UNICEF 'What We Do' Report

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Young Child Survival and Development Overview Maternal and Newborn Health Nutrition Immunization Community Case Management of Pneumonia, Diarrhoea and Malaria and Malaria Control Water, Sanitation and Hygiene Water, Sanitation and Hygiene in Emergencies

6–7 8–10 11–15 16–17 18–21 22–24 25–26

Basic Education and gender equality Overview Early Childhood Development Child–Friendly Education Girls’ Education Education in Emergencies

28–29 30–32 33–35 36–39 40–42

Child protection Overview Birth Registration Violence against Children

44–47 48–49 50–52

Children and AIDS Overview First Decade Second Decade Across Both Decades

54–57 58–60 61–63 64–66

Social policy Overview Social Budgeting Social Protection

68–70 71–75 76–78

Emergencies Overview Disaster Risk Reduction Resilience

80–81 82–83 84–85

All data are based on UNICEF’s The State of the World’s Children, 2014, unless indicated otherwise.



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The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the United Nations. Final boundary between the Republic of the Sudan and the Republic of South Sudan has not yet been determined.

Department of Field Support Cartographic Section


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oveRview Over the past two decades, Eastern and Southern Africa, together with the rest of the world, has achieved a significant decline in under–five mortality. In 1990, 1 in 6 children died before their fifth birthday; by 2012, this number had dropped to 1 in 13, a more than 50 per cent decline.

In fact, in the past several years, ESA has been among the best performing regions in the world. Countries such as Ethiopia, Malawi and Tanzania have already reduced the under–five mortality rate by two–thirds or more. Together with other low–income countries in the region, Madagascar, Mozambique, South Sudan, Uganda and Zambia, they have all achieved reductions, in absolute terms, of more than 100 deaths per 1,000 live births. Despite these successes, ESA still has high rates of mortality. Out of the 20 countries with the highest under–five mortality in the world, five are in this region: Angola, Burundi, Lesotho, Somalia and South Sudan, with 14 in West and Central Africa, and one in Asia. High levels of fertility have also led to a rather gradual decrease in the absolute number of child deaths, from 1.7 million in 1990 to 1.2 million in 2012. Despite the availability and effectiveness of the treatments, children continue to die from causes that can be easily prevented. Pneumonia, diarrhoea and malaria are the biggest killers of children under five years of age. Across the region, disparities are vast and also widening. Children born in the poorest households are almost twice as likely to die before the age of five as children in the wealthiest households. Young children born in a rural area or to a mother who has very little or no education are also at greater risk of dying.

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Under–five mortality rates in ESA (per 1,000 live births) Country

1990

2012

MDG target 2015

Angola

231

164

81

Botswana

48

53

18

Burundi

164

104

61

Comoros

124

78

41

Eritrea

150

52

46

Ethiopia

204

68

66

Kenya

98

73

33

Lesotho

85

100

29

Madagascar

159

58

54

Malawi

224

71

76

Mozambique

233

90

75

Namibia

73

39

24

Rwanda

151

55

52

Somalia

177

147

60

South Africa

251

45

21

South Sudan

251

104

n/a

Swaziland

71

80

28

Tanzania

166

54

53

Uganda

178

69

59

Zambia

192

89

64

Zimbabwe

74

90

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© UNICEF/NYHQ2006–0171/Kamber

overview

“Over the past two decades, Eastern and Southern Africa has achieved a significant decline in under–five mortality. In 1990, 1 in 6 children died before their fifth birthday; by 2012, this number had dropped to 1 in 13, a more than 50 per cent decline.” unicef in eastern & southern africa

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Maternal health Across Eastern and Southern Africa, women are still dying unnecessarily during the most basic and natural act of giving life. In 2010, close to 58,0001 women lost their lives during pregnancy and childbirth, accounting for more than one fifth of all such deaths in the world. Of the region’s 21 countries, 16 have high maternal mortality rates (300 or more maternal deaths per 100,000 live births). In Somalia, a woman’s lifetime risk of dying from maternal causes is 1 in 16, a close second to Chad’s 1 in 15 – the highest in the world. Thanks to national and international efforts, the past two decades have witnessed a worldwide downward trend in maternal deaths. In ESA, between 1990 and 2010 maternal mortality has fallen from 740 to 410 deaths per 100,000 births. However, the pace of progress is far too slow.

“In 2010, 58,000 women in Eastern and Southern Africa lost their lives in pregnancy and childbirth. That’s one fifth of all such deaths in the world!” Only Eritrea is on track to reach MDG 5, reducing maternal deaths by three–quarters by 2015. Angola, Comoros, Ethiopia, Madagascar, Malawi, Mozambique, Rwanda, Tanzania and Uganda are making progress (annual average decline of 2–5.5 per cent), while the other countries are making insufficient (less than 2 per cent) or no progress at all. Hemorrhage is by far the leading cause of maternal deaths. Together with hypertension, it accounts for more than half of all maternal deaths. HIV–related illnesses also play a major role in maternal deaths, especially in Southern Africa where HIV prevalence is high. Despite impressive progress in HIV prevention and treatment for women and children, the ‘indirect’, AIDS– related maternal mortality is over 50 per cent in countries such as Swaziland (67 per cent), South African (60 per cent), Namibia (59 per cent), and Botswana (56 per cent). Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates.

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Maternal and newborn health

Newborn health The health and survival of newborns is closely linked and interdependent with that of their mothers. In most of sub–Saharan Africa, including ESA, neonatal mortality has seen no significant change in over a decade. Over 4 in 10 under–five deaths are among newborns up to 28 days of age, making neonatal mortality reduction increasingly the ‘unfinished business’ of under–five mortality reduction. Ethiopia, Angola, Kenya, Tanzania, Uganda, Mozambique and Somalia account for close to 70 per cent of all neonatal deaths in the region. Maternal and newborn deaths are heavily concentrated around the period of delivery, the day of birth, and the first week following birth, as evident in 50 per cent of all maternal and newborn deaths occurring in the first 24 hours of birth. Yet, more than half of all births in the region take place at home, without the support of a skilled birth attendant. Moreover, less than 1 in 4 postpartum mothers and newborns receive a postnatal visit within 48 hours of birth. This means that the majority of mothers receive no care to prevent or manage complications; initiate and sustain exclusive breastfeeding; and adopt practices, such as cord care, to stave off infection. It also means that should newborns become sick they would not receive adequate treatment or timely referral to clinics.

UNICEF in action

© UNICEF/MLWB2009–00050/Pirozzi

There is now a clear understanding of when, where and why mothers and newborns are dying. Many, up to two thirds, maternal deaths and newborn deaths could be avoided if mothers and newborns were attended at birth by skilled health professionals; received postnatal care, especially the first day and first week; and if essential supplies, equipment and facilities were available. The reasons why mother and newborns are not receiving adequate maternal and antenatal care are largely due to poor health and social infrastructure, weak service delivery, and a shortage of qualified health workers. Compared to their well– off peers, the poor populations are more acutely affected by these challenges. UNICEF’s analyses consistently show that the indicators in maternal and neonatal mortality reflect the greatest and most persistent health inequity worldwide. Supporting national governments, UNICEF, together with the partners under the United Nations Health 4+ (UNH4+) mechanism – WHO, UNFPA, the World Bank, UNAIDS and UN Women, as well as other development partners, civil society organizations and communities, works towards averting of these unnecessary deaths. unicef in eastern & southern africa

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youNg cHiLD suRvivaL & DeveLoPmeNT

Maternal and newborn health

Results for children • As part of the renewed push to end preventable deaths, UNICEF supported countries with analyses to better respond to and avert maternal and newborn deaths. Ethiopia, Zambia, Uganda and Malawi have completed such analyses, highlighting major bottlenecks that hinder the reach and quality of maternal and newborn care services.

• Four of the eight “pathfinder” countries under the UN Commission on Lifesaving Commodities (UNCoLSC) – Ethiopia, Malawi, Tanzania, and Uganda – committed themselves at the highest level to ensure access to quality, yet long neglected lifesaving drugs for women, newborns and children.

• High HIV burden countries in ESA have achieved good progress in the elimination of mother–to–child transmission (eMTCT) of HIV. Seven countries – Botswana, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe – have attained PMTCT coverage of over 80 per cent, and are on track to meet the eMTCT goals by 2015.

• As a region, ESA is increasingly embracing the adoption of an institutionalized community health workforce with clear roles and responsibilities for service delivery at the community level, as exemplified by Ethiopia’s Health Extension Programme. Community health workers in four countries – Ethiopia, Rwanda, Malawi, Uganda and Zambia – now have explicit responsibility for maternal and newborn health promotional and preventive care, as well as providing referral services for sick newborns.

• Ten out of the 21 countries – Botswana, Ethiopia, Kenya, Lesotho, Madagascar, Malawi, Rwanda, South Africa, Uganda and Zambia – have a policy on postnatal home visits for mothers and newborns during the first week of life although implementation is still limited.

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Proper nutrition is a powerful good: children who are well nourished are more likely to be healthy, productive and able to learn. Malnutrition is, by the same logic, devastating. It blunts intellect, saps productivity, and perpetuates poverty for any family and society it touches. While significant progress has been made in ensuring proper nutrition for children, challenges remain throughout the world. For Eastern and Southern Africa, stunting, also referred to as chronic malnutrition (low height for age), is of a particular concern with more than 25 million, or 39 per cent of children under five years of age suffering from it. In addition, 18 per cent of under–fives are underweight (they weigh too little for their age); and 7 per cent are suffering from acute malnutrition (also called wasting, a rapid loss of weight because of illness or insufficient food intake). Unlike

underweight and wasting, stunting is largely irreversible, and it is affecting more children than the first two conditions combined in the region. There are many factors contributing to malnutrition. One of the most significant is the low rate of exclusive breastfeeding from birth to six months of a child’s life. Studies have shown that exclusive breastfeeding is one of the single most effective interventions to combat child mortality. Yet, in ESA, just over half of infants are being exclusively breastfed in that crucial period. Furthermore, inadequate complementary feeding for children older than six months; low consumption of iodized salt by households; low vitamin A coverage for children under–five; and anaemia during pregnancy, all contribute to malnutrition in children.

“One of the most compelling investments is to get nutrients to the world’s undernourished. The benefit from doing so – in terms of increased health, schooling, and productivity – are tremendous.” – Vernon Smith, Nobel Laureate Economist

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Malnutrition the complex and related causes and long–term impacts of malnutrition

maternal and child undernutrition

Impaired brain & cognitive development

Inadequate dietary intake

Immediate causes

Immediate causes operating at the individual level household food insecurity

Poor school performance

Disease

Inadequate care

unhealthy household environment & lack of health services

income poverty: employment, self–employment dwelling, assets, remittances, pensions, transfers etc

Lack of capital: financial, human, physical, social & natural

underlying causes

Underlying causes influencing households and communities basic causes

Impaired productivity & earnings

social, economic, & political context

Source: UNICEF Conceptual Framework for Malnutrition 1990, modified by Black et al, Lancet 2008

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Basic causes around the structure and processes of societies


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Nutrition

UNICEF in Action As data have confirmed, malnutrition starts in utero and increase markedly from three to 23 months of age. Ensuring adequate nutrition during this ‘1000 days window of opportunity’, therefore, is critical in preventing long–term and irreversible damage to children’s health and cognitive and physical development. Together with more than 100 organizations and groups, UNICEF is a partner in the Scaling Up Nutrition (SUN) movement, a global effort to advance health and development through improved nutrition at country levels. The partnership focuses on implementing evidenced–based nutrition interventions and integrating nutrition goals into broader health, development and agricultural efforts.

Routes to better nutrition • Adequate food and nutrient intakes through promoting agriculture and food security;

• ensuring access to health care, including maternal and child health care, water, hygiene and sanitation, immunization, education, family planning, among others.

© UNICEF/NYHQ2010–3086/Pirozzi

• improving social protection, including emergency relief; and

To tackle the widespread and growing problem of malnutrition, UNICEF, together with the European Union launched Africa’s Nutrition Security Partnership (ANSP) to improve nutrition security among women and young children on the continent. The partnership aims to address the root causes of malnutrition, and create an environment of pro–nutrition policy and programmes. unicef in eastern & southern africa

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youNg cHiLD suRvivaL & DeveLoPmeNT

Nutrition

In addition, UNICEF also works in the following areas: Infant and young child feeding Under the Guiding Principles for Complementary Feeding of the Breastfed Child, UNICEF advocates exclusive breastfeeding in the first six months of life and continued breastfeeding up to two years and beyond.

Micronutrient deficiencies Many lives can be saved and improved through a range of cost–effective interventions, including micronutrient supplementation and fortification. To this end, UNICEF supports countries to deliver vitamin A supplementation to children 6–59 months through routine health programmes and also campaigns such as the Child Health Days. It also fosters partnerships to support countries on salt iodization; and leverages funding, commitment and innovations for better essential vitamin and mineral intake of children.

HIV and nutrition HIV has a profoundly negative impact on the nutritional status of children. While the interactions between HIV and nutrition exist at many levels, nutrition programmes are often carried out in a more vertical fashion. In response, UNICEF, together with partners, works on integrating service delivery for prevention and treatment of HIV and undernutrition in children.

Integrated management of severe acute malnutrition Given the lack of a systematic approach to the scale up of community–based management of acute malnutrition, a framework for integration of management of severe acute malnutrition (IMSAM) into national health systems has been developed and is being piloted in the region.

