Pakistan Humanitarian

1 Pakistan Humanitarian

Situation Report No. 27

Learners participating participating Learners

PAKISTAN

Situation in Numbers

in story writing competition practicing practicing competition writing in story KP Waziristan, in South distancing social © © UNICEF/

Reporting Period: 1 – 31st July 2021 (monthly) 5.59 m children in need of Key Highlights humanitarian assistance • Pakistan is facing the fourth wave of COVID-19 cases starting from July, there have been 1,029,811 confirmed COVID-19 cases and 23,360 deaths 110.5 m reported with a positivity rate of 7.7 per cent in the country on 31st July. people in need (https://covid.gov.pk/stats/). • Over 50.7 million people have been reached with messages on COVID-19

prevention and on access to services. 1,029,811 confirmed • Through UNICEF supported health sites, 103,512 children were admitted corona virus cases in for Severe Acute Malnutrition treatment. Pakistan • Over 2.64 million people benefited from continuity of primary healthcare services at UNICEF supported health facilities 1.7 million • UNICEF has reached 317,457 parents, caregivers, children and individuals Children and women with psychosocial support through trained social workforce. require nutrition services

• Through UNICEF support 1,500,000 people have been reached with handwashing behaviour change programme. • 5% of Pakistan’s target population is fully vaccinated whereas; 18% is UNICEF Appeal for partially vaccinated. Preparedness and Response US$ 61.4 million UNICEF’s Response and Funding Status

People reached (through 68% national Media channels) with… © UNICEF/PAKISTANFunding Status (in US$)

Funding status 12%

C4D, CE C4D, AAP and People at high risk supported Other 64% Humanitarian with hygiene promotion… funds, $1m Resources,

WASH Funding status 18% $4m Carry- People, including children 71% forward, receiving PSS $7m

Child Funding status 17% Protection Children accessing safe formal and non-formal education,… 15%

Funding status 16% Education Children and women accessing primary health care in… 75% Funding Health Funding status 43% gap, $49m Children provided with MMN 13%

Funding status

Nutrition 19%

0% 20% 40% 60% 80%100% 1 Leveraging resources and working with government and partners helped WASH, CP and C4D in getting better results

Funding Overview and Partnerships

In 2021, with the revised appeal UNICEF Pakistan needs US$ 61.4 million to support the in-country humanitarian response. US$ 12.21 million (20 per cent) have been received to provide humanitarian support in the country. Additional funds have been received from USAID to support the rollout and response of COVID-19 vaccine. A critical funding gap of US$ 49.19 million (80 per cent) persists and impede the provision of essential emergency services throughout the country especially for preparedness, nutrition and C4D response.

In addition to the humanitarian resources received during the year, US$ 3.76 of existing resources have been re- purposed to support the on-going response. This includes funds received from the United Kingdom, Canada, UNICEF’s set-aside funds, Global Thematic Funds and regular resources.

UNICEF expresses its sincere gratitude to the Governments of United Kingdom, United States, and the Austrian Committee for UNICEF, Asian Development Bank, Central Emergency Response Fund (CERF), World Bank, ECHO, Global Partnership for Education, Gavi -The Vaccine Alliance, Solidarity Fund, Standard Chartered, along with all its public and private donors for their contributions.

Situation Overview and Humanitarian Needs

By the end of June, the National Command and Operation Centre (NCOC) took a detailed review of the disease situation in the country and corresponding non-pharmaceutical interventions (NPIs) being carried out. Forum agreed on implementation of some key NPIs/decisions. These decisions were implemented from 1st July to 31st July 2021 to be review on 27th July 2021 at NCOC. It was decided that normal working hours for public/private offices with 100 per cent attendance will be continued. Market/business activities will continue till 10:00 pm. However, essential services were allowed 24/7. Observance of summer vacation in the education sector was to be at the discretion of respective federating units. Ban on closure of shrines remained in place and cinemas remained shut. Public transport could operate with 70 per cent occupancy with strict COVID-19 Standard Operating Procedures (SOPs). Rail services were allowed to operate with 70 per cent occupancy with strict COVID-19 SOPs. The government is urging compliance on wearing masks and broader lockdowns continue to be implemented with stringent enforcement protocols based on risk assessments.

Since the beginning of July, a clear rise in COVID-19 cases (as can be seen in the graph below) was witnessed indicating the beginning of fourth spike of cases. The latest surge is a concern and is mainly due to the more contagious and deadly Delta variant, along with lax in social attitudes and increased activity around Eid-ul-Azha. Towards the end of July, the government was once again planning stricter restrictions including scaling back market closure timings from 10pm to 8pm, closure of indoor dining/outdoor dining (till 10pm), resumption of 50 per cent work-from-home policy, public transport to operate with 50 per cent occupancy and two days in a week to be observed as safe days when all commercial activities will remain closed with provinces free to choose which days these will be.

The Humanitarian Response Plan (HRP) 2021 was launched jointly by the Ministry of Foreign Affairs, Government of Pakistan and UN on 9th June 2021. The HRP aims to provide integrated lifesaving services to some 4.3 million most vulnerable people affected by shocks ensuring living conditions, resilience, and protection whereas the overall needs are for 11 million people across the country.

EPIDEMIOLOGICAL OVERVIEW

As of 31st July, there have been 1,029,811 confirmed cases, 66,287 active cases, 940,164 recoveries and 23,360 deaths reported. The highest number of these cases are in Sindh, followed by Punjab and Khyber Pakhtunkhwa (detailed figures are given in map below). The bar graph below shows the daily COVID-19 cases from 1st to 31st July 2021.

Confirmed cases across the country

Based on data from NCOC2, as of the end of July, Pakistan conducted 15,995,153 laboratory tests.

COVID-19 Vaccine Updates: The COVID-19 vaccination rollout started on the 3rd February 2021 in Pakistan. The vaccination is being carried out in a phased manner with priority first given to frontline health/workers, senior citizens to people in lower age brackets. Starting from 27th May, the vaccination registration has now been opened for above 18 years old; hence, the entire population over 18 years can now get registered and vaccinated, provided that the supply chain is maintained.

Pakistan has received 44.9 million vaccines doses so far and by 28th July following was the vaccine utilization and balance Vaccine Doses Arrived Doses Utilized Balance AstraZeneca 2,474,400 1,148,595 1,325,805 Cansino 2,029,200 1,172,675 856,525 Moderna 5,500,000 238,947 5,261,053 PakVac 1,337,410 760,416 576,994 Pfizer 127,070 31,145 95,925 Sinopharm 12,720,000 7,723,757 4,996,243 Sinovac 20,550,000 13,513,431 7,036,569 Sputnick 200,000 200,000 0 Grand Total 44,938,080 24,788,966 20,349,114

NCOC vaccine related statistics on 30th July are shown below3.

