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UNICEF Madagascar

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UNICEF Madagascar CHALLENGES & OPPORTUNITIES FOR CHILDREN IN MADAGASCAR COUNTRY CONTEXT Madagascar is one of the poorest Subject to recurrent crisis and disasters. In countries in the world the past 24 months: ■ Widespread extreme poverty : 77,6% <1,90$ per ■ Polio outbreak requiring polio response targeting day (2013); 91% < $3,10$ per day1 11 million children ■ Ranking 161th out of 189 in the Human ■ El Nino – exacerbating chronic drought in the Development Index2 South ■ Alarming social indicators ■ Cyclones ENAWO, AVA , Dumazil and Eliakim hitting the East coast ■ Plague outbreak – highly contagious and deadly – with to date close to 2,500 cases4 reported Around 25 million people, over 50% under 18 years, largely rural (83%)3 People resort to negative coping strategies for survival which in turn contribute to deforestation and environmental Complex political and deteriorating degradation economic context: ■ Emerging from a prolonged political crisis ■ Frequent government reshuffles ■ Rich mineral and natural resource base 130 Political Political crisis crisis 110 1972 1991 Political crisis Political 2001 - 2002 crisis 90 2009 70 50 30 Madagascar 1960 1964 1968 1972 1976 1980 1984 1988 1992 1996 2000 2004 2008 GDP per capita (constant, 1984 = 100) Real GDP growth 1World Bank: http://iresearch.worldbank.org/PovcalNet/home.aspx 3INSTAT 2UNDP 2018 4WHO 2017 SITUATION OF CHILDREN AND WOMEN MADAGASCAR’S SOCIAL SECTORS ARE LAGGING BEHIND TO ACHIEVE THE SUSTAINABLE DEVELOPMENT GOALS (SDG) More than three 47% of all Maternal Enrolment rate 41% of girls aged Almost half of 28% of children 15% of girls aged in four children children under 5 mortality: 353/ has dropped 20-24 years are the population aged 5 to 17 are 10 - 14 victims of are poor (almost are stunted 100.000 live from 83% in married or in living in rural economically physical violence 8.6 million births 2005 to 69% in union before the areas practice active 5th highest children) 2012 age of 18 open defecation chronic Neonatal malnutrition rates mortality Almost 905,000 3rd lowest- in the world accounts for children are not ranking country 42 per cent of attending school in the world under-5 deaths for water and sanitation indicators Challenges and opportunities p.3 for children in Madagascar SITUATION OF GIRLS AND WOMEN ■ Malagasy women and girls live in a traditionally ■ Girls who are married, pregnant or have given birth male-dominated society, leaving them at great risk of are significantly disadvantaged in terms of obtaining human rights abuses and mistreatment. Almost 1/3 of an education (60 per cent compared to 31 per cent women in Madagascar has experienced some form of for girls not married, pregnant or given birth) violence ■ There is limited sexual or nutritional education and ■ Reporting rates of violence against children is low menstrual hygiene management is not considered and prosecution of perpetrators is inadequate, as ■ For young women, accessing public health services is the prevention of violence and the provision of proves to be a challenge due to a lack of household support for child victims resources, availability of (female) providers or the ■ More than 40 per cent of girls aged between 20 and 24 need for permission to access these services years were married or in union before the age of 18 ■ Pregnancy among girls 15-19 years is at 37 per cent (2012). This proportion is 2.5 times higher in rural than urban areas and disparities are remarkable depending on the level of education and wealth ■ 1/3 of maternal deaths are related to teenage pregnancies The “roles” of women – in rural areas (found in a training module aiming at giving advice to women) Over 40 per cent of girls are married before the age of 18 Challenges and opportunities for children in Madagascar p.4 KEY PROGRAMME PRIORITIES 2015-2019 HEALTH NUTRITION ■ Immunization against main childhood ■ Reduce chronic malnutrition/ stunting diseases ■ Prevent and address severe acute ■ Health system strengthening malnutrition/ severe wasting ■ Mother and Child Health services CHILD PROTECTION WATER, SANITATION & HYGIENE RESILIENCE, DISASTER RISK ■ Child Protection system strengthening ■ Sustainable access to basic water, REDUCTION, EMERGENCY ■ Prevent violence and exploitation of sanitation and hygiene PREPAREDNESS & RESPONSE children and improve support for victims ■ Ending open defecation ■ Capacity building of National Disaster ■ Preventing child marriage Risk Reduction Agency ■ Development of Regional Contingency Plans ■ Prepositioning of stocks ■ Piloting innovation e.g. cash transfer, PROTECTION SOCIALE drones EDUCATION ■ Promoting social protection interventions ■ Ensuring that children can go to school for most vulnerable ■ Technical Assistance for the