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2 Contents 58 50 42 36 26 18 13 10 04 Social Protection Protection Social ForEveryChild Protection Ethiopia potential andchallenges of childrenandwomen Child Survival and Health Health Survival and Learning and Development Learning and andHygiene Sanitation Water, Nutrition ForEveryChild Ethiopia UNICEF in Foreword – anancientcountrywith huge For EveryChild –workingfortherights For EveryChild For EveryChild For Every Foreword

Launching the UNICEF country programme (July 2020–June 2025) for Ethiopia just after the advent of the COVID-19 pandemic was a huge challenge. The disruption caused to the country’s 109 million people by the pandemic threatens to jeopardize the significant gains Ethiopia has achieved in human development in the last decade. This situation, compounded by multiple emergencies, risks significantly impacting the lives of millions of children.

Populations living in overcrowded conditions or who lack access to safe water, sanitation and hygiene – such as refugees, the displaced and those living in informal urban settlements – are at higher risk of infections including COVID-19. Moreover, those living in areas prone to shocks, like droughts, floods and desert locust infestations, are also at risk of disease outbreaks.

These factors compound poverty and spotlight the overall inadequacy of the country’s social protection systems. The multidimensional child poverty divide is stark. Some 94 per cent of rural children experience multidimensional deprivation compared to 42 per cent in urban areas. Moreover, education access and performance reveal the wide gaps between the poor and the wealthy, and between urban and rural areas. An estimated one in two children may have gone without any form of education during the eight months schools were closed in 2020 It is a pivotal because they lacked online connectivity. This is concerning as even time for all. before COVID-19, over 2 million children of primary school age were The challenges out of school, and now the figure is expected to be 4-5 million. thrown up by the COVID-19 It is a pivotal time for all. The challenges thrown up by the COVID-19 pandemic pandemic have made us even more aware of the need to reduce have made inequalities. However, we remain resolute to realise our vision, us even more encapsulated in the new country programme, that all girls and boys aware of the in Ethiopia, particularly those with disabilities, children experiencing need to reduce multiple deprivations, and those in humanitarian situations, gain greater inequalities. access, with greater equity, to quality services.

UNICEF in Ethiopia – Foreword 4 Despite the recent challenges, the 2020-2025 UNICEF/Government of Ethiopia country programme is designed to support Ethiopia build on its successes towards achieving the Sustainable Development Goals (SDGs). Children in Ethiopia have more chance of survival today – Ethiopia had halved child mortality from 123 to 55 deaths per 1,000 live births in 2019 – and many more children have a better chance of reaching their potential than before. Many families are also better off as monetary poverty has been halved from 45.5 per cent in 1995 to 23.5 per cent in 2016, and school enrolment has increased by over 5 million students in the past decade. The outlook has also improved for girls, shown by Ethiopia’s improved ranking in the Global Gender Index, moving from 117th in 2018 to 82nd in 2020. Importantly, child marriage has been declining for the last 10 years, the fastest rate among countries in Eastern and Southern Africa.

The new country programme is based on a Country Programme Evaluation, a Gender Programmatic Review, a Partners’ Perception Despite Study, a Situation Analysis and a United Nations Common Country the recent Analysis. The main recommendation from these analyses – to use challenges, integrated, multisectoral programming with diverse partners in both the 2020- development and humanitarian settings to improve value for money 2025 UNICEF/ and have greater impact – has been adopted. Government of Ethiopia Other notable shifts in this country programme include, firstly, country increased collaboration between UNICEF and partners on programme humanitarian, development and peacebuilding initiatives. Ethiopia’s is designed humanitarian needs are still substantial, including catering for the to support needs of about 800,000 refugees, and millions of people displaced by Ethiopia conflicts as well as cyclical droughts, floods and locust infestations, build on its which have had a devastating impact on rural communities and the successes country’s agriculture-based economy. towards Secondly, the programme gives more prominence to gender achieving the transformative programming with interventions aimed at creating Sustainable opportunities for individuals to challenge gender norms, such as on Development child marriage, female genital mutilation (FGM) and gender-based Goals (SDGs). violence. Despite the progress on ending child marriage, 15 million

1. EMDHS, 2019. 2. CSA, Household Income Consumption and Expenditure Survey, 2015/16. 5 © UNICEF/Martha Tadesse

6 children are married in Ethiopia, 6 million of whom married before the age of 15. Also, although FGM is illegal in Ethiopia, 24 million girls and women aged 15-49 (65 per cent) have undergone FGM. Moreover, 26 per cent of girls and women aged 15-49 reported having experienced sexual or physical violence.

Thirdly, the country programme has become more inclusive to focus on children on the move, vulnerable refugees, returnees, and internally displaced and trafficked children, who are at higher risk of violence and exploitation.

Fourthly, the country programme has developed a stronger communication, public advocacy and brand strategy that is integrated with the four flagship priorities. And fifthly, there is increased investment in public system-strengthening and greater focus than before on high-impact results.

The new country programme has four flagship programmes – end child marriage; end open defecation; stop stunting; and every child learning – and is accompanied by a social and behavioural change communication strategy that targets harmful beliefs and practices and encourages communities to challenge them. The programme also invests more in adolescents and youth, particularly to empower them and encourage their participation in society and improve their opportunities and skills. The new country Some of the key actions in health include reducing neonatal mortality, programme has which remains high at 30 deaths per 1,000 live births, and improving four flagship immunization coverage; at the start of the programme about 1.2 million programmes children were not covered by immunization. UNICEF support in this – end child area includes health system strengthening and training, particularly marriage; supporting health extension workers in their role reaching communities end open in remote rural areas. In nutrition, there is a strong focus on ending defecation; stunting, supporting the government to deliver a minimum package of stop stunting; services of nutrition-specific interventions in the sanitation, agriculture and every child and social protection spheres. In water, sanitation and hygiene learning... (WASH), interventions include strengthening WASH systems and

3. UNICEF, Ending Child Marriage: A profile of progress in Ethiopia, UNICEF: New York, 2018. See: https://www.unicef.org/ethiopia/sites/unicef.org.ethiopia/files/2018-10/Child%20Marriage%20 Ethiopia-%20online%20version_0.pdf 4. CSA and the DHS/ICF, Ethiopia Demographic and Health Survey 2016, 2017

UNICEF in Ethiopia – Foreword 7 infrastructure to ensure that they are resilient to the impact of climate change, and ending open defecation, which involves the community-led total sanitation approach. In social protection, UNICEF support includes assisting with the development of a child-sensitive social protection system for vulnerable children. In education, support includes improving learning opportunities for out-of-school children, including the displaced, refugees and those who dropped out of education as a result of the eight-month lockdown from March-October. In this new programme, UNICEF supports interventions that experiment with different types of alternative education, including finding pathways that enable adolescents to re-enter formal education. In child protection, In this country support includes providing technical assistance to strengthen the kit, you can social service workforce for child protection, and assistance to improve read more referrals to services such as health, education and justice. about the In this country kit, you can read more about the situation of children situation of in Ethiopia, learn about UNICEF-supported programmes, and discover children in how people on the ground have been making a difference against Ethiopia, learn tremendous odds. The kit also highlights the need to strengthen the about UNICEF- legal and policy environment to ensure child rights are protected. supported Importantly, we need to ensure that the best interests of the child programmes, are recognised and respected in all policies concerning children. We and discover also need to continue to support national entities to monitor the how people implementation of national and international child rights and gender on the ground equality commitments. have been making a All children, no matter where they live or what challenges they face, difference have the right to survive, thrive and develop to their full potential. The against child and youth population in Ethiopia are a unique resource, and we tremendous must invest in them to ensure sustainable and equitable development odds. for the country. UNICEF Representative, Ethiopia

Adele Khodr

UNICEF in Ethiopia – Foreword 8 © UNICEF/Martha Tadesse

9 Ethiopia – an ancient country with huge potential and challenges

Ethiopia is Africa’s oldest independent Against the Against the backdrop nation with a rich cultural heritage and backdrop of of these huge huge potential for the future. these huge challenges, there have challenges, been significant gains Archaeological discoveries date back over there have in recent years. In 3 million years and the country has never been significant 2019, in recognition been colonized, apart from a five-year gains in recent of his efforts towards occupation by Italy. As a founder member years. peace with Eritrea, of the United Nations and host to many the Prime Minister, international organizations, Ethiopia has Abiy Ahmed, received the Nobel Peace been a leading force on the continent. It Prize. The Government’s liberal economic is also the second most-populous African reform agenda aims for Ethiopia to attain country, with a population expected to the status of a lower-middle-income reach 115 million in 2020, with 49 per country by 2025. Up until 2019, the cent under the age of 18.1 economy was growing at an average of 8 Ethiopia sits on the horn of Africa, sharing per cent and monetary poverty reduced borders with Somalia, Kenya, Sudan, from 45.5 per cent in 1995/96 to 23 per Djibouti and the relatively new nations of cent in 2015/16.5 South Sudan and Eritrea. In 2020, due to Furthermore, in 2018, Ethiopia elected internal conflicts, 8.39 million people in its first woman president, Sahle-Work Ethiopia, including 4.53 million children,2 Zewde, who has made gender equality required humanitarian assistance. one of the country’s top priorities. In addition, 1.8 million people were However, while Ethiopia has improved displaced,3 including 972,000 children, its ranking in the Global Gender Index and Ethiopia is hosting 735,200 refugees4 (moving from 117th in 2018 to 82nd in (mostly from Somalia and Sudan), the 2020), women remain disadvantaged second largest refugee-hosting country in in terms of health services, education Africa.