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Results for children • Over the years, awareness of nutrition issues, particularly stunting, has increased, thanks to advocacy informed by researches and partners. Sixteen out of the 21 countries in ESA now have improved nutrition plans that no longer treat nutrition as a standalone sector, but one that needs to be integrated with health, agriculture, sanitation, welfare, education and others.

• Thirteen countries are in the SUN partnerships, with Burundi and South Sudan being the newest signatories.

• Ten countries have all or most of the provisions of the Code for Marketing of Breastmilk Substitutes as law, with Kenya and South Africa having just recently passed this into legislation.

• Most countries in the region have bi–annual mass vitamin A supplementation as part of the Child Health Day campaign, together with other high impact interventions such as de–worming, immunization and distribution of insecticide– treated mosquito nets.

• Countries are increasingly recognizing Integrated Management of Acute Malnutrition (IMAM) as part of the minimum core package of nutrition interventions. Seventeen of the 21 countries in the region have begun to build national capacities to scale up this approach.


© UNICEF/MLWB2010–00035/Noorani


Immunization, one of the most cost–effective public health interventions, has been protecting children everywhere against common yet potentially life–threatening diseases over the past two centuries. In Eastern and Southern Africa, immunization has long been a standard health care service in all countries, and enormous progress has been achieved.

“In 2012, out of the 14.3 million children under one in Eastern and Southern Africa, 13 per cent, or 1.8 million, were left unprotected.” The vaccines under the current routine immunization programmes protect children against a wide range of common childhood diseases, including tuberculosis (BCG), diphtheria, pertussis (whooping cough) and tetanus (jointly referred to as DPT), polio, measles, hepatitis b (HepB) and meningitis (Hib). Regional coverage for each of the vaccines is above 70 per cent, with some countries achieving 90 per cent of coverage for DPT31.

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In recent years, new vaccines have been introduced to ESA and developing countries around the world to protect children from pneumonia (PCV) and diarrhoea (rotavirus vaccine), two of the biggest child killers, and the human papillomavirus (HPV). Still, many children are not reached, particularly those from the most marginalized and excluded communities. In 2012, out of the 14.3 million children under the age of one covered under routine immunization in all 21 ESA countries, 13 per cent, or 1.8 million, were left unprotected. Most of these children were from rural and remote areas, as well as from urban slums. Children affected by conflict, and those whose families and communities refused to have them immunized, were also part of that group. Nearly 90 per cent of all un– immunized children lived in nine countries – Angola, Ethiopia, Kenya, Madagascar, Somalia, South Sudan, Tanzania, Uganda and Zambia. The Horn of Africa had been polio–free for years, but with the confirmation of a two–year old child infected with the virus in Somalia in May 2013, that record no longer holds. To date, some 200 children and adults have been affected, mainly in Somalia, and also Kenya and Ethiopia. Thanks to the rapid responses by the region’s governments and their partners, the progression of the outbreak has been significantly eased off. The risk of the virus continuing to spread, however, remains high, particularly with close to one million children, most of them in Somalia, have never been immunized or have not received the required number of doses in the Horn of Africa. Three doses of diphtheria, pertussis (whooping cough) and tetanus vaccine.

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youNg cHiLD suRvivaL & DeveLoPmeNT

Immunization

UNICEF in action

Results for children

In response to the challenges in global immunization, WHO and UNICEF developed the Global Immunization Vision and Strategy (GIVS). Launched in 2006, GIVS is a 10–year framework (2006–2015) aimed at controlling illness and death from vaccine–preventable diseases, and helping countries immunize more people with a greater range of vaccines and innovative technologies. Under GIVS, the goal for every country is to ensure that at a national level, 90 per cent of children under one year of age are reached through routine immunization, and at least 80 per cent in every district or equivalent administrative unit. Another goal is to reduce deaths by measles by 90 per cent compared to the 2000 level. In addition, UNICEF, together with partners under the Global Alliance for Vaccines and Immunization (GAVI), helps introduce new and improved vaccines to all countries.

• Botswana, Burundi, Eritrea, Malawi, Rwanda, Swaziland, Tanzania and Zimbabwe reached the GIVS national DPT3 coverage of more than 90 per cent in 2011. Eight other countries – Angola, Comoros, Kenya, Lesotho, Madagascar, Namibia, Uganda and Zambia – are moving towards this target, with DTP3 coverage between 80 and 89 per cent.

• Angola, a country where poliovirus was re– introduced in 2005, made significant progress, with no cases reported since 2012.

• All countries in ESA now conduct periodic follow–up immunization campaigns as part of the regional strategies to control and eliminate measles.

© UNICEF/Kenya/2013/Kun Li

• Fifteen countries in the region have been validated for the elimination of maternal and neonatal tetanus, with Tanzania being validated the latest in 2012.

For the children who are missed during routine immunization, UNICEF and WHO use a number of strategies to close the gap, including advocacy with faith–based leaders. Bi–annual Child Health Days, which combine immunization with vitamin A supplementation, de–worming, and other health interventions, also contribute greatly to the overall immunization efforts.

• Six countries – Burundi, Ethiopia, Kenya, Malawi, Rwanda and South Africa – added the pneumococcal conjugate vaccine (PCV) to their routine immunization programmes. Three countries – Botswana, Rwanda and South Africa – introduced the rotavirus vaccine to protect children against diarrhoea.

• Rwanda has become the only country in the region to have introduced the human papillomavirus vaccine (HPV) for girls aged 9–13, to protect them against cervical cancer, among other diseases, when they become sexually active.

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Across Eastern and Southern Africa, pneumonia, diarrhoea and malaria are the biggest killers of children. In 2012, an estimated 197,000 children died from pneumonia, 115,000 from diarrhoea and 84,000 from malaria. Most of these deaths are preventable, and the treatments are simple and cost–effective. Yet, they remain out of reach for many children, particularly those in the most disadvantaged and marginalized communities.

Total numbers of under–five deaths caused by pneumonia, diarrhoea and malaria in ESA countries, 2012 80 000

70 000

60 000

Malaria

50 000

Diarrhoea 40 000

Pneumonia

30 000

20 000

10 000

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Community Case Management of pneumonia, diarrhoea and malaria and malaria control

The core of iCCM is the Community Health Workers (CHWs), who are trained to prevent and treat these common childhood diseases, and also provide referral services to the families they serve. They are equipped with rapid diagnostic tools, and low– cost, but life–saving medicines, such as artemisinin combination therapy (ACT) drugs for malaria, amoxicillin for pneumonia and oral rehydration salts and zinc tablets for diarrhoea. By reaching the most excluded and marginalized children, CHWs play a critical role in narrowing the gap of inequity in a country’s health systems. Over the past two years, some countries have also started training CHWs to provide care for newborn babies and children, including detecting early signs of malnutrition, and providing ready–to–use therapeutic food for severely malnourished children.

Malaria control Malaria not only kills, it also leads to high levels of anaemia in children and pregnant women, increasing the number of babies born with low birth weight – one of the key underlying causes of infant mortality and developmental delays in children. It is a disease of poverty, affecting mainly the poor living in malaria–prone rural areas that offer few, if any, barriers against mosquitoes. In addition to treatment of malaria through iCCM, malaria can be prevented through the use of insecticide–treated nets (ITNs), which can effectively reduce child mortality by 20 per cent, and indoor spray with insecticides. Since 2005, more than 80 million ITNs have been provided to rural families across the region, and millions of houses have been sprayed with insecticides. These investments have successfully cut malaria cases by more than half in ESA, contributing greatly towards reaching the Millennium Development Goal (MDG) 4 of reducing under–five mortality by two thirds by 2015.

© UNICEF/NYHQ2010–1825/Noorani

Since 2005, governments in the region, with support from UNICEF and other partners, have rolled out an ambitious strategy – integrated Community Case Management, or iCCM – to save children from dying unnecessarily from these killer diseases.

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UNICEF in action In countries throughout ESA, UNICEF is at the forefront of expanding iCCM to halt pneumonia, diarrhoea and malaria at the community level. To improve diagnosis and treatment of these diseases, UNICEF plays a vital role in the procurement, distribution and management of rapid diagnostic tools and essential medicines, as well as ITNs. Support is also provided to help countries train and manage tens of thousands of Community Health Workers to ensure children – especially those who otherwise have no access to treatment – can have a chance to survive pneumonia, diarrhoea and malaria. Despite the availability of CHWs and the life–saving treatments they provide, thousands of children in need are not benefitting from such services. Lack of demand is a major reason. To this end, UNICEF works actively in health education and social and behaviour change to increase the uptake of these services at community level. As a founding member of the Roll Back Malaria (RBM) initiative, UNICEF often supports countries’ fundraising efforts to sustain and expand iCCM and malaria control. This includes assisting countries to develop proposals for donors such as the Global Fund, the World Bank, the President’s Malaria Initiative, and many bilateral donors.

Results for children In countries with limited access to health care facilities, iCCM has helped expand treatment for pneumonia, diarrhoea and malaria to millions of children, especially in hard–to–reach areas.

• A number of malaria–prone countries have shown 50 per cent decline in malaria cases, including Botswana, Eritrea, Ethiopia, Madagascar, Namibia, Rwanda, South Africa, Swaziland, Tanzania and Zambia. Among them, Rwanda, Tanzania and Zambia are three countries with highly endemic malaria areas.

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© UNICEF/NYHQ2013–0556/Vassie unicef in eastern & southern africa

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Poor access to water and sanitation facilities, and unsafe hygiene practices are the main causes of diarrhoea, one of the biggest child killers in the world. Without addressing the problems in water, sanitation and hygiene (WASH), children’s rights to an adequate standard of living and the highest attainable standard of health, as enshrined in the Convention on the Rights of the Child (CRC), can never be entirely fulfilled. Because of this, WASH is regarded as a central component of the millennium development agenda. Progress in this area is closely related to that of child mortality, primary education, and poverty eradication.

“Safe drinking water and adequate sanitation are crucial for poverty reduction, crucial for sustainable development, and crucial for achieving any and every one of the Millennium Development Goals.” –Ban Ki–moon, UN Secretary–General

Not only WASH impacts on children’s health and wellbeing, it impacts on their ability to learn and thrive. In Eastern and Southern Africa, on average, less than half of schools have adequate water supply and sanitation facilities. In many communities, women and girls are burdened with the responsibility of collecting water, a household chore that can take up large parts of their day. Poor water and sanitation can make girls especially vulnerable, especially for those who start menstruating. Many are forced to skip classes and even drop out when their schools do not have separate toilets for boys and girls. School children with disabilities are also disadvantaged. Although there are no sufficient data, many education professionals attest to the lack of access to WASH services for students with physical disabilities.

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youNg cHiLD suRvivaL & DeveLoPmeNT Water, sanitation and hygiene

Progress towards the MDGs As a region ESA still has a long way to go to achieve the Millennium Development Goals (MDGs) of improving access to safe water and sanitation. Only five of the 21 countries in the region – Botswana, Malawi, Namibia, South Africa and Uganda – are on track to meet the MDG target of reducing the proportion of the population without access to safe water by half by 2015. Geographical disparities are vast, with 87 per cent of people in urban areas having access to improved drinking water sources, compared to 52 per cent in rural areas.

Access to sanitation is lagging even further behind. Only three countries – Angola, Botswana and South Africa – are on track to meet the MDG target of reducing the proportion of people without sanitation by half. Open defecation – the unhealthiest sanitation practice of all – is still common in some countries. In Ethiopia, Namibia and Mozambique, for example, the proportion of people who practice open defecation stands at 46, 52 and 41 per cent, respectively. Disparities are enormous. In Namibia, for example, only 10 per cent of the poorest families have access to improved sanitation, compared to 89 per cent coverage among the wealthiest households.

Drinkng water

Sanitation 1

1

2 3

5

2

4

5

6

7 8

9

9

10 11

10 11

13

12 14

14

15

18

16

17

13

12

15

18

17

19

19

20

20

21

Met target

6

7

8

16

4

3

21

On track

Progress but insufficient

Not on track

No or insufficient data

1. Eritrea | 2. Ethiopia | 3. South Sudan | 4. Somalia | 5. Uganda | 6. Kenya | 7. Rwanda | 8. Burundi | 9. Angola | 10. Tanzania 11. Zambia | 12. Malawi | 13. Comoros | 14. Mozambique | 15. Madagascar | 16. Namibia | 17. Botswana | 18. Zimbabwe | 19. Swaziland 20. Lesotho | 21. South Africa

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youNg cHiLD suRvivaL & DeveLoPmeNT Water, sanitation and hygiene

UNICEF in action Working directly with communities and families, UNICEF helps increase access to clean and secure supply of water, and safe and convenient sanitary facilities. While maximizing health benefits that WASH programmes bring, particularly to the survival, growth and development of young children, UNICEF also supports efforts to make schools a more conducive learning environment to children. Separate and decent sanitation facilities in schools can reduce dropout rates, especially among girls, and hygiene promotion not only benefits children, but empowers them to be agents of change in their families and communities.

Behaviour and social change is critical to sustainable access to water and sanitation. UNICEF, therefore, works on changing unhealthy behaviours such as open defecation, and promoting healthy behaviours such as handwashing with soap, and safe water handling, water treatment and storage. Communities are also supported to be drivers of change through programmes such as community–led total sanitation. At the global level, UNICEF is the lead agency in water, sanitation and hygiene in emergencies. In line with its own mandate in emergencies – the Core Commitments for Children (CCCs) in Humanitarian Action – UNICEF supports countries in emergency preparedness and response, with WASH as a critical component.

