1990

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kNations Children's Fund

VNICEF Executive Board1 August 1989 to 31 July 1990

Officer? of the Board:

Chammm (Executive Board): Ms. Margarita Dieguez {McxK-oi

Chairman {Programme Committee}: Mr. Frank Majuur ( N e t h f i l i r u K t

Chairman (Committee on Atiminisirntin/1 mid Fm/rmr): Or. Hnda Badran (Egypt]

t-'a-ft Vicc-Ch&i/rmm: Ms. Lishet Palme iSweden]

Second Vice-Chairman: H.E. Mr. Stanistaw Trepczynski (Poland)

Third Vice-Chairman: Dr. Suyum* Valiva (Indonesia)

Fourth Vicf-Chnintiiw: H.E. Mr. Paul B.iincLi Eng<i [CaniLTDon]

Members of the Board:

AustraliaBenaladeskBarbadosHclfjiiiwlii-nhiRolh'inByelorussian SSRCameroonCanadaChinaEgyptI 'inland

Prance(.rfnumiv. Federal

Republic »/'IndiaIndonesiaItalyJapanKorea,

Republic ofLiberiaMexicoNetherlands

NifnrnjjnaNtffei-iaOmanPakistanPeru1'hilip [rinesPolandSew Toini- and

PruififfSudanSwedenSwitzerland

ThailandUgandaUnion iij'Sm'it-i

Socialist RepublicsUntirti l\niji(ifiiit c/'

(iirnt Rritnsii andNiti-tl/et'ii Ininnd

i'nitfd StntoufAmcnca

UruguayYitjiof/nrirtZimbabwe

Tfxt: Lin SicclcIHnilrntioni; WyartDesif/n: Rcgin.i SolomonPnidttetian: Pcrt-r IXivid, Off Foord-kckcy. PanifKi Knigh t , H.ishi RobiTts

(I) (2)

(S)

04)

W

(15)

If)

(10)

(12)

(3)

(7)

(13)

(4)

C«)

(»D

Cover photographs

(1) UNICEF/3470/89/P«u(2) UNlCEF/3637/89/Momson(3) UNTCEFfli6H/S9/Peni(4) UNlCTF.F/3280/89/Wright(5) UMCEFr3382#9/Sfw*Kuc(6) UNlCEF/3S81/8»yH«nley(7) UNICEK/3471/89/P«u(8) UNlCEF/3166/B9/Bregnard(9) UNlCEF^JMO/SQ/Momson

(10) UNlCEH/3220/89/Rmnw(M)UNlCEF/3261/«9/Wright(12) UNlCEI-'/3198/89/Bregnard(13) UNlCEF/3633/89/Momwn(14) UNlCEF/3367ff9/Schytte(15) UNICEFni65/89/Bregnard

UNICEFAnnual Report

1990Contents

Introductionby the Executive Director, James P. Grant

Programmes1989 - A review 5

Adjustment with a human face 6Child survival and development

Towards universal immunisationOral rehydration therapy/Control of diarrhoea! diseases 9Facts for Life 11Acute respiratory infections 12AJDS 13Guinea worm 14Primary health care 14Bamako Initiative 16Nutrition and food security 19WHO/UNICEF Joint Nutrition Support Programme (JNSP) . . . . 21

Childhood disability 21Social mobilization and programme communication 22Water supply and sanitation 23Basic education 26Women in development 27Sustainable development — the environment 33Urban basic services 34Children in especially difficult circumstances 35Emergency relief and rehabilitation 36Monitoring and evaluation 39Inter-agency co-operation 40

External relationsMobilizing for children 41

United Nations Convention on the Rights of the Child 43Celebrity supporters and special events 45National Committees for UNTCEF 46Non-governmental organizations 46Parliamentarians and religious leaders 47Fund-raising 47Greeting Card Operation 48

ResourcesUNICEF's Finances: income, commitments and expenditures

1988-1990 49AGFUND 55Information resources management 55Human resources management 55Supply management 56

ProfilesLet's go to the Posyandu 8Reversing their fortunes 18Like a gift from heaven 25Eating straight from the garden 32Fragile peace — a remarkable change 37Self-help — an example to the rest of the world 44

Maps and chartsMap; Under-five mortality rate (U5MR) and

number of births 28Table: UNICEF programmes from general resources 30Chart: UNICEF income by source 1989 49Table: 1989 non-governmental contributions 50Chan: UNICEF income 1988-90 50Chart: UNICEF expenditures 1988-90 51Map: 1989 governmental contributions 52Charts: UNICEF expenditures on programmes

by sector 1985/89 54Glossary, . 57

ntroductionby the ExecutiveDirector^James P. Grant

We have entered rhc 1990s on a newwave of international concern to pro-tect children and provide tor theirspecial needs. In December 1989 the159 Member States of the UnitedNations unanimously endorsed theConvention on the Rights of theChild, promising the younger genera-tion a place at the top ot nationalagendas. United Nations Secretary-General Javier Perez de Cuellar liasannounced plans to follow up with aWorld Summit for Children, to beheld at United Nations Headquarters(29-30 September 1990). This will bethe first high-level forum of its kind,enabling national leaders to focus ex-clusively on issues affecting the futureof their children. It will also be thefirst ever North-South-East-Westsummit which literally brings togetherheads of government from all fourcorners of the world.

These are enormously encouragingdevelopments. The bywords of theConvention are survival, development

and protection, and the standards ithas established against neglect, exploi-tation and abuse will provide theframework for Summit discussions.

This public marriage of the Con-vention and its moral imperatives tothe political agendas of individualleaders looms especially large againstthe record of the past decade. Duringthe 1980s UNICEK, with WHO and itssister United Nations agencies, hashelped to pioneer a series of low-costhealth measures to safeguard the livesof infants and young children, demon-strating beyond a shadow of doubtthat the international community hassome very powerful tools for progressat its fingertips. Immunization cov-erage increased from less than 10 percent in 1980 to about 70 per centtoday, now saving the lives of at leasttwo million children under five eachyear. The incidence of polio has alsobeen reduced, and there is hope that itwill be eradicated. This is one of thegoals of the next decade. ORT againstdiarrhoea! dehydration, the number-one child killer, prevented almost onemillion child deaths in 1988, andbreast-feeding made a spectacularcomeback in many industrializedcountries. An additional 700 millionpeople in the developing world gainedaccess to safe drinking water, andmuch was learned about the controlof micronutrient deficiency diseasessuch as anaemia, xerophthalmia,goitre and cretinism. As parents havegained confidence that their childrenwill survive them, life has become lessof a gamble, and couples in manydeveloping countries are now con-sciously planning smaller families.

Positive as these trends have been,however, developing nations have re-alized only a fraction of the potentialottered by basic health technologies.As we embark on the last decade ofthe 20th century, armed with theConvention on the Rights of theChild and our hopes for the Summit,we would do well to remember thatmeetings, words and promises alonewill not save lives or soften the envi-ronments in which our children arcexpected to grow. We might reflect

for a moment on nx. (1979) and thepromises which that occasion alsogenerated for a revolution in csn. Wewere moved at the time to observethat every year should be the Year ofthe Child, and clearly things have notturned out that way.