1. World Bank, Ethiopia Country Overview, 2019 4. United Nations High Commissioner for Refugees, 31 2. Humanitarian Action for Children, UNICEF, 2020 December, 2019 3. Office for the Coordination of Humanitarian Affairs, 5. Ministry of Finance and UNICEF Ethiopia, National ‘Ethiopia: 2020 Humanitarian Needs Overview’, OCHA Situation Analysis of Children and Women in Ethiopia, 2019 2019. 10 and economic opportunities. Although Then, in 2020, the global COVID-19 the practice is illegal, 24 million girls and pandemic hit. The closure of the women aged 15-49 (65 per cent) still education sector for a prolonged period undergo female genital mutilation/cutting (mid-March to mid-October 2020) will and 15 million children are married, 6 have a significant impact, particularly on million of whom married before the age children’s education. It is expected that of 15. the number of out-of-school children will increase dramatically, from 2.6 Moreover, Ethiopia still remains one million to around 4–5 million. This is not of the world’s poorest countries, just denying children their right to an with about 36 million children living education but will also have a detrimental in multidimensional poverty, lacking impact on long-term economic growth access to at least three social services, in the country. The humanitarian toll for example health, housing, education, will also be huge. It is projected that and water and sanitation. Catering for COVID-19, on top of the impact of desert Ethiopia’s population of over 109 million locusts and climate emergency, will people and keeping up with the annual increase the number of children being population growth of 2.5 million is a treated for severe acute malnutrition by massive challenge. A 2018 UNICEF- 24 per cent, which in turn could see a rise supported Sustainable Development in child mortality rates, because children Goals (SDGs) financing analysis estimated with severe acute malnutrition are more that achieving child-sensitive SDGs susceptible to infectious diseases such as would require about US$230 per capita, malaria and measles. per year, far more than the estimated investment of US$40 per capita in 2018. Then, in 2020, the global COVID-19 pandemic hit. The closure of the education sector for a prolonged period (mid-March to mid-October 2020) will have a significant impact, particularly on children’s education.

Ethiopia – an ancient country with huge potential and challenges 11 © UNICEF/Martha Tadesse

12 UNICEF, the lead UN agency for child Tigray rights, has been operating in Ethiopia since 1952, with its Afar headquarters in Addis Amhara Ababa and a presence in nine regions (Afar, Benishangul- Amhara, Benishangul- Gumuz Dire Dawa Gumuz, Gambella, Addis Ababa Oromia, Sidama, Harari Somali, SNNP and

Tigray). Gambela Oromia

Somali Southern Nations Sidama Nationalities and Peoples

UNICEF in Ethiopia – working for the rights of children and women

UNICEF, the lead UN agency for child international and national partners, rights, has been operating in Ethiopia and engaging with children. Moreover, since 1952, with its headquarters in Addis UNICEF supports the Government in Ababa and a presence in eight regions its aspiration for Ethiopia to become a (Afar, Amhara, Benishangul-Gumuz, middle-income country by 2025. Gambella, Oromia, Somali, SNNP and UNICEF Ethiopia’s overall country Tigray). programme has six main areas: (i) health, UNICEF’s goal is to support the (ii) nutrition, (iii) water, sanitation and Government of Ethiopia in its hygiene, (iv) learning and development, (v) commitment to protecting the rights of child protection, and (vi) social policy. In children and ensuring children’s basic addition, UNICEF focuses on three cross- needs are met so that they can reach cutting programmes covering social and their full potential. UNICEF does this by behaviour change communication, gender working closely with the Government, and early childhood development.

UNICEF in Ethiopia – working for the rights of children and women 13 Each programme takes a multisectoral UNICEF Ethiopia’s four flagship priorities and child-rights approach, guided are: end child marriage; end open by the Convention on the Rights of defecation; stop stunting; and every child the Child (CRC). The programmes accessing learning opportunities. The are based on evidence, integrative flagships were selected because they strategies and innovations. contribute to the progress and realization Importantly, each programme abides of a target set within the Sustainable by four key principles: Development Goals, and they address the critical needs and deprived rights of (i) Equity – reaching every child a large number of children. Notably, 15 including the hardest to reach, million children are married in Ethiopia, such as pastoralists, and the most and 6 million of those married before disadvantaged, such as children the age of 15;1 Ethiopia has one of the with disabilities and those living in lowest sanitation coverage rates in Africa, humanitarian situations, including with 22 million people practising open children who are displaced, child defecation; Ethiopia’s undernutrition rates refugees and returning migrants. are higher than (ii) Gender equality and UNICEF Ethiopia’s the average rates transformation – ensuring that four flagship estimated for Africa the empowerment of girls and priorities which as a whole;2 and women is central to programmes. are: end child about 2.6 million This is especially pertinent as marriage; end children aged 7-14 Ethiopia’s ranking in the global open defecation; are out of school Gender Inequality Index is low, at stop stunting; (54 per cent girls).3 82 out of 189 countries. and every child accessing learning (iii) Inclusion – ensuring that no opportunities. child is left behind; for example, ensuring that children with disabilities have their specific needs catered for in schools. 1. UNICEF, Ending Child Marriage: A profile of progress (iv) Sustainability – ensuring the in Ethiopia, UNICEF: New York, 2018. See: https:// www.unicef.org/ethiopia/sites/unicef.org.ethiopia/ programmes can continue for files/2018-10/Child%20Marriage%20Ethiopia-%20 future generations when and online%20version_0.pdf if UNICEF support is no longer 2. Ministry of Finance and UNICEF Ethiopia, National Situation Analysis of Children and Women in Ethiopia, available. 2019. 3. Ibid.

UNICEF in Ethiopia – working for the rights of children and women 14 © UNICEF/Martha Tadesse

Child marriage The flagships is far from being will result in eliminated; 15 direct change million children for children, are married in measured Ethiopia, and 6 by SMART million of those indicators and got married targets. They before the age of are also aligned 15.5 with national priorities, plans and strategies and, as such, will contribute to addressing the complex context of chronic underdevelopment, emergency situations, and can be addressed within the humanitarian-resilience continuum. The achievement of a flagship result will have a positive ripple effect on other associated key indicators for children which are fundamental to the Convention on the Rights of the Child, as well as UNICEF’s mandate and Global Strategic Plan. Successful changes in the indicators and achievement of the targets are measurable and achievable; it is feasible to meet the targets through a well-defined, focused set of sectoral and intersectoral strategies and more concentrated resources.

