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MADAGASCAR Annual Report 2013

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MADAGASCAR Annual Report 2013 MADAGASCAR Annual Report 2013 unitunite fore cfhildror children en 1 Contents 2 1 Dear friends 2013 was a turning point for Madagascar. The political deliver four million school kits and re-open community crisis showed clear signs of coming to a resolution, with health centres in nearly half the districts in the country. parliamentary and presidential elections successfully held Private sector partnerships were strengthened, with greater in December. The international community applauded this implication of mines and tourism establishments in the fight important step forward and a number of donors began re- against sexual abuse of minors. engaging with the country. To secure long-term investments that would ultimately But the effects of the 5-year long crisis are far from over. benefit children and women, UNICEF was instrumental in Poverty is widespread and the crisis reversed a decade of securing a new Global Partnership for Education grant for progress in key social sectors such as health, nutrition and Madagascar and helping expand the EU-financed PASSOBA education. health systems strengthening programme from five to nine regions. Madagascar is now at a crossroad. Its recovery is fragile but set to continue if adequate support and investment is These are just a few of our highlights for the year and many provided. UNICEF is taking this opportunity to mobilise the more are detailed in this annual report for 2013. resources that are urgently needed to revive social sectors while continuing to support the government and other As we move forward, we remain committed to expanding partners to deliver basic services to children and families. our support in Madagascar and look forward to a brighter future for children and women. In 2013, we were proud to advance on a number of fronts. UNICEF strengthened service delivery by targeting the country’s most deprived regions and embedding more than 40 technical assistants within Regional Directorates of the Ministries of Education, Health, Water and Protection & Social Affairs. This was made possible by significant STEVEN LAUWERIER commitments from donors. UNICEF Representative in Madagascar Funding from the European Union helped us to start paying the stipends of more than 20,000 primary school teachers, 2 3 AT A GLANCE Madagascar Economy The economic cost of the crisis has been Support from Population substantial, and the fiscal policy response resulted Half of Madagascar’s population of 21.3 in drastic cuts in the national budget for the the international million is under the age of 18. Children social sectors and public infrastructure. Overall, community under 5 make up 16% of the population. economic growth was flat over 2009–2012. The promise of a resolution to the crisis encouraged The population is largely rural, with only Income per capita, which barely reached US$400 some development partners to re-engage with 17% urbanized. in 2011, returned to its 2003 level. The economic Madagascar in 2012 and 2013. However, financial and social effects of the crisis were intensified by support remains at approximately half of pre-crisis the suspension of many donor activities between levels (Aid Management Platform 2013). Poverty 2009 and 2012. Madagascar is one of the world’s poorest countries. In 2012, the majority of its population (91% of households) lived on less than US$2 a day. Social sectors The country ranks 151 of 187 countries on the Geography and The half-decade long political crisis UNDP Human Development Index. climate severely weakened social services. Health, water Madagascar is the world’s fourth biggest island and sanitation and social protection have suffered after Greenland, New Guinea and Borneo. Because from the most significant budget cuts since 2009, of its isolation most of its mammals, many of its and similar trends can be seen in education. Politics birds, and most of its plants exist nowhere else The political crisis, which has marred on earth. The tropical island is heavily exposed the country since 2009, may finally be to tropical cyclones, which bring torrential rains coming to an end. Both rounds of presidential and destructive floods. Sixteen of the country’s 22 and legislative elections were held by December Millennium regions are at risk of cyclones. Droughts and locust 2013. Hery Rajaonarimampianina was sworn in as infestations are also recurrent phenomena. president in January 2013. Development Goals The only two Millennium Development Goals that Madagascar is likely to reach in 2015 are the ones related to HIV and AIDS and gender parity in education. 