report card on progress and disparities among children in South Africa

Global Goals for Every Child

Ratio of highest to lowest value

Children living below the food poverty line (%, 2014/15)

37

46

25

22

60

39

36

31

27

14

4.2

Children living below the upper-bound poverty line (%, 2014/15)

69

80

62

52

83

76

73

64

61

51

1.6

Eligible children not receiving the Child Support Grant (%, 2014)

18

10

15

35

12

13

16

18

15

33

3.5

Children living in households with no employed adults (%, 2014)

30

46

30

11

37

43

28

31

30

10

4.6

Youth aged 15–24 years neither in employment nor in education or training (%, 2014)

33

33

33

32

35

30

36

37

38

32

1.3

Selected key indicators Social inclusion

Nutrition Children experiencing hunger because of lack of food in the household (%, 2014)

12

11

12

8

19

4

11

15

18

14

4.3

School-going children benefitting from the National School Nutrition Programme (%, 2014)

83

90

83

71

81

96

92

89

88

69

1.4

Newborns weighing less than 2,500 grams (%, 2014)

13

14

13

13

12

10

11

14

19

15

1.9

Children under 5 who are stunted (%, 2014/15)

21

–

–

–

–

–

–

–

–

–

–

Children under 5 who are wasted (%, 2014/15)

3

–

–

–

–

–

–

–

–

–

–

Children under 5 who are underweight (%, 2014/15)

5

–

–

–

–

–

–

–

–

–

–

Children under 5 who are overweight (%, 2014/15)

14

–

–

–

–

–

–

–

–

–

–

Births taking place in public health facilities (%, 2014/15)

86

77

88

82

91

91

81

75

88

88

1.2

Children under 1 year who have received all their recommended vaccinations (%, 2014/15)*

90

81

90

108

90

82

80

82

85

91

1.3

Infant mortality rate (per 1,000 live births, 2010)

35

40

53

24

47

28

39

47

37

20

2.7

HIV prevalence among children 2–14 years (%, 2012)

2

1

2

2

4

3

2

2

1

1

6.3

HIV prevalence among youth 15–24 years (%, 2012)

7

6

5

6

12

3

10

8

4

4

3.9

Children living in households with water piped onto premises (%, 2014)

66

33

91

93

57

44

68

60

79

93

2.8

Children living in households with RDP-standard sanitation facilities (%, 2014)

75

76

83

92

71

51

58

67

85

95

1.9

Ordinary operational school with no or an unreliable water supply (%, 2015)

22

38

7

4

28

21

13

17

10

1

38.0

Ordinary operational school with no sanitation or only an unimproved pit (%, 2015)

29

55

19

0

35

26

24

15

2

0

5,500

Children under 5 attending an ECD facility or day-mother (gogo) outside the home (%, 2014)

49

43

62

71

45

46

33

32

42

48

2.2

Primary school net attendance ratio (2014)

98

98

97

97

98

98

98

97

100

97

1.0

Secondary school net attendance ratio (2014)

78

71

81

82

78

83

76

72

72

77

1.2

Health and HIV

Water and sanitation

Education

Youths (20–24 years old) who have completed primary education (%, 2014)

95

92

96

98

95

96

95

92

94

95

1.1

Youths (20–24 years old) who have completed secondary education (%, 2014)

49

32

49

66

50

37

43

46

45

50

2.1

Pupils achieving proficiency in mathematics in Grade 6 (%, 2014)

35

23

44

52

36

21

27

27

28

51

2.5

Child protection Children under age 5 with a birth certificate (%, 2014/15)

95

–

–

–

–

–

–

–

–

–

–

Children aged 15–17 years who ever experienced any sexual abuse (%, 2014)

35

–

–

–

–

–

–

–

–

–

–

Households who do not allow their children to play outside because of fear of crime (%, 2014/15)

25

16

24

34

23

6

16

7

29

44

7.3

* Data should be read with caution as several districts and provinces recorded values over 100%.

12

National average

Summary report card Income quintile

Gender

Population group

Poorest 20%

Richest 20%

Ratio of richest to poorest

Male

Female

Ratio of male to female

–

–

–

36

37

1.0

41

–

–

–

69

69

1.0

75

15

57

3.8

–

–

–

16

61

0

0.0

30

29

1.0

42

12

0.3

30

36

0.8

Black African

White

Ratio of White to Black

Source

1

0

0.0

NIDS

13

0

0.0

NIDS

75

87

5

GHS

13

3

3

0.1

GHS

36

25

10

0.3

GHS GHS

Indian/ Asian

16 51 30

33 35

Coloured

22

0

0.0

12

12

1.0

14

8

2

1

0.1

94

26

0.3

83

83

1.0

89

68

11

15

0.2

GHS

–

–

–

–

–

–

–

–

–

–

–

DHIS

28

8

0.3

24

18

1.3

–

–

–

–

–

NIDS

4

5

1.4

4

3

1.3

–

–

–

–

–

NIDS

7

2

0.3

5

5

1.0

–

–

–

–

–

NIDS

17

15

0.9

15

12

1.3

–

–

–

–

–

NIDS DHIS

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

DHIS

–

–

–

–

–

–

39

20

10

8

0.2

Census

–

–

–

–

–

–

–

–

–

–

–

SABSSM

–

–

–

3

11

0.3

8

1

1

0

0.0

SABSSM

48

96

2.0

66

66

1.0

60

96

99

95

1.6

GHS

66

97

1.5

75

75

1.0

71

97

100

99

1.4

GHS

–

–

–

–

–

–

–

–

–

–

–

DBE

–

–

–

–

–

–

–

–

–

–

–

DBE

39

76

1.9

50

48

1.0

48

39

56

72

1.5

GHS

97

98

1.0

97

97

1.0

97

98

98

97

1.0

GHS

74

85

1.1

75

80

0.9

78

73

72

79

1.0

GHS

93

99

1.1

94

96

1.0

95

96

97

99

1.0

GHS

32

85

2.7

45

54

0.8

46

49

79

89

1.9

GHS

–

–

–

–

–

–

–

–

–

–

–

DBE

91

100

95

95

1.0

94

97

100

100

1.1

NIDS

–

–

–

37

34

1.1

36

35

25

27

0.8

CJCP

–

–

–

–

–

–

22

34

43

46

2.1

VOCS

Legend Better off than the national average Equal or close to the national average (+/- 1 percentage point) Worse off than the national average CJCP Centre for Justice and Crime Prevention DBE Department of Basic Education DHIS District Health Information System GHS General Household Survey NIDS National Income Dynamics Study SABSSM South African HIV/AIDS Behavioural Risks, Sero-Status and Mass Media Impact Survey VOCS Victims of Crime Survey

13

Global Goals for Every Child

Sociodemographic profile of children

Population, by age group and by sex, 2015

Boys and men

Age in years

01

There are 19.7 million children 0–17 years old living in South Africa today

80+ 70–79 70–74 65–69 60–64 55–59 50–54 45–49 40–44 35–39 30–34 25–29 20–24 15–19 10–14 5–9 0–4 3,500

2,500

Girls and women

2,000

1,500

1,000

500

0

500

1,000

1,500

2,000

2,500

3,000

Population in thousands Source: Statistics South Africa (2015). Mid-year Population Estimates, 2015. Pretoria: Statistics South Africa.

Children make up a large share of the population Population of children 0–17 years old as a proportion of the total population, by province, 2015

41

KwaZulu-Natal

41

Eastern Cape

40

Limpopo 38

Mpumalanga 36

North West Free State

34

Northern Cape

34 31

Western Cape

30

Gauteng

36

South Africa 0%

10%

20%

30%

Source: Statistics South Africa (2015). Mid-year Population Estimates, 2015. Pretoria: Statistics South Africa.

14

40%

50%

Socio-demographic profile of children

The total number of children in the country is starting to plateau, while their share in the population will continue to decline in the next decades

More than half of children live in urban areas

Population of children 0–17 years old as a proportion of the total population, 1990–2050

Percentage distribution of children 0–17 years old by geo-type, 2014

3% Urban formal

39%

18.9 million 2005

19.1 million 2020

41%

48%

Adult population 18+ years

34%

16.8 million 1990

48.7 million

49%

2035

18 million

26% 16.9 million

Urban informal Rural traditional Rural formal

Child population 0–17 years Children as a proportion of the total population

8%

2050

Source: Calculations based on data from the United Nations Department of Economic and Social Affairs (2015). World Population Prospects: The 2015 Revision. New York: United Nations.

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

© UNICEF/Schermbrucker

20 million

43.6 million

37.6 million

29.5 million

46%

15

Global Goals for Every Child

The child population is spread unevenly across the country: five provinces accommodate nearly 80% of all children Numbers and percentage distribution of children 0–17 years old, by province, 2014

23

KwaZulu-Natal 20

Gauteng

12

Limpopo

2

Gauteng 10%

15%

20%

25%

North West 961,591

5%

Legend 403,139

Free State Below 5% 5–9%

Northern Cape

More than 20% Province

Western Cape

1,940,637

15–20% Eastern Cape

2,824,911

10–14%

Number of children Source: Statistics South Africa (2015). Mid-year Population Estimates, 2015. Pretoria: Statistics South Africa.

16

Mpumalanga

4,449,286

3,891,081

5

Free State

0%

1,314,568

7

North West

1,612,599

8

Mpumalanga

Northern Cape

Limpopo

10

Western Cape

2,270,384

14

Eastern Cape

KwaZulu-Natal

Socio-demographic profile of children

Š UNICEF/Schermbrucker

More than half of children live in urban areas.

17

Global Goals for Every Child

South Africa’s children are diverse …

And speak a wide variety of languages

Percentage distribution of children 0–17 years old by population group, 2014

Percentage distribution of children 0–17 years old by mother tongue, 2014 30% 28

5%

16

7

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

Afrikaans

Sesotho/ Southern Sotho/Sotho

85%

Setswana/Tswana

IsiZulu/Zulu

White

Sepedi/Nothern Sotho

0%

3

3

2

1

1 Unspecified

8

Isindebele/South Ndebele /North Ndebele

9

Tshivenda/Venda

Indian/Asian

10

Xitsonga/Tsonga

12

10%

Coloured

Siswati/Swazi

Black African

English

8%

20%

IsiXhosa/Xhosa

2%

Note: The GHS only records in what language the interview with the household’s respondent was conducted. It is assumed this serves as a good proxy of the mother tongue of any child living in that household.