15 UNICEF’s programme of support has development work. Making sure that already seen encouraging results, humanitarian interventions lead to for example in the reduction of child long-term development is especially mortality following increased coverage important in a country like Ethiopia, of high-impact interventions, such as which experiences devastating chronic vaccinations, increased enrolment emergencies, conflicts, cyclic floods in primary education, and increased and droughts which are likely to worsen access to safe water. There are many with climate change, as well as regular reasons for the success of UNICEF- locust infestations, all of which threaten supported programmes. Firstly, UNICEF food security in Ethiopia. Ethiopia has a has a clear mission for children based long history of hosting refugees, and it on the CRC, which most governments does this with progressive laws including around the world – including Ethiopia allowing refugees to obtain work permits, – have ratified. Secondly, UNICEF has attend primary education and access a strong convening power, bringing national financial services. In addition, together the Government and partners UNICEF Ethiopia is supporting the from the national and international government to tackle the global COVID-19 arenas and civil society, including pandemic, which hit Ethiopia in March children and young people, to find 2020. solutions for positive change. Thirdly, the UNICEF’s current country programme respect UNICEF has earned worldwide (which runs from July 2020 to June 2025) enables it to advocate at all levels, will continue its strong collaboration from government to community level. with the Government and partners at all Fourthly, UNICEF has a unique capacity levels, and build on its efforts over the to create links between humanitarian past decades to uplift the lives of children and development work, ensuring that and women in Ethiopia, leaving no child emergency responses build systems behind. and enhance community resilience, as well as creating preparedness through

UNICEF in Ethiopia – working for the rights of children and women 16 © UNICEF/ Mulugeta Ayene

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1. Ethiopia Demographic and Health Survey 5. IBID (EDHS), 2016. 6. UNAIDS, 2020 2. IBID 7. UNAIDS, 2020 3. Ethiopia Mini Demographic and Health Survey 8. UNAIDS, 2020 (EMDHS), 2019. 9. UNAIDS, 2020 4. Ethiopia Demographic and Health Survey (EDHS), 2016. 19 © UNICEF/ Mulugeta Ayene

Progress Over the past two decades, children in Ethiopia have had an increasingly better chance of surviving and thriving. This has been mainly due to the country’s rapid economic growth, increased government investments in public health, and the expansion of health facilities and the health workforce, particularly through the Health Extension Programme, which now reaches over 12 million children per year. Moreover, under the current Health Sector Transformation Plan, the government plans to double the number of rural health extension workers per health post from an average of two to four, increasing the total number from 32,000 to 64,000. The government also plans to improve the quality of care provided in public health facilities.

Today, more children are being protected against vaccine-preventable diseases, diarrhoea, malaria and other diseases. This is reflected in the significant reduction in infant deaths and the total number of children dying before their fifth birthday compared to 15 years ago. In 2005, 123 children under the age of 5 were dying per 1,000 live births, compared to 55 per 1,000 in 2019.10 Moreover, the infant mortality rate decreased from 77 children per 1,000 in 2005 to 43 per 1,000 in 2019.

Despite improvements, many children are still dying from preventable and treatable causes.11

10. EMDHS, 2019. 11. Causes of Child Mortality, 2017 20 According to WHO, most under five deaths were due to pneumonia (18 per cent), diarrhoea (13 per cent) and malaria (7 per cent). Malnutrition was an underlying factor for half of all child Challenges deaths. Among children who are HIV Imagine you were pregnant, eagerly positive, antiretroviral therapy (ART) awaiting your baby. You attended coverage at 34 per cent is well below the the recommended four antenatal national target of 85 per cent of children appointments and had been told that living with HIV on ART by 2020. your unborn baby was developing Surviving the first well. You were given supplements, Surviving the 28 days of life is a including iron, as the nurse said first 28 days challenge. Women you were slightly anaemic, and as of life is a lack access to high- you were slightly underweight, you challenge. quality antenatal, also followed the advice of your obstetric and health extension worker on how to postnatal health care services, and make cheap nutritious meals using mothers often drop out across the locally available foods. Despite your continuum of care. The proportion of pastoralist husband being away, you institutional deliveries in the country had also put in place plans to ensure you increased significantly to 48 per cent in had transport to the hospital when 2019 against only 26 per cent in 2016. the time came. Yet, when you arrived But the decline in neonatal mortality for the birth, you found the health rate has not been significant with 30 per facility, like your home, had no running 1,000 live births in 2019, compared to water or toilets for use, and there was 39 per 1,000 births in 2016. Therefore, no doctor present, only a midwife. quality of clinical care remains a concern, Your labour was long. You were in highlighted by the fact that many neonatal excruciating pain. You were referred to deaths occur at general and referral the district hospital, but an ambulance hospitals.12 According to the World took a long time to arrive. Your baby Health Organization and the Maternal was delivered but died a few hours Child Epidemiology Estimation Group, in after birth. 2018 the main causes of neonatal deaths were complications during labour and immediately after birth (30 per cent), 12. Ibid. prematurity (26 per cent), and sepsis/ 13. WHO and Maternal and Child Epidemiology tetanus (18 per cent).13 Estimation Group (MCEE), 2018.

UNICEF in Ethiopia – Survival and Health For Every Child 21 Disparities in child deaths are stark Other vaccine-preventable diseases also according to region, urban-rural areas, threaten children. It is a concern that household socio-economic status and the increase in coverage for diphtheria, maternal education level.14 Some of the tetanus and pertussis (DTP3) has only most vulnerable infants live in areas been slight, from 53 per cent in 2016 to with annual cyclical droughts or in areas 61 per cent in 2019. Some 1.2 million with large numbers of people who are children remain unimmunized for DTP3. displaced, migrants or refugees. In The other major gap 2020, 8.39 million people in Ethiopia, The other is the lack of expert including 4.53 million children15, needed major gap healthcare. Although humanitarian assistance. In addition, is the lack health workforce 1.8 million people16, including 972,000 of expert population ratios children, were displaced and Ethiopia healthcare have improved over is hosting 735,200 refugees17. Disease the past five years, outbreaks such as measles, cholera and particularly in terms of community yellow fever are common. health services, with all the regions Although the country was declared wild meeting the requirement of 1 nurse per polio virus free in 2017, on rare occasions 5,000 people,18 Ethiopia’s doctor-patient the live weakened virus in OPV can ratio of 1:50,000 is the lowest in sub- circulate in a community for an extended Saharan Africa. About 83 per cent of the period of time and mutate into a form that increasing population (annual population causes paralysis, known as circulating growth of 2.5 million people) are not vaccine-derived poliovirus (cVDPV). being matched with a corresponding This happens only in under-immunized increase in health workers, and to populations and reflects a poor routine compound the problem, health workers immunization programme. Targeted are often not deployed where they are immunization campaigns are undertaken most needed. In addition, a 2016 Service to address these outbreaks. Availability and Readiness Assessment

14. Ministry of Finance and UNICEF Ethiopia, National Situation Analysis of Children and Women in Ethiopia, 2020. 15. Humanitarian Action for Children, UNICEF, 2020 16. Office for the Coordination of Humanitarian Affairs, ‘Ethiopia: 2020 Humanitarian Needs Overview’, OCHA 2019 17. United Nations High Commissioner for Refugees, 31 December, 2019 18. AFRO WHO, Human Resource for Health Profile, 2012.

UNICEF in Ethiopia – Survival and Health For Every Child 22 © UNICEF/ Mulugeta Ayene

highlighted the need for upgrading health facilities; for example, only 30 per cent of health facilities had adequate water sources, with a stark disparity between urban and rural health facilities (76 per cent and 20 per cent, respectively). The lack of water has a big impact on infection prevention, affecting quality of care and contributing to high maternal and neonatal mortality.

The COVID-19 global pandemic poses another major challenge. An analysis predicting the impact of COVID-19 on health in Ethiopia19 highlighted how access and demand for health services were likely to reduce as people feared catching the disease at health facilities. During 2020, access to essential services, like vaccinations and sexual reproductive health care services, was disrupted. Children’s psychosocial well-being is likely to have worsened too, especially for those in vulnerable groups such as the displaced, migrants and refugees, who have already suffered traumatic events.

19. Alessandra et al., 2020 Mitigating the socio-economic impacts of COVID-19 in Ethiopia, with a focus on vulnerable groups.

23 During 2020-25, UNICEF UNICEF in Action support includes: The focus of the Health programme is to establish an equitable, high- Strengthening national and quality, affordable and resilient health sub-national health systems system for newborns, children and for increased coverage of high-impact, adolescent girls and women, including equitable and resilient interventions those in emergency situations. for maternal, newborn, child and UNICEF focuses support on the adolescent health, including for children implementation of the Ministry of in emergency settings. This includes Health’s Health Sector Transformation capacity building for health workers Plan (HSTP) and the operationalisation at all levels and, learning from the of the Optimisation of Health COVID-19 experience, putting more Extension Programme, contextualizing focus on building health systems that will both plans to specific regions and withstand pandemic stresses to ensure groups of people, for example the continuity of services. pastoralist and agrarian communities. A multisectoral approach is key to Strengthening data use, implementation, ensuring linkages particularly at federal and sub- with Nutrition and Water, Sanitation national levels, for policy, strategy, and Hygiene (WASH) programmes. finance and management decisions. This enables equitable and evidence-based UNICEF, with funding from advocacy, planning and financing. UNICEF various donors, supported the also focuses on sustainable procurement, COVID-19 response, focusing strengthening supply chain systems on risk communication and and ensuring equipment maintenance, community engagement (RCCE); particularly for the child health the procurement and provision of commodities needed for high-impact personal protective equipment (PPE), interventions. Also, the development and the provision of oxygen concentrators capacity building of community platforms for enhanced management of severe for use by all sectors is being supported, COVID-19 patients; and the continuity including through social accountability of essential maternal, newborn and mechanisms to drive service finance, child health services. quality and accessibility.