4 5 THE MOST VULNERABLE IN MADAGASCAR Children and women 9 % 51.1% 48 % Five years of political upheaval have made life very difficult for the most vulnerable children and women Children between the ages of 1 and Access to safe drinking water in rural Children affected by in Madagascar. Access to health care, as well as safe drinking water and proper sanitation is very limited, 2 completely vaccinated. This is a areas. Madagascar ranks as the fifth acute malnutrition. more than a quarter of children are excluded from the education system, stunting is high, and there are serious decline from 61.8% in 2008. worst country in Africa for water access. widespread violations of children’s rights. per per 1,000 one 1,000 26 62 Neonatal mortality rate. in 209 14 % 1.5 million Under-five morality rate in 2013. It Access to improved sanitation. Children who are out of primary school. improved slightly from 72/1,000 in The number of maternal deaths in Madagascar is the eighth worst 2008 to 62/1,000 live births in 2012. Madagascar. performing country globally. Two-thirds % Proportion of unqualified teachers. 44 Pneumonia, malaria, % 69 % 30% The percentage of births attended by a 47 Children who complete Women survivors of skilled health worker such as a midwife diarrhoea and Children under 5 who are stunted. primary education. A quarter gender-based violence. or doctor. malnutrition Proportion of children engaged The top four causes of child deaths. in child labour. Sources of data and information: State of the World’s Children 2013; National MDG Survey 2012/2013; Report of the Special Rapporteur on the Sale of Children, Child Prostitution and Child Pornography, 2013; WHO and UNICEF Joint Monitoring Programme 2013. 6 7 OUR PROGRAMME IN CHILD SURVIVAL AND DEVELOPMENT Turning back child mortality HOW UNICEF RESPONDS Builds institutional frameworks and a conducive policy environment to restore the damaged health system. Provides targeted support to the six regions of Anosy, Atsimo Andrefana, Menabe, Analanjirofo, Sava and Analamanga. Helps deliver integrated and life-saving health services to THE CHALLENGE children in communities Madagascar’s already weak healthcare system has been in decline since the start of the Supports basic emergency obstetric political crisis. The government slashed the and neonatal care, as well as PMTCT, health budget by 54 per cent between 2009 to reduce maternal and neonatal and 2013, making it difficult to finance basic mortality. health services. Health facilities closed down, drugs and medical supplies ran out and health workers migrated to cities in search of better Delivers emergency health services paying jobs. Vaccination rates have seriously to children and women affected by declined, neonatal morality is on the rise and cyclones, floods and other disasters. there are high levels of chronic malnutrition among children. 8 9 WHAT WE ACHIEVED / Key results in 2013 iCCM is part of the broader Integrated Management of Revitalizing immunization Childhood Illnesses (IMCI) programme, which saw 70 health workers trained to offer IMCI services in health clinics in five services 5 60% to 78% 3,2 milion 24 hours districts in the Anal anjirofo region. UNICEF and its partners, Madagascar’s Expanded Programme for Immunization including WHO, advocate for IMCI and give technical is severely constrained by inadequate infrastructure, Regions that are the Increase in coverage of Children vaccinated Time taken to reach assistance to countries that apply it. This includes improving poor management, weak outreach services and focus of the ‘Programme long-lasting insecticide against measles victims of Cyclone health worker’s case management skills through classroom frequent vaccine stock-outs. As a result, coverage for d’appui aux services treated nets from 2011 Haruna with medical work and hands-on clinical practice. sociaux de base – Santé’ to 2012 supplies and services the third dose of diphtheria, tetanus and pertussis (PASSOBA) (DTP3) dropped from 72 per cent in 2008 (DHS 2008) Preventing malaria to 61 per cent in 2012 (MDG Survey 2013). Rebuilding the health system assessments of the acquisition and supply chain and The use of insecticide-treated nets, especially long-lasting In order to counter the declining trend in vaccination, helped to finalize an operational guide for the management insecticide treated nets (LLINs), is one of the cheapest and UNICEF continues to support the rollout of new most effective interventions against malaria. In Madagascar, One of the top priorities for the new government is to of essential drugs and the funds generated by the cost vaccines, conduct vaccination campaigns, improve UNICEF supported the universal LLIN coverage campaign strengthen the devastated health system. This is being recovery system applied in the country, as well as equity the cold chain and outreach outreach capacity in 61 target districts. In 2013, 59,000 children and 14,700 done through the health system strengthening programme funds that are constituted by a portion of the funds and support national efforts to eliminate vaccine- pregnant women in one district benefited from the (PASSOBA), which was implemented in five regions with collected to provide health care to the poorest people. preventable diseases. In 2013, UNICEF support led to distribution of 150,000 LLINs directly from UNICEF. LLINs UNICEF support and will be expanded to a total of nine in the following results: distributed in other districts were procured through GFATM 2014 (Anosy, Atsimo Andrefana, Menabe, Analanjirofo, Sava, An integrated approach to and PMI funding.
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