The gender gap of COVID-19 vaccination is shown in the below graph for both first and second dose of vaccine as of 30th July 2021.

2 https://ncoc.gov.pk/#section2 3 https://ncoc.gov.pk/ 3

20,000,000

15,000,000 64%, 11,164,887 10,000,000 Male Female 5,000,000 64%, 4,555,309 36%, 6,328,540 - 36%, 2,540,230 Dose I Dose II

Government Supply agreement: With Government supply agreements Pakistan has received in total 33.63 million doses of vaccines. Out of which 20.5 million are SinoVac, 10 Million are Sinopharm, 1.7 million are Cansino Bio, 1.37 million are PakVac, and 26.9 thousand are Pfizer vaccine.

Donations: Pakistan has also received donation of 2.7 Million doses of Sinopharm vaccine.

Private Entities: Private entities have purchased 510 thousand doses of vaccines; out of which 200 thousand are Sputnick and 310 thousand are Cansino Bio.

COVAX, Humanitarian Action for Children Access to COVID-19 Tool Accelerator Updates:

From COVAX Pakistan has received 8.38 Million doses of vaccines: AstraZeneca 2.47 million doses, Pfizer 100,160 doses, and 5.5 million doses of Moderna Vaccine.

Through COVAX in the month of July Pakistan has received 6.37 million doses of Vaccines which include AstraZeneca Second shipment and Moderna two shipments.

Cold Chain Updates: • All 23 ultra-cold chain equipment (CCE) have been installed: 5 in Federal EPI, 16 in districts and 2 in NIH for lab products. • UNICEF will provide 18 additional Ultra Cold Chains (UCCs)Pakistan to support Pfizer vaccine distribution. The placements of these UCCs are being confirmed by the government, so that installation of generators and air conditioners and their specifications can be confirmed.

Vaccine Communication: UNICEF Pakistan was actively involved in vaccine communication since the beginning of the vaccination drive. The government is now soliciting support in mass vaccination drives and branding of the adult vaccination centres. The government has gradually started a mass media campaign on COVID-19 vaccinations and SOPs from 17th July and the Paid Search Marketing (PSMs) can be seen on Television.

Oxygen needs in the country: Considering the increasing case load of COVID-19 positive cases (mainly delta variant) on daily basis, Pakistan is in the initial phase of fourth wave and is faced with risk of more cases with enhanced requirements for case management and oxygen therapy. Under the Supply Financing Facility (SFF) funding of UNICEF, 1,000 oxygen concentrators have been procured and are already delivered to Expanded Programme on Immunization in Islamabad.

Summary Analysis of Programme Response

1. Communication for Development, Community Engagement and Accountability to Affected People:

Coordination: UNICEF continues to provide leadership, coordination and technical support to the Ministry of National Health Services Regulation and Coordination (MONHSR&C) and its Risk Communication and Community Engagement (RCCE) partners. Both the National and UN RCCE task force teams were established in March 2020. These RCCE forums provide the strategic direction for RCCE efforts in the country. The UN task force team that includes eight UN agencies, meets monthly. In addition to coordination at the federal level, UNICEF is co-lead in all provincial RCCE taskforce teams, aiming to strengthen coordination, planning, monitoring and ensuring timely implementation at both provincial and district levels.

Response: Key RCCE priority areas during this period focused mostly on: 1) Preparations and implementation of RCCE activities during Eid-ul-Adha; 2) Continued research and social analytics; and 3) Preparing RCCE strategy for the fourth wave with updates on vaccination, new variants and SOPs.

Eid-ul-Adha. The federal and provincial RCCE teams finalized a strategy and action plan to help reduce infection and virus transmission during the religious week of Eid-ul-Adha. This high-risk period is defined by its increased population mobility and large-crowd events in homes, marketplaces and religious places of worship. As in previous religious celebrations, key focus areas include a drive to unite and commit religious leaders to minimize religious gatherings, promote preventive behaviours, and practice positive modelling for vaccination and SOPs. Mass media channels were used to encourage limitation of travel and family gatherings, promote solidarity and accountability, encourage female vaccination, and support needs of the federal and provincial RCCE coordination taskforce teams.

Continued research and social analytics. UNICEF RCCE team continues to emphasize the importance and contribution of evidence generation to guide its strategies and approaches. A contract was signed with the International Public Sector Accounting Standards (IPSOS) to conduct monthly KAP surveys, advanced weekly social-media analytics, quarterly direct-observational surveys, and a national mass-media landscape survey. All surveys are under development and results will be presented and shared by mid-August. Initial findings show that the population remains confused about the different variants (62%), there are increased numbers in both vaccine confidence and vaccine hesitancy in different districts across Pakistan, and which will be further investigated in coming weeks. Female vaccination remains at a low 31% and RCCE strategies continue to prioritize the gender lens with influential leaders across Pakistan. Initial insight brings attention to the vertical family structures for roles and responsibilities, lower women access to resources, the need to further advocate and influence laws and policies, as well as creating engagement and conversation on existing norms and beliefs.

RCCE strategies also remain guided by special focus on high-burden districts, identified by percentage of positivity cases and low vaccine uptake. We acknowledge that these are often changing and RCCE teams need to adopt a more flexible strategy to quickly intervene in new areas.

RCCE preparations for the fourth wave. The fourth wave is characterized by both existence of new COVID-19 variants, new perceptions on the need for vaccination, and pandemic fatigue around the efficacy of SOPs. The government has not communicated much about the dangers of new variants and related citizen responsibilities in limiting the spread of new COVID-19 variants. Without causing panic, new messages promoted by UNICEF on Mass and social media include explanation of what a new variant means, its more severe level of contagiousness, and the role of vaccination and SOPs as the only means to suppress its spread.

Religious leaders’ engagement: Through health alliances and existing polio structures, 74,442 religious leaders were engaged and mobilized to promote a higher risk-perception towards COVID-19 and its hidden dangers (of which 5,505 religious leaders were mobilized in the reporting period). Preaching from local mosques, religious leaders reminded followers to abide to SOP rules, including the importance of vaccination, handwashing, the continuous usage of masks and to limit large gatherings, especially during festivities of Eid-ul-Adha.

Media, social-media and production of educational materials (print/video): Television and radio remain the primary sources of trusted information on the COVID-19 in Pakistan. Although TV and radio have the highest outreach, social media is catching up with them in terms of outreach. However, there is a risk of misinformation, since social media is not well regulated. Through national and private media channels with messages on COVID-19 prevention and vaccination reached 2.7 million people.