24 Enhancing primary health and © UNICEF/ Martha Tadesse referral facilities to provide equitable, high-impact and high- quality maternal, newborn, child and adolescent health (MNCAH) services across the continuum of care, including in emergency settings. This focuses on increasing equitable access to high impact interventions through strengthening service delivery and performance with results-based strategies and improving the provision of quality MNCAH services at multiple levels. Strengthening communication and community platforms to increase and sustain demand for high-quality MNCAH services and the adoption of positive health practices, especially for vulnerable populations. Health workers in Ethiopia This involves evidence generation provide essential maternal and to understand bottlenecks affecting child health care services community demand for health services and the implementation of evidence- Health workers in Ethiopia have continued based strategies for social and behaviour door-to-door home visits during the change communication. global COVID-19 pandemic, checking on pregnant women, educating people about COVID-19 precautions, and promoting routine medical check-ups and immunizations. The health workers also stress the importance of delivering babies in a health facility.

For more: https://uni.cf/2VdotoR

UNICEF in Ethiopia – Survival and Health For Every Child 25 Nutrition For Every Child

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1. WHO/World Bank Group Joint Child Malnutrition Estimates, 2017 2. Ethiopia Demographic and Health Survey (EDHS), 2016. 3. EDHS, 2016 4. CSA (Ethiopia) and the DHS Program/ICF, Ethiopia Demographic and Health Survey © UNICEF/ Mulugeta Ayene

28 Progress Challenges Reducing the high levels of child You remember how the weight fell off malnutrition in Ethiopia is a government your 15-month-old baby, Ayesha, at priority. In 2015, the Government launched an alarming rate. She was listless and the Seqota Declaration which aims to end her skin was covered in sores. You child malnutrition in the country by 2030. tried to feed her but she had lost her The Government recognizes that good appetite. nutrition is not just a right and essential You couldn’t wait for the return of for a child’s physical and cognitive your husband —he is a pastoralist and development, but is also fundamental could be away for some time. The for sustainable economic growth and situation was urgent. You had already integral to Ethiopia’s main objective in its lost one child to diarrhoea. So you second Growth and Transformation Plan of decided to leave your young children becoming a lower-middle-income country in the care of your eldest child. You by 2025. In the 2018 Food and Nutrition walked as fast as you could to the Policy, the Government reiterated health centre, an hour away, carrying nutrition as a major public health issue, Ayesha, who was so weak, she was and in 2019, the Ministry of Health just whimpering. launched the National Food and Nutrition Policy which involves seven ministries Three weeks have passed. The local working together to deliver a minimum health extension officer has been package of services of nutrition-specific visiting your home regularly to see interventions in sanitation, agriculture and how Ayesha is progressing. She has social protection. The policy also aims to given you tips on how to prepare assist quality food production, imports, cheap, nutritious food, and also on processing, distribution and purchase. how to prevent diarrhoea with good hygiene. Ethiopia’s breastfeeding rate continues to improve, and is on track to meet the Ayesha sits on your lap sucking the World Health Assembly target of more packet of ready-to-use therapeutic than 50 per cent. food. She is a different child — she has already gained weight, is eating well, and is full of energy as she plays with her sisters and brothers.

UNICEF in Ethiopia – Nutrition For Every Child 29 Ethiopia’s Ethiopia’s The wide disparities in stunting pose a undernutrition undernutrition major challenge, with the highest rates rates are higher rates are higher occurring in children in the two lowest than the average than the average wealth quintiles; children whose mothers rates estimated rates estimated for have no formal education (41.7 per cent); for Africa as a Africa as a whole.5 and with the following regions having a whole. The stunting rates stunting rate above the national average for children under of 37 per cent: Tigray with 49 per cent, 5 are highest for 24- to 35-month-olds; Afar with 43 per cent, and Amhara and this means that these children have Beneshangul Gumuz with 41 per cent.7 missed the critical 1,000-day window of For wasting, the Somali region has the opportunity (conception to 24 months highest level with the risk of death six or the first 1,000 days of life). Stunting times higher than most other regions. affects more than 5.8 million children Anaemia is a public health issue under 5 years of age in Ethiopia. About 2 in Ethiopia which leads to health million children suffer from wasting and complications and, if severe, can result almost half of child deaths are associated in death. According to 2016 data, 57 per with undernutrition.6 Considering both the cent of children aged 6-59 months were cost of treatment and the negative impact anaemic, increasing to 67.8 per cent of on GDP and human capital, UNICEF children in the lowest wealth quintile. The estimates that wasting represents a causes are complex and not just due to burden on Ethiopia’s national economy iron deficiency in the diet. Other causes of between US$158 million to US$230 include parasitic diseases and infections million every year. This amount takes into such as malaria, hookworm infections and a count not only the devastating impact schistosomiasis (bilharzia). of child illness and deaths but also the loss of productivity over the long term for Micronutrient Micronutrient malnourished children who survive and deficiencies deficiencies are also go on to struggle with cognitive functions, are also a major challenge psychomotor developments and fine a major in Ethiopia. These motor skills. challenge in vitamin and mineral Ethiopia. deficiencies put women and children most at risk of infection, chronic diseases and death. For example, the zinc, iodine 5. Ministry of Finance and UNICEF Ethiopia, National Situation Analysis of Children and Women in Ethiopia, and vitamin status of pre-school and 2019. school-aged children is a serious public 6. UNICEF, WHO and World Bank, Joint Child Malnutrition health issue in Ethiopia. Estimates, 2017.

UNICEF in Ethiopia – Nutrition For Every Child 30 Adolescent undernutrition is also a Overall, despite economic growth, the public health issue in Ethiopia. One in quality of nutrition for young children three adolescent girls (aged 15-19 years) (aged 6-24 months) remains inadequate. are malnourished. In adulthood, they More than 80 per cent of children remain malnourished and give birth to aged 6-23 months do not receive the low birthweight babies.8 Good nutrition minimum acceptable daily diet, with for adolescent girls and women of stark differences between urban areas reproductive age is therefore crucial to at 19 per cent (receiving the minimum break the cycle of undernutrition. acceptable daily diet) and rural areas at 6 per cent.10 Moreover, diet diversity for The causes of undernutrition in Ethiopia children under 5 also has an impact on are complex and mostly due to poverty, their micronutrient status. cyclical droughts, floods and locust infestations as well as poor feeding The global COVID-19 pandemic has practices and diseases, particularly further worsened undernutrition and malaria and diarrhoeal diseases. Children could see the number of children living in overcrowded areas, like sites for suffering from severe acute malnutrition the displaced, are particularly vulnerable rising, leading to an increase in child to diarrhoea as they often only have mortality. Some groups are likely to be access to unsafe water and inadequate particularly hard hit, such as pastoralists, sanitation, leading to poor hygiene. children on the move and the urban A condition known as environmental homeless, particularly during times of enteropathy, which is caused by eating restricted movement. faecally-contaminated food, results in damage to the child’s intestines, making them unable to absorb nutrients from food. Since 2015, children in 290 7. Ethiopia Mini Demographic and Health Survey (EMDHS), woredas (districts) have had acute 2019. watery diarrhoea, with some of the worst 8. Ethiopia Demographic and Health Survey (EMDHS), outbreaks in the Somali region.9 2016. 9. United Nations Office for the Coordination of Humanitarian Affairs, ‘Mapping of Recurrent Climate Shocks and Humanitarian Impact vs Development Programming’ (Draft), 2018. 10. Ethiopia Demographic and Health Survey (EMDHS), 2016.