At the time of ivc we had theknowledge and tee lino logics to save100 million child lives by the year2000. After 10 years we had saved justseven million, and our target for the1990s is now 50 million.

What \ve were unable to foresee in19X0 was the crushing impact whichfalling commodity prices, third worlddebt and national economic adjust-ment programmes would have on ourprojections tor the developing world.National economies shrank, externalsources of financing dried up, and thefirst bite of economic restructuringwas felt by the poorest families. Work-ers were laid off, currencies weredevalued, food prices rose and socialspending was cut. An analysis of gov-ernment spending for 57 developingcountries in the first half of the decadeshowed that real health expenditureper capita declined in most of Africaand Latin America, and that per capi-ta government support for food sub-sidies declined in eight out of the 10countries tor which comparable datacould be found.

Per capita public investment in pri-mary schooling also fell in two thirdsof the developing countries for whichwe had data during the 1980s, leavingalmost 100 million children withouthope of formal education. We mustturn that situation around. In 1989UNICEF helped to lay the groundworkfor a 1990 World Conference on Edu-cation for All - an event we arc co-sponsoring with UNDP, UNESCO andthe World Bank in an effort to reviveprimary education and adult literacy,and the mobilization of all forms ofthe media as a 'third channel" ofeducation for all.

A revolution in communicationshas placed new audiences at our door-step. Radio, television and satelliteconnections have given us the capacityto educate families that were prev-iously beyond the reach of conven-tional government services. If we cangive those people the necessaryknowledge, they can do much of therest. If the media can make Coca-Colaand Pepsi household names in the farcorners of the developing world, sure-Iv we can do the same for a 10-cent

packet of OKS and a simple message:'It Saves Lives1. The effective use ofmodern communications to create de-mand and mobilize people on theirown behalf is essential if we are to stepbeyond the pioneering efforts of the1980s.

With new efforts of national mo-bilization and a new internationaloptic on human progress our mosturgent goals for children can beachieved in the 1990s. Over the nextdecade we can reduce by a third themortality rates for infants and youngchildren, and tor mothers in chi ld-birth. We can virtually eliminate se-vere malnutrition. We can eradicatepolio, eliminate neonatal tetanus, andimmunize at least 80 per cent ofyoung children against other diseaseswhich maim and kill. We can reducechild deaths due to diarrhoea by 70per cent and we can cut Alii mortalityby 25 per cent. We can virtuallyeliminate blindness caused by vitaminA deficiency. The list of doable propo-sitions goes on and on. Hut if theinternational community is to honourits moral obligations towards childrenand give more than lip-service to theideals of the Convention, our leaderswill first have to look at the world, andcheir priorities afresh.

UNICKF'S call for 'adjustment with ahuman face" has highlighted the im-pact of economic restructuring on themost vulnerable communities andtheir children. We have argued withtraditional economists and plannersthat the final measure of nationalgrowth is not the upward curve ofGNP but human progress measured byhuman factors such as reduced hungerand malnutrition, increases in life ex-pectancy, lower child death rates, andaccess to health services and educa-tion.

Development in the 1990s shouldbe judged bv human indicators, noteconomic variables. For growth to besustainable, nations must protect anddevelop their human capital. Leadersmust consider nutrition as well asinflation, food intake as well as thebalance of payments, shortfalls inhousehold income as well as govern-ment budget deficits. They must givefirst call to those whose developmentwill shape tomorrow's world.

If present trends continue, morethan 100 million children will dieduring the 1990s - half of them fromthree common diseases which couldbe treated or prevented for a te\\ cents

per child. The survivors will be left tomuddle through in communitieswhere schools have no teachers, whereclinics lack drugs or trained healthworkers. As President Mugabe ofZimbabwe has said: "Few scourges inhuman history can claim so manyvictims as todays debt crisis'".

The debt crisis alone however doesnor explain the lost opportunities ofthe 1980s. We live in a world where achild can be immunized for US$1.50,treated against infection with anti-biotics for a dollar and rescued fromdeath by dehydration with a sachet ofORS costing 10 cents. The central issueis commitment in a world that couldmeet the basic needs of the poorestand most vulnerable of our childrenwith an investment of just USS2.5billion ii year. This sounds like a lot ofmoney, but it is just two per cent ofthe poorer nations' annual arms ex-penditure and would barely cover theSoviet Unions vodka bill for a month.American tobacco companies spend asmuch on cigarette advertising eachyear.

We desperate!}' need a new ethic andsense of moral proportion, and in thisnew era ot international peacemaking,freedom and openness, this year ofthe World Summit for Children, per-haps we shall find them. Our leadershave no reason to doubt what can hedone. They have the tools to ensurethat their children thrive - not merelysurvive. The new decade is very muchin their hands.

fl«v ic/G.A*&James P. Grant

Executive Director

vogrammes

1989 - A reviewAs nations inched open their doors todisarmament, peace and human free-doms in 1989, mankind was chal-lenged as never before to think abouta common future. Walls of distrustand political division began to crum-ble, and leaders began to speak openlyof shared responsibilities for theplanet, its resources and the childrenwho would inherit them.

One tangible expression of thehopes shared by so many nations wasthe General Assembly's unanimousadoption of the United Nations Con-vention on the Rights of the Child,which set minimum standards of pro-tection for children everywhereagainst exploitation, physical abuseand the neglect of their physical andemotional needs. The passage of dieConvention on 20 November after 10years of formulation and negotiationis a landmark challenge to rich andpoor nations alike to give their chil-dren the best they have to often

A World Summit for Children isplanned for 1990. This will be thefirst-ever meeting of heads of Statefrom North, South, East and West —from both developing and developedcountries, and from countries of East-ern and Western Europe. The focuswill be on the doable agenda of priori-ty action for children in the 1990s,and how the implementation of suchactions can be accelerated by bothnational and international efforts.The meeting will cover the Conven-tion and the special needs of children.

Global initiatives to Lput childrenfirst1 were also reflected during theyear in the observance of 'clays oftranquillity1, which enabled childrento be immunized in war-torn El Sal-vador, and through the establishmentof'corridors of peace1 in Sudan for thedelivery of humanitarian relief to chil-dren and women in the south of thecountry-

UN1CHF programme performanceduring 1989 reflected the generalmood of optimism which seized theinternational community. Immuniza-tion coverage continued to expanddramatically, and uci goals wereachieved in 39 countries at the end of1988. A substantial increase in thatnumber is expected for end-1989. Al-most 99 per cent of the population in112 nations now have operational CDDprogrammes, and 60 per cent of theunder-five population have access toOUT services. New programmes havebeen, or are being launched in re-sponse to the challenges of AR.I andAIDS, me is being revitalized throughthe Bamako Initiative to play a centralrole in the achievement of'Health forAll ' in the 1990s.