On social media, Facebook has been the best performing platform for UNICEF Pakistan with 79,133,152 total impressions and 1,254,823 million total engagements between 19 June and 20 July 2021. On average, each Facebook post received 3,165,326 impressions and 50,193 engagements. On Twitter, the total impressions have been 301,458 and total engagements have been 6,139 during the reporting period. On Instagram, the total impressions have been 102,515 and total engagements have been 2,387 during this period. During this period, Pakistan received two COVAX shipments consisting of Moderna and AstraZeneca COVID-19 vaccines respectively. The social media posts (English and Urdu) regarding these shipments received very high impressions and engagements, especially on Facebook.

Community mobilization activities continued in high risk districts throughout the country with additional support from the Polio teams who continued to disseminate messages on the importance of respecting SOPs, vaccination uptake and testing along with messages on Polio. During the period of Jan-July, 13.34 million at risk people have been reached with COVID-19 preventive messages. 5

Feedback Mechanisms: The Polio helpline, now also used for COVID-19 purposes, responds to nearly 40,000 calls each day, of which nearly one-third has been from callers requesting information on vaccinations. Most of the questions were related to the effectiveness of the vaccine, the registration process and information regarding the second dose, including its revised timeline.

The helpline has proven to be an effective tool in building trust between the population, the government and also with implementing partners. It informs callers on how they can register for the vaccine, receive information on eligible citizens, and be directed to the closest vaccination sites. The helpline also provided critical information on where they can get tested and/or get treatment for COVID-19. During the reporting period, 267,228 call received, and 177,964 calls were answered (66 per cent response rate), the number of calls surpasses the number of staff available to respond.

Gaps and Challenges: The arrival of the COVID-19 vaccine continues to overshadow the importance for continued adherence to the COVID-19 SOPs and of the use of mask. It is perceived as if the vaccine has already ended the pandemic in Pakistan. The most common public concerns regarding the COVID-19 vaccine are related to side effects, lack of clear and consistent communications from the government, unavailability of vaccines, difficult access to vaccination centres, complex electronic registration systems, doubt about the general effectiveness of the COVID-19 vaccine, confusion over the six existing vaccines in Pakistan and the differences between them and the revised schedule between two doses. Other public concerns are beginning of fourth wave of COVID-19 and rapid spread of Delta variant in Pakistan.

Partnerships: UNICEF is working with the federal and provincial governments as well as implementing partners which include: WHO, UNHCR, UNDP, FAO, UNAIDS, UNESCO, UNODC, UNWOMEN, UNFPA, UN HABITAT, UNRC, WFP, ICRC, PRCS, GRASP/ITC, Digital Pakistan, UNILEVER, Daraz.pk, Zong4G, AKF, HANDS, Pakistan Medical Association, Rural Support Programme Network (RSPN), Pakistan Alliance for Early Childhood (PAFEC).

2. Water, Sanitation and Hygiene:

Coordination: UNICEF works in close collaboration with the Government of Pakistan, WHO and other sector CSO partners. UNICEF advocated and supported the Ministry of Climate Change to convene coordination meetings with WASH partners at the federal level, while the provinces also held regular coordination meetings with WASH partners in collaboration with the provincial departments. WASH sector coordination meetings at federal level brought together over 70 organizations and government representatives from all the provinces. The same support was extended to the departments of local government in the four provinces to hold similar coordination meetings on weekly basis. All participating organizations regularly report their progress through the 4Ws matrix (Who is doing what, where and when), ensuring effective coordination and efficient use of resources by avoiding duplication.

The IPC/WASH sector, with support from UNICEF and the Global WASH Cluster, has developed an online dashboard which gives a visual view of the 4Ws matrix analysis, showing progress by each partner in each location. The online version is accessible through the following link: https://www.humanitarianresponse.info/en/operations/pakistan/pakistan-wash-sector-working-group-covid-19- response-4ws-data-analysis

Response: UNICEF is implementing country-wide WASH/IPC interventions, focusing its efforts on 20 high burden districts. UNICEF rehabilitated and installed WASH facilities which included ultraviolet water filters, toilets and handwashing stations in 98 healthcare facilities (HCFs): 33 in Sindh, 2 in KP and 63 in Balochistan. Thus far more than 422,681 people (30,127 new) have gained access to safe drinking water and sanitation facilities in these HCFs contributing towards reducing the risk of COVID-19 infection among the healthcare workers and the general public especially care givers and children seeking essential health services.

UNICEF utilized existing WASH programs such as Clean and Green Pakistan and communication networks of volunteers to undertake hygiene promotion and support RCCE efforts. Given the travel restrictions, UNICEF used digital and social media platforms to engage with communities, including with religious leaders in hygiene promotion. To promote handwashing by the public as one of the critical COVID-19 prevention and control measures, UNICEF supported an overall fabrication and installation of 998 handwashing stations (41 new) placed at strategic points in cities

and communities enabling over 2.3 million people thus far (100,000 new) to wash hands properly. Almost 1.5 million people have been so far (450,000 new) supported with hygiene promotion services including COVID-19 prevention and control information.

So far UNICEF has supported the training of 3,679 frontline sanitary and health workers (75 new) on WASH/IPC in HCFs and high-risk communities on WASH/IPC. UNICEF reached an overall of 282,256 children (138,305 girls and 143,951 boys) in 472 schools (331 in KP, 30 in Balochistan and 111 in Sindh) with WASH/IPC services thus far.

Gaps and Challenges: Due to limited resources, UNICEF focused mainly on handwashing in public places, schools and HCFs. However, providing handwashing stations and soap to vulnerable households could have had a significant positive impact.

Partnerships: UNICEF worked with the federal and provincial governments as well as with implementing partners including: AKF, Islamic Relief Pakistan, HANDS, Sarhad Rural Support Programme, Water and Sanitation Agency (WASA) Lahore, Water and Sanitation Services Company (WSSC) Swat, WSSC Abbottabad, The Water and Sanitation Services Peshawar, Peshawar, Balochistan Rural Support Programme, Unilever and Foreign, Commonwealth and Development Office, WHO, UNFPA and UN-Habitat.

3. Child Protection:

Coordination: During the reporting period the Child Protection (CP) sub sector within the Protection Sector remained functional to support the coordination of the COVID-19 response at the national level as well as in most of the provinces.

At national level, a joint meeting was held under the umbrella of the Protection Working Group where the TORs for the national Protection Sector Working Group were revised and its scope was expanded to cover all humanitarians situations along with COVID-19 response. The 2021 workplan for the working group was also reviewed and finalized and members were requested to complete the 5Ws matrix.

In KP, a technical working group (TWG) has been notified by PDMA for the development of the Psychosocial Support First Aid material for the humanitarian workers. The first meeting of the TWG was held and the outline of the PFA handbook has been developed by the members. In consultation with PDMA it has been agreed that a consultant will be recruited to develop the PFA guidelines and to this effect TORs have been developed and shared with PDMA for final endorsement.