31 © UNICEF/Mulugeta Ayene

03232 Increasing the demand for UNICEF in Action improved diets among children, ‘Stop stunting’ is one of UNICEF’s adolescents, and pregnant and flagship priorities for 2020- lactating women to prevent 2025. The goal is to increase the chronic malnutrition. This involves demand, access and use of quality developing a multisectoral social multi-sectoral nutrition services/ behaviour change communication interventions. The interventions are strategy that aims to change harmful for adolescents, pregnant women, social norms and practices, and also mothers and children under 5 years improving year-round availability of of age, including those affected by diversified complementary food through humanitarian situations. food processing and supporting the most vulnerable to access food, especially pregnant women and young children.

Increasing access to micronutrients, particularly for pregnant or lactating women and young During 2020-25, UNICEF children aged 6-59 months. This includes fortification of food like wheat, flour support includes: and salt; increasing micronutrient food supplementation in health services; and Reinforcing interventions introducing early supplementation for to prevent severe acute adolescent young mothers. malnutrition, and when that fails, interventions to treat it. This Reinforcing Ethiopia’s national involves strengthening coordination of and regional government health facilities and multisector platforms mechanisms and systems to to better prepare and respond to nutrition implement Ethiopia’s multisectoral emergencies; increasing access and policy with an accountability framework. quality of routine nutrition screening and This requires enhanced coordination, services for communities to ensure that particularly linking humanitarian malnourished children are transferred interventions with long-term and treated when needed; and improving development, which looks at ways to pre- and in-service training of nutrition improve food systems and make them personnel. resilient to natural disasters.

UNICEF in Ethiopia – Nutrition For Every Child 33 © UNICEF/ Ephrem Tamiru

Last Mile – reaching children in remote areas with live-saving treatment for malnutrition

In 2020, to address the exceptionally large number of children needing treatment for severe acute malnutrition due to the combined effects of COVID-19, a desert locust infestation and climate change, UNICEF introduced the ‘last- mile’ distribution of Ready-to- Use Therapeutic Food (RUTF). The last-mile distribution system allows UNICEF to take RUTF directly to health posts, especially those in hard-to-reach areas, in order to avoid delays in distribution and help the children most in need.

For more: https://uni. cf/2Vjwvw5

UNICEF in Ethiopia – Nutrition For Every Child 34 © UNICEF/ Nahom Tesfaye

35 atr anitation an in a atr For Every Child

o he olio e aana drii er o rrl d o r olio anitation

o hildre a a to anitation o rrl d o r olio o helhre iliie hve iio iliie

o riry hool hve o helhre iliie hve e o er i er ly

o irl hve ied hool o hool hve e ee o ntruation o ederered oile

1. Ministry of Finance and UNICEF Ethiopia, National Situation Analysis of Children and Women in Ethiopia, 2019. 2. Ibid. Progress Challenges Ethiopia achieved the Millennium Imagine you are a teenager. You rise Development Goal related to water in before daybreak to fetch water for the 2015, although it has fared poorly against family, a 30-minute fast trek. When the new higher global standards on safely you go alone, you are unsure who managed water and sanitation. Just 11 you will meet. You are scared. It is so per cent of the population uses safely- remote and you have heard a story of managed drinking water, a slight increase a girl being assaulted. You are worried since 2010 when an estimated 8 per cent too that you might be late for school. of the population had access. Moreover, Often, when you arrive at the water rural-urban disparities are stark, with only source, you find a queue of women 5 per cent of the rural population having and children. Occasionally the water access to safe water compared to 38 per has dried up or looks dirtier than usual. cent in urban areas. But you take whatever is available, and start the journey back, balancing There has been little progress in sanitation the 20-litre barrel on your back. After and good hygiene. Ethiopia has one of a while your shoulders and back hurt. the lowest sanitation coverage rates in But you have no choice and you know Africa, with 22 million people practising that you will have to make yet another open defecation. However, in 2020, journey to the well after school, before COVID-19 put a spotlight on the lack of the sun sets. water, sanitation and hygiene (WASH) and the incidence of disease. This led to intensive communication campaigns on handwashing with soap, making Deprivations in sanitation (along communities more aware of the need to access WASH to prevent disease. with housing) are the largest Meeting that need became even more contributors to multidimensional urgent particularly amongst vulnerable child poverty in Ethiopia. populations. Deprivations in sanitation (along with Lack of access to safe water, sanitation housing) are the largest contributors to and hygiene (WASH) has had a multidimensional child poverty in Ethiopia. detrimental impact on children’s well-being Children living in sites for refugees, in Ethiopia, including, in some instances, returning migrants and displaced people, on their rights to survival, health, nutrition, as well as children in female-headed education, protection and play. households and children with disabilities, are amongst the most vulnerable.

UNICEF in Ethiopia – Water, Sanitation and Hygiene For Every Child 38 Lack of WASH contributes to Water coverage in health institutions communicable disease outbreaks, is low, meaning that girls and women including diarrhoea, which is one of the attending healthcare facilities for antenatal leading causes of death in children under and postnatal care are particularly 5 years of age, especially in emergency vulnerable, as are their newborns. Only settings. Prolonged bouts of diarrhoea 21 per cent of childbirth sites have a basic and other diseases, including worm water supply and only 41 per cent have infestations, can also contribute to sanitation. chronic malnutrition and stunting if not The COVID-19 global pandemic has treated before the 1,000 day window of made vulnerable populations even more opportunity (conception until 2 years of vulnerable. These groups often lack age). Notably, children living in areas with access to water, soap and sanitation, and poor WASH are prone to environmental live in cramped conditions making them enteropathy, a condition that is caused more susceptible to COVID-19. by constant faecal-oral contamination resulting in intestinal inflammation and blunting of the intestinal villi that absorb nutrients from food. Since 2015, children in 290 woredas (districts) have suffered acute watery diarrhoea, with some of the worst outbreaks in the Somali region.3

Significant evidence demonstrates that a lack of WASH also widens the gender gap. Notably, a woman or girl who has to walk long distances to collect water is not only denied valuable time that she could be using for education and/ or other productive activities, but is also vulnerable to assault. Moreover, a lack of gender-segregated toilets and facilities to manage menstrual hygiene can lead 3. United Nations Office for the Coordination of to girls dropping out of school. Lack of Humanitarian Affairs, ‘Mapping of Recurrent Climate WASH also endangers maternal and child Shocks and Humanitarian Impact vs Development health care. Programming’ (Draft), 2018.

39 UNICEF in Action The WASH programme addresses barriers to accessing safely managed water, basic sanitation and good hygiene practices. It aims to ensure that children and their families in rural and urban areas have equitable access to safe, affordable and sustainable water and sanitation services, and are able to practise

During 2020-25, UNICEF support includes:

Improving sustainable and safely- managed water. With UNICEF technical support, water systems and infrastructure are being improved in all settings to ensure that they are resilient to the impact of climate change. The use of remote sensing technology is being used to map groundwater and drill deep boreholes in areas where finding water was previously inconceivable. UNICEF aims to build multi-village water schemes connecting these high-yield boreholes to more beneficiaries, which will be managed by rural water utilities. Also, UNICEF supports more private sector involvement, linking local credit and saving associations and private stakeholders who can provide affordable and sustainable WASH items and infrastructure as well as services at scale. 40 © UNICEF/ Nahom Tesfaye Improving sanitation through ending open defecation. UNICEF mobilizes communities to implement the community-led total sanitation approach – a behaviour change approach involving everyone in a rural community, including schools and health centres, to change sanitation practices with the goal of becoming open defecation free. UNICEF also shares information and behaviour change messages, particularly through health extension workers, school clubs, the school curriculum and the media on good handwashing practices, menstrual hygiene management, and the maintenance of WASH facilities in households, health facilities and schools with separate toilets for girls and boys.

Ensuring populations affected by emergencies receive durable and life-saving WASH services in line with global UN minimum standards. Women and water, a very Along with food and shelter, water and personal relationship sanitation are among the most critical needs for children in an emergency. In When water is easily accessible to 2020, 8.39 million people in Ethiopia, women, it transforms their lives. On including 4.53 million children,4 required average, women and girls around humanitarian assistance. In addition, 1.8 the world spend 200 million hours million people were displaced,5 including every day collecting water. Water is 972,000 children, and Ethiopia is hosting time, health and safety to women 735,200 refugees. and girls in rural settings. Read the story of Belay Jima, a mother of Monitoring the access and use six from the small town of Sheno, of WASH services in all settings. 80 km north of Addis Ababa, the UNICEF provides technical support to the capital of Ethiopia, who talks about government to set up monitoring systems how water impacts the lives and and platforms. livelihoods of rural women and their families. 4. Humanitarian Action for Children, UNICEF, 2020. 5. Office for the Coordination of Humanitarian Affairs, For more: ‘Ethiopia: 2020 Humanitarian Needs Overview’, OCHA https://uni.cf/3jRLl78 2019. 6. United Nations High Commissioner for Refugees, 31 December, 2019.