Results for children • In 2010 alone, about 4.5 million people in 14 countries in ESA got access to water, and 2 million to sanitation facilities through UNICEF–supported programmes. In 2012, the number of new users of sanitation, attributable to UNICEF programming, is well over 7.6 million. • In 2012, 11 countries in ESA had sanitation–specific policies compared to only three countries at the start of the International Year of Sanitation in 2008. Eleven countries now have a national plan towards achieving the MDG target for sanitation, and a number of countries made progress in allocating discrete budget lines for sanitation and hygiene. • The number of countries with national behaviour change communication programmes that promote handwashing with soap is gradually increasing. In 2012, a total of 15 UNICEF country offices in the region supported the commemoration of the Global Handwashing Day, reaching more than 20 million children. • UNICEF promotes and supports the implementation of the Community Approach to Total Sanitation (CATS) – an approach that triggers a change of mindset and social norms to encourage entire communities to abandon open defecation. Countries such as Zambia, Zimbabwe, Eritrea, Ethiopia, Madagascar, Malawi, Angola, Kenya and Mozambique have adopted CATS as a key national strategy to scale up sanitation. • UNICEF has made significant progress in scaling up household water treatment and safe storage, particularly in emergency settings. During the Horn of Africa crisis in 2011, UNICEF was instrumental in supporting hygiene promotion, and providing safe drinking water to the affected population, including schools and feeding centres.

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When emergency strikes, and access to safe drinking water, adequate excreta disposal and means to undertake good hygiene behavior, are all compromised, children become more susceptible to illness and death as a result of diarrhoea and other water, sanitation and hygiene (WASH) related diseases. Eastern and Southern Africa is a region especially prone to natural disasters, including drought, floods, landslides, as well as political upheaval. In recent years, emergencies in this part of Africa have increased dramatically, and become more complex, with many of them involving cross–border issues. In 2011–2012, the Horn of Africa region experienced one of the worst droughts in 60 years, affecting some 13 million people in Somalia, Kenya, Ethiopia and Djibouti. While in the Great Lakes region, intense fighting and prolonged conflict in the Kivu region of the Democratic Republic of Congo have forced tens of thousands of families abandoning their homes, and many crossing over to neighbouring countries, such as Rwanda, Uganda and Burundi.

“The period during and after disasters signifies a time of great risk in the transmission of WASH– related diseases.”

© UNICEF/NYHQ2012–1394/Sokol

The period during and after disasters signifies a time of great risk in the transmission of WASH–related diseases. Conditions are often unsanitary, conducive to disease outbreak. Early identification of appropriate, technically sound WASH interventions is, therefore, critical, for a fast and effective response to disasters.

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youNg cHiLD suRvivaL & DeveLoPmeNT

Water, sanitation and hygiene in emergencies

UNICEF in action Guided by its Core Commitments for Children in Humanitarian Action (CCCs), UNICEF responds to emergencies by ensuring girls, boys and women have protected and reliable access to sufficient and safe water and sanitation and hygiene facilities. UNICEF commits to ensuring: • effective leadership and coordination in the WASH sector; • access to sufficient safe drinking, cooking and personal hygiene water; • access to toilets and washing facilities; • access to critical hygiene information that will prevent especially diarrhoea disease; and • access to safe WASH facilities for children in learning environments and child–friendly spaces.

In these roles, UNICEF is heavily involved in emergency preparedness and planning, and in support to post–emergency reconstruction efforts.

Results for children UNICEF’s long presence in the region, working alongside government and other partners, means that we are there before, during and after a crisis. • During the Horn of Africa response, close to 4.9 million people were provided with an improved water source through newly constructed or rehabilitated sources of water, as well as water treatment and trucking.

• A similar number of people were reached through handwashing and safe drinking water campaigns, as well as the distribution of soap and other hygiene items. These interventions were critical to prevent outbreak of cholera and other acute watery diarrhoeal diseases.

• As the WASH coordinator and leader, in 2011–2012, UNICEF led the preparedness and responses in Kenya, Somalia, Ethiopia, Zimbabwe, South Sudan, Madagascar, Mozambique and Comoros.

• Supporting governments in the region, UNICEF also takes the lead in developing standards of approach and implementation, mapping capacity and gaps, and preparation of funding appeals.

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oveRview Going to school and completing a basic education had long been out of reach for far too many children in Eastern and Southern Africa. Only in recent years, thanks to fundamental shifts in national policies and assistance from development partners, the situation has been steadily improving. Today, an increasing number of children are enrolled in school, and a higher number than ever before is completing a cycle of primary school education.

“Despite the positive trends, in 2010, there were still 9 million children of primary school– age out of school in Eastern and Southern Africa.” Between 2000 and 2011, the number of children in primary school rose dramatically from 42 million to 67 million in the 17 countries where data were available (UIS Data Centre, 2012). The regional primary net enrolment rate now stands at 89 per cent for boys and 86 per cent for girls. However, there are wide variations between countries, ranging from 37 per cent for boys and 34 per cent for girls in Eritrea, to 98 per cent for boys and girls in Tanzania. Despite the positive trends, in 2010, there were still around 9 million children of primary school–age excluded from

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enjoying their right to a basic education. While this has been a considerable improvement from 2000, when 17.6 million children were out of school, the large number of out–of–school children means that the majority of the region’s countries are unlikely to achieve the Education for All and the Millennium Development Goals of Universal Primary Education by 2015.

For secondary education enrolment, as well as attendance, rates are significantly lower. The regional enrolment averages are 32 and 29 per cent for boys and girls, respectively, and an even smaller proportion actually attends school (23 per cent for boys and girls).

Barriers to education The barriers that keep children out of school are formidable and numerous. Vulnerable children, including girls, nomadic children, orphans, children with disabilities, children affected by HIV and AIDS or by armed conflict and natural disasters are at particular risk of missing out. Further, for every two children who start school in ESA, one drops out before graduating. Often, parents cannot afford the direct and indirect costs, such as school books and uniforms, of their children’s schooling. Qualified teachers are in short supply, and many schools are located far away from children’s homes, a factor that can increase the risk of sexual abuse and harassment for girls. Lack of access to safe water and separate latrines for boys and girls can also discourage children, especially girls, from attending school. These barriers, coupled with other obstacles – disability, exclusion and emergencies, for example – create high levels of out–of–school children for ESA. Particularly worrying are the situations in Comoros, South Sudan and Somalia, where more than half of primary school–aged children are not attending school.


Basic eDucaTioN & geNDeR equaLiTy

overview

Poor quality of education and learning achievements The most recent survey on learner achievement in ESA demonstrates that even after completing six years of schooling, only 62 per cent of children attain minimum reading scores, and only 33 per cent achieve minimum standards in mathematics (SACMEQ, 2010)1. As school fees are reduced or eliminated, national budgets need to be increased to keep up with the costs of educating larger numbers of children. But even as access to education is increasingly improving, overall quality is suffering. Pupil–teacher ratios have increased over the last 10 years (UIS Data Centre, 2012), and the teachers on duty receive only minimal, if any, training (UNESCO, 2012)2.

Percentage of primary school–aged children who are out of school Swaziland Namibia

Male Female

4| 3 9| 7

Zimbabwe

13 | 11

Lesotho

13 | 19

Rwanda

14 | 11 14 | 12

Botswana Malawi

16 | 14

Zambia

19 | 18 20 | 17 19 | 19

South Africa Uganda Tanzania

21 | 18

Madagascar

22 | 20

Mozambique

23 | 23

Angola

23 | 25

Burundi

27 | 26 28 | 25 31 | 36

Kenya Eritrea Ethiopia Comoros South Sudan Somalia

Based on attendance figures

36 69 68 82

| | | |

35 69 75 85

In addition, countries show huge variations in learning achievement. For example, in Swaziland, 93 per cent of students at Grade 6 achieved the minimum standard in reading, but the number stands at only 27 per cent in Malawi (SACMEQ, 2010). Similar large variations are also found within countries with the rural poor particularly disadvantaged across the region.

UNICEF in action Over the years, working alongside partners, UNICEF has been supporting governments to ensure that every child in ESA can have a chance to fulfill his or her basic right to a quality education. In 2011, UNICEF launched the Out–of–School Children’s Initiative (OOSCI) with the UNESCO Institute of Statistics, aiming to produce enhanced data and analysis on who is out of school and why. The initiative is a follow–up to the School Fee Abolition Initiative (SFAI). Launched by UNICEF and the World Bank in 2005, it has helped bring millions of children into school through leveraging policies on Universal Primary Education. Along with these initiatives, UNICEF and the World Bank will also roll out a new methodology called the Simulation for Equity in Education to help countries identify cost–effective strategies for reaching children who are excluded from or underserved by education systems. In recent years, UNICEF has become a major partner in managing donor funds, especially in countries where education is threatened by political instability. Two recent examples are the Education Trust Fund in Zimbabwe, where textbooks were provided to every primary school child; and the Fast Track Initiative in Madagascar, where UNICEF helped ensure that the education system continued to function during the country’s political turmoil through interventions such as providing payment to the teachers. UNICEF has also been heavily involved in securing technical and financial assistance for countries through engagement with the Global Partnership for Education (GPE). Currently, UNICEF is performing management entity roles in Burundi, Comoros, Eritrea, Madagascar, Somalia, South Sudan and Zambia. 1 Southern and Eastern Africa Consortium for Monitoring Educational Quality, III Project Results: Pupil achievement in reading and mathematics. 2 EFA Global Monitoring Report 2012: Youth and Skills, Putting Education to Work.

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Experiences in early childhood truly shape a person’s future. The first weeks, months and years are the times when every human being’s cognitive, emotional and social foundations are formed. A baby who is hugged, comforted and stimulated has an essential advantage over those who are not. Children who are nurtured and well cared for are more likely to fully develop their learning and language, as well as emotional and social skills.

“Early Childhood Development (ECD) programmes are pathways that link a child’s early experiences to later learning and development.” Early Childhood Development (ECD) programmes are pathways that link a child’s early experiences to later learning and development. Anchored in growing scientific, economic and human development evidence, ECD programmes can not only improve young children’s capacity to develop and learn, they can break down the inter–generational cycle that prevents children from achieving their full potential from malnutrition, illnesses, impaired learning, and even school dropout.

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Country

Age group

Gross enrolment rate in pre–primary & other ECD programmes (%)

Angola

5

104

Botswana

3–5

19

Burundi

4–6

9

Comoros

3–5

22

Eritrea

5–6

14

Ethiopia

4–6

5

Kenya

3–5

52

Lesotho

3–5

33

Madagascar

3–5

9

Malawi

3–5

Mozambique

3–5

Namibia

5–6

33

Rwanda

4–6

11

Somalia

South Africa

6

65

South Sudan

Swaziland

3–5

23

Uganda

3–5

14

Tanzania

5–6

33

Zambia

3–6

Zimbabwe

3–5

Source: Education for All Global Monitoring Report 2012: Youth and Skills, Putting Education to Work.


Basic eDucaTioN & geNDeR equaLiTy

© UNICEF/NYHQ2009–1243/Pirozzi

Early childhood development (ECD)

While it is difficult to report on ECD access largely due to the age range of children involved, and the varied approaches used; nonetheless, the available data suggest very low ECD coverage across Eastern and Southern Africa. Thankfully, the situation is improving, and more and more governments are now developing ECD guidelines and policies, especially for the most disadvantaged children.

UNICEF in action UNICEF supports early childhood development in the region through various strategies. These include advocacy with stakeholders on the benefits of ECD, and building capacities at all levels of society – governments, teachers, health and social service providers, communities, parents and children. At the policy level, UNICEF plays a crucial role in the development of national plans, setting minimum standards, curriculum design, and teacher training, among others, to help countries implement quality ECD programmes. UNICEF also advocates with governments and donors to increase resources to expand the reach of ECD, especially for vulnerable children who are most in need of such programmes. As a knowledge broker, UNICEF generates new research results on the benefits of early childhood development. Working with partners, such as the Conrad N. Hilton Foundation, UNICEF is currently developing new strategies to improve ECD access for children affected by HIV and AIDS. unicef in eastern & southern africa

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Basic eDucaTioN & geNDeR equaLiTy

Early childhood development (ECD)

Results for children Although ECD programmes are yet to reach all young children in need, many countries are putting policies, systems and resources in place to increase priorities and coverage. • Eleven countries – Botswana, Ethiopia, Kenya, Lesotho, Malawi, Rwanda, Swaziland, South Africa, Tanzania, Uganda and Zambia – are developing national ECD policies and guidelines, while several others are carrying out national parenting programmes to improve early childhood care among vulnerable families.

• In Tanzania and Ethiopia, UNICEF supported the mainstreaming of ECD programmes into the integrated management of childhood illness at the community level to increase access to early stimulation for children under the age of three.

• In a number of countries, governments, in collaboration with UNICEF, have promoted access to ECD services by establishing innovative programmes. These include community–based child care programmes in Malawi, a rapid school readiness initiative in Kenya, a child–to–child mentoring approach in Ethiopia, and expanding ECD programmes to primary schools in Lesotho and Zimbabwe.

© UNICEF/NYHQ2009–2299/Holt

• In South Africa, UNICEF supported a public expenditure study on ECD programmes, the first of its kind in the country. The study tracked funding from its source to the level of service delivery in communities. The initiative produced tools to better target ECD services and increase resources for the sector.

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The concept behind Child–Friendly Education (CFE) is simple at heart: schools should operate in the best interests of the child. They should be designed and run in a way that ensures that all children can learn in a safe, healthy, secure, stimulating and protected environment. The CFE approach focusses on the total needs of the child as a learner so that the student can develop his or her full potential. The goal throughout is to promote child–centred education with teachers who are trained accordingly, and supported by adequate resources and appropriate physical, emotional and

social conditions for learning. It integrates many other areas including health, nutrition, water and sanitation, as well as protection. CFE is not a ‘one–size–fits–all’ model though, and the way child–friendly schools are built and operate may differ from country to country.

