MADAGASCAR Annual Report 2013

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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. Household coverage of LLINs in the target • Atsinanana, Vakinankaratra, Betsiboka and Boeny). PASSOBA National rollout of the pneumococcal vaccine and childhood diseases districts is on the rise, from 60 per cent in 2011 to 78 per is funded by the European Union. UNICEF’s positive results introduction of HPV vaccine in two demonstration cent in 2012. districts. in the initial five regions influenced the European Union’s Children in Madagascar are often sick with multiple illnesses, • 91 per cent of 3.2 million children between 9 decision to finance the expansion to support 460 health which has prompted the Ministry of Health, with support months and 5 years of age vaccinated against centres in the nine programme regions. from UNICEF and WHO, to adopt an integrated approach to measles during the second round of the Mother treating and preventing childhood diseases. In 2013, UNICEF’s technical assistance to PASSOBA helped to and Child Health Week. • Pre-validation survey of maternal and neonatal develop integrated annual work plans in 27 districts. Regular In 2013, UNICEF provided targeted support to 198 sites in tetanus elimination initiative conducted together Monitoring for Action meetings at health centre, district and Tolagnaro district that provide integrated community case with the Ministry of Health and WHO. regional levels were also supported. To strengthen capacity management (iCCM) of childhood diseases. Close to 400 • 50,000 community vaccination registers and restore health services, national medical staff was community health workers run the iCCM sites, delivering introduced to identify and track defaulters. recruited for the five regions and more than a third of health timely and low-cost interventions against pneumonia, • 59 solar refrigerators, 13 cold rooms, 3,500 centres benefited from the 163 new staff. In addition, 44 malaria and diarrhoea. To ensure that quality services Fridge-Tag 2 monitors, 3,650 vaccine carriers and health centres were re-opened. are provided, UNICEF also supported the performance 315 bicycles provided in programme regions to evaluations of 5,386 community health workers in four of strengthen the cold chain and outreach capacity Efforts were made to improve the provision of drugs and the five target regions. medical supplies to health facilities. UNICEF carried out

10 11 Maternal and newborn health Emergency response and surveillance

With a high maternal mortality rate and a recent rise in In coordination with the Health Cluster, UNICEF is neonatal mortality, Madagascar requires assistance to actively involved in providing emergency health care to significantly improve newborn and maternal health care. communities affected by disaster. In 2013, the majority of UNICEF’s support to newborn and maternal health in people affected by Cyclone Haruna in the Morombe, Toliara the country is unfortunately constrained by the lack of 1 and Toliara 2 health districts were reached with medical sufficient funding. As a result, interventions are restricted to supplies and services within 24 hours. Amboasary Sud, Betioky and Tolear II districts in two target regions of Anosy and Atsimo Andrefana. However, with In the regions of Antsimo Atsinanana and Vatovavy the resources that were available, a number of results were Fitovinany, UNICEF continued to support survivors of achieved in 2013: Cyclone Giovana in 2012, with funding from the Central Emergency Response Fund (CERF) and in partnership with • The capacity of 92 basic health centres was the Ministry of Health, WHO and UNFPA. Thirteen health strengthened to deliver basic emergency obstetric and centres were re-opened and 30,205 children under the age neonatal care. This involved training health workers and of 5 (44 per cent of the target population) were treated for equipping the centres. acute respiratory infections, malaria or diarrhoea.

• 943 community health workers in the three target In addition, 1,142 community health sites in the same districts were trained to offer care to pregnant women regions were equipped to deliver basic community curative and newborns, and to improve health-seeking care and provided with health kits containing antibiotics, behaviour in communities. As a result, key indicators antimalarial drugs and oral rehydration salts. Close to 40,000 in the three districts improved between 2012 and children under 5 were treated by community health workers November 2013: the coverage of antenatal care (four for acute respiratory infections, malaria or diarrhoea in five visits) increased from 25 to 35 per cent, institutional districts of two target regions. This represents more than half deliveries from 27 to 33.5 per cent, and postnatal of the children targeted in 2013. consultations from 16 to 55 per cent. The Health Cluster conducted emergency simulation • UNICEF helped to scale up training for health providers exercises in two cyclone prone regions (Atsimo Atsinanana in syphilis, HIV screening for pregnant women, PMTCT and Atsimo Andrefana) and planning and preparation for and paediatric care for newborns with HIV-positive cyclic and periodic disasters is on-going. To ensure rapid mothers and HIV-positive babies in all five PASSOBA response to a new disaster, UNICEF and its partners have regions. More than half of all pregnant women were pre-positioned health kits for 30,000 people for three screened for syphilis and HIV in these regions. months.