UNiCEF-assistcd drinking water sup-ply programmes are reaching increas-ing numbers of people, especially inrural areas, and although the goal ofthe International Drinking WaterSupply and Sanitation Decade willnot be achieved by 1990, many coun-tries will have developed sufficientphysical and human infrastructure tocarry them to the target of 'CleanWater for AlP by the year 2000. Thegreater challenge, however, is in thearea of sanitation services. Progresshere has been limited, and the futureexpansion and sustainability of thisclement will depend on overall eco-nomic and social progress and supportfor education in particular.

The UNICKF programme approachto the advancement of women hasbeen flexible, diverse and focused onthe poorest and most seriously disad-vantaged. The central objective, fromliteracy to income generation to foodsecurity, has been to integrate wom-en's concerns in all areas of program-ming. Women-specific projects havebeen devised only when a countrysituation demands it as an inter-mediate step towards full integration.

The World Conference on Educa-tion for All will provide a uniqueopportunity for countries to reviewtheir education efforts, and UNICEI-1

helped many countries in this area.L'NiCEF's own programme co-opera-tion in education has focused on ac-cess to relevant education; on the needto improve educational opportunitiesfor girls and women; and on theimportance of community participa-tion in the planning and managementof education.

Although many initiatives were

UNICEF has been advocating 'adjustment with a human face1 since 1983,when social indicators started to reflect the tragic consequences ofstructural adjustment programmes m many of the developing world'spoorest communities. Since then there has been growing acceptance of theneed to protect the poor by placing concern for human development aheadof crude economic indicators such as GNF. It has become all too clear topolicy makers in rich and poor countries alike that national economicgrowth by itself is no guarantee against poverty.

Unfortunately, however, the development of interventions to safeguardthe poor against structuraj adjustment policies is proceeding very slowly.There are two main reasons for this. The first is the inability of financialagencies to effectively operate buffer programmes. The second is the sadstate of implementation at national level as governments struggle withdeclining revenues.

International sensitivity to the idea of putting human development andthe needs of children first appears to be growing. Evidence of this in 1989could be seen in the passage of the United Nations Convention on theRights of the Child, in preparations for the March 1990 World Conferenceon Education for All (Jomtien, Thailand), and in the opportunity given toUNlCEF'x Deputy Executive Director, Programmes, to testify before theUnited States Congress in January and February on the need for adjust-ment with a human face.

During the year, UNICEF chaired a recently formed TCGP subgroup onadjustment and was a party to discussions by a small group of heads ofUnited Nations agencies (EGA, ILO, UNDP, UNESCO, w*i») on specificadjustment problems in Africa. In May UNICEF gave testimony to theUnited Nations Secretary-Genera Ps advisory group on the precarioussituation of African commodity exporters, and contributed to a study,'Engendering Development in the 1990s', which was presented to the headsof Government of the Commonwealth in October. UNICEF is also a memberof the steering group of the World Bank's initiative on the SocialDimensions of Adjustment, which is partly financed by UNDP and a numberof bilateral donors.

Analysis and discussion of adjustment-related proposals were expandedduring 1989 to cover a large number of countries including Argentina,Bolivia, Ecuador, the Gambia, Ghana, Guinea, Guyana, Kenya, Madagas-car, Mozambique, the Philippines, Somalia and Tanzania. In countries suchas Ecuador, Guinea, Mozambique and Somalia, UNLCEF offices supportedinter ministerial task forces on the priorities for social and economicprogramming. These meetings were also attended by other United Nationsagencies and NCOS. The UNICEF International Child Development Centre inFlorence held a seminar Ln Abidjan in April to lay the foundation forresearch on the effects of structural adjustment policies on human welfarein Africa south of the Sahara, and the role UNICEF could play in futureinterventions.

During the year, UNICEF also extended special assistance to the Philip-pines, which had been hard hit by the collapse of sugar prices, and to theGambia, which was struggling to adjust to a slump in ground-nut prices. InLatin America, a publication, The Invisible Adjustment: Poor Wotnen and theEconomic Crisis, became a focal point for advocacy.

Following the example of the UNICEF programme of debt relief for childsurvival in Sudan, an agreement has been reached with the Inter-AmericanDevelopment Bank to establish a social investment trust fund in LatinAmerica. The fund will be financed from a number of debt relief operationsin the region. Arrangements for a special African Fund for SocialInvestment are also being studied.

taken during the year, and many pilotprojects were launched, 100 millionchildren still lack the opportunity to

be in school, and high rates of popula-tion growth suggest this number willincrease. Articles L5 and 16 of the

United Nations Convention on theRights of the Child emphasize chil-dren's right to education and encour-age international co-operation toerase illiteracy and ignorance.

The education challenge for the1990s is how to universalize access toeducational opportunities to all chil-dren; how to make the systems moreefficient, effective and relevant; howto spark a literacy revolution at lowcost; and how to seize the emergingcommunications opportunities to dis-seminate the knowledge and skillsneeded for the well-being of thepeople. D

Child survival and development

Towards universalimmunizationGlobal immunization coverage hascontinued to rise dramatically, withthe incidence of immunizable diseasescoming down markedly in manycountries. By the end of 1988, 68 percent of children in the developingworld had received their three doses ofDPT (diphtheria, whooping cough,tetanus) and polio vaccine by their

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first birthday. Coverage with anti-tuberculosis ( B C G ) vaccine hadreached 75 per cent, and measles 60per cent. Protection against measles,the largest child killer among theimmunizable diseases, has almosttrebled since 1981.

In 1986 only 15 countries hadachieved the UCI goal of 80 per centcoverage of all antigens for children,but at the close of 1988, a total of 39countries had done so. Given that anadditional 37 countries had greaterthan 60 per cent coverage in 1988, itwas expected that many more wouldin fact reach the uci goal.

It is estimated that this steady rise-in immunization coverage preventedmore than two million deaths frommeasles, pertussis and neonatal tet-anus during the year. Despite someexcellent progress, however, it shouldbe noted that gaps in immunizationcoverage result in about 2.8 milliondeaths from these same diseases eachyear. It would take several years ofsustained coverage at levels of 80 percent and above to stop transmissionand lower levels of infection.

The numbers of pregnant womencovered by tetanus toxoid remain be-low 40 per cent, and more than750,000 infants died within 10 daysof birth during the year because theirmothers had not been immunizedbefore or during pregnancy-

China has become a world leader onthe immunization front. It set thepace in 1988 with national coveragelevels that were above 95 per cent forall antigens. Its target for 1990 is toachieve better than 85 per cent cov-erage in every county. Bangladesh,India, Nepal, the Philippines and VietNam also made strong progress. Indiahas an accelerated programme in alldistricts and is immunizing a signifi-cantly greater number of childrenevery year.

The MENA region has averaged 70per cent coverage or better for allantigens except tetanus toxoid forpregnant women, and there is anexcellent possibility that all MtNAcountries could achieve uci by the endof 1990.

In the Americas, national immuni-zation days have been used suc-cessfully to improve coverage and tosupport the goal of polio eradication

Let'sgo to the Posytmdu

Radio listeners in rural Indonesiathese days are just as likely to hearcommercials for ORT as forCoca-Cola.