THE INCLUSIVE ELEMENTS THAT ARE CENTRAL TO CHILD–FRIENDLY EDUCATION Rights based & inclusive school

T

g

safe & protective school

tion sector poli a c c u ed environm y g n i l en ab t n & l e ing e a r n h c in ea

gender sensetive school

community engaged school

academically effective school

health promoting school unicef in eastern & southern africa

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UNICEF in action UNICEF works with the governments in Eastern and Southern Africa to help them develop school systems that are child–friendly to all children, especially the most disadvantaged. CFE principles are reflected in the development of national policies, plans and standards, and have the following characteristics:

Rights–based and inclusive

No child should be excluded from education because of his or her gender, race, culture, language, ability or social status. However, investments in education often miss their mark. Recent research, including Out–of–School Children’s Initiative (OOSCI) studies, carried out by UNICEF and UNESCO suggest that efforts are often skewed in favour of children from better–off families and those who live in urban centres. Children with disabilities, for example, remain invisible in many countries and belong to one of the most marginalized groups.

Gender–sensitive

A core principle of CFE is to make sure that both girls and boys learn in an environment that is free from gender bias and other forms of stereotyping. Education systems and schools should strive to provide gender–sensitive facilities, curricula and textbooks, and address issues such as gender–based violence and gender equality.

Safe and protective

CFE is supported by strong violence prevention policies and innovative mechanisms that allow pupils to safely report abuse. This is particularly important when assisting children affected by natural and manmade emergencies.

Community–engaged

Effectiveness, transparency and accountability in schools are enhanced by strong partnerships between parents, teachers and children.

Academically effective

Teachers are the single most important resource in children’s education. CFE promotes purposeful teaching and learning, including interactive, child–centred and gender–sensitive teaching methods. Despite this, studies suggest that most children in ESA are taught through highly didactic methods, and that teacher absenteeism and lack of training are also critical issues.

Health promoting

Children cannot learn properly if they are sick, hungry or stressed. To bolster children’s capacity to learn, schools need to provide nutritional and health support, including health checks, immunization, de–worming and vitamin A supplements. Access to water and sanitation is also a critical contributing factor to children’s well–being.

Partnerships With many governments struggling to allocate sufficient budget to ensure quality education for all, partnerships are critical. A key intervention in promoting CFE over the past years has been the Schools for Africa initiative. Launched in 2004, this multi–country, multi–donor partnership is led by UNICEF and its National Committees, the Nelson Mandela Foundation, and the Hamburg Society, newly renamed to Peter Krämer Stiftung, for the Promotion of Democracy and International Law. To date, the initiative has contributed more than US$164 million, fulfilling the dreams of an education for 21 million children across 11 countries including those in ESA – Angola, Ethiopia, Madagascar, Malawi, Mozambique, Rwanda, South Africa and Zimbabwe. With its extraordinary success, the SFA initiative has been expanded to West and Central Africa and Asia.

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Basic eDucaTioN & geNDeR equaLiTy

Child–friendly education

Results for children • Kenya, Rwanda, South Africa and Tanzania established minimum standards and indicators for quality education based on CFE principles. Angola also mainstreamed the participatory CFE framework into the education sector.

• Many countries are using the CFE framework to develop teaching materials, manuals and other tools for improving, assessing and assuring the quality of education. Kenya, Tanzania and Uganda applied CFE principles to quality assurance and national teacher training systems.

• In Madagascar, UNICEF supported the design of eco–friendly school, using compressed earth as construction material to reduce the impact on deforestation.

© UNICEF/NYHQ2004–0361/Furrer

• In Rwanda, teacher resource centres were supported to help teachers respond more effectively to the needs of their students. Extracurricular clubs called Tuseme (means “speak out”) were created to strengthen HIV prevention. UNICEF is also a major partner supporting school construction in the country.

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For far too long, the right to education has been denied to many girls across the world. In Eastern and Southern Africa, poverty, poor access to school, lack of sanitary facilities and social norms such as child marriage and female genital mutilation/cutting, have all been preventing girls from realizing this basic right. As a result of these and other factors, in countries such as Angola, Eritrea, Ethiopia and Mozambique, the enrolment rate of girls in primary school is lower than that of boys, and in secondary and tertiary education the figure is even lower across the region as a whole.

© UNICEF/NYHQ2009-1247/Pirozzi

This comes at a time, when girls’ education has proven to be one of the most cost–effective strategies to promote development and economic growth. Studies have shown that educated mothers tend to have healthier, better nourished babies, and that their own children are more likely to attend school; thus helping break the vicious cycle of poverty. Recognizing such impacts, UNICEF ensures that gender equality cuts across all its programmes, including education.

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PRIMARY AND SECONDARY SCHOOL ENROLMENT AND PARTICIPATION IN EASTERN AND SOUTHERN AFRICA Primary school enrolment ratio (net)%

Primary school attendance ratio (net)%

Secondary school enrolment ratio (net)%

Secondary school attendance ratio (net)%

Angola

93

78

77

75

12

11

21

17

Botswana

87

88

86

88

57

65

36

44

Burundi

73

74

18

15

12

11

Comoros

31

31

10

11

Eritrea

37

33

69

64

32

25

23

21

Ethiopia

85

80

64

65

16

16

Kenya

84

85

72

75

52

48

40

42

Lesotho

72

75

87

91

23

37

26

40

Madagascar

78

80

23

24

27

28

Malawi

84

86

28

27

10

10

Mozambique

95

89

77

77

17

15

25

22

Namibia

84

89

91

93

47

62

Rwanda

86

89

15

16

Somalia

18

15

12

8

South Africa

90

91

80

83

South Sudan

32

25

8

4

Swaziland

86

85

96

97

29

37

42

52

Tanzania

98

98

79

82

26

24

Uganda

90

92

81

81

16

19

Zambia

91

94

81

82

38

36

Zimbabwe

87

89

48

49

country


Basic eDucaTioN & geNDeR equaLiTy

Girls’ education and gender equality

UNICEF in action

Results for children

To boost girls’ education, the United Nations Girls’ Education Initiative (UNGEI), a partnership of organizations dedicated to promoting girls’ education, was launched in 2000 by the then UN Secretary–General Kofi Annan. Its goal was to ensure that by 2015, all children are able to complete primary schooling, with girls and boys having equal access to free, quality education.

• In 14 ESA countries, UNICEF supported gender audits to assess the needs of girls in school and identify barriers to education. The gender audits are critical in deepening the understanding of the lives of girls and influencing education policy and planning.

UNICEF is the lead agency and secretariat for UNGEI. Together with its partners, such as UNESCO, the World Bank, bilateral donors and NGOs, UNICEF works towards transcending barriers to girls’ education and narrowing the gender gap in primary and secondary education. The focus is on the countries and regions with the widest gender disparities in primary education – those places where simply being born female resigns so many children to a life of illiteracy and missed opportunities.

• Under the UNGEI partnership, the Girls’ Education Movement (GEM) and the Girls’ and Boys’ Education Movement (GBEM) were established in Lesotho, South Africa, Swaziland and Uganda. The movements mobilize communities to support girls’ school retention and completion. Training for GEM and GBEM members in ESA were hosted in Kenya, Malawi and Rwanda for a greater gender mainstreaming in education.

© UNICEF/UGDA2010–00285/Noorani

• In collaboration with the Forum for African Women Educationalists (FAWE), UNICEF provided technical and financial support to gender training for teachers in Kenya, Tanzania, Malawi, Zambia and Ethiopia.

Committed to enhancing the evidence base, UNICEF is leading the way in research focusing on how different drivers of inequality interact to exclude girls and boys from school. Work has been carried out through the global Out–of–School Children’s Initiative (OOSCI), as well as collaborative research with UNESCO to understand factors contributing to gender inequalities.

• The UNICEF–supported child–friendly education (CFE) framework promotes equality and equity in enrolment and achievement among girls and boys by eliminating gender stereotyping. Gender–sensitive curricula and textbooks, as well as separate latrines for girls and boys are key vehicles for enhancing gender equality in education. Kenya, Rwanda, South Africa, Tanzania and Zimbabwe are institutionalizing the CFE model to improve girls’ and boys’ access to quality education.

• In South Africa, UNICEF supports the government’s Techno Girl mentorship programme, which was launched in 2005 as part of GBEM. The programme helps girls make informed career choices, with an emphasis on science, technology and engineering. In 2011, 7500 girls from disadvantaged backgrounds in all nine provinces were involved in the programme.

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© UNICEF/NYHQ2006–2267/Pirozzi


© UNICEF/NYHQ2012–1417/Sokol

Cyclones, earthquakes, floods, conflicts and other emergencies wreak havoc on society and deeply affect children. Fulfilling the right to education is most at risk during such times and during the transition period following a crisis. Education is not only a basic human right, but a tool for recovery. Past experiences have shown that it not only restores schooling and its related benefits to affected people, it also helps countries transform and rebuild or ‘build back better’ the institutions and systems destroyed during the emergency. The benefits of education in crisis–stricken and post–crisis societies are far–reaching. During emergencies, children in school can be cared for, accounted for and protected from abduction, recruitment into militias, and sexual and economic

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exploitation. By reestablishing a daily routine and helping to restore a sense of normalcy, schools become therapeutic spaces in the midst of destruction. They help families get back on their feet by allowing parents breathing space to organize their lives. If managed effectively, education can also act as a catalyst for building peace, encouraging parties that once opposed each other to work together for the sake of their children. In the fragile wake of conflict, societies can create a more inclusive education system with a curriculum that promotes peace and reconciliation, and overcomes stereo types and prejudice. As such, UNICEF considers education an integral part of any humanitarian response to an emergency, equally important as food, shelter, water, sanitation, and health care.


Basic eDucaTioN & geNDeR equaLiTy

Education in emergencies

UNICEF in action In Eastern and Southern Africa, it is a key priority for UNICEF to strengthen the capacity of governments and other institutions in all 21 countries to prepare for and respond to humanitarian crises. Hundreds of employees from education ministries have been trained on education in emergencies, including the building of temporary learning spaces and development of emergency curricula. Based on this, countries have developed localized contingency plans and disaster risk reduction strategies, and incorporated emergency education in their national sector plans and budgets. Displacement remains a major issue in ESA with 18 out of the 21 countries currently hosting refugees. To meet the diverse needs of this large and vulnerable group, UNICEF has greatly strengthened its partnership with UNHCR to improve education for refugee children, both in terms of access and quality.

“During emergencies, children in school can be cared for, accounted for and protected from abduction, recruitment into militias, and sexual and economic exploitation.”

Results for children • In the wake of the Horn of Africa crisis, Dadaab refugee camps in Kenya received a large influx of refugees from neighbouring Somalia. UNICEF and UNHCR developed a joint education strategy together with other partners to address the education needs of children within the camps and in the host communities. More than 119,000 children in Dadaab refugee camps and drought affected areas received education, as a result.

• Enrolment increases as Somalia’s education system recovers from more than two decades of violence and conflict. In 2011–2012, more than 750,000 children were able to go to school, a 60 per cent increase from 2006–2007. Current estimates from the most fragile part of Somalia – Central South Zone – suggest that nearly 400,000 children, 45 per cent of them girls, are enrolled in UNICEF–supported schools.

• In South Sudan, continued conflict and natural disasters have disrupted the lives and education of many children. In 2012, UNICEF provided temporary learning spaces as well as teaching and learning materials. Key tools for education in emergencies were developed and distributed, including the contextualized INEE Minimum Standards and the Teacher’s Code of Conduct. In addition, UNICEF provided training material to help teachers offer psychosocial support to children, designed an education cluster information management database, and advocated against the occupation of schools by armed forces and displaced populations.

• With major funding provided by the Government of Netherlands, more attention is now given to the role of education in peacebuilding. The intention is to ensure coherent responses embrace emergency preparedness and response, conflict and Disaster Risk Reduction, and education for peacebuilding, in UNICEF’s support to education in ESA.

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oveRview Eastern and Southern Africa have made great strides in protecting children from abuse, exploitation and violence. Today, more countries have child protection policies in place, and the spending on child protection services have also been on the rise. Efforts to prevent and respond to violations of children’s rights have multiplied and become more effective across the region, and public campaigns have been intensified to put the spotlight on violence against children.

Despite these achievements, however, necessary laws, legal systems and enforcement mechanisms are still lacking throughout the region. Deep rooted cultural beliefs and practices, such as corporal punishment, child marriage and female genital mutilation/cutting (FGM/C), continue to be prevalent in many places, putting children, especially those from the most marginalized communities, at harm.

Country

UNDER–FIVE BIRTH REGISTRATION (%)

Angola

36

Botswana

72

Burundi

75

Comoros

88

Among them, child marriage remains extremely common. About one third of the region’s women aged 20 – 24 were married before their 18th birthday. FGM/C is particularly prevalent in Eritrea, Ethiopia, Kenya, Somalia and Tanzania. In Somalia, 98 per cent of women have undergone this practice, the highest in the world.

Eritrea

Not available

Ethiopia

7

Kenya

60

Lesotho

45

Madagascar

80

While there are no specific regional data on violence against children, national studies in Kenya, Tanzania Swaziland and Zimbabwe suggest that between 30 and 40 per cent of girls under 18 years of age suffered from sexual abuse and violence in their lives.

Malawi

Not available

Mozambique

48

Namibia

78

Rwanda

63

As a region, ESA has the highest rate of child labour in the world, together with West and Central Africa. Nearly a third of children aged 5–14 in these two regions are engaged in work.