Response: UNICEF and its partners have trained a total of 8,658 social workforce professionals (5,214 women and 3,444 men) in psychosocial support and stigma prevention in all provinces through a package developed by UNICEF, including 726 trained during the reporting period (413 women and 313 men) in Sindh, Punjab and Balochistan provinces. A total of 317,457 parents, caregivers, children and individuals (50,661 girls, 49,778 boys, 111,218 women, 105,800 men) received psychosocial support by trained social workforce professionals in Punjab, KP, Sindh, Balochistan, GB and AJ&K with 10,061 reached within the reporting period (Punjab: 1,886, KP: 1,737, Sindh: 6,337 and Balochistan: 101). This includes 1,447 Individuals (228 girls, 183 boys, 706 women and 330 men) who received specialized counselling sessions in all the provinces.

Messages on stigma and violence against children have reached a total of 11,006,836 including 372,682 people during the reporting period. The total number of children who received child protection services supported by UNICEF in Sindh and Balochistan has reached 2,906 children (933 girls and 1,973 boys), this includes 339 children (56 girls and 283 boys) who received child protection services during the reporting period.

During the reporting period, UNICEF undertook a rapid assessment of children in selected government-run residential alternative care facilities and found a sharp increase in the number of children entering alternative care compared to the 2020 baseline. In response, UNICEF convened an internal workshop to review the data and identify strategies aimed to accelerate action to address the growing issue of concern.

Gaps and Challenges: In Sindh, the recent wave of COVID-19 and delta variant has brought further challenges for conducting face to face sessions in the communities. It was also challenging to conduct virtual community sessions due to non-availability of smart phones and internet in some vulnerable communities. Some communities are also denying

the existence of corona virus and this presents specific concerns while conducting outreach sessions as it becomes difficult to make them follow the SOPs like wearing a mask or maintain social distancing. To mitigate these challenges smaller groups were formed and masks and sanitizers were also provided for the face-to-face sessions in the communities. Social distancing and open space were also arranged for these sessions.

In Punjab, child protection coordination efforts are hampered as Social Welfare Department is waiting for revised notification of Women and Child Working Group from PDMA until such time they cannot convene regular meetings. In KP, although there has been more focus on improving coordination between Health, Education, Social Welfare Department and KP Child Protection Working Group (CPWG), efforts and resources need to be maximized to enhance coverage of child protection interventions in schools.

Partnerships: To respond to COVID-19, UNICEF is working with Ministry of Human Rights, Ministry of Planning, Planning Commission, Provincial Social Welfare Departments, Child Welfare Bureau, Child Protection Welfare Commission, Provincial Departments of Health, National and Provincial Disaster Management Authorities (N/PDMA) , Civil Society Organisations, UNHCR, UNFPA among others.

4. Health:

Coordination: As a frontline partner of the Government of Pakistan in COVID-19 response, UNICEF is working closely with MONHSR&C, Provincial and Regional Health Departments, UN partner organizations, Development partners, Academia and CSOs since the start of the pandemic.

Response: UNICEF is supporting Provincial and Regional health departments to ensure continuity of essential primary healthcare services including immunization, Ante-Natal Care (ANC), Post-Natal Care (PNC), delivery services, childcare and curative care for adults in 136 targeted health facilities reaching 424,582 people during the reporting period (Balochistan: 8,315; Sindh: 196,707; KP: 3,398; Punjab: 212,141, AJK: 3,000; GB: 1021) with a total reach of 2.65 million people. Measles immunization reached a total of 17,964 children under one year of age (Balochistan:1,119, Sindh: 4,546; Punjab: 4,521; KP 7,396 and GB: 382) during the reporting period with a total of 83,469 children vaccinated against measles in the 136 UNICEF supported health facilities. UNICEF has provided basic PPEs (gloves, sanitizers and masks) to 521 frontline health workers during the reporting period (186 women and 335 men) and reached a total of 16,158 frontline workers during year 2021.

UNICEF-supported IPC training reached 9,578 frontline health workers in total with 266 health workers trained during the reporting period. UNICEF supported the training of 3,496 frontline health workers and community volunteers on COVID-19 and case identification and referral of suspected cases with 190 trained during the reporting period. Clinical Management of Children with COVID-19 training was provided to a total of 1,354 paediatricians trained during 2021 and 11 trained during the reporting period.

Gaps and Challenges: Despite progress on the vaccine coverage in country with fully vaccinated at 5 per cent of the target population, the coverage of vaccination is still very low in comparison to the eligible population. Vaccine hesitancy and low number of vaccination sites are the major challenges. Low uptake of vaccine by women due to multiple reasons, mainly social norms and scarcity of female vaccinators, is another challenge. Negative propaganda against vaccine is also affecting vaccine uptake in the rural areas of Pakistan. Non-Compliance to COVID-19 SOPs by general population is a challenge which steered Pakistan towards fourth wave.

Partnerships: GAVI, MoNHSR&C, Federal and Provincial EPI and provincial and regional health departments and the National EOC on polio. Health Service Academy, Pakistan Pediatric Association, Pakistan Medical Association, Public Health Association, Family Physician Association of Pakistan, Sir Ganga Ram Hospital, SARHAD (a CSO), PHC Global, Aga Khan Foundation and Agha Khan Development Network, in GB and Health Services Academy, Premier Advertisers, for COVID-19 pandemic response.

5. Nutrition:

Coordination: Sector coordination continued under the joint leadership of the government of Pakistan and UNICEF. To coordinate and oversee the nutrition response to the COVID-19 pandemic, a total of 5 meetings of Nutrition Working Group (NWG) took place during this period, 2 at National and 3 at the sub-national level ( Punjab: 2 and Sindh: 1). National Nutrition Working Group (NNWG) updated the Nutrition dashboard with maps and now these are available

online to partners and government. The Nutrition team completed and finalized the consultation on Humanitarian Needs Overview and Emergency Preparedness and Response Plan process.

MONHSR&C is working closely with the key stakeholders including provincial governments, UNICEF, WHO, WFP, INGOs and NGOs for integration of Nutrition indicators in the DHIS-2 and to draw consensus on the final list of nutrition indicators proposed by Nutrition Technical Working Group, a federal level consultative meeting held on 27th July. UNICEF carried out progress review session with USAID Bureau for Humanitarian Assistance team on USAID Food for Peace (FFP) project and apprised the donor on the existing funding constraints in nutrition program which will directly impact the continuation of nutrition services in many districts supported by USAID FFP as the project is closing down in September. Continuous advocacy at national and global level is ongoing to secure resources in Nutrition program to bridge the funding gap. Ministry of NHSRC and Health Services Academy are working jointly on Nutrition Report – “Monitoring Results for SDGs “and held its first consultation with all the key partners in July 2021.