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

Nationwide, only one in three children live with both biological parents, with large differences between provinces and population groups Per cent distribution of children 0–17 years old by living arrangements, 2014

56

Western Cape

35

55

Gauteng

31

38

Free State

3 6

36

5 3

Northen Cape

33

44

2

21

North West

32

45

2

21

Mpumalanga

29

46

26

Limpopo KwaZulu-Natal

24

Eastern Cape

22

45

0%

5

20%

41 40%

44

Coloured

4

54

3

84

White

Living with both biological parents

24

34

Indian/Asian

26

8

78 0%

21

80%

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

18

29

Black African

15

9 3 5 4 3

34 4

60%

With neither parent

24

4

With mother only With father only

21

2

40 35

South Africa

3

48

10

23

Living with both biological parents

100%

20%

40%

60%

80%

100%

With mother only With father only With neither parent

Socio-demographic profile of children

The vast majority of children not living with a parent reside with their grandparents or other relatives Child’s relationship to head of the household when both biological parents are absent, 2014

2%

2% 6%

Grandchild Other relative

22%

(Step-) brother or sister

64%

© UNICEF/Schermbrucker

Adopted child Other

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

One in six children have lost one or both parents

Children in the poorest households are most likely to be deprived of parental care

Percentage of children who have lost one or both parents, 2014

Percentage of children who are orphaned or not living with either parent, by quintile of expenditure per capita, 2014

30% 21

KwaZulu-Natal Free State

20

Eastern Cape

20

Mpumalanga

20

27

26 20%

22 19

18

North West

17

16

Northern Cape 15

Limpopo

13

10%

10

12

Gauteng

8 Not living with either parent

7

Western Cape

4

16

South Africa 0

5

10

15

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

20

25

0%

Poorest

Poorer

Middle

Richer

4

Lost one or both parents

Richest

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

19

Global Goals for Every Child

About one in 10 children have migrated from another province or country Percentage of children born outside of their province of usual residence, by province, 2011

2

11

Western Cape

1

11

Mpumalanga North West

10

1

Northern Cape

10

<1

7

Free State

© UNICEF/Williams

3

18

Gauteng

Eastern Cape

6

KwaZulu-Natal

6

1 <1 <1

5

Limpopo South Africa 0%

Born in a different province

1 9

1

5%

10%

Born outside of the country 15%

20%

25%

Source: Calculations based on data from Statistics South Africa’s 10% sample of the Census 2011.

Survey data indicate that 5% of children 5–17 years old have a disability, though reliable and comprehensive statistics on childhood disability are lacking Percentage of children 5–17 years old with a severe disability, 2014

10

Northern Cape 9

North West Free State

7

Limpopo

7 6

Eastern Cape 5

KwaZulu-Natal Gauteng

4

Mpumalanga

4 3

Western Cape

5

South Africa 0%

2%

4%

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

20

6%

8%

10%

Note: In the GHS, persons with disabilities are identified using the Short Set of Disability Questions developed by the United Nations Washington Group (WG) on Disability Statistics. The questions are designed to identify those who are at greater risk than the general population of experiencing restrictions in performing tasks (such as activities of daily living) or participating in roles (such as working). They ask whether people aged 5 years and above have difficulties in functioning in six core domains: walking, seeing, hearing, remembering, self-care and communication. The questions will identify many children with disabilities in the age range 5–17 years, but will miss many children with developmental or psychosocial disabilities.

Socio-demographic profile of children

Š UNICEF/Schermbrucker

reliable and comprehensive statistics on childhood disability are lacking.

21

Global Goals for Every Child

02

South Africa has made good progress in reducing the share of children living in extreme poverty …

Percentage of children living in households below the national food poverty line, 2004–2014

Social inclusion

60%

40%

20%

0%

Goal 1 End poverty in all its forms everywhere

Goal 8 Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all

Goal 10 Reduce inequality within and among countries

Target 1.2 By 2030, reduce at least by half the proportion of men, women and children of all ages living in poverty in all its dimensions according to national definitions 22

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

Source: Hall, K. & Sambu, W. (2016). Analysis of Stats SA’s General Household Surveys 2004–2014. Children’s Institute, University of Cape Town.

But seven out of 10 children are still living below the national poverty line Percentage of children living in households below the national upper-bound poverty line, by province, 2014–2015 100%

80%

60%

40%

83

80

76

73

69

64

60 46

62

61 52

39

36

Note: Based on the upper-bound poverty line of ZAR 779 and food poverty line of ZAR 335 per person per month in 2010/11 prices as defined by Statistics South Africa. The lines were adjusted for inflation using Statistics South Africa’s CPI data.

37

31 25

20%

51

27

22

Below poverty line 14

0%

KwaZulu- Eastern Natal Cape

Limpopo Mpumalanga

North West

Free State

Northern Cape

Gauteng Western Cape

Below food poverty line South Africa

Source: Calculations based on data from SALDRU’s National Income Dynamics Study (NIDS) 2014–2015, Wave 4 (dataset version 1.0) using post-stratified, cross-sectional weights.

Social inclusion

Disparities in poverty rates between population groups remain extremely high Percentage of children living in households below the national upper-bound poverty line and below the food poverty line, by population group, 2014–2015

80%

Target 3.2

75 60%

By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and underfive mortality to at least as low as 25 per 1,000 live births

51 40%

41

20% 16

Below poverty line

13 1

0%

Black African

Coloured

Below food poverty line

<1 <1

Indian/Asian

White

Source: Calculations based on data from SALDRU’s National Income Dynamics Study (NIDS) 2014–2015, Wave 4 (dataset version 1.0) using post-stratified, cross-sectional weights.

Children living with their mother only, in female-headed households and those who have lost their father are more likely to live in poverty Percentage of children living in households below the national upper-bound poverty line, by orphanhood status and by sex of the household head, 2014–2015 100% 80% 60%

80 67

83 74

70 58

70

77

79

52

40%

© UNICEF/Schermbrucker

20% 0%

Not an orphan

Maternal orphan

Paternal orphan

Orphanhood status

Double orphan

Male-headed household

Female-headed household

Sex of the household head

Both parents

Father only

Neither parent

Mother only

Child’s living arrangements

Source: Calculations based on data from SALDRU’s National Income Dynamics Study (NIDS) 2014–2015, Wave 4 (dataset version 1.0) using post-stratified, cross-sectional weights.

23

Global Goals for Every Child

Nearly half of all children experience multiple deprivations in non-monetary dimensions of poverty, especially sanitation, water and shelter Percentage of children experiencing deprivation in non-monetary dimensions of poverty, by dimension, 2008/09

Note: The definitions and cut-off points used for each domain are available in the source document.

Data are not directly comparable with information presented elsewhere in this report. Updated estimates of multidimensional child poverty based on the Living Conditions Survey 2014/15 are forthcoming.

49

Sanitation 35

Water

34

Shelter 27

Education 18

Energy 11

Information 8

Food 2

Health

49

Deprived in two or more dimensions 0%

10%

20%

30%

40%

50%

Š UNICEF/Schermbrucker

Source: Statistics South Africa (2013). Men, Women and Children: Findings of the Living Conditions Survey 2008/09. Pretoria: Statistics South Africa.

24

Social inclusion

The spatial distribution of multiple child deprivation still overlaps with the location of the former homelands South African Index of Multiple Child Deprivation at municipal level, 2011

Former homelands

Multiple child deprivation

Source: Adapted from Wikimedia Commons, https://commons.wikimedia.org/wiki/ File:Bantustans_in_South_Africa.svg

Source: Southern African Social Policy Research Insights, 2016.

Least deprived Less deprived

Venda

u kul zan Ga

Lebowa

Deprived Severely deprived

na wa ats h t u Bop

KwaNdebele

KaNgwane Swaziland

Most deprived Province Limpopo

QwaQwa Lesotho

KwaZulu

Mpumalanga North West

Transkei Free State

Ciskei

KwaZulu-Natal

Northern Cape

Eastern Cape

Western Cape

25

Global Goals for Every Child

12 million children benefit from the Child Support Grant, the largest cash transfer programme on the African continent Number of beneficiaries of the Child Support Grant, 1999–2016

12,000,000 12 million

Target 1.3 8,000,000

Implement nationally appropriate social protection systems and measures for all, including floors, and by 2030 achieve substantial coverage of the poor and the vulnerable

4,000,000 Note: Data refer to the number of beneficiaries at the end of March each year.

22,000 0

1999

2001

2003

2005

2007

2009

2011

2013

2015

Source: South African Social Security Agency (SASSA) Statistical Reports.

Uptake of the Child Support Grant has risen among all age groups, due to efforts to better reach eligible children and the progressive extension to older children …

Percentage of children receiving the Child Support Grant, by age, 2004 and 2014

100% 2014 75%

2004

50%

© UNICEF/Schermbrucker

25%

26

0%

<1

1

2

3

4

5

6

7

8

9

10

11

Age (single years) Source: Calculations based on data from Statistics South Africa’s General Household Survey 2004 and 2014.

12

13

14

15

16

17

Social inclusion

Yet, an estimated 18% of all eligible children are not accessing the Child Support Grant. Levels of exclusion are especially high…

Among young children under the age of one …

Percentage of eligible children not receiving the Child Support Grant, by age, 2014

<1 1 16

3

16 14

4

15

5 13

Ages

9

11 14

10

13

11

13

12 13

North West Mpumalanga

15 Northern Cape

14

Cannot be measured

15 21

16

Free State 28

17 0%

10%

Rates of CSG exclusion No data

18

14 15

Limpopo

Gauteng

14

7 8

Percentage of eligible children not receiving the Child Support Grant, by municipality, 2011

25

2

6

And children living in urban formal areas and the provinces of Western Cape and Gauteng

43

20%

30%

40%

KwaZulu-Natal

50%

Very low Low Average High

Western Cape Eastern Cape

Very high Province District municipality

Source: DSD, SASSA & UNICEF (2016). Removing Barriers to Accessing Child Grants: Progress in Reducing Exclusion from South Africa’s Child Support Grant. Pretoria: UNICEF.