12 13 OUR PROGRAMME IN NUTRITION Reducing the burden of malnutrition

HOW UNICEF RESPONDS Supports regional and central coordination of the National Nutrition Office.

Helps provide treatment for children with severe acute malnutrition.

Supports interventions to prevent or reduce chronic malnutrition, including THE CHALLENGE micronutrient supplementation, de-worming and promotion of exclusive Madagascar has seen its chronic malnutrition breastfeeding, child diet diversification rate decrease slightly since 2008/2009 but stunting and morality remain high. The end and maternal nutrition. of the political crisis is an opportunity for Madagascar to make nutrition a top priority. However, more funding and technical support, from both domestic and global sources, is Monitors and responds to needed to help the country turn its vision for nutritional emergencies. nutrition into reality.

14 15 WHAT WE ACHIEVED / Key results in 2013

1,744 90% 63% 45,000 6 million Community health Proportion of children Of 6,387 of children Displaced people who children supplemented with workers trained in under 5 who were under 5 successfully can be fed for seven days vitamin A (94% in round 1) infant and young child supplemented with two treated for severe acute with high-energy food nutrition counselling doses of vitamin A during malnutrition during an emergency Child Health Weeks

Let the SUN shine between the salt iodization programme and programmes 74,000 aims to reduce salt consumption. pregnant women supplemented Madagascar joined the international Scaling Up Nutrition with iron/folic acid (SUN) movement in 2012, to better align financial and Improving infant and young child technical resources for national nutrition initiatives. The nutrition (60% of expected pregnancies) challenge has been to mobilise sufficient funding from the international community to help put SUN principles into The first two years of a child’s life are particularly important, practice. as good nutrition during this period lowers the risk of illness and death and helps children grow well. In 2013, in line with the SUN principles, UNICEF continued 5 million to work with the National Nutrition Office to improve In Madagascar, UNICEF supports infant and young child children dewormed coordination of nutrition programmes in the country. To feeding (IYCF) as a key strategy to improve child survival and Mother and Child date, coordination has focused on policy and strategic development. In 2013, focus was put on improving IYCF in (97% in round 1) development, with plans, in 2014, to shift attention to six districts of Analamanga, Anosy and Analanjirofo regions Health Weeks operational coordination of ground-level activities in that are home to 162,000 pregnant and lactating women addition to national management. and 130,000 children under the age of 2. UNICEF supported in 2013 the training of 439 health staff and 1,744 community A number of advances were made in nutrition policy and workers in IYCF counselling, including early initiation and 1 million planning. UNICEF supported the costing of the national exclusive breastfeeding, adequate complementary feeding children screened for acute nutritional plan and advocated for nutrition to feature and nutrition for pregnant mothers. In one region, a pilot prominently in the national school health plan. Other was carried out with NGO partner Population Services malnutrition (25% of children activities included revising the national protocol for the International to provide a multi-vitamin and mineral powder under 5) management of acute malnutrition; technical support for to more than 5,000 children between the ages of 6 months the nutrition component of a nationwide survey tracking and 2 years. progress toward the MDGs; and facilitation of a consensus

16 17 Treating severe malnutrition Recipes and robust children

Severe acute malnutrition (SAM) is a life-threatening In a little room behind the mayor’s office in condition that needs urgent medical attention. UNICEF has Antananarivo, community nutrition worker Louis Olga been supporting the Ministry of Health to treat children teaches women and girls about nutrition. It’s a modest with SAM by providing therapeutic nutritional food and room but richly decorated with posters that give good other related supplies to 641 nutrition rehabilitation facilities advice to the young mothers. “Exclusive breastfeeding across the country. In 2013, 63 per cent of the 6,387 children in the first six month! Don’t feed anything else!”, with SAM1 were successfully treated though the cure rate is “Prepare well-balanced meals!”. The wall is full of ideas below the 75 per cent target. and a multitude of recipes on healthy cooking.

Responding to nutritional “Through the cooking lessons, I show them that it is possible to eat healthily with the ingredients they can emergencies afford and which are available in the village market, says Olga who has worked in this center since 2002. The southern regions in Madagascar are usually vulnerable to seasonal food insecurity but no nutrition- The centre offers growth monitoring, monthly related emergencies were reported in 2013. However, weighting of children, education about nutrition and a contingency stock was pre-positioned in a UNICEF health, as well as cooking lessons. Olga’s expertise in warehouses, including high-energy biscuits that can cover newborn and infant feeding and maternal nutrition, the needs of 45,000 displaced persons for seven days and as well as how to communicate with mothers and therapeutic milk and ready-to-use therapeutic foods that children, was gained through training by the UNICEF- can treat 1,000 children with SAM. supported Regional Office for Nutrition.