Accelerated Action Plan-Health received extension for one year and will continue nutrition activities at OTP sites and in communities with existing modalities. Simultaneously ACF also received approval for extension of their project till October 2021.

UNICEF Response: As part of the Nutrition Response during the COVID-19 pandemic, a total of 3,065 UNICEF- supported OTP sites provided nutrition services (Balochistan: 183; KP: 127; Punjab: 1,720 and Sindh: 1,035). With UNICEF direct support around 100,050 children of 6-59 months of age (49,078 boys and 50,972 girls) screened for malnutrition using MUAC at nutrition sites (Balochistan: 54,873 and KP: 45,177; other provinces reports are pending) in the reporting month. Similarly, a total of 88,682 children suffering from severe acute malnutrition (SAM) (Boys: 39,602 and Girls: 49,080) have been admitted for treatment. In the reporting month, 2,157 (boys: 917; girls: 1,240) children newly enrolled for the treatment of SAM in OTP sites (Balochistan: 861, KP: 1,296 and Sindh's report is pending). In the meantime, a total 233,401 children 6-59 months (boys: 115,243; and girls: 118,158) received Multi-micronutrient supplementation with 20,222 (boys: 9,886 and girls: 10,336) benefited during the reporting period and the provincial breakdown is (Balochistan: 3,064; KP: 17,158 and Sindh’s report not received).

With UNICEF’s support, counselling on Infant and Young Child Feeding (IYCF) practices in the COVID-19 context through Lady Health Workers (LHWs) and other community-based networks conducted in the Sindh province’s community and reached 61,363 pregnant and lactating women during this period through community engagement efforts. Capacity building workshop for master trainers completed on Early Childhood Development (ECD) and Parenting package in Karachi, Hyderabad, Tharparker and Larkana.

In Punjab, BFHI Assessment of Hospitals on the WHO standard Assessment tools initiated for 20 target Hospitals and assessment completed in 7 hospitals in District Lahore, Jhang, Vehari and assessment is planned in 2 districts in the month of July 2021. UNICEF in collaboration with Reproductive, Maternal, New-born and Child Health program capacitated 100 Community Midwives (CMWs) on lactation management in Tando Allah yar, Mirpurkhas and Dadu districts in Sindh. Similarly, in Baluchistan Baby Friendly Hospitals Initiative and lactation management trainings are also carried out to capacitate the frontline healthcare staff.

Preparation for commemoration of global breastfeeding week is underway at federal and provincial level. The planned activities will be conducted in collaboration with government counterparts. Social media campaign is designed for the entire month of August to sensitize the general population on the importance of breastfeeding during COVID-19 pandemic. Through Social media (Facebook, WhatsApp, Instagram, and Twitter) 11,835 viewers were reached in Punjab and KP provinces.

Gaps and Challenges: Issues reported previously in May and midyear 2021 sitreps on the quality of Ready to Use Therapeutic Food (RUTF) is not yet resolved 4and all efforts are made by UNICEF nutrition and supply team to manage this matter at the earliest to avoid disruption in the continuation of nutrition services. The nutrition services in KP province’s settled districts are continuously experiencing a shortage of supplies especially RUTF in the COVID-19 high risk districts of KP. The Funding constraints to support nutrition services will lead to closure of 74 nutrition sites in the Newly Merged Districts. UNICEF Pakistan; however, is continually advocating with donors at national and regional level

4 UNICEF Pakistan Sitrep reports https://www.unicef.org/appeals/pakistan

for funding support. In Baluchistan, LHW’s coverage is very low in targeted union council, the gaps will be filled through Community Health Worker model and mobile clinic services

Partnerships: To respond to COVID-19, UNICEF is working with MONHSR&C, Provincial Health Departments, Ministry of Planning Development and Reform, WFP, WHO, Nutrition Development Partners, CSOs UN, Scaling UP Nutrition (SUN) networks, NDMA, PDMA, Pakistan Paediatrics Association and Pakistan Gynaecologist Association.

6. Education:

Coordination: UNICEF co- leads Education in Emergency response coordination with federal and provincial education ministries/departments and support humanitarian organizations, UN agencies and development partners in continuation of learning during school closure and adherence to SOPs for safe re-opening of schools.

Education Cannot Wait (ECW) selected Pakistan for the development of a Multi-Year Resilience Programme (MYRP). ECW will provide seed funding for three years (between 15 per cent and 45 per cent) for MYRP. Education Sector Working Group (ESWG) – Education in Emergencies (EIE) is coordinating with ECW Secretariat with a virtual scoping mission to Pakistan from 27th July to 3rd August 2021, objectives of the mission are to obtain a better understanding of the context, opportunities, and challenges of working in Pakistan. During the mission, virtual meetings have been held with relevant education stakeholders, including UN agencies, donors, implementing partners and civil society organizations. Next step includes establishment of MYRP Development Committee, development of programme document and approval of MYRP for Pakistan by ECW Executive Committee.

Percentage of teachers’ vaccination increased to 98 per cent in Punjab, 82 per cent of teachers have been vaccinated in KP. Provinces are being requested to collect data of partial and fully vaccinated teachers. In view of the high risk of COVID-19 in Sindh, educational institutes are closed from 16th July till further notification. In Punjab, schools remained closed till end of July due to summer break while in Khyber Pakhtunkhwa and Balochistan schools re-opened after Eid holidays.

Response: UNICEF is supporting the Provincial Education departments with the safe return to schools and ensuring adherence to the Safe Schools SOPs following school reopening and monitoring the compliance.

To support safe operation of schools additional 222 (40 women) teachers and education officers trained on safe reopening and operations of schools, taking total teachers and education officers reached to 9,641 (3,552 women). In addition, 20,547 teachers (9,300 women) and education officers have been trained on Mental Health and Psychosocial Support (MHPSS). To support continuity of learning, an additional 5,328 parents have been reached with encouraging messages for enrolment/ attendance of children through SMS and different social media platforms during this reporting period, taking total number of parents reached to 530,348.

A comprehensive Teacher’s Vaccination Communication strategy has been developed and shared with all provinces. The approved resources including flyers for teachers in English and Urdu, 3 videos about vaccines, 4 videos about myth busting (developed by MONHSR&C) and awareness materials on prevention i.e. a flier on mask wearing in three languages have been shared with provinces who further disseminated these materials widely through WhatsApp and other social media channels.

Information materials on Continuity of Learning (CoL) and staying safe at school have also been provided to implementing partners in KP with their branding for further dissemination. Video on CoL and staying safe at school and 7 vaccination related videos have also been branded with School Education department (Punjab) logo and shared for further dissemination.

Gaps and Challenges: To mobilize emphasis on teachers’ vaccination in Sindh, targeted public service messages are being focused upon through radio and via SMS relating teachers’ vaccination.