For almost three years, the statenetwork, Radio Republik Indonesia,and 473 private commercial stationshave been airing a variety ofadvertisements, mini soap operasand talk shows on subjects such asORT immunization, nutrition,breast-feeding, family planning,malaria control, hygiene andsanitation. Almost 50 per cent of allrural households in the country own aradio receiver, and it is estimated thatabout 52 million people tune inregularly to programmes which carrycso messages-.

This enhanced outreach throughprivate stations was made possibleby Indonesia's Association of PrivateCommercial Stations, following aUNiCEF-supported workshop in 1986.The workshop trained radio producersand writers in the production ofbroadcasting programmes on MCHissues, and helped to stimulateinterest in public service messagesfor children. Radio was used exten-sively throughout the rural areas inthe 1970s and early 1980s topromote the 'Green Revolution',which transformed Indonesia from amajor rice importer to an exporter,and it was hoped that a similarmiracle could be performed in thearea of mother and child health.

One of the prime commercialvehicles for the messages is a martialarts programme called The BlackPearl, which is broadcast weekly on35 stations in the 11 most populatedprovinces. Between legendary battlesin the Snake Jungle involving thegreat fighter Nyai Sulih and the evilArdo Walika and his henchmanSarpa, listeners hear two-minutespots featuring the jingle 'Let's go tothe Posyandu", complete withinformation about 'one-stop' inte-grated health services.

Radio Republik has been airing 16similar advertising spots together withhealth talk shows and a 24-partseries, Flowers of Life, on maternaland child care. The spots weredeveloped in co-operation with theCentre for Health Education andUNICEF, which are currently workingon a 52-part radio adaptation ofFacts for Life. The Facfs for Lifeseries will be aimed at a national

network of 54,000 listener groupswhich was developed for the GreenRevolution and can be found inalmost every village nation-wide. Atypical group has about 30 membersincluding community leaders, healthvolunteers, teachers and farmers,who listen in with a facilitator to guide

Extensive use was made of radioduring a six-month-long OHT cam-paign in South Sulawesi Province in1988-1989. During that period, theDepartment of Health, with technicaland financial assistance from UNICEF,produced advertising spots for home-made ORS and a generic brand

discussions, answer questions andhelp with follow-up action.

Radio is the medium of choice forIndonesia's rural poor, A reliablesingle-band radio can be obtained forUS$3-US$5 and has the greatadvantage that even the very young,the elderly and the illiterate can sharethe entertainment and informationthat it conveys.

known as Oralit. The messages wereaired 17.000 times over 15 radiostations, and USAID followed up laterwith support for a campaign alongsimilar lines in West Java.

* Integrated village health post.

in the hemisphere by the end of 1990.The countries of the Caribbean havetargeted 1995 for the elimination of"measles.

Coverage tor the eastern and south-ern Africa region has passed 50 percent, and eleven countries haveachieved the uci target. Several coun-tries, however, have been constrainedby civil conflict and economic reces-sion. West and central Africa pose diegreatest challenge owing to a lack ofinfrastructure and severe economicdifficulties. Nigeria is an exception,having doubled its coverage levels inthe past year.

As countries have achieved higherimmunization coverage levels, theyhave started to concentrate on lesseasily accessible areas and populationgroups which have long been withouthealth services. Many have started todevelop or strengthen health manage-ment information systems in order toassess the incidence of disease, mor-tality and coverage. uxictF has beenworking closely with WHO to supportthese activities.

International co-operation for EPJhas continued to flourish throughinter-agency co-operation amongWHO, UNICEF, bilateral donors andNCiOs. Financial support from bilateraldonors has increased, and Canada,Italy, Sweden and the United Statesprovide support both through UNICEFand direct country channels. Japan hasalso started to support immunizationactivities in a number of countries.Rotary International has expanded itsfunding for polio vaccine and socialmobilization activities in more than80 countries.

UNICEF, WHO, the World Bank,UNDP and the Rockefeller Foundationcontinue to support the Task Forcefor Child Survival as a facility topromote lie I and other child healthinitiatives. The Task Force continuesto publish the quarterly newsletter,World Immunization New (WIN), andhas scheduled an international meet-ing in Bangkok (1-3 March 1990) topromote final efforts to achieve UCI/1990 targets and to develop an inter-national consensus on strategies forachieving child survival goals duringthe rest of the 1990s.

tfs to cdticatf healthin the preparation atuf use uf

trwiiriottal atilutiiitu to treatiiiatvtmcal dehydration.

Oral rehydrationtherapy/Control ofdiarrhoea! diseasesUNICEF offices in 112 countries arenow involved in national CDD pro-grammes, extending coverage to anestimated 99 per cent of the develop-ing world. In some cases, UNICEF isthe major source of support for thesenational efforts.

Recent global estimates suggestthat almost 60 per cent of childrenunder five years of age have access to atrained, regularly supplied provider ofORS, although regional access rangesfrom 75 per cent in Asia to just 25 percent in Africa. The global use rate rosefrom 14 per cent to 19 per cent during1987, the last year for which figuresare available.

Increased access to, and use of, ORSis attributable in part to the continuedexpansion of ORS production. Therearc now 59 producer countries, andUNICEF has provided direct produc-tion assistance to more than halt" ofthem. It is estimated that in 1989 theequivalent of 350 million litres ofrehydration salts were produced glob-ally—up from 40 million litres in1980. More than 75 per cent of thisproduction was in the developingworld. At least seven developingcountries are now self-sufficient inORS, and some export small quantitiesto neighbouring countries.

The use of OUT—either by ORS or arecommended home fluid—saved anestimated 750,000 young lives lastyear. At the end of 1987, almost one inthree episodes of child diarrhoea wastreated with CRT in health facilities orat home. Use of ORT was highest inLatin America where 35 per cent ofall cases were treated with ORT, andlowest in Africa (15 per cent). Theglobal target for ORT use by 1990 is 50per cent.

UNICEF offices give extensive sup-port to the improvement of diarrhoeamanagement within health facilitiesand at home. Within health facilitiesthis support has included:» the improvement of national CDD

action plans and/or treatmentguidelines (Brazil, DemocraticYemen, E th iop ia , Guatemala ,Kenya, Mali, Mexico, Mozam-bique, Namibia, Nepal, Niger,Pakistan, Papua New Guinea,Tunisia, Yemen Arab Republic,Zambia);

» improvements in ORS supply anddistribution in non-producer coun-tries (Botswana, Cameroon, Chad,Lao Peopled Democratic Republic,Mongolia, Somalia, Sudan, Ugan-da), and in those countries wherelocal production fell short of needs(Algeria, Iran, Mauritius, Morocco,Myanmar, Pakistan, Viet Nam,Zambia, Zaire);

» the establishment of diarrhoeatraining units (DTUS) and ORT cor-ners for training health workers atcentral and peripheral levels (Bang-ladesh, Bhutan, Botswana, Burun-di, Cameroon, Colombia, Com-oros, Democratic Yemen, Ethiopia,Gua temala , India, Madagascar,Malawi, Mongolia, Nepal, Paki-s t an , P h i l i p p i n e s , R w a n d a ,Somalia, Sri Lanka, Sudan, Swazi-land, Uganda, Viet Nam, YemenArab Republic, Zambia, Zimbab-we);