UNICEF in Ethiopia – Water, Sanitation and Hygiene For Every Child 41 earning and eeopent For Every Child iion hildre re erolled i hool

o iion hildre ed he iol hool droo re o o hool gir re i

iol eder riy i riry o hool hve e o hool i , ih reiol diriie ederered oile ri ro i he oli reio o i ddi

1. EMIS 2018/19 2. Federal Ministry of Education, 2018. 4. Education Management Information System (EMIS) 3. Ministry of Finance and UNICEF Ethiopia, 2018/19. National Situation Analysis of Children and 5. Ministry of Education, ESSA 2018/19. Women in Ethiopia, 2019. 6. National Adolescent and Youth Strategy 2016-2020.

Fele eher o or o he ileher rio i ll iderre eher oly riry level rde d o ll riry hool eher eodry level d o ll eodry hool eher

eodry hool erole re re oly ne third o de i rde or rde or rde d ha o he de i rde d oly or rde ih oy ored elo i roiiey i o o he de level

o irl hve ied hool oe he reee riry hool oi ee o entration ie oe oleio re d hool do not hae adeate aiitie oly or erl hyiee ee

Source: Ministry of Finance and UNICEF Ethiopia, National Situation Analysis of Children and Women in Ethiopia, 2019 © UNICEF/ Mulugeta Ayene

Progress Ethiopia has made commendable gains in education. More children in Ethiopia are enrolled in school than ever before, with an increase of over 5 million primary school students (Grades 1-8) in the past decade, taking the number to 26 million in general education (i.e., pre-primary, primary and secondary). This increase includes a 41 per cent gross enrolment rate in early childhood education (ECE) compared to just 22 per cent in 2011/12.7 The ECE opportunities, however, are not uniform, and depend largely on socio- economic status. Children from poor families have less access compared to their counterparts from the rich quintile. Access to ECE opportunities is also better in urban areas than in the remote hard to reach rural areas.

The country has a three-year kindergarten programme (mostly private), a one-year formal pre-primary programme (called ‘O’ class in public schools), and non- formal options such as the accelerated school readiness programme for children who have no ways of accessing school readiness programmes, including displaced and refugee children.

7. Ministry of Education, ESSA 2018/19 and 2011/12 includes public and private education. 44 Despite the progress in education, about 4 million children aged 7-14 are out of school (51 per cent of whom are girls)8 and are denied a chance to learn and Challenges develop to their full potential. The challenges start Imagine your home village was The with quality early attacked, your parents were killed and challenges learning, a critical you fled for your life, walking through start with foundation for learning. the night, hiding during the day, until quality early Regional disparities are you reached safety. The memory learning, marked; only 4.5 per haunts you. You no longer live in the a critical cent of young children house you called home, or shop in foundation for in the Somali region the local market where everyone learning. access early childhood knows you. You no longer play with education (ECE) compared to 86.8 per your friends or eat with your family. cent of their peers in the Tigray region.9 But you can have education and that, Moreover, the expansion of ECE has for now, is what gives you some come at the expense of quality, including normalcy and hope. the ongoing challenges of poorly- equipped schools, lack of standardized teaching methods and curriculum, and The Government is developing a national insufficient training for teachers. ECE strategy and costed federal and regional-level operation plans to ensure In primary school, many children, that all children, including refugee particularly girls, do not attend regularly children, can access uniform quality ECE. or drop out before they move onto The Government is also reviewing the secondary school. Many young people primary and secondary school curriculum who complete secondary school do not and is training teacher instructors and receive quality education and they lack teachers, including refugee teachers, in the right skills for employment. The the new curriculum in order to improve curriculum is not well aligned with the learning outcomes countrywide. labour market and 21st century skills.

8. Ministry of Finance and UNICEF Ethiopia, National Situation Analysis of Children and Women in Ethiopia, 2019. 9. Ministry of Education, ESSA 2017/18.

UNICEF in Ethiopia – Learning and Development For Every Child 45 The 2015 National Learning Assessment Ethiopia also has to cater educationally for showed that a third of students in Grade a large population of refugees (753,200), 4 and half of the students in Grade 8 and at the height of the emergency in scored below basic proficiency levels. 2019, 2.8 million school-age children in sites for displaced people. Refugee Drop out and low attendance rates are education is particularly challenging as much higher among girls and in rural almost 55,000 of the refugee children areas, especially in regions with large in Ethiopia are unaccompanied or pastoralist communities, namely Oromia, separated from their families.12 Most of SNNP, Somali and Afar where girls’ the teachers in schools for refugees are education generally has a lower value either unqualified or underqualified, and than that of boys. Girls are more likely refugees in Ethiopia have extremely low to be saddled with domestic chores and primary school completion rates at only many marry as children, especially in the 22 per cent compared to the national later years of primary school. Despite average of 57.7 per cent. a reduction in the incidence of child marriage, there are around 16 million COVID-19 COVID-19 poses married children in Ethiopia. Violence poses another major in schools threatens both genders.10 A another major challenge. On 16 2018 UNICEF study on school-related challenge. March 2020, the gender-based violence found that girls are Government closed more likely to face psychological bullying, schools for more than seven months sexual violence and harassment, while and advocated for continuity of learning boys experience corporal punishment through distance education, including more often. The gender challenge is home schooling via the Internet for those highlighted by the fact that Ethiopia with access, and via radio and television ranked 121 out of 160 countries on the to reach children unable to access online UN Gender Inequality Index in 2017. 11 content. Yet the educational divide is likely to have widened, particularly the

UNICEF in Ethiopia – Learning and Development For Every Child 46 © UNICEF/ Mulugeta Ayene

gap between the rich and the poor, and those who are able to access learning content online and those who are not, and it will be more pronounced for children already severely disadvantaged like refugees and those with special educational needs. Lack of adequate WASH facilities in many schools could also become a more critical factor in children dropping out of education as families fear the spread of the disease through poor hygiene.13 Moreover, the shortage of adequate WASH facilities and classrooms, and teachers having to facilitate learning through shifts in order to maintain social distancing will pose a challenge in areas with high student population density as schools reopen.

10. Heslop et al., The Code of Conduct on Prevention of School-Related Gender-Based Violence: A study of policy enactment in Ethiopia, UCL Institute of Education: London, February 2019. 11. UNDP, 2019. 12. UNHCR fact sheet, September 2018. 13. Cancedda et al., Mitigating the socio-economic impacts of COVID-19 in Ethiopia, with a focus on vulnerable groups, Policy Brief, August 2020.

47 Improving learning opportunities UNICEF in Action for out-of-school children, including ‘Every child accessing learning those who are marginalised and affected opportunities’ is one of UNICEF’s by humanitarian situations. This involves flagship priorities for 2020-2025. The collecting data on out-of- school children goal is for every child, particularly the to gain a better understanding of the most marginalized and those affected underlying factors affecting different by humanitarian situations, to be out-of-school groups, coming up with provided with inclusive, equitable, a comprehensive costed strategy and quality education and learning experimenting with different types of opportunities. alternative education, including finding pathways that enable adolescents to re- enter formal education.

Building knowledge and skills by taking a holistic approach, supporting During 2020-25, UNICEF the Government to improve school support includes: leadership and community engagement, the teaching of the mother tongue in Expanding early childhood ECE, and the teaching of mathematics education (ECE) by creating an enabling and science in the upper grades. environment for quality ECE services UNICEF provides technical support for for all children, including the most improving both teaching methods and marginalised and those who are affected educational materials including improving by humanitarian crises. This involves skills of teachers in host and refugee supporting the Ministry of Education to communities and curriculum reform. establish a comprehensive strategy for UNICEF is also committed to improving ECE, and supporting parents and other educational outcomes for refugees, caregivers to participate in early childhood including supporting initiatives to improve development activities. the skills of refugee teachers.