Partnerships: Ministry of Federal Education, Provincial Education Departments, Indus Resource Centre, Knowledge Platform, Microsoft, Viamo and SABAQ Foundation.

Supply and Procurement Services

During July, through the COVAX facility, the following vaccines have been received.

- 2.5 million doses of Moderna was received on 2 July - 1,236,000 doses of Astra Zeneca were received on 17 July - 3 million doses of Maderna was received on 26 July

COVAX facility has also confirmed that an additional 6 million doses of Sinopharm vaccine will be delivered to Pakistan during August. For further allocations of Pfizer (10 million) and Astra Zeneca (1.2 million), awaiting anticipated delivery date to be confirmed, which is anticipated to be during the third quarter of the year. To support the Pfizer allocation, a quantity of 18 Ultra Cold Chain equipment has been allocated to Pakistan. To support the installation of this equipment US$100,000 has been provided to UNICEF Pakistan office to procure required ancillary equipment, for which assessment is currently ongoing, and once confirmed local procurement can commence.

All supplies procured under the US$ 15 million World Bank Pandemic Emergency Financing (PEF) Fund allocated to Pakistan have now been distributed as agreed with the Ministry (MONHSRC).

Also, 2.4 million surgical masks procured from UNICEF supply division using HAC-A funding have now been delivered to Karachi seaport and Drug Regulatory Authority of Pakistan and Ministry of Foreign Affairs (MOFA) approvals have now been received, therefore distribution will be undertaken to locations as agreed with MONHSRC in support of the COVID-19 vaccine rollout in Pakistan.

Delivery of all Laboratory Equipment of the value of US$ 1.5 million funded by Asian Development Bank (ADB) has now been completed, with the exception of fridges and freezers, which have now arrived in Karachi seaport. MOFA clearance has now been received, therefore these remaining supplies should be delivered to the UNICEF warehouse early August. These supplies will be consolidated with the equipment already available in the UNICEF warehouse and distribution to 20 Laboratories’ throughout Pakistan. There have been extended delays in the delivery of some items due to the global supply chain disruptions as agreed with MONHSRC.

Under the Supply Financing Facility (SFF) funding, 1,000 Oxygen Concentrators have been procured and are already delivered to Expanded Programme on Immunization in Islamabad. Accessories were also procured to be utilised with the Oxygen Concentrators. This includes 50,000 Prongs (adult) and 15,000 Prongs (child) that have also been received in Pakistan, and 500 Pulse Oximeters, for which there is no firm date for delivery provided by supply division. Due to the urgency of the situation the Oxygen Concentrators will therefore be distributed with the Prongs, and the Pulse Oximeters will be distributed separately once received.

Humanitarian Leadership, Coordination and Strategy

NATIONAL COORDINATION

The National Security Committee, chaired by the Prime Minister, established a National Coordination Committee (NCC), to formulate and implement a comprehensive strategy to stop COVID-19 transmission and mitigate its consequences. The NCC established the NCOC to synergize and articulate a unified national effort to respond to the COVID-19 pandemic, and to implement NCC’s decision. It also designated the NDMA as the leading operational agency. In each province, the Chief Ministers have convened task forces to coordinate the response, with the PDMA as the leading provincial operational agency. Furthermore, the Emergency Operation Centre (EOC) at the National Institute of Health (NIH) has been activated as an Incident Command and Control Hub. A technical working group with three sub committees for RCCE, supply/cold chain and vaccine logistic and surveillance of Adverse Event Following Immunization (AEFI) have been established at Federal EPI. They regularly report on the readiness level to the MoNHSRC.

UNICEF contributed to the development of the National Vaccine Deployment Plan (NVDP), prioritization of eligible populations for vaccination and application for COVAX vaccines exercise, National Immunization Technical Advisory Groups (NITAG) and National Interagency Coordination Committee (NICC).

UN COORDINATION

The UN in Pakistan has established a Crisis Management Team (CMT) comprising of: WHO; UNICEF; WFP; UNHCR; UNFPA; IOM; UNOCHA; UNDP; UNAIDS; DSS and the RC which meets every Friday. For COVID-19 vaccine introduction, together with national authorities, WHO, World Bank and donors, UNICEF is part of the country Technical working group and sub committees on cold chain/vaccine logistics and RCCE. UNICEF is supporting the planning for cold chain and vaccine need assessment and procurement, as well as RCCE.

UNICEF’s Response Strategy UNICEF Pakistan is working through a multipronged response strategy which includes: (1) public health response to COVID-19; (2) continuity of essential services; and (3) mitigation of the socio-economic impact of COVID-19. To support breaking the current chain of transmission, the public health response is focused on the high burden cities which are most affected with the highest number of new COVID-19 cases and high case test positivity rates since March 2021 – the 3rd wave of COVID-19 in Pakistan.

Public health response to COVID-19 • C4D, Community Engagement and AAP: to provide timely and accurate information to families and communities and promote behaviour to reduce risk and limit transmission during the second wave of COVID- 19 cases. For the third wave response, particular focus will be given to adapt according to the epidemiology and leverage four platforms including 1) Civil society (prioritizing AJK and GB), 2) Religious leaders’ engagement and mobilization, 3) Polio Networks mobilizing the community-based volunteers and 4) Youth Groups to be engaged for peer-to-peer awareness.

• Water sanitation and Hygiene through (a) Water Sanitation and Hygiene (WASH) support to targeted primary health facilities, quarantine and isolation centres and in the communities and (b) protection of frontline health workers.

• COVID-19 Vaccine introduction and Deployment: UNICEF as a member of technical working group is providing support for preparation of COVID-19 vaccine, procurement and deployment including risk communication and awareness raising as well as support for cold chain. UNICEF is also part of the COVAX consortium comprised of GAVI, WHO, CEPI and UNICEF that is supporting Pakistan in the scale up of the COVID-19 vaccination.

• Procurement services in support of the Government to ensure timely sourcing and availability of quality essential medical supplies and personal protective equipment (PPE).

• Child protection, to ensure children and families of cases and contacts affected by COVID-19 are provided with appropriate care and psychosocial support, and for stigma prevention.

Continuity of essential services • Education to ensure teachers, parents and students are informed about COVID-19, continuity of learning and facilitate safe reopening of schools and learning education institutions.

• Health for managing mild cases and referral of severe cases with the aim to strengthen primary healthcare (PHC) system and ensure continuity of life saving basic health services like MNCH and immunization.

• Nutrition with the aim to ensure access to promotional, preventive and curative nutrition services to people affected by and people at risk of Coronavirus infection, with a focus on nutrition vulnerable groups. Nutrition Emergency: Similar approach is to be adopted to ensure nutrition services in selected high burden malnutrition districts. It is also important to note that UNICEF in partnership with the government will functionalize nutrition facilities across country by making them safe through provision of PPEs and thus will leverage recourses of Government and secure same services for children with malnutrition.