» efforts to curb the inappropriateuse of a n t i b i o t i c s and a n t i -diarrhocal drugs. In Nigeria, theuse of public funds for the purchaseof anti-diarrhoeals is forbidden, andsimilar steps have been taken inEthiopia, India, Jordan, Pakistanand some other countries, UNICEFoffices in the MENA region havebeen especially active in this area(Iraq, Jordan, Syrian Arab Repub-lic, Tunisia, Turkey, Yemen ArabRepublic). Efforts have been madethrough government officials tolimit supplies and through publiceducation and health worker train-ing to reduce demand.At household level, UNICEF has put

emphasis on the increased use of avail-able foods and fluids (Bhutan,Bolivia, Brazil, Comoros, Honduras,India, Malawi, Pakistan, Syrian ArabRepublic). In Brazil, Nepal, Nigeria,Peru, Thailand and Zimbabwe, sugar-and-salt solutions are promoted na-tionally. In other countries the trendis towards traditional solutions suchas coconut water {Comoros), sweetpotato water (Papua New Guinea),rice water (Madagascar) and cereal-based mixtures in China, Ethiopia,Ghana and Zimbabwe. Research onother alternatives is continuing inMalawi, Kenya and Rwanda. Onceeffective solutions are identified,U N I C E F helps to educate heal thworkers in their preparation and use,as well as to design clear instructionsso that mothers will understand why,when and how to administer them.

10

Almost all UNICEF offices are in-volved in training. In Brazil, a majoreffort continues to train volunteerhealth workers in the poor and un-dcrserved north-east region, and inIndia, the efforts of the India MedicalAssociation (IMA) to train 25,000 ofits members nation-wide, will be eval-uated in 1990. Other countries receiv-ing UNICEF assistance with broad-based t r a in ing strategies inc ludeAlgeria, Bolivia, Colombia, India,Kenya, Lesotho, Nepal, Niger, Paki-stan, Peru, Sri Lanka, Sudan, Turkey,Viet Nam, Zambia and Zimbabwe.

Countries giving special attention topotential ORT providers outside thehealth sector include Bhutan, Dji-bouti, Iran (religious leaders), Nepal(Scouts, Jaycees), Egypt (local gov-ernment officials), Turkey (primaryschool teachers), Lebanon, Somalia,Syrian Arab Republic, Tunisia, Tur-key, Thailand (pharmacists).

UNK'KF supports a variety of com-munications activities for CDD pro-grammes. These include the prepara-tion of materials for communicationsbetween health workers and mothers;die production of books, lesson plans.

and brochures tor distribution inschools and among non-health sectorgroups; and the development of massmedia messages for radio and televi-sion.

In recent years, increasing attentionhas also been directed to the preven-tion of diarrhoea, particularly incountries where improved treatmenthas substantially lowered mortality.In Egypt, UNICEF is leading a majoreffort to identify key behaviours inselected northern regions, to test com-munications messages designed tomodify behaviour, and eventually tointegrate these messages into the na-tional CDD effort. Other preventivemeasures include the promotion ofbreast-feeding (Angola, Brazil, Cen-tral African Republic, Colombia,Ecuador, Egypt, Honduras, Jordan,Pakistan, Philippines, Zaire); im-proved nutrition (Afghanistan, Gam-bia, Ghana, Mongolia, Nigeria, Pacif-ic Islands, Zaire); improved personalhygiene (Bhutan, Botswana, Jordan,Malaysia, Mongolia, Papua NewGuinea, Tanzania); increased access towater and sanitation facilities (Af-ghanistan, Burundi, Egypt, Jordan,Kampuchea, Maldives, Mauritius,Mexico, Nepal, Pakistan, Papua NewGuinea, Rwanda, Sao Tome and Prin-cipe, Sudan, West Bank and Gaza,Zimbabwe). In addition to designinginterventions in these areas, severalcountry offices are helping govern-ments to evaluate their impact.

In the MENA region, emphasis hasbeen placed on the establishment ofsentinel surveillance systems to gatherinformation for monitoring and eval-uation (Democratic Yemen, Djibouti,Egypt, Iraq, Lebanon, Sudan, Turkey,Yemen Arab Republic). In Africa,preference has been given to a generalimprovement in health informationsystems as well as diarrhoea treatmentsurveys and comprehensive pro-gramme reviews (Angola, Madagas-car, Malawi, Mauri tania , Nigeria,Somalia, Togo, Uganda, Zaire); andin Latin America, a number of coun-tries (including Brazil) have conduct-ed diarrhoea treatment surveys andare continuing to research knowledge,attitudes and practices related to ORT(Guatemala, Honduras, Mexico). InAsia, several countries are monitoringprogress towards specific targets inthe fields of training, ORT use andreduction in diarrhoea! mortality(Bhutan, China, Myanmar, Pakistan,Philippines, Viet Nam).

The Facts for Life initiative is being integrated into activities in everyUNICEI- region and has been incorporated into many country programmesnow before the Executive Board. A headquarters support unit has beenestablished to collect and exchange experiences, to share promotion planswith the co-publishers—WHO and UNESCO—ami to develop internationalcollaboration with NCOS and other institutions.

So far, more than 30 countries arc carrying out activities ranging fromstraightforward distribution to the full involvement of governmental andother partners in the transformation and use of the messages in otherways.

In the Philippines, for example. Facts tor Life is fully integrated into themobilization process in some of the poorest barrios in the country.Messages are being widely broadcast by national and provincial radiostations, and in schools,.

In Sri Lanka, the Government, non-governmental groups, media andreligion organizations formed a steering group to co-ordinate activities,and a national version of the booklet was officially launched at a gatheringof Buddhist community development workers.

Ghana analysed the potential for partnerships among national organiza-tions and institutions, questioned mothers on their current knowledge,attitudes and practices, and used the results in workshops with com-municators to map national strategies.

The Chinese edition reflects particular Chinese health problems such aschild disability, which affects 51 million Chinese, and the growing use oftobacco, especially among women and youth, and its impact on pneumonia,the number one child killer in China. To make the essential messages moreaccessible to the general population, which includesa large number of semi-literate rural workers, cartoons were used,

A major meeting to launch a world-wide initiative to meet basic learningneeds, the World Conference on Education tor All (Jomtien, Thailand, 5-9March 1990) will incorporate the concept of empowerment through theknowledge and skills detailed in Facts for Life,

Meanwhile, the international scouting movements, the Young Womcn^sChristian Association and other international N<;OS are devising their ownmaterials to stimulate use of the Facts for Life initiative at the nationallevel. Just a few mpnths after the UNICEFAVHO/L'NESCO 'tore' edition ofFacts for Life went into circulation, an additional 1.5 million copies ofnational or subuational editions were being circulated or produced in otherlanguages. The messages were interpreted in cartoons and billboards andexpressed in the words of puppets as well as by radio, television andnewspapers.

u

Acute respiratoryinfectionsAcute respiratory infections rankamong the most common diseasesaffecting children the world over.They are also among the most danger-ous, accounting for 25 to 30 per centof the 15 million child deaths eachyear.