UNICEF in Ethiopia – Learning and Development For Every Child 48 UNICEF prioritizes support for © UNICEF/ Mulugeta Ayene initiatives that narrow the gender gap, including strengthening clubs for adolescent girls and mainstreaming gender into the teacher education system. In addition, UNICEF addresses school-related gender-based violence (SRGBV), for example, by reinforcing GBV reporting and encouraging student organizations and parent-teacher associations to redress social norms that impede adolescent girls’ progression in schools.

Strengthening education and governance in order to improve the Education Management Information System. This system will be evidence- based, equity-focused and risk-informed, and will assist the sector planning Tsadkan: the preschool teacher and governance as well as policy who makes toys for children development, such as the General Education Proclamation that articulates a While many preschool teachers in right to free and compulsory pre-primary, rural areas lack resources, some primary and junior secondary education in teachers, using locally available public schools. UNICEF support includes materials, have found creative ways improving the generation, analysis and to make their classrooms child use of data at woreda (district) and school friendly and innovative ways to levels, ensuring the integration of refugee engage their young students with data as well as data on students with homemade educational toys. special educational needs. For more: https://uni.cf/2B9TDDf

49 rotetion For Every Child e

lo one arter o irl o oe ed d oe ed yer yer re rried y age eeriee phial violene d re rried y age

o hildre ed yer ly o hildre der d o le d yer o e i Ehioi hve ele hildre reeively re heir irth regitered ih eed i hild laor ivil horiie © UNICEF/ Mulugeta Ayene

o girl d oe hve deroe ele eil ilio F

Progress Child protection is a major task anywhere, but it is a huge challenge in this vast, diverse, heavily populated country that is prone to natural disasters and hosts a large number of refugees and displaced people.

Yet, significant gains have been made. The first national child protection case management framework is now in place which has an inclusive approach for all children, including those in emergency situations and children on the move like refugees, migrants and the displaced. In August 2019, a National Costed Roadmap to end Child Marriage and Female Genital Mutilation and Cutting (FGM/C) for 2020- 2024 was launched. Child marriage has been declining for the last 10 years, the fastest rate among countries in Eastern and Southern Africa. Moreover, more children are now being reached by health, social work and justice systems. Notably, between January and October 2020, some 9,829 children (5,816 girls) who experienced violence were referred to the appropriate services, compared to the 3,922 in 2018. While most cases go unreported and/or the information management system is not fully in place, it provides the necessary data to make the case for financial and human resources to not only respond to but also prevent and mitigate violence against children. And support has been ongoing for the increasing number of children in emergency situations. 52 A quality child protection system needs to be strengthened for all children, including the most vulnerable who are at risk of violence, exploitation, abuse and harmful practices. Some categories of children Challenges are more at risk such as those living in Imagine you are 13 years old and poverty, returning migrants, refugees, excelling at school. You have started the internally displaced and children with to believe that your dream of going disabilities. to medical school in the future could There are many child protection become a reality when COVID-19 forces challenges: violence against children, schools to close. At home, you have no including trafficking, child marriage, FGM, computer or access to a smartphone. gaps in justice for children including Your family now expects you to spend access to justice, child labour and low your days fetching water, farming and rates of birth registration. helping with household chores. Worse still, they announce they think you should One of the One of the main get married. Your world is crashing down main difficulties difficulties in around you and you can’t even talk to in addressing addressing violence your teacher or your best friend. violence against against boys and girls boys and girls is that it is prevalent is that it is and normalised. For prevalent and example, data from normalised. the multi-country Young Lives longitudinal study shows 1 in 10 children in Ethiopia report having experienced sexual violence,1 yet 66 per 1. The data available in the 2016 EDHS have been cent have neither asked for help nor told presented in this section. anyone about the violence.

UNICEF in Ethiopia – Protection For Every Child 53 Child marriage Child marriage Many children are engaged in exploitative is far from being is far from being child labour, particularly in rural areas, and eliminated; 15 eliminated; 15 an increasing number of boys and girls million children million children are working and/or living on the street are married in are married in and in informal urban settlements where Ethiopia, and 6 Ethiopia, and 6 sexual, physical and substance abuse are million of those million of those common. got married got married Only 3 per cent3 of children under 5 before the age before the age of years of age in Ethiopia have their of 15.2 Children 15.2 births registered with civil authorities, who are married which is amongst the world’s lowest tend to live in registration rates. Families face many poor, rural areas and have less education, barriers to registering their children. For with the highest incidence in the Afar example, the presence of both parents and Somali regions. Likewise, FGM, is considered mandatory at the time of although less prevalent, is still high at 65 registering, which disadvantages many per cent in the 15-49 year age group, and women, particularly those who are single remains almost universal among women mothers, pastoralists or refugees. Fees of reproductive age in the Afar and Somali are also charged for birth certificates in regions. some regions, although not for refugees, The justice system often fails to protect and up-to-date proof of identification the rights of children. Despite various (kebele identification) for both parents policy and legal frameworks, policy is demanded. Moreover, many people gaps persist, most notably on domestic are unaware of the benefits of birth violence and the age of criminal registration and the protection risks for responsibility which, at 9 years, is children if they are not registered. extremely low. Children over 15 years are treated as adults in the justice system.

Since March 2020, COVID-19 has had a devastating toll, particularly on those already disadvantaged like the poor and children who were on the move, causing more distress and harm to their mental health and psychosocial well- being. Moreover, the already widespread violence against women and children at home worsened as a result of the pandemic. An analysis predicting the impact of COVID-19 on health in Ethiopia4 highlighted that the closure of schools meant that a key element of the child protection system (i.e. the link to the allied system of education) had been temporarily unavailable. For example, teachers are often the people to whom children confide if they suspect a peer is about to enter into child marriage or is being abused in some other way.

2. UNICEF, Ending Child Marriage: A profile of progress in Ethiopia, UNICEF: New York, 2018. See: https:// www.unicef.org/ethiopia/sites/unicef.org.ethiopia/ files/2018-10/Child%20Marriage%20Ethiopia-%20 online%20version_0.pdf 3. This does not include data for refugees, as the system was amended to register vital events of refugees after the 2016 EDHS was completed. 4. Cancedda et al., ‘Mitigating the socio-economic impacts of COVID-19 in Ethiopia, with a focus on vulnerable groups’, Policy Brief, August 2020

55 UNICEF in Action

The goal for the child protection Enabling children, families programme is that every child in and key child protection actors Ethiopia will have legal identity to stand up against child and will be safe and protected marriage, FGM and violence in from violence, exploitation, abuse development and humanitarian and harmful practices, including settings. For example, girls, whether child marriage and FGM. ‘End in education or out of school, married child marriage’ is one of UNICEF’s or unmarried, are being encouraged to flagship priorities for 2020-2025. participate in life skills training and gender clubs (in schools) and other platforms for out-of-school girls.

The community conversation manual that is used to engage a range of community During 2020-25, UNICEF members in a facilitated dialogue on key issues in the community, and which support includes: helps raise awareness and supports Strengthening a resilient subsequent social norms change, is also child protection system for being updated. development and humanitarian Strengthening the capacity settings. UNICEF advocates and of mandated agencies and provides technical assistance to ministries for birth registration strengthen the social service workforce and increasing demand for birth for child protection, and assistance to registration to be part of a civil improve referrals to services such as registration and vital statistics system in health, education and justice. UNICEF development and humanitarian settings. also supports the gathering of quality data UNICEF is also advocating and providing through a child protection information technical support to eliminate barriers to management system (CPIMS) and birth registration. collaborating with other relevant partners including the United Nations High Providing more protection to Commissioner for Refugees (UNHCR) children who come into contact and the International Organization for with the law. For example, UNICEF Migration (IOM). In addition, UNICEF advocates to raise the minimum age supports engaging with children and of responsibility and is working with communities to have a say in their own other UN agencies and justice actors for protection as well as addressing the comprehensive justice sector reform, impact of COVID-19. including for increased access of children to specialized justice support systems.

Social workers assist child migrants returning to Ethiopia to reintegrate into society Social workers in Ethiopia like Tirusew Getachew have been working with local officials to assist returning migrant children to reintegrate with their families and communities, and enrol in school. The social workers conduct a vulnerability assessment on the children, some of whom have suffered psychological, sexual and physical abuse. The children are then referred for psychosocial support and other health or care services. Afterwards, the social workers begin the process of tracing a child’s family – a process that can come up against many challenges.