Somalia

3

South Africa

95

South Sudan

35

Despite notable progress in countries like Burundi with the demobilization children formerly associated with the armed forces, children continue to be recruited in countries such as Somalia and South Sudan. The total number of children being used in conflicts is not known, but the UN estimates that thousands of children and young people are affected.

44

The migration of children because of conflict is an ongoing problem in countries in the Horn of Africa, including Ethiopia, Kenya and Somalia, as well as Yemen, Sudan, and in Southern Africa countries, Mozambique, Zimbabwe, Swaziland and South Africa. There is also a significant movement of children amongst the countries of the Great Lake Region, Rwanda, Uganda and South Sudan, due to the conflict in the Democratic Republic of Congo.

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Swaziland

50

Uganda

30

Tanzania

16

Zambia

14

Zimbabwe

49


cHiLD PRoTecTioN

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UNICEF in action

“Deep rooted cultural beliefs and practices, such as corporal punishment, child marriage and female genital mutilation/ cutting, continue to be prevalent in many parts of Eastern and Southern Africa.”

UNICEF’s vision and approach is to create a protective environment, where girls and boys are free from violence and exploitation, where laws and practices minimize their vulnerability and risk factors, and where children themselves are equipped to build their own resilience. In collaboration with the national legislatures and law enforcement agencies in all 21 countries, UNICEF has identified a series of strategic priorities to accelerate action for the protection of children. These priorities reflect an important shift from issue–oriented projects to a more systemic and integrated approach that addresses both prevention and response to the challenges. These priorities include: • building national child–protection systems; • strengthening evidence–building and knowledge management; • addressing cultural values and supporting social change; and • enhancing child protection in conflict and natural disasters.

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© UNICEF/UGDA201300590/Sibiloni


A fundamental right Nothing would seem simpler than recording the name, sex, parentage, and time and place of a child’s birth. However, this “first rights” of a child, as enshrined in both the UN Convention on the Rights of the Child and the African Charter on the Rights and Welfare of the Child, remain unfulfilled for the majority of Africa’s children. Only 44 per cent of sub–Saharan Africa’s children under–five years of age are registered today, and in rural areas, the rate is even lower. For children of Eastern and Southern Africa, the reality is even more worrying: only 38 per cent of children are registered, ranging widely from 3 per cent in Somalia to 95 per cent in South Africa.

“Only 38 per cent of children had their births registered in Eastern and Southern Africa, raging widely from 3 per cent in Somalia to 95 per cent in South Africa.” In addition to geographic disparities, growing economic inequities between and within countries adds up to one more barrier that hinders children’s chance of being registered at birth. In Zambia, for example, the official rate of birth registration is just 14 per cent. However, in some provinces this rate is less than 1 per cent. Moreover, only 5 per cent of the Zambian children born in the poorest households have their births registered, and that is significantly lower than the 31 per cent for those born in the richest households. Without a birth certificate, children cannot enroll in school and are not eligible to receive child support grants. Addressing inequities or protection of marginalized groups would not be possible in the absence of population data. Nor can good governance, human rights and the rule of law be achieved. When children have no legal proof of age and legal identity, they are more vulnerable to early marriage and other harmful practices, including child labour, illegal inter–country adoption, and recruitment into armed forces and groups or commercial sexual exploitation. Minimum age of criminal responsibility and other legal protective measures may not apply to those who are in contact with the law. Lack of birth certificates can also complicate the processes for repatriation of refugee children, as well as family tracing for children separated from their families. Although most countries in ESA have legal provisions to facilitate timely registration of births, few have policies that ensure birth certificates are free. Many are faced with shortage of funds with their civil registration systems, which are often not in line with the international standards. There is also a lack of awareness among citizens on the importance of civil registration for children, and this is further hampered by social barriers that prevent the registration of particular groups of children, such as children with disabilities, migrant children, orphans, pastoralist children, children from minority ethnic groups, and children living and working on the streets.

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cHiLD PRoTecTioN Birth registration

UNICEF in action Improvements in civil registration on the African continent have been few and far between. However, in close partnership with governments and other development partners, UNICEF is increasingly relying on innovative strategies to radically improve national civil registration systems. These include:

Legal Reform: UNICEF provides technical assistance to national reviews of legal

Results for children • Across the region, UNICEF advocated for the foundational importance of civil registration for children. Two yearly statutory AU Ministers’ meetings on civil registration were agreed, requiring governments to report progress on civil registration to the AU Heads of States. In addition, all African countries are to develop plans to help accelerate their civil registration work for children.

and policy frameworks that govern civil registration systems to ensure that all innovative strategies recommended have a legal basis. Information and Communication Technology (ICT): Most of Africa’s civil registration systems are still paper–based. The availability of affordable mobile phone technology, extensive cellular network coverage and Internet use, provide important opportunities for birth

• Kenya and Malawi have recently passed civil registration legislation, covering both registration of births and national IDs. In Uganda and Namibia, UNICEF support helped align existing laws to include electronic registration and computerization of records. In Malawi, where until recently, registrations of births were not even compulsory, UNICEF advocacy led to the enactment of the National Registration Act in 2009, which requires birth registration of all children in the country.

registration. Expanding National Partnerships with other Sectors: UNICEF promotes closer collaboration with various relevant sectors, such as the health sector, social protection sector, as efficient and more sustainable

• With the fast penetration of mobile phones and the Internet, Uganda has pioneered some ground– breaking work on using mobile technology devices for transmitting birth notifications with UNICEF support.

ways to accelerate registration of births. Leveraging High–Level Political Commitment and Resources: At the regional level, UNICEF has successfully positioned civil registration of children

• Uganda’s Mulago Referral Hospital now has a computerized, Internet–enabled registration system. That system is currently introduced into more than 130 hospitals across the country.

as integral to the Africa Programme on Accelerated Improvement of Civil Registration and Vital Statistics (APAI– CRVS), an initiative led by three Pan–African organizations – African Development Bank, the African Union Commission and

• Since 2005, UNICEF Mozambique has been providing ongoing support to the Ministry of Justice to clear the backlog of registration. To date, nearly 8 million people have been registered, including more than 7 million children.

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No violence against children is justifiable; all violence against children is preventable. Yet as the landmark the United Nations Secretary–General’s Study on Violence against Children (2006) confirms that such violence exists in every country of the world, cutting across culture, class, education, income and ethnic origin. In Eastern and Southern Africa, researches carried out by UNICEF and partners reveal a picture of widespread violence against girls and boys. In Swaziland, for example, a 2007 study showed that nearly 1 in 4 women experienced physical violence as children, 1 in 3 experienced sexual violence, and 3 in 10 were emotionally abused. A similar study in Tanzania found that nearly 3 in 10 women and 1 in 7 men experienced sexual violence as children. Data generated by these initiatives indicate that while some violence is unexpected and isolated, the majority of violent acts experienced by children is small, yet repeated, and is often perpetrated by people who are part of their lives: parents, teachers, schoolmates, employers, boyfriends or girlfriends. Much violence against children is un–reported and un–recorded. They remain hidden for many reasons. One is fear: many children are afraid to report incidents of violence against them. Social acceptance of violence is another factor. Violence is also invisible because there are no safe or trusted ways for children or adults to report it. No matter its cultural, economic or social background, every society, can and must stop violence against children. This does not mean sanctioning perpetrators only, but requires transformation of the ‘mindset’ of societies and the underlying economic and social conditions associated with violence.

“Violence against children studies conducted in Kenya, Malawi Swaziland, Tanzania and Zimbabwe, confirm an endemic pattern of violence against children.” 50

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cHiLD PRoTecTioN Violence against children

In response to the UN Secretary–General’s Study on Violence against Children, UNICEF in ESA was the first to partner with governments to measure the magnitude, context and nature of violence against children. With support from the Centers for Disease Control and Prevention (CDC) in the United States, national population–based surveys were conducted in several countries to generate important evidence on violence against children. To date, studies have been conducted in Kenya, Malawi, Swaziland, Tanzania and Zimbabwe. The findings confirm an endemic pattern of violence against children — girls and boys, alike. Homes and schools, two spaces where children spend the majority of their time, are proven to be unsafe. These are the sites where multiple types of violence occur, including emotional, physical and sexual.

Prevalence of sexual violence prior to age 18 reported by females and males aged 18–24 in countries completed the UNICEF–CDC violence against children study 50 45 40 37.8

35 32.5

31.9

30 27.2

25 17.5

20 15 11.6

10

8.9

5 0

Swaziland

Tanzania

Zimbabwe

Kenya

The findings also indicate very high levels of physical violence – over 70 per cent of boys and girls reported severe beatings, with teachers and parents as primary perpetrators across all countries. Reporting of incidents of violence, however, is poor – 50 per cent for girls and even fewer for boys. Of these who did report, less than half ever received services. Given the region’s high HIV prevalence, the findings of these studies reveal yet another worrying pattern: for those who experienced sexual violence as children, they are more disposed towards risky sexual behaviors. Data from Swaziland, Tanzania and Kenya all confirm that both the males and females are more likely to have multiple sexual partners, and less likely to use protection during sexual intercourse.

© UNICEF/NYHQ2012–0703/Holt

UNICEF in action

In addition to population–based surveys in the five countries, South Africa and Uganda have produced substantial national data through desk reviews to help the governments, UNICEF and other partners better understand violence against children. Violence against children is multi–dimensional and calls for a multifaceted response. An increasingly popular strategy for addressing violence is through the establishment of ”one–stop centers” (OSCs), which provide integrated, multi–disciplinary services in a single physical location, including health care, psychosocial support, and police and justice sector responses. A comparative case study in Kenya and Zambia shows that the OSC model appears to be the most effective in providing medical and legal support to victims. Despite the advances made in data and evidence, the drivers of violence against children, its societal and economic determinants, have yet to be understood to their fullest extent. Unveiling them will contribute positively to prevention and service delivery efforts, and thus remains an important area for UNICEF’s child protection work in ESA. unicef in eastern & southern africa

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cHiLD PRoTecTioN Violence against children

Results for children Governments in the region are paying increasing attention to providing stronger legal frameworks and other mechanisms to protect children from violence: • Kenya, Ethiopia, Uganda, Swaziland, Madagascar, South Africa and Zimbabwe passed laws to address sexual offenses against children and women, including strengthening law enforcement and prosecution of offenders. • Several countries, including Mozambique, Swaziland, Tanzania, Zimbabwe, Uganda and Malawi, set up specialized police units to ensure a child – and gender–sensitive response to sexual violence as part of a comprehensive response. • Mozambique and Uganda supported the implementation of the National Communication Strategies for the Prevention of Violence involving all sectors including the faith–based communities.

© UNICEF/NYHQ2010–1836/Noorani

• In Botswana, Zimbabwe, South Africa, Lesotho, Swaziland, Kenya and Uganda, UNICEF supports child helplines, where children can report cases of abuse, and seek referrals for counseling and psychological support. In Kenya, children who do not have access to a telephone can attend drop–in centres where counseling services are provided.

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• Rwanda, Kenya, Tanzania, Malawi, Zimbabwe, Uganda, South Africa, Mozambique developed gender–based violence policies with significant sections or chapters that address the explicit needs of children (versus adults) in health care and justice settings. • Corporal punishment is prohibited by law in penal institutions in seven ESA countries – Mozambique, Namibia, Malawi, Kenya, Uganda, Ethiopia and Zambia. However, the effectiveness of the laws is questionable since there are few mechanisms to monitor or protect children’s rights.


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oveRview With only 5 per cent of the world’s population, Eastern and Southern Africa is home to half the world’s population living with HIV. Today the region continues to be the epicentre of the HIV/AIDS epidemic, with 48 per cent of the world’s new HIV infections among adults, 55 per cent among children, and 48 per cent of AIDS–related deaths1.

The Southern Africa sub–region, in particular, experiences the most severe HIV epidemics in the world. Nine countries – Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe – have adult HIV prevalence rates of over 10 per cent. At an estimated 26 per

“With only 5 per cent of the world’s population, Eastern and Southern Africa is home to half the world’s population living with HIV.” cent, Swaziland has the highest HIV prevalence rate in the world, followed by Botswana (23.4 per cent) and Lesotho (23.3 per cent). With 5.6 million people living with HIV (17 per cent), South Africa is home to the world’s largest epidemic. In the past 10 years, efforts to halt the spread of the epidemic by national governments and development partners have borne fruits: new infections among adults have decreased by more than 50 per cent in Botswana, Ethiopia, Malawi, Namibia,

Rwanda, Zambia and Zimbabwe; and by more than 25 per cent in Kenya, Mozambique, South Africa, and Swaziland. Among children, the number of new infections has dropped from 330,000 in 2001, to 180,000 in 2011. Despite the progress, there are still 17.1 million adults and children living with HIV in Eastern and Southern Africa, and the figure continues to increase as antiretroviral therapy (ART) ensures millions of people with HIV can now live a healthy life. Moreover, most people on ART start treatment late, limiting the overall impact of antiretroviral medicines. For many pregnant women living with HIV, such treatment remains out of reach, especially for those living in rural areas, and those fearful of stigma and discrimination if they are tested positive. Of the 960,000 pregnant women living with HIV in 2011, more than 90 per cent of them resided in just nine countries – South Africa, Mozambique, Uganda, Tanzania, Kenya, Zambia, Zimbabwe, Malawi and Ethiopia. Compared to adults, the progress in providing treatment to children is much slower. Out of the 2.2 million children who needed ART in 2011, only 33 per cent were receiving it.