Mitigation of the impact of COVID-19 • Advocacy through (a) parliamentary engagement on child sensitive budgeting, (b) national and provincial advocacy, including joint advocacy with other un agencies and partners, in support of the COVID-19 socio- economic impact framework and plan, and (c) implementation of the UNICEF Pakistan advocacy plan ‘response and recover’ to COVID-19.

• Evidence generation on (a) multi-dimensional child poverty analysis to influence policy action and allocations, (b) development of nutrition sentinel surveillance system to provide routine information on nutrition and inform policy and programme action and (c) VAC study to identify and respond to violence against children due to the COVID-19 response.

• Systems development: (a) continuing engagement in the finalization of the universal health benefit package and tools that are covid-19 sensitive, (b) education sector analysis and planning, (c) provision of alternative care for children without parental / family care and (d) positioning of Civil Registration and Vital Statistics (CRVS) in the context of COVID-19.

• Social protection: technical / advisory support (studies) to the emergency cash transfer scheme on children to inform medium term policy action on child-sensitive social protection programme in Pakistan.

Human Interest Stories and External Media

During July 2021, UNICEF, managed to airlift two major consignments of COVID-19 vaccines donated by the Government of the United States to the COVAX Facility, to Pakistan. The first consignment of 2.5 million doses of Moderna (mRNA-1273) COVID-19 vaccines was received on July 4, and the second consignment of 3 million doses arrived on July 26, 2021. Both consignments were handed over to the Ministry of National Health Services, Regulations and Coordination for distribution to vaccinations centres across the country. UNICEF documented and projected the delivery of these consignments of COVID-19 vaccines through mass and social media.

COVID-19 related multimedia content was developed and disseminated as UNICEF continued its campaign through UNICEF staff receives in Pakistan, the second consignment of 3 mass and social media urging people to get vaccinated and to million doses of Moderna (mRNA-1273) COVID-19 vaccines keep adhering to COVID-19 preventive behaviours even after donated by the US Govt. to the COVAX Facility vaccination. UNICEF also continued to implement its 2020- 2021 Sub-Advocacy Strategic Framework to help reduce COVID-19 virus transmission and promote the continuity of essential services for the most vulnerable children while mitigating the socio-economic impact of the crisis on families.

Press Releases • COVAX delivers second consignment of US-donated Moderna COVID-19 vaccines to Pakistan – Link • 2.5 million Doses of COVID-19 vaccine supplied through COVAX start being rolled out in Pakistan – Link • COVID-19 reversals in childhood vaccinations in South Asia undo years of progress, new WHO, UNICEF data shows - Link • Another 1.2 million doses of COVID-19 vaccine reach Pakistan through COVAX - Link • UNICEF signs supply agreement for Sinopharm COVID-19 vaccine - Link • Reopening schools cannot wait - Link

Social Media • V For Vaccination Campaign - Link 1, Link 2, Link 3, Link 4, Link 5 • Arrival of 2nd shipment of Moderna COVID-19 Vaccines – Link 1, Link 2, Link 3, Link 4 • Precautions against COVID-19 during Eid Ul Adha – Urdu Video, English Video • Arrival of 2nd shipment of Astrazeneca COVID-19 Vaccines – Link 1, Link 2, Link 3, Link 4, Link 5 • World Mask Week - Link • Arrival of 1st shipment of Moderna COVID-19 Vaccines – Link 1, Link 2, Link 3, Video

Next SitRep: 1 September 2021

Who to contact for Ms. Aida Girma Mr. Innousa Kabore Dr. Hari Krishna Banskota further information: Country Representative Deputy Representative Chief of Health Pakistan Pakistan Pakistan Tel: +92 300 854 4275 Tel: +92 345 500 6578 Tel: +92 301 856 4602 Email: [email protected] Email: [email protected] Email:[email protected]

Annex A Summary of 2021 Programme Results

UNICEF and Operational partners Task Force /Sector

Change Change Sector Target* Gender Results since last Target Results since last report ▲▼ report ▲▼

C4D, Community Engagement and Accountability to Affected People

People engaged through social 550,000 Total 50,193 731▲ media People reached (through national Media channels) with messages (on 75,000,000 Total 50,685,494 2,707,102▲ COVID-19 prevention and) on access to services

At-risk populations reached through 7,000,000 Total 13,345,322 555,714▲ community engagement activities.

Callers through the national Helpline who shared relevant 3,000,000 Total 1,670,460 177,964▲ concerns, received clarifications, and provided feedback. Water Sanitation and Hygiene

Males 735,000 24,823▲ 735,000 24,823▲ People at high risk of COVID-19 supported with hygiene promotion 2,706,253 Female 765,000 25,836▲ TBD 765,000 25,836▲ activities. Total 1,500,000 50,659▲ 1,500,000 50,659▲

Children accessing appropriate Boys 143,951 143,951 water, sanitation and hygiene 242,500 TBD facilities and hygiene services in Girls 138,305 138,305 learning facilities and safe spaces. Total 282,256 0 282,256 0 Health facilities provided with 430 Total 98 0 TBD 98 0 essential WASH services. Community sites with handwashing 1,658 Total 998 41▲ TBD 998 41▲ facilities in the affected areas.

Child Protection, GBViE and PSEA

Males 105,800 3,104 ▲ 105,800 3,104 ▲ Female 111,218 4,445 ▲ 111,218 4,445 ▲ Children and caregivers accessing mental health and psychosocial 445,333 Boys 49,778 1,415 ▲ 621,107 49,778 1,415 ▲ support. Girls 50,661 1,097 ▲ 50,661 1,097 ▲ Total 317,457 10,061 ▲ 317,457 10,061 ▲ People reached with prevention messages on stigma and violence 18,025,391 Total 11,006,836 372,682 ▲ 19,563,421 11,006,836 372,682 ▲ against children, including gender- based violence. Children and adolescents who Boys 1,973 283▲ 1,973 283▲ received child protection services, 5,500 Girls 933 56▲ 49,443 933 56 ▲ including gender-based violence services. Total 2,906 339▲ 2,906 339▲

Males 3,444 313▲ 3,444 313 ▲ Number of social and care workers trained on psychosocial support and 10,234 Female 5,214 413▲ 17,057 5,214 413 ▲ stigma reduction. Total 8,658 726▲ 8,658 726▲

Education 51,893 Boys 38,393 Children accessing safe formal and 54,238 non-formal education, including 533,451 Girls 1,040,803 ECE. 40,738 106,131 Total 0 0 79,131

Schools (formal and non-formal) implementing safe school protocols 5,335 Total 0 9,736 1,217 1,181 (infection prevention and control).