Twenty-year-old Fabienne Ratovomalala has been coming to the centre since she was 12. She is proof incarnate of the effectiveness of the method. “In the beginning I loved the sewing and crochet training that was offered. Later, after my pregnancy, I brought my child along. I didn’t have any problems during my pregnancy and my child grew well. At every weighing session he had gained more weight.” Today, her six-week-old child’s vaccination calendar is well maintained. Fabienne also breastfeeds exclusively and gets help with breastfeeding technique during the sessions.

1 Based on reports received until end of September 2013.

18 19 OUR PROGRAMME IN WATER, SANITATION AND HYGIENE Providing the necessities of life

HOW UNICEF RESPONDS Helps create a national policy environment for WASH and builds capacity for planning, delivery and monitoring and evaluation of services across the country.

Supports building of water points, promotes use of sanitation facilities, and promotes good hygiene in communities, schools, nutrition and health centers in five target regions of Atsimo Atsinanana, Anosy, Androy, Atsimo Andrefana and THE CHALLENGE Analanjirofo. Madagascar has very poor access to safe drinking water and adequate sanitation, and the country ranks as the fifth worst country Provides emergency-affected in Africa for water access (JMP 2013). National communities with access to water expenditure in water and sanitation in 2013 and sanitation, and promotes was 35 per cent of the health sector budget, hygiene practices to avoid and this is due to drop in 2014 to 10 per cent. outbreak of epidemics. Other than the African Development Bank, there has been little investment in the sector from external donors since the political crisis began in 2009.

20 21 WHAT WE ACHIEVED / Key results in 2013 WASH in schools Improving sanitation

WASH in schools is the first step towards ensuring a With only 14 per cent of the population using improved healthy physical school environment. Schools with quality latrines, open defecation (using fields, forests, rivers etc. to 14,000 100,000 38,000 111,000 WASH programmes can lessen the spread of disease and defecate) is commonplace in Madagascar. It is, however, encourage children, especially girls, to enrol and stay in a practice that contaminates food and water sources, People provided access School children who Villagers who People affected by school. In Madagascar, UNICEF and its partners made good posing a major health threat to already improverished to an improved water received information on abandoned open emergencies who progress in installing safe water points, toilets and hand communities. Community Led Total Sanitation (CLTS) is an source in remote hygiene during Global defecation and built received support from washing stations in 60 per cent of targeted schools in five innovative methodology for mobilising communities to end rural areas Handwashing Day and their own latrines the WASH Cluster provinces. This benefitted close to 16,500 students. open defecation by creating and implementing their own washed their hand with sustainable sanitation and hygiene plans. soap provided during Hygiene practices were promoted during the distribution of that day hand washing devices and water filters in 111 schools along UNICEF was instrumental in establishing the CLTS Plus with educational material. More than 27,000 students now network in Madagascar, a strategic collaboration among drink safe water and understand the importance of using government line ministries, UNICEF, WaterAid, the Global Strengthening the WASH sector What the studies revealed latrines and washing their hands with soap at critical times. Sanitation Fund, USAID and the Japan International Soap was also distributed to 500 schools with nearly 100,000 Cooperation Agency. During the year, the network Bottleneck analysis: Identified the need for improved sector students during Global Handwashing Day on 15 October. produced planning documents, new sector strategies, A priority for UNICEF in Madagascar is to help re-build coordination, wider sustainable service delivery strategy, monitoring tools and procedures to take the CLTS one of the most neglected sectors in the country. In 2013, and critical need for additional sector financing. four studies were carried out in the sector to determine Bringing clean water to programme forward at the level of scale the country needs government capacity for programme planning and Sustainability evaluation: Revealed that WASH services are not communities to cover the huge gap in sanitation. implementation in the water, sanitation and hygiene sustainable because communities have unrealistic expectations of managing their own systems without external support. (WASH) sector. The findings will be used to inform advocacy Supply chains are also fragile, there is weak institutional Work continued to improve access to safe drinking water activities aimed at improving the existing WASH national capacity at decentralized level to manage services and service in communities. Fourteen thousand vulnerable people policy, strategy and overall sector performance. delivery models are absent. Operation and maintenance of were reached in the rural north and northeastern Sofia services are constrained by the lack of funding. and Analanjirofo regions, as well as in urban settlements UNICEF also focused on building the capacity of in Antsirabe and Antananarivo. However, this was below government staff to improve management and Community Led Total Sanitation (CLTS) assessment: target for 2013 because the government, UNICEF and implementation of WASH programmes. Central and regional Showed that the sector’s stakeholders do not sufficiently support social and behaviour change in sanitation and do other partners remain financially constrained to scale up directors at the Ministries of Water, Health and Education not monitor change at community level effectively. There is community-based WASH. In 2014, financial support from the were trained in financial management, procurement, the need to continue sector harmonization and increase sector Department for International Development (DFID) will be a UN Harmonised Cash Transfer system, emergency response performance and sustainability. major boost in strengthening decentralized service delivery and community empowerment approaches. Global Analysis Assessment of Sanitation and Drinking in the five regions. Water study (lead by WHO): Madagascar’s water and sanitation sector lacks funding, which compromises the implementation of recent WASH policies, strategies and plans.