27

Global Goals for Every Child

The number of beneficiaries of the Foster Child Grant grew sharply in the mid 2000s as children orphaned by HIV and AIDS entered the formal foster care system

Three quarters of children benefiting from the Foster Child Grant are living with their grandparents or other relatives

Number of beneficiaries of the Foster Child Grant Grant, 1999–2016

Percentage distribution of children receiving the Foster Child Grant by relationship to the head of the household, 2014

600,000 470,000

7%

400,000

5% Grandchild

11%

Other relative

50% 200,000

(Step-) brother or sister

27%

46,500 0

Adopted child

1999

2001

2003

2005

2007

2009

2011

2013

Other

2015

Source: South African Social Security Agency (SASSA) Statistical Reports.

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

Nearly half of Foster Child Grant beneficiaries live in KwaZulu-Natal and Eastern Cape

The Care Dependency Grant reaches 127,000 caregivers of children with severe disabilities in need of full-time and special care

Percentage distribution of beneficiaries of the Foster Child Grant by province, 2016

Number of beneficiaries of the Care Dependency Grant, 1999–2016

KwaZulu-Natal

23

Eastern Cape

23

Limpopo

11

Gauteng

11

Free State

8

North West

8

131,000

120,000 90,000 60,000

7

Mpumalanga

30,000

6

Western Cape

16,835

3

Northern Cape 0%

5%

10%

Source: South African Social Security Agency (SASSA) Statistical Reports.

28

150,000

15%

20%

25%

0

1999

2001

2003

2005

2007

Source: South African Social Security Agency (SASSA) Statistical Reports.

2009

2011

2013

2015

Social inclusion

Š UNICEF/Schermbrucker

Urban children are the most excluded from receiving the child support grant.

29

Global Goals for Every Child

Unemployment remains a serious challenge: 30% of children live in families with no working adult, including almost half in the Eastern Cape Percentage of children living in households with no employed adults, by province, 2014

46

Eastern Cape 43

Limpopo 37

KwaZulu-Natal 31

North West

30

Free State

Target 8.5

30

Northern Cape 28

Mpumalanga 11

Gauteng

10

Western Cape

By 2030, achieve full and productive employment and decent work for all women and men, including for young people and persons with disabilities

30

South Africa 0%

10%

20%

30%

40%

50%

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

Unemployment and child poverty are strongly correlated Percentage of children living in households with no employed adults, by quintile of expenditure per capita, 2014

80%

60%

61

© UNICEF/Schermbrucker

40%

30

23

20%

0%

Poorest

Poorer

5

1

<1

Middle

Richer

Richest

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

Social inclusion

One in three young people are neither in employment nor in education or training

The gender disparity in youth inactivity becomes more pronounced with age

Percentage of youth aged 15–24 years neither in employment nor in education or training (NEET), by population group, 2014

Percentage of youth aged 15–24 years neither in employment nor in education or training (NEET), by age and by sex, 2014 60%

40%

Females 36

35

33

30%

Males 40%

25 20% 20% 10%

0%

10 0% Black African

Coloured

Indian/Asian

White

National average

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

15

16

17

18

19

20

21

22

23

24

Years Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

Youth with disabilities are nearly twice as likely to be inactive and not engaged in learning compared with their non-disabled peers

No disability

With disability

33%

59% © UNICEF/Schermbrucker

Percentage of youth aged 15–24 years neither in employment nor in education or training (NEET), by disability status, 2014

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

31

Global Goals for Every Child

Income growth of the bottom 40% of the population was lower than the national average Annualised growth in mean consumption per capita, 2006–2011

5% 4%

4.4

4.1

3%

Target 10.1

2% 1%

By 2030, progressively achieve and sustain income growth of the bottom 40% of the population at a rate higher than the national average

0%

Bottom 40%

Total population

Source: World Bank’s Global Database of Shared Prosperity. Based on analysis of Statistics South Africa’s Income and Expenditure Surveys in 2006 and 2011.

Levels of income inequality are high in all nine provinces Gini coefficient (based on income per capita including salaries, wages and social grants), by province, 2011

0.73

North West

0.70

Eastern Cape Mpumalanga

0.69

KwaZulu-Natal

0.68

Limpopo

0.68

Free State

0.67 0.65

Northern Cape

0.64

© UNICEF/Schermbrucker

Gauteng

32

0.62

Western Cape

0.69

South Africa 0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

Source: Republic of South Africa (2015). Development Indicators 2014. Based on Statistics South Africa’s Income and Expenditure Survey 2010/11.

Social inclusion

South Africa still ranks among the most unequal societies in the world Gini coefficient, latest available year

Income inequality by country No data 0–25 26–35 36–45 46–55 56–100

Source: UNU-WIDER’s World Income Inequality Database (WIID3c, September 2015). Available from: www.wider.unu.edu/project/wiid-world-income-inequality-database.

33

Global Goals for Every Child

03 Nutrition

The share of children who experience hunger has declined significantly since the early 2000s …

Percentage of children experiencing hunger because there was not enough food in the household, 2002–2014

30%

30

20%

12 10%

Target 2.1 By 2030, end hunger and ensure access by all people, in particular the poor and people in vulnerable situations, including infants, to safe, nutritious and sufficient food all year round

0%

2002

2004

2006

2008

2010

2012

2014

Source: Calculations based on data from Statistics South Africa’s General Household Surveys 2002–2014.

But there are large differences in reported child hunger among provinces Percentage of children experiencing hunger because there was not enough food in the household, by province, 2002 and 2014

19

KwaZulu-Natal Northern Cape

18

North West Free State

12 11

Mpumalanga

11

Gauteng

8

29 48 34 17 2014

28

4

South Africa 0%

28

14 17

Eastern Cape

Limpopo

32 29

15

Western Cape

30

12 10%

20%

30%

2002 40%

Source: Calculations based on data from Statistics South Africa’s General Household Surveys 2002 and 2014.

34

Note: The General Household Survey asks: “In the past 12 months, did any child in this household go hungry because there wasn’t enough food?”

Children living in households reporting ‘sometimes’, ‘often’ or ‘always’ are classified as experiencing hunger.

50%

Nutrition

Children in the poorest and female-headed households are much more likely to experience hunger Percentage of children experiencing hunger because there was not enough food in the household, by quintile of expenditure per capita and by sex of the household head, 2014

30%

20%

22 16 12

10%

9 5

0%

Poorest

Poorer

Middle

2

<0

Richer

Richest

Female

Quintile

Male

Target 2.2 By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons

Sex of the household head

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

Nationwide, more than one in three children under the age of 5 have some form of malnutrition

Eight out of 10 pupils are receiving regular meals at school

Percentage of children aged 6–59 months who are stunted, wasted, underweight or overweight, 2014–2015

Percentage of learners benefitting from the National School Nutrition Programme, by province, 2014

100% 94

89

88

85

84

75%

Stunting (chronic undernutrition) 79

80

78 65

63

Wasting (acute undernutrition) Underweight (composite form of undernutrition)

50%

21 3 5

Overweight 25%

0%

Note: ‘Any form of malnutrition’ refers to the percentage of children aged 6–59 months who have one or multiple forms of malnutrition.

14

Any form of malnutrition 0% Limpopo Mpumalanga Eastern Cape

North West

Northen Cape

KwaZuluNatal

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

Free State

Western Cape

Gauteng

35 5%

10%

15%

20%

25%

30%

35%

South Africa Source: Calculations based on data from SALDRU’s National Income Dynamics Study (NIDS) 2014–2015, Wave 4 (dataset version 1.0) using post-stratified, crosssectional weights.

35

Global Goals for Every Child

The national prevalence of stunting is gradually declining Percentage of children under age 5 who are moderately or severely stunted, by data source, 1993–2015

10%

NIDS 2014/15

15%

SANHANES 2012

20%

NIDS 2008

25%

NFCS 1999

Reduce by 40% the number of children under 5 who are stunted

SAVACG 1994

30%

DHS 2003

35% PSLSD 1993

Global World Health Assembly nutrition target

5% 0%

Both rural and urban areas have large numbers of stunted children Percentage distribution of children aged 6–59 months who are moderately or severely stunted by geo-type, 2014–2015

1990

1995

2000

2005

2010

Note: Malnutrition estimates are based on the WHO Child Growth Standards for children under 5 and may be different from other published estimates based on the NCHS reference and/or different age groups. Stunting is defined as height for age below minus two standard deviations from the median height for age of the standard reference population.

2015

Source: WHO (2012). Global Database on Child Growth and Malnutrition; HSRC (2013). SANHANES-1: Data analysis on anthropometry in children under 5 years of age. Own calculations based on data from SALDRU’s National Income Dynamics Study (NIDS) 2014–2015, Wave 4 (dataset version 1.0) using post-stratified, cross-sectional weights.

Children in the poorest households are more than three times as likely to be stunted as children in the richest households Percentage of children aged 6–59 months who are moderately or severely stunted, by quintile of expenditure per capita, 2014–2015

30% 28

Rural informal

35%

46%

Rural formal

25 20%

20

Urban informal Urban formal

12%

7%

8

0% Source: Calculations based on data from SALDRU’s National Income Dynamics Study (NIDS) 2014–2015, Wave 4 (dataset version 1.0) using post-stratified, crosssectional weights.

36

12

10%

Poorest

Poorer

Middle

Richer

Richest

Quintile Source: Calculations based on data from SALDRU’s National Income Dynamics Study (NIDS) 2014–2015, Wave 4 (dataset version 1.0) using post-stratified, cross-sectional weights.