11,247 11,509 Males Teachers /education officials trained 9,300 9,604 on MHPSS (Mental Health and 10,675 Female 16,687 Psychosocial Support) Total 20,547 0 21,108 0

Males 6,089 182▲ 6,089 182▲ Teachers /education officials trained on safe reopening/operation of 10,675 Female 3,552 40▲ 16,687 3,552 40▲ schools 9,641 9,641 Total 222▲ 222▲ Parents reached with messages encouraging learning activities 1,067,541 Total 530,348 5,328▲ 2,133,804 556370 5,328▲ (through SMS and different social media). Health

Males 170,784▲

Number of people benefitting from Females 178,404▲ continuity of primary healthcare 3,511,636 services at UNICEF supported Boys 49,153▲ health facilities Girls 26,241▲

Total 2,649,832 424,582▲

Boys 9,487▲ Number of children < 1 247,242 vaccinated against Measles Girls 8,477▲ Total 83,469 17,964▲

Males 335▲ Number of frontline health workers reached with basic PPEs (masks, 150,000 Females 186▲ gloves and hand sanitizers) Total 16,158 521▲

Males 105 Health care facility staff and ▲ community health workers trained 20,000 Females 161▲ on infection prevention and control Total 9,578 266▲

Number of frontline health workers Males 96▲ and community volunteers oriented 50,000 on COVID-19 and referral of Females 94▲ suspected cases Total 3,496 190▲

Number of Paediatricians & Family Males 6▲ Physicians Trained on Clinical 2,000 Management of Children with Females 5▲ COVID Total 1,354 11▲ Nutrition

Boys 39,602 917▲ 60,788 3,633▲ Children aged 6 to 59 months with severe acute malnutrition admitted 102,413 Girls 49,080 1,240▲ 167,857 74,736 4,348▲ for treatment Total 88,682 2,157▲ 135,524 7,981▲ Primary caregivers of children aged 0 to 23 months receiving infant and 1,607,460 Total 777,107 100,051▲ 1,904,864 1,417,315 155,867▲ young child feeding counselling

Boys 115,243 9,886▲ 148,375 11,552▲ Children aged 6 to 59 months receiving multiple micronutrient 813,940 Girls 118,158 10,336▲ 813,940 149,718 11,938▲ powders Total 233,401 20,222▲ 298,093 23,490▲

* The indicators/targets in this sitrep have been revised, the new HAC appeal has been approved by Regional Director, (approval by EMOPs Director pending.)

2020+2021 Cumulative Response COVID-19 UNICEF Results Sector Results Cumulativ Sector 2020 2021 Cumulative 2020 2021 e

Risk Communication and Community Engagement (C4D)

People engaged through Social Media 41,895 50,193 50,193 People reached (through national Media channels) with messages (on COVID-19 83,000,000 50,685,494 133,685,494 prevention and) access to services At-risk populations reached through 37,102,079 13,345,322 50,447,401 community engagement activities. # of callers through the national Helpline shared relevant concerns, received 5,428,871 1,670,460 7,099,331 clarifications, and provided feedback. Infection Prevention and Control (WASH) People at high risk of COVID-19 supported with hygiene promotion 10,247,624 1,500,000 11,747,624 28,330,000 1,500,000 29,830,000 activities and facilities Children accessing appropriate WASH facilities and hygiene services in learning 701 282,256.00 279,967 1,477 282,256 283,733 facilities and safe spaces.

# of community sites with handwashing 2,138 98 2,236 3,767 98 3,865 facilities in the affected areas # of schools in targeted high-risk areas supported with IPC measures and 1,352 998 2,350 1,750 998 2,748 improved water and sanitation Psychosocial Support and Child Protection Children and caregivers accessing 216,144 317,457 533,601 219,007 317,457 536,464 mental health and psychosocial support People reached with prevention messages on stigma and violence 57,532,480 11,006,836 68,539,316 63,863,751 11,006,836 74,870,587 against children, including gender-based violence Children and adolescents received child protection services, including gender- 1,176 2,906 4,082 1,176 2,906 4,082 based violence services Social and care workers trained on psychosocial support and stigma 8,290 8,658 16,948 8,388 8,658 17,046 reduction Education Children accessing safe formal and non- 79,131 79,131 158,262 8,814,507 106,131 8,920,638 formal education, including ECE. Schools (formal and non-formal) implementing safe school protocols 0 5,335 5,335 0 1,217 1,217 (IPC). Teachers /education officials trained on 28,258 20,547 48,805 538,494 21,108 559,602 MHPSS Teachers / education officials trained 3,035 9,641 12,676 3,035 9,419 12,454 on safe reporting/ operation of schools

Parents reached with messages encouraging learning activities (through 278,857 530,348 809,205 354,864 551,042 905,906 SMS and social media). Building Resilient Health Systems - Health Number of people benefitting from continuity of primary health care services 3,459,844 2,649,832 6,109,676 at UNICEF supported health facilities Number of children < 1 215,241 83,469 298,710 vaccinated against Measles Number of frontline health workers reached with basic PPEs (masks, gloves 104,565 16,158 120,723 and hand sanitizers) Number of frontline workers trained on 137,079 9,578 146,657 infection prevention and control Number of frontline health workers and community volunteers oriented on 92,273 3,496 95,769 COVID-19 and referral of suspected cases Number of Pediatricians & Family Physicians Trained on Clinical 0 1,354 1,354 Management of Children with COVID Nutrition Children aged 6 to 59 months with SAM 161,702 103,512 265,214 228,819 147,609 376,428 admitted for treatment Primary caregivers of children aged 0 to 1,575,965 777,107 2,353,072 1,898,018 1,417,315 3,315,333 23 months receiving IYCF counselling Children aged 6 to 59 months receiving 0 233,401 233,401 0 298,093 298,093 MM powders

Annex B

Funding Status:

Funds available Funding gap *Humanitarian Other 2020 carry Sector Requirements resources Resources forwarded $ % received in 2021 used in 2021 funds Nutrition 18,235,897 300,000 115,000 3,011,199 14,809,698 81% Health 6,822,354 635,763 0 2,326,955 3,859,636 57% Water, sanitation and hygiene 13,267,318 0 1,956,868 376,892 10,933,558 82% Child protection, GBViE and 11,310,084 85,749 921,950 882,589 9,419,796 83% PSEA Education 4,708,089 0 762,913 9,731 3,935,445 84% C4D, community engagement 5,886,000 290,597 0 444,509 5,150,894 88% and AAP Emergency preparedness 1,177,200 64,251 0 28,787 1,084,162 92% Total $ 61,406,942 $ 1,376,360 $ 3,756,731 $ 7,080,662 $ 49,193,189 80% *Funding Received in 2021 includes HQ allocations to HAC appeal.