The number of orphans due to AIDS continues to increase2. The region now has 10.5 million children who have lost one or both parents to AIDS. Against the mounting needs, care and support to the children made vulnerable by HIV and AIDS are nowhere near adequate. In most countries in the region, only around 20 per cent or less of these children receive some sort of external support. Girls and young women are disproportionately affected by HIV. Of the 2.7 million 15–24 year–olds living with HIV in the region, 70 per cent are female. In the countries most affected by the epidemic, such as Swaziland, Lesotho and Botswana, more than 1 in 10 females in that age group are living with HIV. Many of those young women appear to have been infected by men who are several years older and therefore more likely to be living with HIV.

1 Unless indicated otherwise, all data in the chapters of Children and AIDS are cited from Getting to Zero: HIV in Eastern and Southern Africa. UNAIDS, 2013. 2 Belsey, M. & Sherr, L (2011) The definition of true orphan prevalence: Trends, contexts and implications for policies and programmes. Vulnerable Children and Youth Studies, 6:3.

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Overview

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UNICEF in action For more than two decades, UNICEF has been the leading voice for children in the global AIDS response, galvanizing commitment, resources and action to address the impact of HIV on children. In collaboration with UN agencies and other partners, UNICEF has championed four priority areas: • prevention of mother–to–child transmission of HIV; • paediatric HIV care and treatment; • prevention of HIV among adolescents and young people; and • protection, care and support for children affected by HIV and AIDS.

Through Unite for Children, Unite against AIDS campaign, launched in 2005 by UNICEF and our partners, work carried out in these areas has made direct contribution towards the realization of the global HIV commitments, including the Millennium Development Goals (MDGs). While challenges remain, scientific advances and their implementation have brought the world to a tipping point in the fight against AIDS. An AIDS–free generation is finally within our grasp. To optimize our contribution to achieving an AIDS–free generation, UNICEF has adopted an integrated programme approach, focusing on strengthening the delivery of high impact interventions, while working across sectors to integrate HIV responses into a broader development context.

HIV Investment Framework Reduce Risk

Reduce the likelihood of transmission

Reduce mortality and morbidity

1. PMTCT 2. Treatment 3. Targeted approaches for key populations 4. Condom promotion and distribution 5. Male circumcision 6. BehaviouR change tailored to epidemic

Critical Enablers

Synergies: Social protection, Education, Legal reform, Gender, Poverty, Violence, Health and community systems and others

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Overview

Today, UNICEF supports pregnant women, mothers, children and adolescents affected by or at risk of HIV at two critical stages – the First Decade and the Second Decade of life, and across both decades in key areas such as child protection, social protection, education, health and nutrition. The emphasis of UNICEF’s work in the First Decade is on infants, children under five, pregnant women and mothers, through HIV testing and treatment linked to antenatal services, early infant diagnosis, and paediatric treatment and care.

© UNICEF/NYHQ2009–2634/Pirozzi

For the Second Decade, UNICEF has shifted away from a broad emphasis on ‘young people’ (15–24 years) to a more targeted group of adolescents (10–19 years). Special attention will be given to adolescent girls in generalized epidemics, adolescents living with HIV, and key adolescent populations. Across both decades, UNICEF supports countries in expanding HIV–sensitive social protection, care and support for families and communities affected by HIV and AIDS, to mitigate the impact of HIV and strengthen the resilience of vulnerable children.

An AIDS–free generation starts with children HIV across the first two decades of life

HIV prevention treatment care and support First Decade

Second Decade

Social Protection, Nutrition, Health, WASH, Education, Child Protection, Emergencies, Gender Equality, and Human Rights

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Ensuring no baby is born with HIV is an essential step towards achieving an AIDS–free generation. Over the past two decades, programmes such as prevention of mother–to– child transmission of HIV, or PMTCT, have received immense attention from national governments, development partners and donor communities around the world, resulting in an increasing number of pregnant women in need having access to antiretroviral treatment, and fewer babies being born with HIV. In Eastern and Southern Africa, efforts to eliminate mother– to–child transmission have been intensified dramatically. In 2011, 72 per cent of pregnant women in need of such services were reached with effective drug regimens, which can reduce the risk of mother–to–child transmission to less than 5 per cent. However, with 960,000 pregnant women living with HIV in 2011 – that’s more than any other region of the world – the need continues to be immense. More than 90 per cent of them resided in just nine countries – South Africa, Mozambique, Uganda, Tanzania, Kenya, Zambia, Zimbabwe, Malawi and Ethiopia. Without effective treatment, more than half of all babies born with HIV will die before their second birthday. Yet, in 2011, only 33 per cent of children in need of treatment received antiretroviral therapy. In high–burden countries in Southern Africa, HIV contributes to 10–28 per cent of all deaths among children under five years of age. HIV also contributes to high levels of maternal deaths in ESA, especially in Southern Africa, ranging from 27 per cent in Mozambique to 67 per cent in Swaziland.

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“Without treatment, more than half of all babies born with HIV will die before their second birthday. Yet, in 2011, only 33 per cent of children living with HIV in Eastern and Southern Africa received treatment.”


cHiLDReN & aIDs

The first decade

UNICEF in action With years of investments, achieving an HIV–free generation is finally within reach. The work towards a world free of HIV for UNICEF and our international, national and civil society partners is guided by the Global Plan to Eliminate New Infections among Children by 2015. The Global Plan aims to keep HIV infection rate for children born to women living with HIV below 5 per cent, and reduce the number of new infections among young children by 90 per cent compared to 2009. To this end, UNICEF has set two goals in its strategic plan for Eastern and Southern Africa:

with maternal, newborn and child health, as well as family planning services. Recent research indicates that antiretroviral treatment reduces the risk of HIV transmission within couples by 96 per cent1. Therefore, finding innovative ways to engage sexual partners of pregnant women through routine health services, and linking these partners to prevention, treatment and care will be an important strategy for preventing new infections2.

• ensuring 80 per cent of all pregnant women living with HIV are reached with triple ARV regimens by 2015; and

Whether HIV–infected or not, children born to women living with HIV have increased risk of morbidity and mortality. Poverty, isolation and distance from health care facilities can further place them beyond the reach of life–saving care. By making things as simple as possible, UNICEF works to reach more women and children, especially in rural areas where health services are scarce. Offering HIV testing that gives results in just a few minutes as part of routine antenatal care for pregnant women is a first step, and providing treatment of ‘one pill, once per day’ as early as possible for those who are tested HIV–positive is a second. Such treatment not only protects the health of the mother living with HIV, but also prevents transmission to her child – in utero, during delivery or during the breastfeeding period. Another key area for UNICEF is the integration of HIV care, treatment and support with antenatal, postnatal and child health services. Prevention of HIV infection among women of child–bearing age, for example, as well as prevention of unintended pregnancies among women living with HIV can be achieved only if PMTCT services are integrated

© UNICEF/NYHQ2009–1910/Pirozzi

• nsuring 80 per cent of children living with HIV are reached with ART by 2015, from the baseline of 32 per cent in 2009.

Increased community involvement, mobilization and engagement is also key, particularly in reducing stigma and discrimination. In addition, UNICEF works together with partners to ensure HIV– exposed children are identified early and provided with follow– up treatment, care and support throughout childhood, and into adolescence and adulthood. 1 Cohen, Myron S., et. al., Prevention of HIV–1 Infection with Early Antiretroviral Therapy, The New England Journal of Medicine, 2011. 2 World Health Organization, Guidance on couples HIV testing and counselling – including antiretroviral therapy for treatment and prevention in serodiscordant couples. WHO, Geneva, 2012.

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cHiLDReN & aIDs

The first decade

Results for children • Ten countries in the region developed, launched or started implementing strategic and operational plans to eliminate mother–to–child transmission of HIV as per the Global Plan. These are Botswana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland and Tanzania.

• In several countries, UNICEF and partners supported the adaptation of the new WHO guidelines, as well as reprogramming of existing grants by the Global Fund for PMTCT and helping high burden countries apply for new funding rounds.

• Among the 22 priority countries for eliminating mother–to–child transmission, five – all in ESA – reached the 2001 UNGASS goal of providing ARVs (excluding single–dose nevirapine) for PMTCT to 80 per cent of pregnant women living with HIV. They are Botswana, Lesotho, Namibia, South Africa and Swaziland.

• Botswana leads the way in wide–scale provision of PMTCT services. According to the 2011 Universal Access Progress Report, more than 95 per cent of HIV–positive pregnant women received ARVs to prevent vertical transmission. As a result, mother–to–child transmission has been reduced to 4 per cent.

• The availability of PMTCT in Lesotho has further increased to 94 per cent of all health facilities, and the proportion of pregnant women who receive PMTCT services rose to 89 per cent in 2010, from only 16 per cent in 2006.

• Mozambique has also seen its national PMTCT programme developing in the right direction. The country registered a 16 per cent increase in the number of PMTCT sites integrated with maternal and child health services in 2011.

“Recent research indicates that antiretroviral treatment reduces the risk of HIV transmission within couples by 96 per cent.” 60

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© UNICEF/NYHQ2009–0277/Nesbitt

• In Zimbabwe, an innovation that addresses the lower coverage of ART for rural pregnant women was successfully piloted with UNICEF support. The programme involves the use of point–of–care technology – new diagnostics that enable immediate results of HIV tests. By reducing long waits for test results, point–of– care devices also reduce the risk that mothers and babies will be lost to follow–up by health workers.


In 2011, there were an estimated 1.2 million adolescents 10– 19 years old living with HIV in Eastern and southern African, more than half of all HIV–positive adolescents globally. During the past 10 years, with intensified investments in prevention and treatment, HIV prevalence among young men and young women showed a decline in almost all countries in the region, especially in Botswana, Ethiopia, Malawi, South Africa, Tanzania and Zimbabwe. Some of the reduction came as a result of safer behaviour patterns, including increased uptake of HIV testing and counseling, delay of first sex, reduction in the number of partners, and increased condom use. The percentages of young people living with HIV vary widely across the region, but the risk of becoming infected is disproportionately higher for young women than for young men in every country except in Madagascar. Girls’ disproportionate vulnerability to HIV infection stems from both greater physiological susceptibility to heterosexual transmission, and from social and economic disadvantages and gender inequality they confront. Among young women, estimated prevalence in 2011 was as high as 12–15 per cent in Lesotho, South Africa and Swaziland. Even though HIV prevalence has been declining among adolescents in most of the region, knowledge of AIDS is still surprisingly low. On average, among the 15–19 years old, only about 39 per cent of males and 34 per cent of females demonstrated comprehensive knowledge1 of AIDS, with only two countries exceeding 50 per cent: Namibia and Swaziland.

“In 2011, there were an estimated 1.2 million adolescents 10–19 years old living with HIV in Eastern and southern African, more than half of all HIV–positive adolescents globally.” 1 Comprehensive knowledge is a combination of 5 indicators including 2 on modes of transmission and 3 misconceptions.

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UNICEF in action In order to achieve better results for adolescents in the second decade, UNICEF programming has shifted away from a broad emphasis on “young people” to a more targeted focus on adolescents (10–19 years). To this end, UNICEF, working jointly with UNFPA, WHO and UNESCO, supports countries to strengthen comprehensive approaches to HIV prevention, treatment, and care and integrated service delivery for adolescents. A mix of interventions are being strengthened to lower the risk of HIV transmission among adolescents. These include utilization of HIV testing and counselling, the use of male and female condoms, voluntary medical male circumcision, prevention of mother–to–child transmission – from HIV– positive adolescent mothers to their children, and increased access and early initiation on antiretroviral treatment. UNICEF also advocates for more focused investments to address inequalities and tackle conditions that exacerbate adolescent vulnerability to HIV, such as risky behaviours linked with gender violence and poverty. Working jointly with sectors such as child protection, social protection, and education will be critical for implementing such a strategy. By encouraging and supporting active involvement and leadership of adolescents, including those living with HIV, we can ensure that HIV prevention, treatment and care programmes among adolescents are adolescent–specific and better tailored to their needs.

Results for children • In Lesotho, HIV prevalence among 15–17 years old girls declined from 6 per cent in 2004 to 3 per cent in 2009, while in Malawi, HIV prevalence among young women 23–24 years of age declined from 17 per cent in 2004 to 8 per cent in 2010. In both countries HIV testing and counseling was the behavior that contributed to the most impressive changes.

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The second decade

Results for children continued • In South Africa, about 2000 adolescents belong to Girls and Boys Education Movement clubs in schools, where they receive life skills and information on AIDS, gender–based violence, teenage pregnancy and other issues.

• In Kenya, a life skills curriculum for use in primary and secondary schools has been finalized and is now being implemented.

• In Namibia, the HIV–prevention focussed life skills programme My Future is My Choice has been made mandatory for all Grade 8 learners.

© UNICEF/NYHQ2008–1635/Pirozzi

• In Tanzania, a national life skills education framework was approved in 2011 and a draft HIV–sensitive life skills package was piloted in three districts in 2012. UNICEF is also supporting the Tanzania Commission for AIDS to create a programme for teenage girls who are in and out of school to reduce HIV, unwanted pregnancies and gender–based violence in selected districts.

• In Botswana, an adolescent care package was developed in 2011 and included HIV counselling and treatment, sexual and reproductive health, nutrition and HIV prevention.

• Zimbabwe has developed an Adolescent Sexual Reproductive Health, HIV and AIDS Strategic Plan (2011–2015) and established a HIV/AIDS and Life Skills Secretariat.