Nutrition

The national prevalence of wasting is below the global target of 5% Percentage of children under age 5 who are moderately or severely wasted, by data source, 1994–2015

NIDS 2014/15

NIDS 2008

DHS 2003

SANHANES 2012

Note: Malnutrition estimates are based on the WHO Child Growth Standards for children under 5 and may be different from other published estimates based on the NCHS reference and/or different age groups. Stunting is defined as height for age below minus two standard deviations from the median height for age of the standard reference population.

0% 1990

1995

1996

2000

2005

2010

2015

Source: WHO (2012). Global Database on Child Growth and Malnutrition; HSRC (2013). SANHANES-1: Data analysis on anthropometry in children under 5 years of age. Own calculations based on data from SALDRU’s National Income Dynamics Study (NIDS) 2014–2015, Wave 4 (dataset version 1.0) using post-stratified, cross-sectional weights.

© UNICEF/Schermbrucker

Reduce and maintain childhood wasting to less than 5%

5%

NFCS 1999

Global World Health Assembly nutrition target

SAVACG 1994

10%

37

Global Goals for Every Child

The incidence of low birthweight has not reduced over the last decade Percentage of live births weighing less than 2,500 grams, 2005–2014

20%

Global World Health Assembly nutrition target

15%

13 11

10%

5%

Reduce by 30% the number of infants born with a weight lower than 2,500 grams

0%

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

Source: National Department of Health’s District Health Information System (DHIS) Database, reported in: Padarath, A. et al. (eds) (2016). South African Health Review 2016.

Durban: Health Systems Trust.

Northern Cape has the highest incidence of low birthweight, with nearly one in five newborns weighing less than 2,500 grams Percentage of live births weighing less than 2,500 grams, 2005–2014

19

Northern Cape 15

Western Cape North West

14

Eastern Cape

14 13

Free State

13

Gauteng 12

KwaZulu-Natal 11

© UNICEF/Marinovich

Mpumalanga

38

10

Limpopo

13

South Africa 0%

5%

10%

15%

20%

Source: National Department of Health’s District Health Information System (DHIS) Database, reported in: Padarath, A. et al. (eds) (2016). South African Health Review 2016.

Durban: Health Systems Trust.

Nutrition

Š UNICEF/Hearfield

The incidence of low birthweight has not reduced over the last decade.

39

Global Goals for Every Child

Global World Health Assembly nutrition target

The prevalence of overweight during early childhood appears to have decreased since the early 2000s Percentage of children under age 5 who are overweight, by data source, 1994–2015

30%

20%

0%

Adolescents girls are much more likely to be overweight than boys Percentage of children aged 5–19 years who are overweight or obese (according to age-dependent BMI cut-off points), by age group, 2014–2015

30%

1990

NFCS 1999

SAVACG 1994

10%

1995

2000

2005

2010

2015

Source: WHO (2012). Global Database on Child Growth and Malnutrition; Own calculations based on data from SALDRU’s National Income Dynamics Study (NIDS) 2014–2015, Wave 4 (dataset version 1.0) using post-stratified, cross-sectional weights.

Childhood obesity is more prevalent among those from wealthier families Percentage of children aged 5–19 years who are overweight or obese (according to age-dependent BMI cut-off points), by quintile of expenditure per capita, 2014–2015

30%

29

Note: Malnutrition estimates are based on the WHO Child Growth Standards for children under 5 and may be different from other published estimates based on the NCHS reference and/or different age groups. Overweight is defined as weight for height above two standard deviations from the median weight for height of the standard reference population.

NIDS 2014/15

DHS 2003

No increase in childhood overweight

10

25 8

20%

20

8

20%

10

Females

10%

Males

17 17 3 10%

12

5 12

19 16

13

Obese 0%

5–9 years

10–14 years

15–19 years

Source: Calculations based on data from SALDRU’s National Income Dynamics Study (NIDS) 2014–2015, Wave 4 (dataset version 1.0) using post-stratified, crosssectional weights.

40

0%

Overweight Poorest

Poorer

Middle

Richer

Richest

Source: Calculations based on data from SALDRU’s National Income Dynamics Study (NIDS) 2014–2015, Wave 4 (dataset version 1.0) using post-stratified, cross-sectional weights.

Nutrition

Nearly one in four women of reproductive age are anaemic, a condition that reduces their individual well-being and increases the risk of maternal and neonatal adverse outcomes Prevalence of anaemia among women aged 16â&#x20AC;&#x201C;35 years, by geo-type, 2012

28

Rural informal 19

Urban formal

18

Rural formal

23

South Africa

Achieve a 50% reduction in the rate of anaemia in women of reproductive age

0%

5%

10%

15%

20%

25%

30%

35%

Note: Anaemia is a condition in which the number and size of red blood cells, or the haemoglobin concentration, falls below an established cut-off value (12 g/dL), consequently impairing the capacity of the blood to transport oxygen around the body. It is an indicator of both poor nutrition and poor health.

Source: Shisana, O. et al. (2013). South African National Health and Nutrition Examination Survey (SANHANES-1). Cape Town: HSRC Press.

Š UNICEF/Schermbrucker

Global World Health Assembly nutrition target

32

Urban informal

41

Global Goals for Every Child

04 Health and HIV

South Africa has started reversing the trend of rising maternal mortality Maternal mortality ratio (modelled estimate, per 100,000 live births), 1990–2015

200

150

138 Note: Maternal mortality ratio is the number of women who die from pregnancy-related causes while pregnant or within 42 days of pregnancy termination per 100,000 live births. The data are estimated with a regression model using information on the proportion of maternal deaths among non-AIDS deaths in women ages 15–49, fertility, birth attendants and GDP.

108 100

50

0

Goal 3 E nsure healthy lives and promote well-being for all at all ages

Target 3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births

1990

1995

2000

2005

2010

2015

Source: WHO, UNICEF, UNFPA and The World Bank (2015). Trends in Maternal Mortality: 1990 to 2015. Geneva: WHO.

More than one in three maternal deaths are caused by non-pregnancy related infections such as HIV and tuberculosis Percentage distribution of recorded maternal deaths by cause, 2011–2013

14%

Non-pregnancy related infections

35%

10%

Obstetric haemorrhage Hypertension Medical and surgical disorders

11% 15%

Sepsis

16%

Other causes

Source: National Department of Health (2015). Saving Mothers 2011–2013: Sixth Report on Confidential Enquiries into Maternal Deaths in South Africa.

42

Health and HIV

South Africa has already achieved the SDG target for neonatal mortality but it needs to accelerate progress in reducing infant and under-five mortality

Target 3.2

Estimated under-five, infant and neonatal mortality rate (per 1,000 live births), 1990â&#x20AC;&#x201C;2015

By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and underfive mortality to at least as low as 25 per 1,000 live births

80

60

Note: Neonatal refers to the first 28 days of life. Infants are children under age 1.

60

47

41

40

20

34 Under-five mortality rate

20 11

0

Infant mortality rate Neonatal mortality rate

1990

1995

2000

2005

2010

2015

Source: United Nations Inter-agency Group for Child Mortality Estimation (2015).

A Black African child is almost five times more likely than a White child to die before his or her first birthday

Most causes of under-five deaths are either preventable or treatable Percentage distribution of deaths among children under age 5 by cause, 2015

Infant mortality rate (per 1,000 live births), by population group, 2010 25% 40

39

20%

30 15% 20

25

20

17

12

10%

9

9

9 7

10

0

9

10

Black African

Coloured

Indian/Asian

8

White

Source: Statistics South Africa (2015). Census 2011: Estimation of Mortality in South Africa. Pretoria: Statistics South Africa

5% 4 0%

Pneumonia

Prematurity

Injuries

HIV and AIDS

Diarrhoea

Congenital

Intrapartum

Sepis

Other

Source: Estimates for child causes of death by the WHO and Maternal and Child Epidemiology Estimation Group (MCEE) (2016).

43

Global Goals for Every Child

Geographic disparities in child survival remain high Infant mortality rate (per 1,000 live births), by province and by district, 2010

Infant mortality rate Less than 20

Limpopo

20â&#x20AC;&#x201C;39 Gauteng

40â&#x20AC;&#x201C;59 60 and above

North West

Mpumalanga

Province District municipality Free State

KwaZulu-Natal Durban

Northern Cape 53

Free State North West

47

KwaZulu-Natal

47 40

Eastern Cape

Western Cape

39

Mpumalanga

Cape Town

37

Northern Cape

Port Elizabeth

28

Limpopo 24

Gauteng 20

Western Cape 0

44

Eastern Cape

10

20

30

40

50

60

Source: Statistics South Africa (2015). Census 2011: Estimation of Mortality in South Africa. Pretoria: Statistics South Africa.

Health and HIV

South Africa continues to have the largest AIDS epidemic of any country worldwide

Orphaned children face a higher risk of contracting HIV compared with their non-orphaned peers

HIV and AIDS epidemiological estimates, global and South Africa, 2015

HIV prevalence among children 0–18 years, by orphanhood status, 2012

Target 3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases

Children 0–14 years Adults 15+ years All ages Children 0–14 years Adults 15+ years All ages

Source: UNAIDS (2016). HIV and AIDS estimates, based on Spectrum modelling.

12%

11.5

8% 6.9

4%

3.9 1.7

0%

Not an orphan

Paternal orphan

Maternal orphan

Double orphan

Source: Shisana, O. et al. (2014). South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. Cape Town: HSRC Press.