Special ■ Improving quality of education ■ Social sector budget analysis and evidence Resilience Plan for the South generation for children ■ Early Childhood Development ■ Situation analysis and evidence generation for children Challenges and opportunities p.5 for children in Madagascar NUTRITION SITUATION5 Stunting (chronic undernutrition): A major public health and development concern ■ 5th worst affected country in the world: 47% of all children under 5 ( ̴ 2 million) suffer from stunting, principally in rural areas ■ Children in the highlands are the most affected by stunting (≥60 per cent) ■ Stunting has a permanent impact on physical growth and intellectual development Each year severe acute malnutrition affects more than 8% of children under 5, particularly in the south UNICEF PROGRAMME Goal ■ Lead community nutrition preventive interventions mass screening and mobile services for the most with a focus on pregnant women and children under vulnerable to provide more equitable access to ■ Support national and regional authorities to improve the age of 2 years services nutrition status and reduce the prevalence of stunting through improved and equitable nutrition services and ■ Maintain and improve quality of the curatives care practices interventions (treatment of severe wasting) ■ Improve multisectoral integration and coordination Priority Focus with a focus on health and water, sanitation and ■ Advocate for increased attention to nutrition and for hygiene. the strengthening of the national nutrition information ■ Anticipate and respond timely to nutritional crises system KEY RESULTS ■ Support the Government to develop the 3rd National deworming during Mother-Child Health Weeks. Nutrition Action Plan ■ 2,15 million children between 6 and 59 months ■ Cost estimation of the investment needed to reduce screened for acute malnutrition; severe cases One in two children is stunted chronic malnutrition in Madagascar completed in 2017 referred to appropriate health services has resulted in improved national nutrition budgeting ■ 75,000 children under 5 years treated for severe and certain donors investments for reinforcing specific acute malnutrition since 2015, 50,000 of which were nutrition interventions emergency cases ■ 3,6 million children between 6 and 59 months ■ Implementation of a nutrition surveillance system benefit twice a year from vitamin A supplements and in regions vulnerable to nutritional crises, including Challenges and opportunities p.6 5ENSOMD for children in Madagascar WATER, SANITATION & HYGIENE SITUATION One of the lowest countries in the world in terms of access to water and sanitation with a serious impact on children’s health ■ Madagascar ranks 3rd lowest globally in the use of unimproved sources of water and use of basic sanitation ■ Only 10 % of the population uses basic sanitation facilities ■ Only 36% of the rural population have access to improved water sources (8th lowest country in the world) ■ Limited access to clean water and poor sanitation and hygiene practices are of particular concern, especially given the link with chronic malnutrition and diarrhea which affects children under 5 years UNICEF PROGRAMME Goal ■ Promoting the development of sustainable models such as the integration of WASH, health and nutrition ■ Improve households’ equitable access for children programmes through provision and use of WASH and students to safe drinking water, sanitation, healthy packages in rural communities, schools, health and environments and to promote safe hygiene practices nutrition centres Priority Focus ■ Advocacy for increased political commitment and investments in the WASH sector ■ Mobilizing communities to scale up Community-Led Total Sanitation and implementing behaviour change ■ Supporting the Government to be an effective communication programmes convener on sanitation issues and to improve sector coordination, information-sharing and efficiency KEY RESULTS ■ Investment Case: Making the case to prioritize and ■ Pumps, boreholes, water systems: More than 570,000 Only one in three persons in the invest in WASH gained access to safe water rural area has access to improved ■ Building pipelines: Securing water for all in the South, ■ Community-led total sanitation: More than 2,545,000 water sources introducing multiple uses of water to strengthen food people abandoned open defecation security: drinking, micro-irrigation ■ Emergency WASH: Drought response (Resilient ■ Championing innovation for increased cost approach); Cyclone response (water purification effectiveness and equity: satellite imagery to detect and rehabilitation of water points); Plague response groundwater in arid zones (covering hospital WASH and disinfection, prevention and control needs) Challenges and opportunities p.7 for children in Madagascar HEALTH SITUATION
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