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Since the dramatic increase in provision of antiretroviral treatment in the mid–2000s, AIDS–related mortality has been declining rapidly. In 2011, 800,000 lives were claimed by AIDS in Eastern and Southern Africa, fewer than the 1.3 million lost in 2005. In several countries in ESA, including Botswana, Ethiopia, Kenya, Namibia, Rwanda, Zambia and Zimbabwe, AIDS–related mortality declined by more than 50 per cent between 2005 and 2011. As a result, fewer children are being orphaned because of AIDS. Despite this, a disconcertingly large number of children in the region – estimated at 10.5 million in 2011 – had lost one or both parents to AIDS, and needed care and support. The strain AIDS causes on extended families, communities, and children themselves is enormous and well documented. Research from South Africa shows that children orphaned by AIDS and those living with a parent with AIDS, face greater risks of emotional and physical abuse and sexual exploitation than other children1. Many HIV affected children face huge challenges, including loss of parents, deepening poverty and economic vulnerability, reduced access to health services and education, and discrimination.

“In 2011, an estimated 10.5 million children in Eastern and Southern Africa had lost one or both parents to AIDS, and needed care and support.” With millions of children made vulnerable by the epidemic, care and support to help them survive and be protected from abuse and exploitation are nowhere near adequate. Where data is available, the percentage of children receiving external support remains low: only in Swaziland (41 per cent) and Botswana (31 per cent) significant numbers of vulnerable and orphaned children are being reached. In most other countries in the region, around 20 per cent or less (7 per cent in Tanzania) of these children receive some sort of external support. 1 Cluver, L. Orkin, M. et al (2011) Transactional sex amongst AIDS orphaned and AIDS affected adolescents predicted by abuse and extreme poverty, Journal of Acquired Immune Deficiency Syndromes.

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cHiLDReN & aIDs

Across both decades

In Eastern and Southern Africa, UNICEF’s programming in the protection of children affected by AIDS has two key programme priorities: • ensuring 50 per cent of the poorest households receive external economic support; and • ensuring priority countries have HIV–sensitive social protection and child protection systems and policies in place.

Social protection, care and support works at all levels, from local and community to national, and from improving health, maintaining continuity in education, preventing marginalization, to reinforcing and supporting families in the face of poverty and illness. Over the past 10 years, social safety nets that are inclusive of vulnerable households affected by HIV have

been expanded significantly in ESA, such as cash transfers. There has also been an increased focus on strengthening social services workforce at the lowest levels, to improve the capacity of care workers and social workers to identify and support children made vulnerable by HIV and AIDS. UNICEF’s work in providing care and support to children affected by HIV and AIDS not only includes mitigating the impact of the epidemic on households, but also seeking to increase children’s and adults’ access to HIV prevention, treatment and care programmes. Central to achieving results is a thorough understanding of social determinants of HIV risk and vulnerability, such as poverty, inequality, social exclusion and gender norms. UNICEF also puts a strong focus on integrating HIV work in other areas, such as health, nutrition, water and sanitation, education, child protection, social protection, and emergencies. In addition, increased attention has been given to promote innovative technologies and approaches to empower children to be active participants in shaping HIV programming.

© UNICEF/NYHQ2009–1923/Pirozzi

UNICEF in action

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cHiLDReN & aIDs

Across both decades

Results for children Between 2000 and 2011, the number of cash transfer programmes, which have shown to have positive impact on families affected by HIV and AIDS, increased nearly tenfold throughout sub–Saharan Africa. • South Africa’s social protection programme is one of the most advanced and wide reaching for a middle–income country, helping to reduce income inequality among the poor, elderly and disabled. One of its best–targeted grants, the Child Support Grant has expanded more than tenfold since 2000, and in 2011, 10 million children benefitted from it. • In Lesotho, the Child Cash Grant, initiated by UNICEF with funding provided by the European Union, was recently incorporated into the country’s larger social protection agenda. Since 2009, the number of children reached under the Grant has expanded from 5000 to almost 50,000, with many of them from child–headed households or living with elderly grandparents.

© UNICEF/MLWB2011–00399/Noorani

• In Mozambique, nearly half a million people, 60 per cent of them children, benefitted from social protection programmes in 2011, 60 per cent were children. Advocacy by UNICEF, the World Bank and the IMF led to the government allocating US$32 million to social protection programmes.

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oveRview

Around the world, UNICEF works towards the realization of children’s rights – the rights to survival and development – as enshrined in the Convention on the Rights of the Child. For many years, however, these efforts have mostly been uni– dimensional, and divided along the sectoral lines, i.e., health, education, child protection and HIV. But a child does not happen to be undernourished, without access to an education, or without a birth certificate, by chance. These manifestations are the outcomes of many determinants at play. While sector work addresses the most immediate causes (and to some extent underlying causes) of the problem, a deeper layer of causes is usually left out of the analysis. Social policy is precisely concerned about addressing those causes, which are related to the political economy, as well as the overall socioeconomic environment shaping public decisions making.

© UNICEF/UGDA2010–00132/Noorani

In Eastern and Southern Africa, two thirds of the countries are low–income and low development countries, as measured by Gross National Income (GNI) per capita and Human Development Index (HDI); more than half of the countries post high income inequality, as measured by the Gini Cofficient (see table right). In addition, more than half of the region’s population is under the age of 18. Such high share of children in the population should entail significant social spending, especially in education and health. The available data, however, suggest that many governments struggle to allocate enough resources to these crucial areas and to reach children who are most in need – those from the poorest households, from rural areas or born to mothers with the least education.

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Economic and demographic indicators of ESA countries, 2011 Gross National Income (GNI) per capita USD

Human Development Index (HDI)

Angola

4,060

0.51

Botswana

7,480

Burundi

Government spending on education* (% GDP)

Government spending on health (% GDP)

10,944 (56%)

3.5

3.5

58.6

0.63

874 (44%)

7.8

5.1

250

0.36

4,149 (45%)

6.1

8.7

33.3

Comoros

770

0.43

382 (56%)

5.3

64.3

Eritrea

430

0.35

2,733 (48%)

2.6

Ethiopia

400

0.40

44,051 (51%)

4.7

4.7

29.8

Kenya

820

0.52

21,514 (53%)

6.7

4.5

47.7

1,220

0.46

1,073 (53%)

12.8

Madagascar

430

0.48

11,184 (53%)

2.8

4.1

44.1

Malawi

340

0.42

8,497 (57%)

5.4

8.4

Mozambique

470

0.33

12,797 (53%)

6.6

45.7

Namibia

4,700

0.61

1,089 (50%)

8.4

5.3

63.9

Rwanda

570

0.43

5,598 (52%)

4.8

10.8

50.8

Somalia

5,126 (53%)

South Africa

6,960

0.63

20,097 (40%)

6.0

8.5

63.1

South Sudan

1.7

45.5

3,300

0.54

609 (51%)

7.8

8.0

51.5

Tanzania

540

0.48

19,860 (44%)

6.2

7.3

37.6

Uganda

510

0.46

24,782 (73%)

3.2

9.5

44.3

Zambia

1,160

0.45

7,470 (51%)

6.1

54.6

640

0.40

6,509 (50%)

Countries

Lesotho

Swaziland

Zimbabwe

Upper middle income

Child population, under 18 (thousands)

Lower middle income

2.5

Gini Coefficient

Medium HDI

*Latest year with available data

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overview

UNICEF in action Social Policy in UNICEF spans across three broad main areas, while trying to answer specific questions about child vulnerability:

Social protection: How to mitigate the effects of poverty and vulnerability on children’s lives? How to build systems that will make them resilient in the long term? How to integrate social protection interventions with policies and service delivery in other sectors?

Social budgeting and public finance: How to increase the availability, efficiency and equity of public expenditure for child–sensitive social protection and child–related social services?

Besides programmatic work in these three areas, social policy delivers on situation analyses and research, knowledge management, and policy advocacy on child rights. A strong focus is placed on building partnerships, particularly with the ministries of finance, economic development, planning, as well as the parliament, academic institutions, and other development partners such as the European Union, the IMF and the World Bank.

“Many governments in Eastern and Southern Africa struggle to allocate enough resources to social sectors, such as health and education, and to reach children who are most in need.” 70

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© UNICEF/NYHQ2007–2104/Claude Mutabazi

• Child poverty and vulnerability: Who are the poor children? What are the specific factors that make them poor or likely to become poor?


In recent years, many countries in Eastern and Southern Africa have recorded strong economic growth. And the number of countries exporting large quantities of natural resources is growing by the year. This has the potential to significantly increase government revenue in these countries, creating greater space for increased government expenditure. However, increased government expenditure does not necessarily translate into increased social expenditure. Some countries might be tempted to invest more where impact is more visible in the short–run, such as the infrastructure sector, hence a lesser focus on social sector, for example, investing in safety nets for the most vulnerable members of the society. Angola, for example, despite earning billions of dollars through its oil industry, still has one of the highest child mortality rates in the world. Meanwhile, the gap between the rich and the poor continues to widen, particularly in middle–income countries, such as Angola, Botswana, Namibia, South Africa and Swaziland.

While acknowledging that financial resources alone are not sufficient to durably improve the situation, UNICEF makes the case for harnessing available resources, especially domestic resources, and tracking their expenditure to ensure that they effectively reach children and ultimately improve their situation. Public finance, especially the social sector budgeting process, is the single most powerful tool available to promote equity and basic services for disadvantaged children.

“Public finance is the single most powerful tool available to promote equity and basic services for disadvantaged children.”

© UNICEF/NYHQ2007–1381/Pirozzi

A country’s budget is perhaps the most powerful tool a government has to implement its policies and advance the rights of its children. Whether children’s rights to health, nutrition, education and protection can be fully realized or not, depends heavily on whether these rights are given due consideration and prioritized during the budgeting processes, in which resources are marshalled and policies are translated into financial commitments.

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UNICEF in action Investing financial resources to help children survive and develop is, first and foremost, a moral imperative. But investing in children is also important on practical grounds. It yields positive benefits to economies and societies. Since the foundation of an individual’s health and well–being is laid during early childhood, the most opportune time to break the cycle of poverty, or prevent it from beginning, is during that time.

© UNICEF/NYHQ2009–2616/Pirozzi

UNICEF’s mission is to help countries ensure that all children survive and develop into their full potential, as well as those that will allow them to develop to their full potential. To maximize resources for children, UNICEF supports governments in identifying funding sources, creating consensus around the need to invest more in children, and using public finance policies to achieve sustainable progress in the fulfillment of children’s rights. UNICEF works with governments and partners, including civil society, development agencies, and the donor community to help ensure that budget and policy priorities reflect this commitment.

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social budgeting

While UNICEF’s specific work varies from country to country, there are several common goals, each contributing to stronger public finance policies for children:

• improving equity by helping ensure that children, women and poor families are not marginalized in both the actual public sector allocations as well as the decision–making process of arriving at these; • improving efficiency by helping achieve the best possible results for children for the amount of resources committed; and • contributing to stability by helping secure adequate resources to sustain investments in the social sectors and promote social protection, notably during crises.

Results for children • In 2013, social budgeting, public finance or public expenditure reviews have been carried out in nine countries in the region. In countries such as Kenya, Malawi and Mozambique, these exercises have served to build the capacity of government officials, legislators, and civil society to understand and influence public spending for children.

• Budget allocation reviews were carried out in Uganda and Mozambique, to examine how the national budget is allocated to social sectors, such as education, health, water and sanitation, and assess whether it is aligned with development objectives, such as national development plan, MDGs, and other major international development goals.

• Benefit Incidence Analyses have been undertaken in Madagascar, Malawi, Rwanda and Uganda and their conclusions will inform policy makers on the impact of public expenditure on population groups of different income status.

• Kenya’s social budgeting and social intelligence reporting on education, health, WASH, nutrition and social protection has helped identify weaknesses in service delivery, and promote dialogue on how to make follow– up actions.

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© UNICEF/NYHQ2009–1250/Pirozzi


Why are children still out of school in areas where education facilities are available? If antenatal services are free in the local clinics, why are some expectant mothers not seeking them? When disasters strike – droughts, floods, loss of job, civil unrest – what prevents families from meeting their basic needs and taking care of the most vulnerable members of the community, including children, women and the elderly? The answers to these questions are complex. They can be related to quality of services, and how they are delivered. They can also be related to vulnerabilities caused by economic or social factors, such as poverty, limited assets, stigma, power imbalances, and social exclusion. Social protection, which consists of a set of policies and programmes, is designed to reduce such vulnerabilities. Social protection interventions such as cash transfers, user fee abolition, and anti–discrimination legislation, can not only remove economic and social barriers that prevent women and children from accessing services, but also

strengthen the capacity of households to withstand, adapt and mitigate shocks. Until recently, social protection had been considered a privilege of developed nations. The countries in Eastern and Southern Africa, however, have decided that social protection is no longer a luxury that they cannot afford. In 2006, 13 countries in the region signed the Livingstone Accord under the auspices of the African Union, committing themselves to developing national social protection strategies and integrating them into their national development plans and budgets. The Livingstone Accord was followed by the Social Policy Framework for Africa (2008), a signal of increased political commitment from the African nations to social protection. The declarations represented an emerging consensus that a minimum package of essential social protection measures must be in place in every society. For UNICEF, these commitments have opened up new opportunities in the fulfillment of children’s rights to survival, development and protection.