© UNICEF/Schermbrucker

Children 0–14 years Adults 15+ years All ages

Globally South Africa Share (%) Number of people living with HIV in 2015 1.8 million 240,000 13% 34.9 million 6.7 million 19% 36.7 million 7.0 million 19% People newly infected with HIV in 2015 150,000 5,100 3% 1.9 million 370,000 20% 2.1 million 380,000 18% AIDS deaths in 2015 110,000 8,000 7% 1.0 million 170,000 17% 1.1 million 180,000 16%

45

Global Goals for Every Child

Some 235,000 children are living with HIV across the country

The prevalence of HIV among children has decreased in nearly every province

Estimated number of children 0–14 years old who are infected with HIV, 1990–2015

HIV prevalence among children 2–14 years, by province, 2002 and 2012

3.9 4.4

KwaZulu-Natal

400,000

Limpopo

2.8

North West

300,000

235,000

200,000

2.2

Gauteng Free State

1.7 1.7

Eastern Cape Western Cape 5,800 0

1990

4.7 3.7 3.4

1.2

3.8

0.7

2000

2005

2010

2015

2.4

0%

1%

2012

7.1

South Africa 1995

5

1.3

Northern Cape

100,000

4.3

2.1

Mpumalanga

Note: Provincial estimates need to be interpreted with caution because of relatively small sample sizes among children.

4.7

2%

5.6 3%

4%

5%

2002 6%

7%

8%

Source: UNAIDS (2016). HIV and AIDS estimates, based on Spectrum modelling.

Source: Shisana, O. et al. (2014). South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. Cape Town: HSRC Press.

New HIV infections among children are declining rapidly due to scaled-up efforts to prevent mother-to-child transmission

Adolescent girls and young women are disproportionately vulnerable and at high risk

Estimated number of new HIV infections among children 0–14 years old, 1990–2015

HIV prevalence among youth, by sex and by age, 2012

20%

100,000

88,400

17.4 15%

80,000 60,000

10%

40,000 5%

5.6

5.1

20,000 4,163 0

1990

1995

2000

2005

Source: UNAIDS (2016). HIV and AIDS estimates, based on Spectrum modelling.

46

0.7

5,053 2010

2015

0%

15–19 years

Females Males

20–24 years

Source: Shisana, O. et al. (2014). South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. Cape Town: HSRC Press.

Health and HIV

Nearly 30% of pregnant women in the country are HIV positive, with marked differences between districts HIV prevalence among pregnant women (15–49 years) attending antenatal public clinics, by district, 2013

HIV prevalence Limpopo

Less than 10% 10–24%

Gauteng

25–39%

North West

40% and above

Mpumalanga

Province District municipality

Free State

KwaZulu-Natal

Durban

Northern Cape

Eastern Cape

Cape Town

Western Cape

Port Elizabeth

Source: National Department of Health (2015). The National Antenatal Sentinel HIV Prevalence Survey, South Africa, 2013.

47

Global Goals for Every Child

One in seven adolescent girls have already given birth, pointing to a need for strengthening reproductive health services Percentage of women aged 15–19 years who are mothers or who have ever been pregnant, by geo-type, 2014–2015

22

Urban informal

Target 3.7

18

Rural informal 14

Rural formal

By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes

9

Urban formal

14

South Africa 0%

5%

10%

15%

20%

25%

Source: Calculations based on data from SALDRU’s National Income Dynamics Study (NIDS) 2014–2015, Wave 4 (dataset version 1.0) using post-stratified weights that were calibrated to the 2015 mid-year population estimates.

Birth rates are significantly higher among adolescent girls from the poorest households

Less than half of women of reproductive age are using modern contraceptive methods to prevent unplanned pregnancies

Percentage of women aged 15–19 years who are mothers or who have ever been pregnant, by quintile of expenditure per capita, 2014–2015

Estimated percentage of women aged 15–49 years who are protected against unplanned pregnancies for a year using modern contraceptive methods (couple year protection rate), by province, 2014/15

60

Western Cape 25

Poorest

58

KwaZulu-Natal 49

Limpopo 17

Quintile

Poorer

43

North West Richer

6

Richest

6

0%

5%

40

Mpumalanga

10%

15%

20%

25%

Eastern Cape

39

Gauteng

39 47

South Africa 0%

Source: Calculations based on data from SALDRU’s National Income Dynamics Study (NIDS) 2014–2015, Wave 4 (dataset version 1.0) using post-stratified weights that were calibrated to the 2015 mid-year population estimates.

48

44

Free State

8

Middle

45

Northern Cape

10%

20%

30%

40%

50%

Source: Massyn N. et al. (eds) (2015). District Health Barometer 2014/15. Durban: Health Systems Trust.

60%

Health and HIV

Close to nine out of 10 births take place in public health facilities Estimated percentage of deliveries that take place in public health facilities under supervision of trained personnel, by province, 2014/15

Target 3.8

97

Gauteng 91

Limpopo

Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all

Free State

88

Northern Cape

88

Western Cape

88 82

KwaZulu-Natal

81

Mpumalanga 77

Eastern Cape

75

North West

86

South Africa 0%

20%

40%

60%

80%

100%

Source: National Department of Health’s District Health Information System (DHIS) Database, reported in: Padarath, A. et al. (eds) (2016). South African Health Review 2016.

Durban: Health Systems Trust.

A relatively low share of children live in households with financial protection against health-care costs Percentage of children covered by a medical aid scheme, 2014

28

Gauteng 25

Western Cape 20

Northen Cape 16

Free State 13

Mpumalanga 11

North West 10

© UNICEF/Hearfield

KwaZulu-Natal Eastern Cape

8

Limpopo

8 15

South Africa 0%

5%

10%

15%

20%

25%

30%

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

49

Global Goals for Every Child

Only 10 out of 52 districts have achieved the national target of 95% full immunisation coverage Estimated percentage of children under 1 year who have received all their recommended vaccinations, 2014/15

Limpopo

Gauteng

Immunisation coverage Less than 75% 75â&#x20AC;&#x201C;84%

North West

85â&#x20AC;&#x201C;94% Mpumalanga

95% and above Province

Northern Cape

District municipality

Free State

Note: Calculated from the number of children fully immunised (defined as first visit where all required vaccinations are completed) divided by the population under 1 year. A primary course currently includes BCG, OPV1, DTaP-IPV/Hib 1, 2, 3, HepB 1, 2, 3, PCV 1,2,3, RV 1,2 and measles 1.

Durban

KwaZulu-Natal

Western Cape Eastern Cape Cape Town

Port Elizabeth

Source: Massyn N. et al. (eds) (2015). District Health Barometer 2014/15. Durban: Health Systems Trust.

50

Health and HIV

Nearly all pregnant women living with HIV receive treatment to stop HIV transmission to their babies, but less than three in every four children living with HIV are on antiretroviral medications Estimated percentage of pregnant women living with HIV who received ARVs for PMTCT and percentage of children (aged 0–14) and adults (aged 15+) living with HIV receiving antiretroviral therapy (ART), 2015 100% 95 75%

50%

49

45

25%

0%

Pregnant women

Children 0–14 years

Adults 15+ years

Source: UNAIDS (2016). HIV and AIDS estimates, based on Spectrum modelling.

The share of children living with HIV receiving antiretroviral therapy has more than doubled in the last five years Estimated percentage of children (aged 0–14) living with HIV receiving antiretroviral therapy (ART), 2010–2015

80%

74

60%

40%

33

0%

2010

2011

2012

2013

2014

© UNICEF/Hearfield

20%

2015

Source: UNAIDS (2016). HIV and AIDS estimates, based on Spectrum modelling.

51

Global Goals for Every Child

05

The share of children under 5 attending day-care or educational facilities outside their homes has grown to nearly 50% Percentage of children under age 5 attending an early childhood develpment facility or day-mother (gogo) outside the home, 2002–2014

50%

Education

49

40% 30% 20% 10%

Goal 4 Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all

7

0%

2002

2003

2005

2006

2007

2008

2009

2010

2011

2013

2014

There are marked differences in early childhood care arrangements between South Africa’s provinces Percentage distribution of children under age 5 by main child care arrangements, by province, 2014

26

45

Gauteng

KwaZulu-Natal

8

35

Eastern Cape Northern Cape

26

Mpumalanga

26

16 7

33

South Africa 0%

20%

2

50

5

1

53

3

2

6

3

64 16 40%

3 43

60%

1

10

58 3

29

3 8

42

1 2

8

46

25

20

7

41

9

37

Limpopo

4

29

13

35

Western Cape

24

17

45

Free State

North West

7 80%

Note: Early childhood development facility includes pre-school, nursery school, crèche, edu-care centre and Grade R. Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

52

2012

Source: Department of Basic Education (2015). General Household Survey (GHS): Focus on Schooling 2014. Pretoria: Department of Basic Education.

Target 4.2 By 2030, ensure that all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education

2004

ECD facility Day-mother (gogo) At home with parent or guardian

1

At home with another adult

2

Other

100%

Education

Children in the poorest households are least likely to be exposed to stimulation activities outside the home

The reception year programme (Grade R) has expanded dramatically since the early 2000s

Percentage distribution of children under 5 by main child care arrangements, by quintile of expenditure per capita, 2014

Number of learners enrolled in Grade R in ordinary schools, 2003–2014

1 6

100%

2 7

3

1

5

7

80% 60%

8

792,325 800,000

13

29

39

45

54

1,000,000

3

16

Other

21

40%

15

15

15

At home with parent or guardian Day-mother (gogo)

20% 0%

600,000

At home with another adult

24

31

37

42

60

Poorest

Poorer

Middle

Richer

Richest

400,000

316,086

200,000

ECD facility 0

Note: Early childhood development facility includes pre-school, nursery school, crèche, edu-care centre and Grade R. Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Source: Department of Basic Education (DBE) EMIS Reports.

Around nine out of 10 pupils participated in some form of pre-primary or Grade R before starting primary school Percentage of children who attended pre-primary or Grade R before starting primary school, by age, 2014–2015

100% 80%

91

92

93

91

94

6

7

8

9

10

90

89

87

87

11

12

13

14

60% 40%

0%

© UNICEF/Schermbrucker

20%

Age (single years) Source: Calculations based on data from SALDRU’s National Income Dynamics Study (NIDS) 2014–2015, Wave 4 (dataset version 1.0) using post-stratified, cross-sectional weights.

53

Global Goals for Every Child

The number of out-of-school children has fallen by one third since the early 2000s Number of children 7–18 years old not attending an educational institution, 2002–14

1,000,000 818,600 800,000

Target 4.1

600,000

530,500

400,000

By 2030, ensure that all girls and boys complete free, equitable and quality primary and secondary education leading to relevant and effective learning outcomes

200,000 0

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

Source: Department of Basic Education (2015). General Household Survey (GHS): Focus on Schooling 2014. Pretoria: Department of Basic Education.