The vast majority of these deaths isdue to pneumonia, which claimed thelives of some four million childrenunder five in 1989. Pneumonia strikesquickly. Rapid deterioration often oc-curs within the first three to five days,and the risk of death is greatest forinfants under two months.

Awareness of the ARi problem isincreasing. Over half of all countryreports for 1989 contained separateARJ sections highlighting the urgencyof the problem in statistics for mortal-ity, hospital admissions or visits tohealth facilities.

The development of effective na-tional programmes to control ARI hasbeen slow for .several reasons.

First, ARi is not a single syndrome.Effective control programmes requirerecognition and t rea tment ofpneumonia as well as distinction be-tween pneumonia and coughs andcolds. To be successful, ARI pro-grammes must be part of well-functioning health systems in whichtrained health workers are regularlysupplied with appropriate antibiotics.

Second, until recently, there hasbeen a lack of training and supportmaterials for diagnosis and treatment.

Third, a number of policy decisionshave been required on technical issuesfor which limited practical experienceor data are available.

Fourth, the restricted managerialand logistical capacity of nationalhealth systems in much of the devel-oping "world is also a limiting factor.

The number of governments re-questing UNTCHF assistance in ARJ con-trol has grown dramatically over thepast three years, and UNICEF hasstepped up its efforts, in line withstrategies promoted by the WHO/ARIProgramme in Geneva. It has alsoenlisted the support of Johns HopkinsUniversity in Baltimore to developstrategics for Aiu programmes inBolivia, Gambia and Thailand. Theimpact of efforts in each of thesecountries will be evaluated at the endof 1991 as a guide to future UNICEF

L2

assistance in other parts of the world.Other UNICEF support to national

A R I efforts has included:» the development of diagnosis and

treatment guidelines in 19 coun-tries, aimed primarily at reducingdeaths from pneumonia;

» training courses for doctors andother health workers (Ethiopia,Philippines, Sudan), and produc-tion of training prototypes such asflipcharts and brochures (Lao Peo-ple's Democratic Republic, Myan-mar, Peru);

» communications activities, includ-ing development of messages forthe mass media (Turkey); researchinto messages that would encouragemothers to seek help outside thehome (Oman); and materials to beused by health workers during theircontacts with mothers (Colombia,Peru, Sudan, Zimbabwe);

» the development of evaluation pro-cedures, with UNICEF providing as-sistance in three general areas: im-provement of routine reporting(Botswana, Dj ibout i ) ; gathering

irry an ttiftnwt'He from ffjtiM involved in chil.programmes with fntjb-ruk

'f, The^tvniir^i number oftAJBS-affectftt pfwms — and

the tmtttfirtffgftifratwtt af orphanswhose parents have riicti of A IDS— place (tfMitwnaJ strains on all

at health and wcial ncrvirfs.

information on the knowledge, atti-tudes and practices of mothers andhealth workers (Bolivia, Lesotho,Thailand, Turkey, Zimbabwe); andorganization of treatment surveysboth within and outside health fa-cilities (Viet Nam, Zimbabwe).

AIDSThe international conference. The Im-plications of AIDS on Mothers andChildren, held in Paris in November1989 and co-sponsored by UNICEF, hasheightened global awareness of themagnitude and consequences ofpacdiatric AIDS, as well as a commit-ment to addressing related problems.

AIDS is casting a dark shadow acrosschild health programmes in manyparts of the world. HIV will result insevere and largely untreatable illnessin hundreds of thousands of childrenduring the 1990s, and experts prtdictthat in areas with high rates of HIV

infection among pregnant women,child survival gains made since the1960s will be eliminated and evenreversed. Almost all infants born withHIV infection die within five years—afact which will impact heavily onU5MR.

WHO has estimated that during the1990s the number of persons Hiv-infected globally will be three timesgreater than in the 1980s, and that thenumber of adults developing Ains-related illnesses over the same periodwill be about nine times greater.

Hiv-rclated deaths in infants andchildren are directly related to thenumbers of pregnant women who areinfected, and these numbers are grow-ing rapidly in Africa and parts of theCaribbean. In Africa, an estimatedone million women of reproductiveage are already infected, and over onein four women are already infected insome high-risk groups and urbanareas.

In the Caribbean, women have be-come increasingly vulnerable as het-erosexual transmission increases. Inone Caribbean nation, about 10 percent of the pregnant women whowere tested for the virus in one urbanslum were found to be infected.

From Asia, disturbing HIV datahave already been recorded amongintravenous drug users and prosti-tutes in Thailand. Male drug users canbe expected to infect their femalepartners and future children.

The AIDS virus can also impact onthe well-being of women and childrenindirectly. A growing case-load ofHIV/AIDS-affected persons places addi-tional strains on national health andsocial services for all. Another dra-matic consequence of the virus is anemerging generation of orphanswhose parents have died of AIDS.

In 1989, there were few countries inthe world \vhich had not officiallyreported cases of AIDS, and nearly allcountries had developed national AIDSprogrammes. Many developing na-tions are receiving technical and fi-nancial support from a wide range otdonors, including UNICEF. UNICEFhas been working closely with theWHO Global Programme on AIDS topromote education and sale sexualbehaviour. UNICMF is helping govern-ments directly with Alps-preventionmessages for men and women at risk,and has been working through jour-nalists, political leaders, women'sgroups, religious leaders, TBAs and

,

others to reach the public with accu-rate information about AIDS and waysof preventing its transmission.

UNICEF has also provided support inseveral African and Caribbean nationsfor the inclusion of Hiv/Ains preven-tion messages in health and family lifeeducation for adolescents.

UNICEF is also assisting govern-ments to study the socio-economicimpact of AIDS on women and chil-dren, including .AIDS orphans, and tofind sui table and affordable re-sponses.

School heal th education pro-grammes at primary and secondarylevels have proved to be a particularlyeffective channel for AIDS- prevent ioneducation. The education infrastruc-ture is well established and schools areoften more evenly placed geograph-ically than health centres, ensuringcost-effective ness and wide coverage.Moreover, school-based AlDS-preven-tion projects reach children at a critic-al age—before they become sexuallyactive. UNICEF is supporting healtheducation projects in Burundi, Kenya,Rwanda, Tanzania, Uganda and otherAfrican countries.

The UNICEF AiDS-prevention pro-gramme is growing rapidly and nowassists nearly every Atns-affectedcountry in Africa and the Caribbean.

Guinea wormDuring its 1989 session, the UNICEFExecutive Board approved a pro-gramme to determine the extent ofguinea worm disease in Africa and todevelop national plans for guineaworm eradication. National surveyshave since taken place in Kenya andNigeria, and preparations are underway for national surveys in Benin,Cote d'lvoire, Ethiopia, Ghana andTogo.

fn Benin, the UNICEF water supplyand health education project hasserved as the basis of a national planfor guinea worm eradication, and inNigeria UNiCEF-supportcd water sup-ply projects continued to demonstratethe importance of improved watersupply in eradication efforts.