For more: https://uni.cf/3gcpczI

57 ocia Protection For Every Child

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Ehioi r aon 1. Ministry of Finance and UNICEF Ethiopia, National Situation Analysis of Children and orie i he lol eder Women in Ethiopia, 2019. eliy de 2. Ibid. Progress Social protection is essential to ensure that every child has an equal chance in life. This involves ensuring every child has equal access to social services. It also involves addressing poverty, gender inequality and discrimination, improving support for children with disabilities, and encouraging child participation and engagement to monitor the situation of children and better understand their aspirations.

Ethiopia has made some progress in the socioeconomic sphere. Monetary poverty has almost halved from 45.5 per cent in 1995 to 23.5 per cent in 2016, and per capita income rose from US$130 in 2000 to US$790 in 2018.3 Moreover, the public budget continues to prioritise pro- poor sectors, with the aim of improving coverage and quality. Data for the 2016/17 fiscal year on national and sub-national public expenditure on social services as a share of total expenditure was 26.5 per cent for education; 7.7 per cent for health; and 6.6 per cent for water and energy; however, the social protection and water, sanitation and hygiene (WASH) sectors remained heavily dependent on donors.

Since 2015, Ethiopia has been building up a social protection system with five areas of intervention: social safety © UNICEF/ Martha Tadesse nets; livelihood and employment schemes; social insurance; access to social services; and legal protection and support for survivors of violence and abuse. In 2019, 4.87 million children 60 benefited from the rural Protective Safety Net Programme (PSNP) and the Urban Productive Safety Net Programme (UPSNP), while 10 million children benefited from community-based health Challenges insurance (CBHI). Imagine you are a 10-year-old girl Despite monetary poverty reducing who has been separated from her from 45.5 per cent in 1995/96 to 23.5 family during conflict and is living per cent in 2015/16,4 88 per cent of in a makeshift home in an informal children (about 36 million children) live in settlement with thousands of other multidimensional poverty, lacking access displaced people. You have been to at least three social services, for relying on the goodwill of your example health, housing, education and neighbours but you often go to bed water and sanitation. hungry and scared, and recently you have suffered fevers. You are Moreover, disparities are no longer studying and you want to stark, most notably in terms of find your family, but don’t know how. socioeconomic factors, geography, Then, fortunately, a social worker gender and disability status. comes along. She takes you to the health centre, and then registers Moreover, disparities are stark, most you in a temporary learning centre. notably in terms of socioeconomic Now you live in a tent with a foster factors, geography, gender and disability family while social services trace your status. For example, 25.6 per cent of parents. It is this simple intervention the rural population lives in monetary that has saved your life and given you poverty compared to 15 per cent in hope. urban areas. The multidimensional child poverty divide is even starker, with 94 per cent of rural children experiencing multidimensional deprivation compared to 42 per cent in urban areas. Across regions, the incidence ranges from 18 per cent in Addis Ababa to 91 per cent in Afar, Amhara and SNNPR.

3. World Bank, Ethiopia, Country Overview, 2019. 4. Ministry of Finance and UNICEF Ethiopia, National Situation Analysis of Children and Women in Ethiopia, 2019.

UNICEF in Ethiopia – Social Protection For Every Child 61 Poverty in Ethiopia stems from a Children with disabilities are also myriad of causes which include lack particularly disadvantaged. An estimated of opportunities for development in 7.8 million people live with some form of rural areas, low-quality healthcare and disability in Ethiopia, with children and education, and low investment in water youth under the age of 25 constituting and sanitation. Poverty in the country is about 30 per cent of them.9 Although further entrenched by social and gender the government introduced the National norms, the impact of climate change Action Plan for Persons with Disabilities and, in recent years, inter-ethnic violence 2012-2021 and the federal Ministry of which has displaced millions of people. Education introduced a Master Plan for In 2020, 8.39 million people in Ethiopia, Special Needs and Inclusive Education including 4.53 million children5, needed 2016, the legal frameworks focus on the humanitarian assistance. In addition, clinical aspects rather than the social 1.8 million people6, including 972,000 issues related to disability. children, were displaced, and Ethiopia The global COVID-19 pandemic has had currently hosts 735,200 refugees7 a huge impact on children in Ethiopia, (mostly from Somalia and Sudan). especially due to prolonged school Some of the most disadvantaged children closures and restrictions on movement. are girls. Ethiopia ranks 82nd out of 189 Some of the hardest hit by COVID-19 are countries in the global Gender Inequality likely to be the urban poor or ‘near-poor Index. Girls tend to drop out of school population’, especially women, and the to get married (15 million children are pandemic has the potential to reduce married, 6 million of whom married access to social protection schemes.10 before the age of 158). Then, as adults, Critically, too many children slip through women lack access to resources and the social protection safety net. community participation; are denied Even before the impact of COVID-19, decision-making power in the household; public spending for children had been are vulnerable to gender-based insufficient to ensure every child violence and harmful practices; and are received the support she or he needs. responsible for most unpaid care work. A 2018 UNICEF-supported Sustainable Development Goal (SDG) analysis Some of the most estimated that achieving child-sensitive disadvantaged SDGs would require US$230 per capita children are girls. per year, much more than the estimated investment of US$40 per capita in 2018.

More than 80 per cent of children aged 6-23 months do not receive the minimum acceptable daily diet, with stark differences between urban areas at 19 per cent and rural areas at 6 per cent.10 Moreover, diet diversity for children under 5 also has an impact on their micronutrient status.

The global COVID-19 pandemic has further worsened undernutrition and could see the number of children suffering from severe acute malnutrition rising, leading to an increase in child mortality. Some groups are likely to be particularly hard hit, such as pastoralists, children on the move and the urban homeless, particularly during times of restricted movement.

5. Humanitarian Action for Children, UNICEF, 2020 6. Office for the Coordination of Humanitarian Affairs, ‘Ethiopia: 2020 Humanitarian Needs Overview’, OCHA 2019 7. United Nations High Commissioner for Refugees, 31 December, 2019 8. UNICEF, Ending Child Marriage: A profile of progress in Ethiopia, UNICEF: New York, 2018. See: https:// www.unicef.org/ethiopia/sites/unicef.org.ethiopia/ files/2018-10/Child%20Marriage%20Ethiopia-%20 online%20version_0.pdf 9. Ministry of Finance and UNICEF Ethiopia, National Situation Analysis of Children and Women in Ethiopia, 2019. 10. Cancedda et al., ‘Mitigating the socio-economic impacts of COVID-19 in Ethiopia, with a focus on vulnerable groups’, Policy Brief, 2020.

06363 Increasing national and regional UNICEF in Action government capacity to develop, The social policy programme aims to coordinate, finance and implement an support and promote research, child- adaptive and integrated gender- and child- focused policies, social protection sensitive social protection system for systems and budgets for children in vulnerable children. This involves UNICEF social sectors. The aim is to reduce supporting tailored capacity building and all forms of child poverty, including leadership development at federal and multidimensional poverty, while regional levels. promoting social inclusion. Supporting the government to use a child lens for public finance at national and regional levels. For example, in partnership with development partners, supporting domestic resource mobilization and advocating for sustainability of social sector financing.

During 2020-25, UNICEF Encouraging national entities support includes: to promote, coordinate, advocate for and monitor the Supporting the government to implementation of national and collect, analyse and use sex- international child rights and For disaggregated data and evidence gender equality commitments. example, UNICEF has been supporting to formulate equitable and child-focused the Ministry of Children, Women and development policies. Youth to establish a system of tracking and reporting national and global gender equality commitments.

In Ethiopia, protecting vulnerable families becomes more urgent as COVID-19 takes its economic toll

Woinshet Fanta lives with her four children in a single room near Addis Ababa’s old train station. She used to sell potatoes and sliced chips in her neighbourhood. Hers has been a hard life, a struggle for survival that was made harder some years ago by the death of her husband. Now Woinshet’s role as sole breadwinner for her family has been threatened by the measures put in place to control the COVID-19 infection. Since petty traders were barred from selling their goods door-to-door, Woinshet has been limited to selling outside her front door, meaning that her income has shrunk dramatically. For now, Woinshet is relying on neighbours to get by. But this means that there is little money to cover her and her family’s basic needs, like food and shelter, and with no community health insurance, they are not able to meet their basic health care needs.

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65 UNICEF in Ethiopia

UNICEF in Ethiopia – Social Protection For Every Child 66