Access to primary education is near universal, but secondary school attendance is below 80% Primary and secondary school net attendance ratio, by province, 2014

100%

100

98

98

97

80% 71

72

72

98

97

76

77

97

78

98

97 82

81

98 83

78

60%

© UNICEF/Schermbrucker

40%

54

20%

0%

Note: Primary school net attendance ratio is the number of children attending primary or secondary school who are of official primary school age (7–13 years), expressed as a percentage of the total number of children of official primary school age.

Secondary school net attendance ratio is the number of children attending secondary school or higher who are of official secondary school age (14–18 years), expressed as a percentage of the total number of children of official secondary school age.

Primary Secondary Eastern Cape

Northern Cape

North West

Mpumalanga Western Cape

KwaZuluNatal

Free State

Gauteng

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

Limpopo

South Africa

Education

Over one in 10 pupils of secondary school age are still in primary school, because they entered school late or repeated grades

Children in the poorest households are up to nine times more likely to repeat the same grade compared with children in the richest households

Percentage of pupils of secondary school age (14–18 years) attending primary school (Grade 1–7), by province, 2014

Percentage of learners in primary or secondary school who are repeating the same grade, by quintile of expenditure per capita, 2014 20%

17

19

15

Northern Cape

13

North West

13

KwaZulu-Natal

11

Limpopo

11

17

17

15%

10%

15

10

10

9

9

8.4

10

Free State

5%

7

Western Cape

4

5

Gauteng

2

11

South Africa 0%

5%

0%

10%

15%

20%

Poorest

Poorer

Middle

Richer

Secondary school

Mpumalanga

Primary school

Eastern Cape

2

Richest

Total

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

Many children across the country face serious learning difficulties

Less than half of children who reach Grade 9 adequately master their home language and nearly all fail to meet learning standards in mathematics

Percentage of pupils achieving acceptable proficiency in mathematics and language, by province and by grade, 2014

Percentage of pupils achieving acceptable proficiency in mathematics and language, by school grade, 2014

MATHEMETICS

LANGUAGE

80%

Eastern Cape

58

23

3

59

62

39

Free State

71

44

4

72

79

59

Gauteng

73

52

4

71

80

48

KwaZulu-Natal

71

36

3

71

77

49

Limpopo

49

21

1

57

60

27

Mpumalanga

60

27

2

63

78

61

Northern Cape

60

28

3

59

67

45

North West

54

27

1

60

75

57

Western Cape

73

51

6

68

82

49

South Africa

65

35

3

66

77

48

Grade 3

Grade 6

Grade 9

Grade 3

Grade 6

Grade 9

Source: Department of Basic Education (2015). Report on the Annual National Assessments of 2014. Pretoria: Department of Basic Education.

77 60%

66 65

48 40% 35 20% Language 3 0%

Grade 3

Grade 6

Mathematics

Grade 9

Source: Department of Basic Education (2015). Report on the Annual National Assessments of 2014. Pretoria: Department of Basic Education.

55

Global Goals for Every Child

Despite high levels of access to education, only half of young people have completed secondary schooling

Completion of schooling is markedly lower among children in the poorest households

Percentage of youth aged 20–24 years who have completed primary/secondary education, by province, 2014

Percentage of youth aged 20–24 years who have completed primary/secondary education, by quintile of expenditure per capita, 2014

100% 95

96

95

94

92

96

95

95

92

66

46

45

49

43 37

32

20%

Western Cape

KwaZuluNatal

Free State

North West

Northern Cape

Mpumalanga

Limpopo

Eastern Cape

51 40%

41 32

20%

0%

Poorest

Poorer

Middle

Richer

Richest

Quintile Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

© UNICEF/Schermbrucker

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

South Africa

Secondary school

49

Primary school

50

40%

Gauteng

67

60% 50

0%

85

80%

80%

60%

99

97

95

94

93

Secondary school

98

Primary school

100%

56

Education

Š UNICEF/Schermbrucker

Completion of schooling is markedly lower among children in the poorest households.

57

Global Goals for Every Child

Target 4.5 By 2030, eliminate gender disparities in education and ensure equal access to all levels of education and vocational training for the vulnerable, including persons with disabilities, indigenous peoples and children in vulnerable situations

Gender parity has been achieved in primary education, while girls are more likely than boys to attend and complete secondary education Net attendance ratios (NAR) and percentage of youth aged 20–24 years who have completed schooling, by level of education and by sex, 2014

100%

97

97

94 96

80% 75

80

60% 54 45

40%

Males

20%

School attendance Primary

Secondary

Female

97

Male

97

Ratio of females to males Rural Urban Ratio of rural to urban Poorest 20% Richest 20% Ratio of poorest to richest

School completion Primary

Secondary

80

96

54

75

94

45

1.00

1.07

1.02

1.19

97

76

93

35

97

79

97

57

1.00

0.96

0.96

0.61

97

74

93

32

98

85

99

85

0.99

0.87

0.94

0.37

Orphaned

96

74

94

40

Non-orphaned

97

79

96

55

0.99

0.94

0.98

0.73

With disability

90

43

63

22

Without disability

98

78

96

50

0.92

0.55

0.66

0.43

Ratio of orphans to non-orphans

Ratio of disabled to non-disabled Parity: 0.97–1.03 Near parity: 0.95–0.96 or 1.04–1.05 Disparity: < 0.95 or > 1.05

58

0%

Females Primary NAR

Secondary NAR

Primary school Secondary school

Access

Completion

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

Disparities between urban and rural children are small, except for completion of secondary schooling Net attendance ratios (NAR) and percentage of youth aged 20–24 years who have completed schooling, by level of education and by residence, 2014

100%

97

97

97

80%

79

93

76

60%

57

40% 35 Rural

20% 0%

Urban Primary NAR

Secondary NAR

Access

Primary school Secondary school Completion

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

Education

Children who have lost a parent have equal access to education, but are less likely to complete school

Children with disabilities lag furthest behind and are the most marginalised group

Despite the no fee school policy, children from the poorest households are less likely to complete their education

Net attendance ratios (NAR) and percentage of youth aged 20–24 years who have completed schooling, by level of education and by orphanhood status, 2014

Net attendance ratios (NAR) and percentage of youth aged 20–24 years who have completed schooling, by level of education and by disability status, 2014

Net attendance ratios (NAR) and percentage of youth aged 20–24 years who have completed schooling, by level of education and by wealth status, 2014

100%

100%

100%

40

20% 0%

Primary NAR

Secondary NAR

Access

Primary school Secondary school Completion

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

78 63 50 43

20% 0%

22 Primary NAR

Secondary NAR

Access

97

99

93 85

85 74

60% 40%

98

80%

Primary school Secondary school Completion

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

60% 40% 32

20% 0%

Primary NAR

Secondary NAR

Access

Primary school Secondary school Completion

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

© UNICEF/Schermbrucker

40%

Non-orphans

55

90

Poorest 20%

74

60%

96

Richest 20%

79

80% Orphaned children

80%

98

With disability

96 94

Non-disabled

97 96

59

Global Goals for Every Child

There are large differences in the availability of education facilities between South Africa’s provinces Percentage of schools with access to different types of infrastructure, by province, 2015

Eastern Cape Free State Gauteng KwaZulu-Natal Limpopo Mpumalanga North West Northern Cape Western Cape South Africa

Target 4.a Build and upgrade education facilities that are child, disability and gender sensitive and provide safe, non-violent, inclusive and effective learning environments for all

Communication facilities 99 99 100 99 99 99 100 99 100 99

Sports facilities 41 67 78 45 68 71 73 70 75 65

Computer centres 11 35 80 33 15 40 40 55 59 41

Libraries 8 35 63 24 7 19 22 28 55 29

Laboratory facilities 6 27 33 11 6 12 19 17 33 18

Source: Calculations based on data from the Department of Basic Education’s National Education Infrastructure Management System (NEIMS) Standards Report May 2015.

Good progress has been made to ensure that learners have access to textbooks

The use of corporal punishment by teachers is declining but remains high, especially in KwaZulu-Natal and Eastern Cape

Percentage of learners who indicated experiencing a lack of books at school, 2005 and 2014

Percentage of school-going children who experienced corporal punishment by teachers, by province, 2009 and 2014

Mpumalanga

5

North West

5

KwaZulu-Natal

4

Eastern Cape

4

Gauteng

4

2

Northern Cape

2

0%

14 25

21

Eastern Cape

21 12

Northern Cape

Gauteng Western Cape

8 4

15%

20%

25%

0%

20 13

8

3

12

3 3

South Africa

15 10%

6

25

15

12 11

Mpumalanga

11 9

24

12

6

North West

Source: Department of Basic Education (2015). General Household Survey (GHS): Focus on Schooling 2014. Pretoria: Department of Basic Education.

60

KwaZulu-Natal

Free State

7

5%

2009

Limpopo

8

3

Limpopo Free State South Africa

11 24

3

Western Cape

2014

2005

2014

12 5%

10%

16 15%

20%

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2009 and 2014.

25%

Education

Š UNICEF/Schermbrucker

Good progress has been made to ensure that learners have access to textbooks.

61

Global Goals for Every Child

06

South Africa has achieved high coverage of the use of improved drinking water sources Percentage distribution of the population by drinking water source in the home, 1990–2015

100%

Water and sanitation

80%

13

3 4

4

20

27

60%

73

56 Surface water

40%

Other unimproved 20%

Other improved Piped onto premises

0%

Goal 6 Ensure availability and sustainable management of water and sanitation for all

1990

1995

2000

2005

2010

2015

Note: Estimates are based on data from South Africa’s censuses and national household surveys, including the October Household Surveys, General Household Surveys, Demographic and Health Surveys, Income and Expenditure Surveys, World Health Survey, Study on Global Ageing and Adult Health and National Income Dynamics Study.