22 23 CLTS in action WASH in emergencies

As a WASH Cluster lead, UNICEF coordinated the sector’s 600 community health response to the 2013 Cyclone Haruna emergency. UNICEF directly supported the needs of 34,300 people, and in its role workers trained in the CLTS of cluster lead, ensured rapid response delivery to more than approach. 111,000 affected people in the aftermath of Cyclone Haruna. WASH kits with essential water treatment plants, water filters and temporary latrines were distributed to 62 affected Community health workers schools and 40 health centres Stagnant. Surface waters were drained and where appropriate, institutions and homes mobilized more than disinfected. Key messages for hygiene promotion reached all affected families. To strengthen emergency preparedness and 137,600 villagers in response, UNICEF helped to train 22 regional water directors the five target regions to end in WASH cluster coordination who are now equipped to coordinate emergencies in their respective regions. open defecation and use self- constructed latrines.

More than 1,100 latrines were built, serving 38,000 community members.

Communities will be linked to private sector masons, carpenters and other relevant service providers involved in latrine maintenance and improvement.

24 25 OUR PROGRAMME IN EDUCATION Developing young minds

HOW UNICEF RESPONDS Works at national and regional levels to strengthen investment in, and management of the education system.

Helps to improve teacher training and quality of education.

Supports increased enrolment and retention of children in primary THE CHALLENGE education in eight core regions of Although there has been some progress Androy, Anosy, Atsimo Atsinanana, Diana, in improving primary school enrolment in Melkay, Sofia, Analanjirofo and Atsimo Madagascar, the education system is still Andrefana. plagued by under-resourcing, poor quality of teaching and dilapidated and overcrowded classrooms. The drop out rate stands at 17 per cent and only 3 out of 10 children successfully Ensures that children affected by complete their primary school education. emergencies are able to Communities are very poor, which increases continue learning. the risk of children not going to school or dropping out. Less than 10 per cent of young children attend preschools.

26 27 WHAT WE ACHIEVED / Key results in 2013 Less children missing out on education

+4 million 32,500 20,000 9,500 School kits distributed to Drop in the number of out- Community-recruited Primary school teachers 158,000 every primary school in of-school children, from teachers that began who received in-service Madagascar 158,000 at the beginning of receiving stipends peer training 125,700 2013 to 125,700 at the end of the year 79,000 Investing in education Improving monitoring and evaluation