UNICEF is working closely with UNand other agencies and in July co-sponsored with UNDP the Internation-al Donors Conference in Lagos, Nige-ria, and will co-sponsor with \VHO theThird African Regional Conferenceon Dracunculiasis in Cote dTvoire inMarch 1990. Work continues wi thGlobal 2000 of die Carter Center, theU.S. Centers tor Disease Control, theU.S. Peace Corps, USAID and theJapan International Co-operationAgency (JICA).

Primary health careIn the wake of economic constraintsthat arc forcing governments to seeklow-cost alternatives in health, PHCsystems developed steadily in 1989,spurred in part by unprecedented in-terest among political leaders.

There is growing recognition of theneed for community financing in PHC,both to overcome severe governmen-tal budgetary constraints and to in-crease community involvement inmatters affecting public health, Work-shops have addressed these issues inSouth-East Asia and African coun-tries in particular, where the BamakoInitiative has dramatically changedperspectives on PHC.

In order to retain and expand PHCservices despite economic difficulties,interest has focused on ways ofensuring the sustainability of im-munization programmes, of decen-tralizing health services, of strength-ening district management systemsand of integrating die various ele-ments of PHC into national and com-munity-based systems. Other areasalso receiving attention are healthmanagement information, logisticsand referral services.

The decentralization of health man-agement to local levels has continuedin all regions, although the pace haspicked up significantly in Africa,where the district has become theprimary focus. Countries such asKenya, Sierra Leone, Somalia, Zaireand Zambia have reinforced this ap-proach with improved training pro-grammes to build management capac-ity at district, subnational and nation-al levels. Local strategies have alsomade strong gains in South-East Asiaand the Western Pacific (India and thePhilippines).

In an endeavour to improve healthinfrastructure and expand me cov-erage, 'countries including Angola, theGambia and Zimbabwe are either re-habili tat ing or constructing ruralhealth centres, and UNICEF has assist-ed with diagnostic, laboratory andother clinical functions. UNICEF hasalso provided equipment support in13 provinces of Viet Nam for 200community health centres, 80 poly-clinics and 20 district hospitals.

United Nations agencies have beenactive in Angola, Ethiopia andMozambique. In Angola, clinicalequipment has been supplied for 40health centres and 300 health posts.

M

vires remains a priority in tilltries, with TRAs itt bijjbind, Saff nuitlwrfwitfi is n tnnfftrttfnt.it, tvgcrhfr with amfrnt for<cnrrat health (ifat-rifikrtcfiit ftirk-

and 24 technicians have been trained.In Ethiopia, 123 mechanics have beengiven in-service training at centraland regional levels. In Mozambique,efforts have been directed to the im-provement of logistics and the reha-bilitation of the health infrastructure.

Health information systems arc ex-tremely weak in many countries, al-though .some progress is being made.A major problem is a shortage ofreliable and timely data. India, SriLanka and Thailand arc currently in-volved in a collaborative effort toimprove the quality of their causc-of-dcath statistics.

The success of immunization pro-grammes has focused attention on theneed to integrate them into the basicMCH/PHC systems in many countries-Moves arc also under way in Benin,Ethiopia, Kenya, Malawi, Nepal,Somalia and Togo to integrate Verti-cal' programmes for malaria and coninto comprehensive health systemsbased on PHC. In Togo, health pro-grammes have been integrated in 21districts.

Training for health workers, train-ers, birth attendants and other per-sonnel remains ji priority in all coun-tries. In Swaziland, 350 communityleaders and workers from health-related sectors were trained in a pro-gramme to improve intcrsectoral co-ordination. TBAS are in high demandin Nepal, which hopes to train 12,000by 1992, and in Pakistan, 5,000 TBAswere given training aimed at expand-ing their role in PHc:. In China, 1,600short courses on advanced MCH weregiven to 75,000 participants includ-ing 700 doctors. Sri Lanka held work-shops on safe motherhood issues forobstetricians, paediatricians, and5,000 medical officers and midwivcs.Saudi Arabia has developed a nationalMCH package for doctors and mid-wives. .Djibouti, Liberia and Mali arcupgrading and expanding their MCHcentres, and in Sierra Leone and Mali,the national Men/Family PlanningDivisions in the Ministries of Healthh a v e been r e o r g a n i z e d andstrengthened.

The safe motherhood initiative, in-cluding concern for adolescent girls,has become a major new thrust inMCH. National and regional work-shops have been held in many coun-tries in 1989, including the AfricanRegional Safe Motherhood Confer-ence in Niamey (Niger) in Januaryand the non-governmental Safe

IB

Motherhood Meeting at Bellagio (Ita-ly) in February.

As safe motherhood concerns gath-er momentum, Sri Lanka has estab-lished a task force to monitor andinvestigate maternal deaths; Moroccohas drafted a five-year plan to create arural maternity service; and Indonesiahas formed 'mother awareness groups1

to encourage women to assume great-er responsibility for their own healthcare and that of their children. In thepast 10 years, UNICEF has assisted inthe training of 88,000 of the 104,000registered TBAS in Indonesia, and theGovernment plans to train 110,000more.

Among the parasitic and infectiousdiseases that threaten public health,malaria and tuberculosis continued togain ground and attention in 1989.

Chloroquinine resistance to fal-ciparum malaria is spreading, andefforts to contain the situation areconstrained throughout the Africa re-gion by shortages of trained person-nel. UNICEF is supporting studies onchloroquinine resistance and the useof pyrethroid-imprcgnated mosquitonets as one alternative. In many coun-tries in Africa and South-East Asia,malaria control has been integratedinto MCH activities.

Malaria is also resurgent in CentralAmerica and in Bolivia, where 95 percent is due to Plasmodium vivax. Inthe Middle East, it has become neces-sary to monitor large-scale populationmovements to and from malarialareas. There has been no significantchange in the malaria situation inSouth-East Asia, however.

Developing countries report an es-timated seven million new cases oftuberculosis each year, and despite theavailability of treatment some twomillion of the victims die annually.

Leprosy also remains a disease ofpoverty in Africa, South-East Asiaand the Middle East. There arc Fivemillion registered leprosy cases world-wide.

An emerging issue in 1989 was theincidence of ccrcbrospinal meningitisand the level of preparedness againstepidemics in Sahclian Africa fromCape Verde to Ethiopia.

BAMAKO INITIATIVE

Since the 1987 resolution of African Ministers of Health, the Bamako Initiativegathered significant momentum in sub-Saharan Africa. In September 1988,guidelines were adopted for the implementation of the Initiative, addressing itsthree main components:» strengthening the community capacity to organize health actions and district-

level management systems in order to increase and sustain PHC coverage;» strengthening the essential drugs supply system;» ensuring the financing of recurrent costs, with the aim of community self-

reliance in five years.Many countries in sub-Saharan Africa have embarked on an analysis of the

performance of the PHC system and the worsening health status of women andchildren in the harsh light of structural adjustment programmes.