Source: WHO/UNICEF JMP (2015). South Africa: Estimates on the Use of Water Sources and Sanitation Facilities.

Geographic disparities have decreased, but children’s access to adequate water still lags in Eastern Cape, KwaZulu-Natal and Limpopo Percentage distribution of children 0–17 years old by source of drinking water in the home, by province, 2002 and 2014

2014

2002

2014

2002

2014

2002

100%

2002

By 2030, achieve universal and equitable access to safe and affordable drinking water for all

2014

Target 6.1 80% 60% Surface water

40%

Other unimproved 20%

0%

Eastern Cape

Limpopo

KwaZuluNatal

North West

Mpumalanga

Northern Cape

Free State

Gauteng

Source: Calculations based on data from Statistics South Africa’s General Household Surveys 2002 and 2014.

62

2014

2002

2014

2002

2014

2002

2014

2002

2014

2002

Other improved

Western Cape

Piped onto premises

Water and sanitation

Nationwide, nearly one in five children in the poorest households drink water from rivers, streams and other unimproved sources

More than one in five schools across the country do not have a reliable water supply

Percentage distribution of children by source of drinking water in the home, by quintile of expenditure per capita, 2014

Percentage of ordinary operational schools with no or an unreliable water supply, 2015

60%

5 6

8

2

3

1 8

2

20

30%

34 3 25

33

63

96

75

48

13 10%

10 7 3 4

Other improved Piped onto premises

Poorest

17

Surface water Other unimproved

22 2 20

21

20%

40%

0%

4

26

89

20%

40%

0 1 3

Poorer

Middle

Richer

Richest

0%

Eastern Cape

KwaZulu- Limpopo Natal

North West

Mpuma- Northern langa Cape

Free State

4 4

Unreliable water supply

80%

11

No water supply

100%

1

Gauteng Western Cape

South Africa

Quintile Source: Calculations based on data from the Department of Basic Education’s National Education Infrastructure Management System (NEIMS) Standards Report, May 2015.

© Photosky/Dreamstime.com

Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

63

Global Goals for Every Child

Access to piped water is especially problematic in the mountainous areas in Eastern Cape and KwaZulu-Natal Percentage of children living in households with access to piped water on-site or from communal taps, by municipality, 2011

Legend

Limpopo

Gauteng Less than 5% 5–15% 15–25%

North West

25% and above Mpumalanga

Province District municipality

Northern Cape

Local municipality

Free State KwaZulu-Natal

Western Cape Eastern Cape

Source: Calculations based on data from Statistics South Africa’s 10% sample of the Census 2011.

64

Water and sanitation

Š UNICEF

South Africa has made moderate progress in improving access to adequate sanitation.

65

Global Goals for Every Child

South Africa has made moderate progress in improving access to adequate sanitation Percentage distribution of the population by sanitation facilities, 1990–2015

66

Target 6.2

Open defecation

60% 17 40% 20%

By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations

0%

Improved sanitation facility

18

Shared

80%

4 8 22

14

Other unimproved

100%

51 1990

1995

2000

2005

2010

2015

Note: Estimates are based on data from South Africa’s censuses and national household surveys, including the October Household Surveys, General Household Surveys, Demographic and Health Surveys, Income and Expenditure Surveys, World Health Survey, Study on Global Ageing and Adult Health and National Income Dynamics Study.

Source: WHO/UNICEF JMP (2015). South Africa: Estimates on the Use of Water Sources and Sanitation Facilities.

The rate of progress varies between provinces: children’s access to sanitation has increased nearly fourfold in the Eastern Cape since the early 2000s Percentage of children living in households with access to RDP-standard sanitation facilities, 2002 and 2014

Limpopo 21

51

Mpumalanga

37

North West KwaZulu-Natal

2014

58 47

2002

67

35

71

Eastern Cape 21

76

Free State

52

83

© UNICEF/Schermbrucker

Northern Cape

66

78

Gauteng

86

Western Cape

92 92 95

South Africa 20%

85

48 40%

75 60%

80%

100%

Note: RDP standard toilet facilities refers to flush toilets connected to a public sewerage system or a septic tank, and a pit toilet with a ventilation pipe.

Source: Calculations based on data from Statistics South Africa’s General Household Surveys 2002 and 2014.

Water and sanitation

The poorest are least likely to use an improved sanitation facility Percentage of children living in households with access to RDP-standard sanitation facilities, by quintile of expenditure per capita, 2014

100% 97

92 80% 60%

79 71

66

40% 20% 0%

Poorest

Poorer

Middle

Richer

Richest

Quintile Source: Calculations based on data from Statistics South Africa’s General Household Survey 2014.

Nearly 30% of schools only have an unimproved pit or no sanitation facilities at all Percentage of ordinary operational schools with no sanitation or only an unimproved pit, 2015

55

Eastern Cape 35

KwaZulu-Natal 26

Limpopo 24

Mpumalanga 19

Free State 15

North West Northern Cape

2 © UNICEF/Schermbrucker

Gauteng < 1 Western Cape < 1 29

South Africa 0%

10%

20%

30%

40%

50%

60%

Source: Calculations based on data from the Department of Basic Education’s National Education Infrastructure Management System (NEIMS) Standards Report, May 2015.

67

Global Goals for Every Child

In 13 municipalities, more than a quarter of children live in households still practising open defecation Percentage of children living in households with no toilet facility, by municipality, 2011

Legend

Limpopo

Gauteng Less than 5% 5–15% 15–25%

North West

25% and above Mpumalanga

Province District municipality

Northern Cape

Local municipality

Free State KwaZulu-Natal

Western Cape Eastern Cape

Source: Calculations based on data from Statistics South Africa’s 10% sample of the Census 2011.

68

Water and sanitation

Š Tjkphotography/Dreamstime.com

In 13 municipalities, more than a quarter of children live in households still practising open defecation.

69

Global Goals for Every Child

07

Many children have experienced violence or threats of violence in their lifetimes Percentage of school-going children aged 15–17 years who ever experienced victimisation as a result of conventional crime, by type of crime, 2014

50%

Child protection

45 40% 30% 26 20%

21

19

16

10% 0%

Goal 5

Has experienced theft

Has been robbed

Has been threatened Has been attacked with violence without a weapon

Has been attacked with a weapon

Source: CJCP (2015). Research Bulletin: The Optimus Study on Child Abuse, Violence and Neglect in South Africa. Cape Town: Centre for Justice and Crime Prevention.

Achieve gender equality and empower all women and girls

The share of deaths due to interpersonal violence increases as children enter adolescence, especially among boys

Goal 16

Percentage of deaths due to interpersonal violence, by age group and by sex, 2013

Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels

Target 16.1 Significantly reduce all forms of violence and related death rates everywhere

20%

Males Females

15%

10%

5%

0%

0–4

5–9

10–14

15–19

20–24

Age group Source: IHME (2015). GBD Compare. Seattle, WA: Institute for Health Metrics and Evaluation, University of Washington, 2015. Available from: vizhub.healthdata.org/gbd-compare.

70

Child protection

A large share of families do not allow their children to walk to school or to play outside the home because of fear of crime Percentage of households with children who do not allow their children to walk to school or to play outside because of fear of crime, by province, 2014/15

50% 44 40% 38 34

30%

29

26 20%

24 19

25

23 17

17

10%

16 11

18

16 9 4

0%

Western Cape

Gauteng

Northern Cape

Free State

KwaZulu-Natal Eastern Cape

Mpumalanga

Does not allow children to walk to school

7

2

North West

6

Limpopo

Does not allow children to play outside South Africa

Source: Calculations based on data from Statistics South Africa’s Victims of Crime Survey 2014/15.

Percentage of households with children who do not allow their children to walk to school or to play outside because of fear of crime, by population group, 2014/15

Percentage of school-going children aged 15–17 years who have ever been exposed to violence in the home, by type of violence, 2014

50%

40%

44

46

43 37

34

30% 28

22

20% 15 10%

0%

Does not allow children to play outside

Nearly a quarter of children have been exposed to violence within their families

Does not allow children to walk to school

There are marked differences in fear of crime between South Africa’s population groups

Ever seen a parent get kicked, choked or beaten up by another parent

Indian/Asian

Coloured

14

Ever seen a parent get hit or slapped by another parent

19

Ever seen a parent threaten to hurt another parent and it seemed they might get hurt

24

Ever seen a parent hit, beat, kick or physically hurt brothers or sisters 0%

White

Note: Based on self-administered questionnaires among randomly selected children across Grades 10 to 12.

23

Exposure to any family violence

28 5%

10%

15%

20%

25%

30%

Black African

Source: Calculations based on data from Statistics South Africa’s Victims of Crime Survey 2014/15.

Source: CJCP (2015). Research Bulletin: The Optimus Study on Child Abuse, Violence and Neglect in South Africa. Cape Town: Centre for Justice and Crime Prevention.

71

Global Goals for Every Child

Maltreatment and abuse of children is widespread in South Africa Percentage of school-going children aged 15â&#x20AC;&#x201C;17 years who have ever experienced abuse, by type of abuse, 2014

Target 5.2 Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation

Target 16.2

40% 35

35

30%

20% 16

15

10%

0%

Sexual abuse

Physical abuse

Emotional abuse

Child neglect

Source: Artz, L. et al. (2016). Sexual Victimisation of Children in South Africa. Final Report of the Optimus Foundation Study: South Africa. Zurich: UBS Optimus Foundation.

Š UNICEF/Schermbrucker

End abuse, exploitation, trafficking and all forms of violence against and torture of children

Note: Based on questionnaires administered to randomly selected children across Grades 10 to 12.