UNICEF has been helping to advocate for greater UNICEF also supported national data collection systems investments in basic education. During the year, significant by training all regional Ministry of Education staff on SMS funding was secured for education. UNICEF facilitated monitoring. The capacities of teacher training colleges were the successful submission of a new US$85 million Global reinforced in all eight regions with new equipment and the Out-of-school children Partnership for Education (GPE) grant, which will be formulation of regional action plans for teacher training. Audits Beginning End Target by supervised by The World Bank. The European Union also of regional education authorities also highlighted the need to of 2013 of 2013 end 2014 provided €15 million to finance the gap between GPE help strengthen governance issues in 2014 and beyond. grants and support payment of community-recruited teachers, distribution of school kits and school feeding. Strengthening the education Targeted work continued to increase school access in the UNICEF also began the process of the paying stipends to system to support enrolment and eight focus regions. In partnership with the International more than 20,000 community-recruited teachers in 12 Working with regional education retention Labor Organization, UNICEF supported the construction regions using funds from the European Union. UNICEF is authorities of four pre-schools, 112 primary schools and 12 lower- piloting a payment system via mobile phones, which has secondary classrooms. With UNICEF financial support, the potential to be expanded to other areas in the future if it The number of out-of-school children in primary schools in the World Food Programme provided meals to more proves to be an effective way of paying these stipends. To help strengthen the decentralized education system in six out of the eight core regions decreased in 2013. These than 216,000 children in the three most food insecure Madagascar, UNICEF deployed national programme officers include Androy, Anosy, Atsimo Atsinanana, Diana, Melkay and regions— a major factor in increasing enrolment and within each of the 22 regional education authorities (DRENs Sofia. UNICEF and the government contributed to this result boosting retention rates. UNICEF also helped to narrow – Direction Regionales de l’Education Nationale). As a result, by distributing more than 4 million school kits to the entire the gender equity gap by providing scholarships to more DRENs are now progressively aligning their work with public primary school student population in the country. The than 4,000 girls for post-primary education; disseminating the new 2013–2015 National Interim Education Strategy, Government of Norway and the European Union provided key messages on the value of girls’ education through strengthening their analysis and planning capacities funding for this activity. Substantive assistance was also community dialogues, radio programmes and printed and establishing Regional Education Councils to expand provided to a Go-to-School campaign run by the Ministry of material; and life skills support for students, teachers and partnerships and enhance coordination. Education. community members.

28 29 Teacher education Education in emergencies

It is well known that teacher quality is one of the most important Cyclone Haruna slammed into the southwestern coast of factors in how children perform academically and in other areas. Madagascar in February 2013, causing wind damage and then Like many other developing countries, Madagascar has relied flooding when a major damn burst in the regional capital of on contract teachers – hired mainly from the community – to Tulear. Schools were shut down but the majority opened within compensate for the lack of government teachers. Contract a week of the disaser. However, some children were only able teachers typically have less education and training than civil to go back to school after four weeks because their classrooms service teachers, and are often paid much lower salaries. Despite were used to shelter people whose homes had been destroyed a challenging environment for teacher training and support, by the storm. several initiatives in 2013 helped to maintain and in some instances, improve the quality of teaching and learning. An evaluation revealed that more than 230 classrooms could not be used because their roofs had been destroyed. UNICEF At the pre-primary school level, Early Learning and mobilized funding from the African Development Bank Development Standards were validated and the development to support the repair and reconstruction of 20 classrooms of a national curriculum was started. UNICEF helped to reach damaged by the cyclone. Out of the 28,000 plus children 1,000 pre-school teachers with pedagogical training. Regional affected by the cyclone, 22,000 received educational and trainers were supported to introduce similar training across the recreational kits, which also had radios that will enhance the country. communities’ capacity to generate early warning messages during future emergencies. More than 9,500 primary teachers benefited from in-service peer training on how to teach children from different backgrounds (inclusive teaching) and literacy and numeracy skills in early grades. They also were given access to syllabi and support materials for teaching Malagasy. At the upstream level, UNICEF supported the drafting of a national teachers’ competency framework – a set of minimum standards on competencies that teachers should have in order to teach. Work also began on an accelerated training programme for community-recruited teachers.

At the post-primary level, junior secondary school teachers were trained and school improvement plans implemented in more than 250 junior secondary schools, benefitting more than 23,000 girls and close to 27,000 boys. UNICEF continued supporting lessons on disaster risk reduction in junior secondary schools classrooms and capacity building for local educational authorities.

30 31 OUR PROGRAMME IN CHILD PROTECTION Keeping children safe from abuse, violence and exploitation

HOW UNICEF RESPONDS Helps create a comprehensive child protection system at national and decentralized levels.

Strengthens the juvenile justice system.

Works with communities to prevent THE CHALLENGE abuse, violence and exploitation, The child protection system in Madagascar including sexual exploitation of children. confronts long-held traditional beliefs that downplay the status of children in society. It is also challenged by a dysfunctional judicial Provides care and support for survivors system with weak government oversight that of violence, abuse and exploitation. does not adequately safeguard the rights of children. Sexual violence against children has increased tremendously in Madagascar. Commercial sexual exploitation and sexual Protects children caught up in tourism involving children in also reportedly humanitarian disasters. on the rise since the crisis started. However, reporting and prosecution of the perpetrators, as well as care and treatment for the victims are largely inadequate.