“In 2006, 13 countries in Eastern and Southern Africa signed the Livingstone Accord, committing themselves to developing social protection strategies and integrating them into their national development plans.” 76

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social protection

Components of social protection Social transfers: Predictable direct transfers to individuals or households, both in–kind and in cash, to protect them from the impacts of shocks and support the accumulation of human, financial and productive assets. Examples: cash

unicef in action Throughout the region, UNICEF supports governments in the development of national social protection strategies or frameworks, as well as the implementation of social protection programmes and systems, ensuring that they are child–sensitive, inclusive and nationally–owned. Here are some of the key areas that UNICEF focuses on:

transfers, in–kind transfers, public works. Programmes to ensure access to services: Programmes that reduce economic and social barriers households face when accessing social services. Examples: User fee abolition, health insurance, birth registration. Social support and care services: A range of services that help identify and reduce vulnerability and exclusion, particularly at the individual and household level, to improve people’s capacity to overcome shocks and strains, and link them to existing programmes and services. Examples: family support services, home-based care.

Policy, strategy development and reform: In addition to support national governments in developing social protection strategies and frameworks, UNICEF supports reforms in the legal and justice systems so that they are consistent with the international treaties, such as the Convention on the Rights of the Child, the African Charter on the Rights and the Welfare of the Child, and the Convention on the Elimination of all Forms of Discrimination against Women.

Development of integrated social protection systems: Access to services in health, nutrition, education and protection is critical to children’s development, and it also lays the foundation for future human and economic gains. To this end, UNICEF supports countries in their efforts of moving towards a multi– dimensional and coordinated social protection response.

Expansion of coverage and promoting government ownership: UNICEF works closely with governments in the region to progressively expand the coverage of their social protection programmes, so that more vulnerable children and women are reached. Ensuring these programme’s sustainability and government–ownership is also a key focus for UNICEF.

Legislation and policy reform: Changes to policies and legislation in order to remove inequalities in access to services or livelihoods/economic opportunities, thereby helping address issues of discrimination. Examples: maternity and paternity leave, inheritance rights, employment guarantee schemes.

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© UNICEF/NYHQ2006–0424/Pirozzi

social protection

HIV–sensitive social protection: Evidence shows that social protection interventions, such as cash transfers, impact positively on prevention, access to treatment, as well as mitigating the negative effects of HIV and AIDs on children and their families. Across the region, UNICEF supports the development of national HIV–sensitive policy frameworks and interventions. The work is particularly relevant as ESA remains to be the epicentre of the AIDS epidemic.

Generating an evidence base: Together with partners, UNICEF supports the Transfer Project, a research initiative that examines the impact of government–sponsored social cash transfer programmes in more than 13 countries in sub– Saharan Africa.

Results for children UNICEF supports governments in ESA in the drafting and revision of comprehensive Children’s Acts to bring national laws and legislations in line with international standards. To date, such Children’s Acts have been drafted and reviewed in Botswana, Ethiopia, Uganda, Malawi, Namibia, Mozambique, South Africa, Swaziland and Tanzania. Another important area of UNICEF contribution is cash transfers. With UNICEF support, the following countries have made some of the most noteworthy achievements: • South Africa’s Child Support Grant, introduced in 1998, has become the country’s largest social assistance programme, covering over 10 million children. Originally limited to children under the age of 7 years, the programme has been expanded to cover children up to 17 years of age. Eligible primary caregivers receive a monthly support of about US$28 per child. A recent evaluation shows that the Grant directly impacts on poverty and vulnerability reduction, while helps break inter–generational cycles of poverty and exclusion. • In Kenya, UNICEF provides technical and financial assistance to the country’s flagship programme, the Cash Transfer Program for Orphans and Vulnerable Children. As of 2013, the programme covers over 155,000 households and 542,000 OVCs across the country. With the support of UNICEF and other key partners, such as the UK and the World Bank, the Government of Kenya is currently starting a major expansion of coverage for all social assistance interventions, as well as moving towards a harmonized social protection system to effectively address multiple vulnerabilities of children and families. • In Lesotho, the Ministry of Social Development, the European Union and UNICEF work together in addressing the vulnerabilities of children affected by poverty, exclusion and HIV. The Child Grant Programme, initiated in 2009, has been expanded to cover 50,000 households, up from 5,000. Moreover, the country is moving towards a comprehensive social protection system. • In Zimbabwe, during 2013, almost 60,000 children at risk of and exposed to violence, exploitation and abuse received quality support and care, and almost 100,000 children in over 32,000 poorest households were reached with cash transfers under the Child Protection Fund, an aligned funding and technical partnership mechanism for the implementation of the government’s National Action Plan for Orphans and Vulnerable Children. The Fund is supported by UNICEF and partners, including the European Union, and the governments of Sweden, the UK, Netherlands and Switzerland.

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oveRview Nowhere are children and women more at risk of natural hazards and manmade disasters than in Eastern and Southern Africa. For millions of children and their families, their survival and wellbeing are under constant threat due to a sharp increase in food insecurity, political instability, epidemic outbreaks and natural disasters. As critical as it is, however, many states are too fragile and ill–equipped to deal with these threats. In 2011, the crisis in the Horn of Africa reached a boiling point when the UN declared famine in two regions of southern Somalia. Although the famine officially ended in February 2012, and hundreds of thousands of lives were saved through the combined humanitarian efforts of the governments, international community and partners, the progress remains fragile. Elsewhere in the region, other emergencies loom. Intense fighting and prolonged conflict in the Kivu region of the Democratic Republic of Congo have left families displaced, and tens of thousands of refugees, majority of them women and children, entering Uganda and Rwanda. Burundi, already struggling to cope with an influx of Congolese refugees, also needs to assist its own repatriated refugees from Tanzania. In the north, the newly independent South Sudan is trying to rebuild itself after more than two decades of civil war. Two years after it declared independence in 2011, the country is still grappling with multiple crises, from severe food insecurity and government–initiated austerity measures, to the on–going influx of refugees and the continued threat of conflict. In December 2013, fighting broke out between the government and rebel forces. By the time a ceasefire was agreed, more than 600,000 people were displaced, with 120,000 also seeking refuge in neighbouring countries. In Southern Africa, a major food crisis has already put millions of people at risk, largely in Angola, Lesotho, Malawi and Zimbabwe. In Swaziland, the country with the world’s highest

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HIV prevalence, women and children are particularly vulnerable to natural disasters and economic shocks. In recent years, the country was hit by a financial crisis caused by the collapse of transfers from the Southern African Customs Union, among other factors. Swazi households were rocked with escalating food prices, job losses, wage cuts and reduced access to credit. Shortages of life–saving drugs, including antiretroviral drugs put thousands of children and women at risk.

UNICEF in action In 2014, UNICEF will continue to respond to emergencies whenever they strike, and invest in long–term solutions by building the capacity of governments and national partners to recognize and respond to the unique humanitarian needs of women and children. A strong focus is on strengthening resilience of families and communities in vulnerable regions such as the Horn of Africa. After all, hazards only become disasters when people’s and society’s capacities to withstand them are compromised.

“Nowhere are children and women more at risk of natural hazards and manmade disasters than in Eastern and Southern Africa.”


emeRgeNcies

© UNICEF/NYHQ2011–2409/Grarup

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As they are in many other parts of the world, natural hazards such as drought, storms and floods are a regular part of life in Eastern and Southern Africa. But hazards become disasters only when people’s or a society’s capacities to cope within existing resources are overwhelmed. Disaster risk, therefore, is the potential loss in lives, health status, livelihoods, assets and services that may occur in a particular community or society. And it is the poor and marginalized who are most at risk. Disaster Risk Reduction (DRR) aims to identify, assess and reduce those risks. It targets the national, sub–national, and, in particular, the community level, where people often face risk and know best how to prevent or reduce it. DRR calls for governments, civil society, the private sector, and other actors to partner with the most vulnerable people to help prevent hazardous situations from evolving into disasters, mitigate the impact of hazards, and prepare for the worst.

unicef in action UNICEF’s presence before, during and after an emergency provides unique opportunities for including disaster risk reduction into both the development and humanitarian contexts. Its core programmes in the areas of health, nutrition, water, sanitation and hygiene (WASH), education, child protection, and HIV/AIDS provide the ideal instruments to prepare for, prevent and mitigate disaster risk. UNICEF–supported DRR programming is in line with the international Hyogo Framework for Action (2005–2015), and is focused on four principal areas:

• DRR for children and women is a national and local priority; • different risks faced by girls, boys and women are identified and addressed; • safer and more resilient conditions for girls, boys and women; and

© UNICEF/NYHQ2011–1019/Holt

• strengthened humanitarian preparedness, response and recovery through capacity development.

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In Eastern and Southern Africa, such efforts now include, for example, support to the construction of safe school buildings, as well as emergency preparedness plans and disaster risk reduction in school curricula, developing child protection systems in areas prone to natural hazard and conflict, hygiene awareness, and disaster–related disease outbreak prevention.


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Disaster risk reduction

Results for children • Throughout the region, UNICEF is actively engaged in policy dialogue to advocate for a child–focused DRR. To date, eight countries have created DRR National Platforms.

© UNICEF/NYHQ2010–0394/Hyun

• Substantial work has been done in promoting disaster risk management through education, including safe school buildings, emergency preparedness plans and DRR in school curricula, with a global Netherlands grant.

“Disaster Risk Reduction (DRR) aims to reduce the damage caused by natural hazards like earthquakes, floods, droughts and cyclones, through an ethic of prevention.”

• UNICEF has supported the routine collection of district–level early–warning data since the 1990s in Ethiopia, as part of the support to hazards analysis and early–warning systems.

• In Kenya, pilot vulnerability and capacity assessments at district level have been conducted to inform emergency and development planning.

• In Namibia, UNICEF provided technical guidance to the government to formulate the first National Disaster Risk Reduction Plan.

• In Rwanda and Madagascar, UNICEF supported construction of earthquake–resistant child–friendly schools and health centres.

• Across Southern Africa, in partnership with other agencies, UNICEF supported the development of regional cholera preparedness and response plans for flood situations.

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In recent years, despite increased scale and effectiveness of humanitarian responses, millions of people continue to be affected by largely predictable shocks and stresses, and live through their negative consequences. The famine in Somalia during the Horn of Africa crisis in 2011, and yet another food and nutrition crisis in the Sahel in 2012, were tipping points for these frustrations.

© UNICEF/NYHQ2010–0396/Hyun

Looking at past humanitarian and development efforts, the international community diagnosed a failure to address the underlying causes of crises. It was concluded that insufficient attention had been paid to the capacities – and ultimately the resilience – of the most vulnerable communities, an integral element of sustainable development.

“Resilience: The ability to withstand threats or shocks, or the ability to adapt to new livelihood options, in ways that preserve integrity and do not deepen vulnerability.” 84

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Resilience building

UNICEF and resilience

Protection

While multiple definitions exist, resilience can be understood as “the ability to withstand threats or shocks, or the ability to adapt to new livelihood options, in ways that preserve integrity and do not deepen vulnerability”.

Resilience in children can only be built in safe spaces, including homes and schools, where they are cared for and their capacity to deal with adversity is developed. In Somalia, for example, resilience of individuals, families and communities are supported through a range of protection measure that address hazards of population mobility, harmful social norms, including gender–based violence, and trauma associated with conflict.

Peacebuilding Conflict and insecurity are among the most significant development challenges. Because of this, peacebuilding is a key component of UNICEF’s corporate strategy in resilience building. For countries affected by conflict or at risk of it, peacebuilding plays a crucial role in repositioning UNICEF programming through addressing drivers that undermine social cohesion, human security and individual resilience to withstand and recover from shocks.

Education An educated child will have more of the resources needed for his or her resilience. Educated girls, for example, are likely to become heads of more resilient families, and are more capable of steering their children towards good health, nutrition, and education, compared to their non–educated peers. Educated children of both sexes have more opportunity to employment within and beyond the country, and are better positioned to not only support their own lives, but also those of their wider communities, such as through remittance economies.

© UNICEF/NYHQ2011–1013/Gangale

Over the years, UNICEF has contributed to strengthening resilience through its work in social protection, disaster risk reduction (DRR), climate change, peacebuilding, and national capacity development, as guided by the organization’s Core Commitments for Children in Humanitarian Action (CCCs). The resilience agenda is very closely linked to UNICEF’s equity agenda, and the effort of building resilience has been carried out through the following programmes:

Health and nutrition A healthy family is more capable of withstanding shocks, and supporting others when disasters strike. Programmes to build resilience through health interventions focus on community and family nutrition and health care, as well as prevention and treatment of diseases and malnutrition. They also address reproductive and psychosocial health, and equitable access to health and nutrition services.

Water, sanitation and hygiene Reliable and affordable water supply for people, animals and crops is a critical factor to avert many of the crisis–ridden stresses and shocks. Empowerment of communities to change behaviour and adapt more healthy and dignified practices, such as community–led sanitation initiatives, contributes to household resilience. Such programmes can also be an entry point to develop other community actions and skills.

Cash transfers Cash transfers – small predictable sums of money given to the most vulnerable families – are a key pillar of the resilience strategies UNICEF and its partners employ to help communities withstand shocks. Past experiences show that in the period following an acute emergency, reliable and predictable cash–transfer programmes can assist families to rebuild their livelihoods and avoid migration and destitution. Cash transfers also call attention to disparities between the poor and the poorest of the poor, and help place the latter at the centre of a nation’s social policy agenda. unicef in eastern & southern africa

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© UNICEF/RWAA2011–00103/Noorani


Prepared by UNICEF Eastern and Southern Africa Regional Office Design by K&i Design Studio February 2014


UNICEF Eastern and Southern Africa Regional Office P.O. Box 44145 Nairobi, Kenya 00100 Email: unicefesaro@unicef.org Facebook: UNICEFAfrica Twitter: @UNICEFAfrica www.unicef.org/esaro