Testtttttttttttttttttttttttttttttttttttt Country Office Annual Report 2019 Republic of Cameroon Update on the context and situation of children On July 1st, 2019, the Cameroonian population, is estimated at 24,348,251, 50.6 % female; 52% aged below 18 years old (BUCREP 2019). The population is young and generates strong socioeconomic demand. In rural areas, limited access to basic social services and effects of climate changes lead to household impoverishment and severe child deprivations. From 2011 to 2018 (DHS), under-five mortality has dropped from 122 to 79 per 1000 life-births while neonatal mortality decreased from 31 to 28. Nevertheless, achieving under-five mortality targets set by SGD agenda by 2030 remains challenging for the country. In this regard, UNICEF strengthened its support to (i) increase immunization coverage especially for the most deprived children, (ii) combat main children’s killer diseases, (iii) reduce stunting prevalence with special focus on the most 4 vulnerable regions (East – North – Adamawa – Far-North). Youths and adolescents aged 15-24 years old (23% national population) are challenged by (i) unemployment/underemployment, (ii) sexually transmittable diseases and HIV infection, (iii) gender-based violence, (iv) drug consumption and abuse. Discordances between labor market demand and jobs seekers skills remains challenging and threatening to economic growth, development, security, social cohesion and peace. Early entry in sexual activity (16.5 in rural area and 17.6 in urban area) and early marriages (43% of women aged 17 – 19 years old) expose girls to unwanted early pregnancy and increases risks of maternal mortality. Despite the confirmed decrease in HIV prevalence in the general population (DHS 2018) from 4.3% (2011) to 3.4% (2018), new infections are still increasing among youths and adolescents. The knowledge of appropriate means to prevent HIV infection is lowest amongst adolescents aged 15 – 17 years old (30.2% among boys and 28.4% girls). Compared to 2010/2011, access (131% to 117%), completion (71% to 67%) and transition from primary to lower secondary (60% to 48%) have decreased in the 2017/2018 school year. Nearly 36% children are out-of-school, North- West and South-West not included. Out-of-school girls are exposed to several forms of adverse practices including child marriages and other forms of Gender-based violence and exploitation even more aggravated in emergency situations. The Grand National Dialogue convened by the Government in 2019, gathered key political players to seek lasting solutions to sociopolitical unrest and threats faced by the Country notably to the North-West/South-West (NW/SW) crisis. The law on decentralization and special status awarded to North-West and South-West regions are the most important outcomes. This law prescribes allocation of 15% of the national budget to local councils but not specific on roles distribution on management and accountability of development affairs attached to the special status awarded to NW/SW. In 2019, the overall economic growth is estimated at 4%. This growth does not provide enough resources to create jobs opportunities for youths. Government has continued implementing the economic program agreed with the Bretton Woods financial institutions. Public budget allocations to social sector is also affected by both economic performance and ongoing crises. In 2019, children in the country have been affected by several climate change-influenced humanitarian situations including floods in the North and Far-North regions. In the Far-North, floods have affected crops-growing activities and may therefore expose the population to food insecurity, hunger and malnourishment at the pick of the dry season. Severe and acute malnutrition may increase and jeopardize many children and mothers’ lives if appropriate surveillance and response are not taken. Measles (48/189 health districts) and cholera (1293 case, 56 deaths, 17/189 health districts) epidemics have also been registered over the reporting period. Two cases of vaccine derived polio-virus were also confirmed, one in Mada Health District, Far-North region and the other one in Chad. Epidemics repetitiveness is due to some factors notably, security degradation, weak performances of immunization services, limited access to WASH. Epidemic outbreaks also occurred in areas affected by man-made crises, prevailing insecurity thus rendering our response even more complex. Two major crises, the NW/SW crisis that included population displacements within the regions’ hard to reach areas and into neighboring regions, and the Boko Haram crisis, emanating from Nigeria and affecting mostly the Far-North region, continued to have traumatic consequences for child rights. The spillover effects