32 33 A 12-month national Campaign to End Violence Against WHAT WE ACHIEVED / Key results in 2013 Children was launched to mobilize communities against child violence. UNICEF supported the development of audio and video spots, which were broadcast daily on national 4,417 120 80 30,000 TV and radio. Additionally, UNICEF produced 58,000 flyers and posters and 22 billboards on violence against children, Child survivors of abuse Juvenile offenders Hotel industry managers Children who received which were posted in all 22 regions of the country. and violence who awaiting trial outside trained in prevention of retroactive birth received support detention sexual exploitation of registration Providing care and support to children survivors

The year saw a 45 per cent increase in reporting of cases Strengthening the juvenile justice This led to the adoption of a code of conduct on the of child abuse, violence and exploitation. With UNICEF protection of children from commercial sexual exploitation. support, care and support was provided to all 4,417 children system Close to 190 peer educators in two of the country’s most whose cases were reported to Child Protection Networks. In prominent mining companies were also trained to enforce Antananarivo, services were provided to children in the form Major breakthroughs were achieved in juvenile justice in a zero tolerance policy on commercial sexual abuse and of an integrated package of psychosocial and medical services 2013. The Ministry of Justice adopted a set of alternative exploitation of children. Communication tool kits were in a centralized, urban location in Befeletatana. Here, children measures to pre-trial detention of minors for petty crimes developed to introduce the training to these mining receive medical care and psychosocial support from a team and the Minister instructed all courts to apply them. One companies’ personnel and sub-contractors. of professional social workers in the hospital, and non-hospital hundred and twenty of a targeted 150 juvenile offenders legal support. directly benefitted from this action and are awaiting trial Preventing child abuse and outside of custody. Community-based child protection interventions exploitation implemented in 25 of Antananarivo’s poorest neighbourhoods Keeping children protected from were also effective. The integrated package of high impact sexual exploitation Deeply entrenched yet harmful cultural beliefs and practices services supports families in two service centres with training are often at the root of child abuse and exploitation. to facilitate income-generating activities. In 2013, 210 community mobilisers were trained on The Special Rapporteur on the sale of children, child interpersonal communication and facilitation of community prostitution and child pornography, Najat Maalla M’jid, dialogue around the protection of children from abuse Birth registration visited Madagascar in 2013. She strongly encouraged and exploitation. Subsequently, community mobilisers the government to step up efforts to combat the sexual Madagascar has a relatively high birth registration rate developed 25 action plans to prevent harmful practices exploitation of children and ensure that perpetrators are compared to other African countries but a fifth of children against children, which will be implemented in 17 districts punished. are not registered or have a birth certificate. To reach in seven regions in 2014. Twenty-five community dialogues, children who have missed out on registration, the National attended by children, women and other community Several initiatives were taken during the year to protect Institute of Statistics with support from UNICEF conducted members, were also conduced in two districts in western children vulnerable to this risk. UNICEF trained 80 hotel a study on pockets of exclusion from birth registration. Menabe. industry managers in two tourist regions on child rights. The national database and report will be released in early

34 35 2014. Some 30,000 children who had never been registered Recipes and robust children received retroactive birth registration during the year. UNICEF also supplied typing machines to 71 communes in Seventeen-year-old Andry* lost her mother a few years the three regions with the highest proportions of children ago. The eldest in the family, with two little sisters, she excluded from birth registration. lives with her unemployed father and grandmother. Like many of Madagascar’s young victims of the sex Child protection in humanitarian trade, Andry decided to help her family by selling sex. situations At the age of 13, she started going out at night to earn money without really knowing the dangers of having As an active member of the Protection Cluster, UNICEF unprotected sex with many men. assisted children caught up in the aftermath of Cyclone Haruna. Approximately 1,800 children of the cluster’s In 2009, she joined an organization of sex workers. It targeted 3,000 benefitted from care and support in three was then that she heard of SISAL, a UNICEF-supported child-friendly spaces created in storm-affected areas. UNICEF organization in Tuléar that provides medical care and also helped to distribute messages to affected families on training for sex workers. The organization also assists how to protect their children during emergencies. Twenty children who are victims of sexual exploitation. Andry community volunteers were mobilized to identify separated and nine other children were trained by SISAL as peer and unaccompanied minors and provide psychosocial educators and spend time talking and counseling counselling to families in distress. other children about the dangers of sex work and how to prevent sexually transmitted illnesses and HIV. They In preparation for cyclone season, UNICEF pre-positioned also distribute condoms. five child-friendly kits with the capacity to benefit 1,000 children. These kits, which contain assorted children’s “The work is not easy,” says Andry, “But if everyone games, will be stored in cyclone-prone coastal regions. A plays their part, we can reduce the number of young database including all trained Child Protection Network girls who sell sex or at least reduce some of its members in emergency prone areas is current and can be associated dangers.” activated in the event of humanitarian emergencies. Since becoming a peer educator, Andry rarely goes out to nightclubs. With the help of SISAL, a livelihood project is being developed to help Andry and her family earn an income and become self-reliant.