72

Child protection

Percentage of school-going children aged 15–17 years who ever experienced any sexual abuse, by type, 2014

Percentage of school-going children aged 15–17 years who ever experienced any sexual abuse, by sex, 2014

By adults

Boys and girls are equally vulnerable to sexual abuse, although the types of abuse they experience tend to be different

Abuse with contact (without consent)

By other children

One in three adolescents report having experienced some form of sexual abuse in their lifetime

Abuse (without consent)

40%

11

37 16

Sexual experience with an adult 9

Forced sexual intercourse (actual or attempted)

20%

12 13

Sexual harassment (verbal or written)

10% 35

Experienced any form of abuse 0%

35

34

30%

Note: Girls more likely to experience ‘contact sexual abuse’ than boys, who report higher levels of ‘exposure’ and non-contact forms of sexual abuse.

5%

10%

15%

20%

25%

30%

35%

0%

Boys

Girls

Total

Note: Based on self-administered questionnaires among randomly selected children across Grades 10 to 12.

Source: Artz, L. et al. (2016). Sexual Victimisation of Children in South Africa. Final Report of the Optimus Foundation Study: South Africa. Zurich: UBS Optimus Foundation.

Source: Artz, L. et al. (2016). Sexual Victimisation of Children in South Africa. Final Report of the Optimus Foundation Study: South Africa. Zurich: UBS Optimus Foundation.

More than half of all reported crimes against children are sexual offences

The number of cases of child neglect and ill-treatment is decreasing, but data are plagued by under-reporting

Percentage distribution of reported contact crimes against children by type, 2013/14

Number of cases of neglect and ill-treatment of children reported to the police, 2004/05–2014/15 6,000

2% 2%

Sexual offences

20%

5,568

4,000

Common assaults

53%

Attempted murder

23%

2,398

Assaults with intent to wound 2,000

Murder

0 Source: South African Police Service (SAPS) Crime Statistics.

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Source: South African Police Service (SAPS) crime statistics. Available from: www.issafrica.org/crimehub.

73

Global Goals for Every Child

South Africa is on track to achieve universal coverage of birth registration: 95% of children under 5 have a birth certificate

100%

13

3

4

3

3

97

96

97

97

24–35

36–47

48–59

87

By 2030, provide legal identity for all, including birth registration

75%

50%

25%

0%

Significant progress has been achieved in improving the timeliness of birth registration in all provinces

0–11

12–23

Has a birth certificate

Target 16.9

Does not have a birth certificate

Percentage of children under age 5 with a birth certificate, by age (in months), 2014–2015

Age in months Source: Calculations based on data from SALDRU’s National Income Dynamics Study (NIDS) 2014–2015, Wave 4 (dataset version 1.0) using post-stratified, cross-sectional weights.

Percentage of recorded births that were registered within the year of birth, by province, 1998 and 2014

Birth registration rates are somewhat lower among children from the poorest households Percentage of children under age 5 with a birth certificate, by quintile of expenditure per capita, 2014–2015

Mpumalanga KwaZulu-Natal

82

10

0%

9 91

80

16

5 95

4

4

96

96

Middle

Richer

0 100

75%

79

13

79

14

50%

75

13

Gauteng South Africa

100%

86

34

North West Eastern Cape

86

42

Free State

65

50

1998

76

22 20%

2014

40%

60%

80%

25%

Has a birth certificate

Northern Cape Limpopo

87

71

Does not have a birth certificate

Western Cape

100% 0%

Poorest

Poorer

Richest

Quintile Note: The relatively low figure for Gauteng is mainly attributed to the centralisation of the processing of late birth registrations from 15 years of age in the City of Tshwane district municipality.

Source: Calculations based on data from Statistics South Africa’s recorded live births 1998 and 2014 datasets.

74

Source: Calculations based on data from SALDRU’s National Income Dynamics Study (NIDS) 2014–2015, Wave 4 (dataset version 1.0) using post-stratified, cross-sectional weights.

Child protection

Š UNICEF/Schermbrucker

South Africa is on track to achieve universal coverage of birth registration.

75

Global Goals for Every Child

Technical note

About the data Data presented in this publication are derived from a wide range of national and international sources. This note provides a brief description of the datasets that were consulted and analysed to compile information on progress and disparities among children in South Africa.

Census and surveys • Population and housing census: South Africa’s latest census was conducted in 2011. It collected information on household characteristics, including dwelling type, home ownership, household assets, access to services and energy sources, and individuals’ characteristics, including age, population group, language, religion, citizenship, migration, fertility, mortality, employment status, employment activities, and health and functioning. Secondary data analysis was carried out of the 10% sample database released by Statistics South Africa in 2015.

• General Household Survey: The GHS is a national household survey that has been conducted annually by Statistics South Africa since 2002. It is designed to measure multiple facets of the living conditions of South African households and covers six broad areas, namely: education, health, social development, housing, household access to services and facilities, food security and agriculture. The target population of the survey consists of all private households in all nine provinces of South Africa and residents in workers’ hostels. The survey does not cover other collective living quarters such as students’ hostels, old-age homes, hospitals, prisons and military barracks, and is therefore only representative of non-institutionalised and non-military persons or households in South Africa. Secondary data analysis was carried out of the GHS 2014 dataset and selected previous years.

• National Income Dynamics Study: The NIDS is a longitudinal survey of individuals and their households implemented by the Southern Africa Labour and Development Research Unit (SALDRU) based at the University of Cape Town’s School of Economics. It examines changes in poverty and well-being; household composition and structure; fertility and mortality; migration; labour market participation and economic activity; human capital formation, health and education; vulnerability and social capital. The study began in 2008 with a nationally representative sample of over 28,000 individuals in 7,300 households across the country. The survey was repeated in 2010–2011 (Wave 2), 2012 (Wave 3) and 2014–2015 (Wave 4). Secondary data analysis was carried out of the Wave 4 dataset (version 1).

• Income and Expenditure Survey: The IES is conducted every five years by Statistics South Africa, most recently in 2010/11. The main purpose of the survey is to determine the average expenditure patterns of households in

76

Technical note

different areas of the country. This survey forms the basis for the determination of the ‘basket’ of consumer goods and services used for the calculation of the Consumer Price Index (CPI).

• Living Conditions Survey: T he LCS is a periodic survey conducted by Statistics South Africa to identify and profile poverty in the country, and to give policy-makers information on who is poor, where the poor are located and what it is that drives poverty. The information collected is also used to update the CPI basket of goods and services which is used to track inflation.

• South African National Health and Nutrition Examination Survey: T he SANHANES collects data on the health and nutritional status of South Africans with respect to the prevalence of non-communicable diseases (specifically cardiovascular disease, diabetes and hypertension) and their risk factors (diet, physical activity and tobacco use). It was conducted in 2012 by the Human Sciences Research Council (HSRC).

• National Antenatal Sentinel HIV Prevalence Survey: This annual survey by the Department of Health collects data from 24 cross-sectional antenatal sentinel points to monitor HIV infection trends, at national, provincial and district levels in South Africa, using the standard unlinked and anonymous methodology (WHO/UNAIDS).

• National HIV, Behaviour and Health Survey: This HSRC-led survey collects data on the HIV status of individuals and information on socio-demographic and behavioural factors. It was conducted in 2002, 2005, 2008 and 2012.

• Victims of Crime Survey: T he VOCS is a regular country-wide household survey by Statistics South Africa that focuses on people’s perceptions and experiences of crime, as well as their views regarding access to and effectiveness of the police and justice system. Households are also asked about community responses to crime.

Secondary data analysis was carried out of the VOCS 2014/15 dataset.

• Optimus Study on Child Abuse, Violence and Neglect: The Optimus Study provides the first-ever representative data in South Africa on child maltreatment and exposure to other forms of violence. It was conducted by the Centre for Justice and Crime Prevention (CJCP) and the University of Cape Town (UCT). The study forms part of a larger programme on comparative research on the subject, with studies conducted in Switzerland and China.

• Survey of Activities of Young People: T he SAYP is a household-based sample survey that collects data on the activities which children aged 7 to 17 years get involved in, including market production activities, production for own final consumption and household chores, as well as school activities. It was implemented as a supplement to the Quarterly Labour Force Survey (QLFS) in Q3 in 2010.

• Other surveys that were used for trend analysis in this publication include: the Community Survey 2007; the National Food Consumption Survey (NFCS) 1999 and 2005; the Demographic and Health Survey (DHS) 1998 and 2003; the National Youth Risk Behaviour Survey 2008; and the Living Standards and Development Survey 1993.

77

Global Goals for Every Child

Administrative data sources • Education Management Information System: The EMIS is maintained by the Department of Basic Education and contains data on a wide range of indicators related to education.

• National Education Infrastructure Management System: The NEIMS contains data about the condition of infrastructure and facilities at each of public schools across the country.

• SOCPEN: T he South African Social Security Agency (SASSA) releases monthly SOCPEN reports with updated statistics on the coverage of different social assistance grants.

• Recorded live births: This dataset, released annually by Statistics South Africa, contains information on all births recorded on the National Population Register and can be used, for example, to explore timely and late registration of children’s births.

• Causes of death: T his dataset, released annually by Statistics South Africa, contains information on mortality and causes of death based on death notifications registered at the Department of Home Affairs, including child deaths.

• District Health Barometer: F unded by the National Department of Health, the annually published DHB tracks a wide range of health indicators at the district level.

• Crime statistics: The South African Police Service (SAPS) maintains a database with crime statistics. Statistical reports are released into the public domain annually.

Other data sources • Mid-year population estimates: T he annual mid-year population estimates released by Statistics South Africa contain data at national and provincial level, disaggregated by age groups.

• United Nations Inter-Agency Group for Child Mortality Estimation: The UN IGME publishes annual estimates of child mortality using a common statistical approach to reconcile estimates from different national sources.

• United Nations Maternal Mortality Estimation Inter-Agency Group: The UN MMEIG publishes annual estimates of maternal mortality using a common statistical approach to reconcile estimates from different national sources.

• WHO/UNICEF estimates of national immunisation coverage: WHO and UNICEF release annual estimates of the coverage of immunisation, based on surveys and administrative data submitted by countries.

• UNAIDS estimates of HIV prevalence: The UNAIDS Secretariat releases annual estimates of HIV prevalence and related indicators. The estimates are based on national Spectrum files that are developed and maintained by a country team of experts.

78

References

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Global Goals for Every Child

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