have displaced children, families and communities. The NW/SW crisis, in its third year, continued with frequent clashes between government forces and non- state armed groups. In total, 653,902 people have been displaced along with 203,634 returnees. The Boko Harm crisis, characterized by predatory cross-border attacks on civilians, has created 271,000 IDPs, 110,000 returnees and 106,000 Nigerian refugees in Far-North region. Over 2019, the intensity of both conflicts increased leading to greater child survival and protection needs. Page 1 of 7 Page 1 of 7 Testtttttttttttttttttttttttttttttttttttt Country Office Annual Report 2019 Republic of Cameroon Humanitarian threats to children in Cameroon increasingly compete with the continuing need for inclusive sustainable development. Response to humanitarian situations led Country Programme (CP) geographical focus to move from four to six regions. UNICEF scaled up field presence from three to five operational business units including new outposts in Bamenda (North-West region) and Kousseri (Far-North region). This change in both magnitude and complexity of demand occurs in a challenging environment marked notably by poor donor response for lack of government commitments. Out of USD 39.5 million needed, only 15% was funded with severe consequences for UNICEF capacities to respond though CERF and internal EPF loan facilities enabled some key deliverables to be met. Additionally, access constraints and the limited range and experience of government and non-governmental humanitarian partners further impacted on response efficiency, efficacy and effectiveness. In 2020, UNICEF will prioritize 1) strengthening the quality and coverage of gender-sensitive humanitarian response for children; 2) strengthening child protection capacities; 3) supporting joint principled government/inter-agency contingency planning and rapid response for new emergencies (including for vaccine preventable and communicable diseases); and 4) conducting advocacy on the impact of conflict on children. The response will emphasize systems strengthening, and linking humanitarian action, development and peacebuilding in local contexts. Major contributions and drivers of results As outlined in the 2019 Annual Management Plan, the Country Office focused on seven priorities: emergency preparedness and response, decentralization of Programme functions, resources mobilization, planning processes and three Key Results: Immunization, Birth registration and stunting. Two major crises (NW/SW crisis and Boko Haram crisis in the Far-North) are ongoing in the country with significant impact on children rights. The spillover effects have displaced people, families and communities. More than 450,268 people remain displaced along with 203,634 returnees in the ongoing NW/SW crisis and 271,000 IDPs, 110,000 returnees and 106,000 refugees in Far-North region. Needs in humanitarian response have significantly increased. Consequently, CP field focus has shifted from four to six regions. Mindful of the complexity of the NW/SW crisis, Country Office implemented several strategies to meet the needs of affected children: optimization of human and financial resources; functionality of all four UNICEF co-led clusters; acceptance of humanitarian assistance through partnerships with non-governmental organizations; establishing rapid response mechanisms; implementation of third-party monitoring strategies and utilization of U-Report for independent feed-back. UNICEF reached 152,947 children aged 6 months to 15 years with measles vaccination; 54,240 families received long- lasting insecticide-treated nets; 76,154 children with severe acute malnutrition (SAM) received treatment; and 260,479 people received WASH kits. Some 1,000 conflict-affected children received a birth certificate and 8,037 unaccompanied and separated children were identified and/or placed in alternative care arrangements and received follow-up. A special Rapid Response Mechanism was established to reach hard-to-reach populations in NW/SW with multi-sector assistance. Cluster coordination commitments were met for nutrition, WASH, education and child protection. To adapt to the changing programmatic environment challenges, the Country Office strengthened the decentralization of field operations. Within the scope of the Accountability Framework, ownership and accountability of Field Offices was reinforced with operational plans, managerial capacity development, strengthening evidence-based Programme management for effectiveness and efficient delivery for children. At decentralized level, complementarities, synergies through entry points approach was reinforced as well as local leadership and gave way to innovative approaches on Programme Accountability through: - Cross-sectoral