*Her name and certain details in this story have been change to protect the identity of the child.

36 37 OUR INTER-SECTORAL PRIORITIES A common thread

COMMUNICATION FOR 34 radio programmes were produced and broadcast, reinforcing the peer educators’ messages. UNICEF also DEVELOPMENT supported the Ministry of Youth to promote youth life skills using an ‘edutainment’ approach, continuing the production Communication for Development (C4D) uses different of the TV series ‘Dzaomalaza’, which will be broadcasted in approaches to help communities, families and children 2014. identify solutions to problems that affect children and women in their midst. ADVOCACY AND MEDIA One such approach is the promotion of key family practices such as enrolling and keeping children in school, UNICEF ensured advocacy and media work for children’s vaccinating them and washing hands with soap to avoid rights in all programme areas and facilitated media infection. In 2013, UNICEF helped to define 12 minimum visits during the intensified coverage of the Madagascar essential family practices in Madagascar in consultation with presidential elections. More than 600 articles related to community representatives and the Ministries of Education, children and women were published. UNICEF was especially Health, Water and Social Affairs. They will be validated in successful in using the attention of the world’s media on 2014 and promoted through community campaigns. Madagascar’s presidential elections to place key messages about children and women in Al Jazeera, LA Times, The Another approach in creating behaviour change is Guardian, Associated Press and other global outlets. The team through campaigns and interpersonal communication. In also hosted the visit of musician Katy Perry, which was vital for 2013, UNICEF helped to roll out four national campaigns, her decision to become a UNICEF Goodwill Ambassador. including the Go-to-School Campaign, two Mother and Child Health Weeks and one campaign to engage UNICEF Madagascar’s social media presence continued to individuals to report cases of violence against children. grow with more than 2,000 new Facebook friends and 1,600 Close to 5,000 social mobilisers were trained on one-on-one followers on Twitter. and group communication. In cooperation with the University of Antananarivo, a new Young people are a key target group for C4D. During the module on Child Friendly Journalism was introduced into year, 40 peer educators were mobilized to reach 2,200 the curriculum. The UNICEF documentation center was also young people and several youth forums were held as part relocated from the country office to the university campus, of the Human Security Project in the capital city. Through where the number of monthly visitors soared from 70 to an a partnership with the NGO Search for Common Ground, average of 700.

38 39 UNICEF renewed its partnership with the state media, southern regions of Madagascar, which will complement OUR AMBASSADORS resulting in free airtime that is currently used for a child the MDG survey. UNICEF also finalized the situation analysis protection campaign. For the third year in a row, a one- of children and women and will disseminate the report minutejr workshop was run, where children told their in 2014. A number of programme evaluations were also Celebrity visitors in 2013 stories on camera in one minute. The films were screened launched during the year to support UNICEF Madagascar’s in partnership with the Annual Short Film Festival. A decentralized, bottom-up programme planning. number of cultural events were organized with the Alliance Celebrities have been a vital and unique part of UNICEF’s history since 1953, when celebrated actor Danny Francaise and the Centre Malgache pour le Developpement Kaye became UNICEF’s first Goodwill Ambassador. UNICEF Ambassadors are prominent individuals in film, EMERGENCY PREPAREDNESS AND television, music, sports and beyond. They demonstrate leadership in their professions and serve as positive de la Lecture Publique et Animation Culturelle (CEMDELAC) RESPONSE to promote issues like exclusive breastfeeding and child role models through their work. Over the years, UNICEF Ambassadors have played a critical role in raising participation. awareness of the needs for children, and have continued to use their talent and fame to fundraise, advocate, Thousands of children and their families in Madagascar are and educate on behalf of UNICEF. constantly under threat of natural disasters and most are ill PRIVATE SECTOR PARTNERSHIPS equipped to deal with crisis. It is therefore imperative that all Katy Perry relief providers are adequately prepared to respond to the Katy Perry is UNICEF’s newest Goodwill Ambassador. She UNICEF maintained and renewed nine private sector needs of children and women when emergencies strike. was appointed in December 2013, with a special focus partnerships that support UNICEF Madagascar’s programme on young people. Katy visited Madagascar in April 2012, with financial and/or in-kind donations. Partners include UNICEF strengthened its own emergency preparedness bringing much-needed attention to children and women in mining companies Ambatovy and QMM as well as and response strategy by including specific disaster risk the country. Over her four-day visit, Katy saw a full range of companies such as DHL, telecom operators Orange, Telma reduction and response activities in the annual work plans education, nutrition, health and child protection to water, and Airtel, and cement company Holcim. of all programme sections. In addition, the nearly 50 staff sanitation and hygiene activities. based in the field received an orientation on national UNICEF promoted Children’s Rights and Business Principles disaster monitoring and response mechanisms. Barbara Schöneberger (CRBP) by providing technical assistance to companies to Barbara Schöneberger is a well-known German actress, singer develop and apply staff codes of conduct that respect child National partners also benefitted from UNICEF’s expertise in and TV host. As a UNICEF ambassador, Barbara Schöneberger rights. For the two biggest mineral companies, Ambatovy emergency preparedness and response. UNICEF supported joined the UNICEF-Pampers campaign “1 pack = 1 vaccine” and QMM, UNICEF provided support to review company the National Office of Risk and Disaster Management to in 2013 to eliminate neonatal tetanus. In July 2013, she went codes of conduct, develop sensitization tools for internal improve its capacity in this area while school teachers and to Madagascar to follow the journey of vaccines, from the use on prevention of children’s sexual exploitation, and train administrators were trained to help communities reduce airport to the child in remote areas of southern Madagascar. 60 internal trainers. their vulnerability during emergencies.

SOCIAL POLICY The preparatory work paid off when Cyclone Haruna hit Jean Van de Velde the southwestern coast, affecting more than 41,000 people. Jean Van de Velde is a French professional golf player. On the UNICEF is a leader in generating data, information and UNICEF responded by providing safe drinking water, helping occasion of the Open de France in 2012, Jean Van de Velde was evidence on children and women, both globally and in children return to school, carrying out emergency measles officially appointed as Ambassador for the UNICEF National individual countries. In Madagascar, several key surveys immunization and providing daily psychosocial support to Committee in France. In June 2013, he visited Madagascar to were completed in 2013, including the UNFPA-led MDG children. experience first-hand UNICEF’s work in child survival, education, survey and a Multiple Indicator Cluster Survey 4 for four nutrition, water and sanitation and child protection.

40 41 DONORS Thank you

DONORS Norwegian Committee for UNICEF African Development Bank PAC T AIM - Association Intercooperation Spanish Committee for UNICEF Bill & Melinda Gates Foundation The GAVI Fund Canadian National Committee for UNICEF The Government of the United Kingdom Canadian International Development Agency UNICEF-Madagascar Consolidated funds from UNICEF National United Kingdom Committee for UNICEF Committees United Nations Foundation Inc. Danish Committee for UNICEF United States Fund for UNICEF Donor Pooled Fund (mixed donors) United Nations Office for the Coordination of European Commission Humanitarian Affairs Finnish Committee for UNICEF United Nations Trust Fund for Human Security French Committee for UNICEF United States Agency for International Development German Committee for UNICEF World Health Organization Iceland Committee for UNICEF The World Bank Italian National Committee for UNICEF Thematic Funds Japan Committee for UNICEF Basic Education and Gender Equality Luxembourg Committee for UNICEF Global - Education Micronutrient Initiative Global - Humanitarian Response Netherlands Committee for UNICEF Young Child Survival and Development The Government of Norway

42 43 Finances

Programme budget and expenditure, 2013 (US$) 1.7 12.5 3.76 3.4 39 105 2.3 4 million 100% million million million million million million million

50% million million million million million million million million

0% 10.8 2.3 1.8 29.6 70.7 1.9 3.65 1.9

Health Nutrition WASH Education Youth and Child Intersectoral Cross-sectoral HIV/AIDS protection programme costs Budget Estimated expenditure

Photo credits: © UNICEF Madagascar/2014/Rindra Ramasomanana

Page 41: Photo Katy Perry: © UNICEFNYHQ/2013-0166/Holt Photo Barbara Schöneberger : © UNICEF Madagascar/2013 Photo Jean Van de Velde: © UNICEF France

44 45 UNICEF Madagascar United Nations Children’s Fund Maison Commune des Nations Unies, Zone Galaxy Andraharo B.P. 732 Antananarivo Tel: (261-20) 23 300 92 Email: [email protected] Web: www.unicef.org/madagascar

Facebook: www.facebook.com/UNICEF.Madagascar Youtube: UNICEF Madagascar Twitter: www.twitter.com/unicefmada

Daniel Timme Chief – External & Media Relations (MRE) Mobile: +261 (0)32 03 411 31 [email protected]

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