This led to a widespread recognition of the need to increase the effectiveness,efficiency and sustainability of PHC systems in order to improve MCH coverage-These preoccupations are reflected in the PHC strategies of the country pro-gramme recommendations and plans of operation for Botswana, Cape Verde,Chad, Mozambique, Sierra Leone and Uganda to be presented to the 1990Executive Board.

These strategics include integration of En and other essential PHC/MCHinterventions; decentralization of PHC management including training of localhealth staff in planning, management and monitoring of PHC; essential drugspolicies; contribution of communities to health financing and their participationin the management of local PHC services.

The programmes for Benin, Guinea, Kenya, Nigeria, Sierra Leone and Togothat were already approved by the 1989 Executive Board have shown substantialprogress.

In Benin, the implementation of Bamako Initiative strategies in the context ofthe national EPI/PHC programme effectively started in February 1988 in 44communes spread across the country. In these communes, the number of monthlycurative attendances nearly tripled between 1987 and 1989. In addition, pre-natal consultations nearly doubled, the number of deliveries by trained attend-ants increased by 50 per cent in the same period, and the percentage of fullyvaccinated children tripled. Forty ol" the most essential drugs were used at anaverage cost of US$0.50 per treatment, yielding, on the average, USSL5Q perpatient.

This margin permitted over 40 centres to recover their local operating costs.Studies carried out in six parts of the country on the impact of this system onequity are presently being analysed.

During the first half of 1989 these strategics were adopted as national healthpolicy and extended to a total of 300 of Benin's 400 health centres.

Guinea started implementing Bamako Initiative strategics in one third of its300 health centres in 1988. The monitoring of the first 33 centres in mid-1989showed results very similar to Benin—mainly a strong increase in utilization ofcurative and MCH services and an average drug cost of US$0.50 per treatmentwith an average charge to the patient of USS0.80. The proportion of localoperating costs and drug costs recovered was 90 per cent on the average. Theexpansion of the programme to another 70 health Centres is planned for early1990,

Sierra Leone has a three-yearplan to strengthen individual PHC components inthree localities, and Nigeria is focusing on community-level activities whichcomplement support in the areas of essential drugs and health systems, from theWorld Bank, USAro and other donors. Kenya is expected to move from thepreparatory study phase to operational activities in 1990.

In Togo, extensive baseline studies on the three components of the BamakoInitiative were undertaken by a mixed govcmment-university-liNlCEF/WHQteam. During a national seminar, gradual implementation of the strategies of theInitiative was planned, starting in 1990.

Preparatory studies on areas of major national concern are under way withUNICEF support in Ethiopia, Ghana, Mali, Mauritania, Tanzania and Zaire, andsimilar activities arc being supported in Burundi, Cameroon, Liberia, Rwandaand Sudan, with initial funding from the Bamako Initiative Global Reserve. A

16

number of countries are expected to present programme proposals to theExecutive Board for support in 1991.

Among issues which are being closely monitored are the rational use of drugs,problems of cost recovery, management of community funds, equity of access toPHC, referral services, essential drugs supply and information management(Bamako Initiative Progress Report to the Executive Board, E/ICEF/1989/L. 3).

UNICEF has provided advocacy and other .support to national planning effortsand the implementation of MCH/PHC services. Many countries have establishedintersectoral commissions which act as lead bodies for I'HC strengthening withsupport from UNICEK, WHO and other agencies. uKriCEF regional offices havealso supported inter-country consultations to enhance understanding by sharingexperiences, particularly in the area of micro-planning, which is key to thedecentralization of health management and services as envisaged under theInitiative.

During 1989, the Bamako Initiative Management Unit at UNICEP Headquar-ters continued its efforts to develop the conceptual framework of the Initiativeinto a broad-based MCH/PHC revival.

A conference on community financing in PHC was held in Paris in February todiscuss the experience of many francophone African countries. Participants camefrom Africa, European institutes and NCOS, WHO, the World Bank and UNICEE Itwas organized jointly by the French Committee for UNICEF, the InternationalChildren's Centre in Paris and UNICER This was the first international conferenceheld to discuss the policy implications and technical issues arising from theBamako Initiative that could be addressed from previous African experience.

A second conference was organized in September in Freetown, Sierra Leone, byUNICEF, Health Action International, Oxiam and the Government of SierraLeone, and attended mainly by over 60 African PHC specialists, representingboth NGOs and Ministries of Health and including representatives from bilateralagencies, WHO and UNICEK Participants were able to visit several districts to learnof the progress of PHC in Sierra Leone under the Bamako Initiative and the roleof non-governmental and other organizations in its development.

During the year, UNICEK strengthened its collaboration with WHO through theestablishment of a management unit in the AFRO regional office in Brazzaville,Congo, and through formal consultations at secretariat and country level.

In the past 12 months, growing interest has been generated by the Initiativeamong countries outside Africa, notably in Nepal and Viet Nam.

!

Reversing their fortunes

The 271,000 people of MasasiDistrict, like villagers elsewhere in thesouth-eastern corner of Tanzania,were in desperate need of a newapproach to food production. And lastyear came hope that thesecommunities, which over the yearshave been ravaged by drought andhunger could reverse their fortuneswith only modest external support. Aproject to mobilize community foodproduction in the sparsely populatedMtwara region brought tens ofthousands of acres of land undercassava, sorghum and legumes, andmany children now have enough foodto eat for the first time in three years.

The 'Onjama' programme startedin 1987 in Masasi. (In Swahili,Onjama means 'eradicate hunger inMasasi'.) The programme wasstarted by the local government withlimited UNICEF support in 1988. and ithas helped to turn Masasi District intothe new green belt of Tanzania.

Traditionally, yields from foodproduction have been low, due topoor seeds and soil conditions.Villagers also relied heavily on maizeas the staple food, a crop that wasnot ideally suited to the recurrentperiods of drought in Masasi.

Cash income to buy food had alsodwindled since local cashew trees,the source of the area's main exportcrop, were attacked by a fungus,which cut production dramatically.Poor roads, and insufficient pricingand marketing infrastructure madethe situation even worse. Foodavailability was limited andmalnutrition in the region was one ofthe highest in the country—nearly 50per cent of all children suffered frommoderate or severe protein energymalnutrition in 1987,

The district realized that some

change was necessary. UNICEF wasasked to help, and a plan was drawnup to support increased production ofdrought-resistant crops, particularlycassava and sorghum. In 1988,before the plan could be imple-mented, Masasi was hit again bysevere drought. The district receivedprovisions of food aid but wanted alonger-term solution that would avoiddependence on outside help.

In late 1988 the DistrictCommissioner in Masasi organizedthe Onjama programme andrequested UNICEF assistance. Thedistrict authorities mobilized allable-bodied adults to plant one acreof cassava and one acre of a cashcrop (usually sorghum, cowpea orgreen gram). UNICEF Tanzaniaprovided limited but key transportassistance and an initial supply ofsorghum seeds. The Governmentalso organized trucks from local NGOSand even used the Prime Minister'splane to bring in seeds from otherareas.

By early 1989 the results of theOnjama programme were alreadyspectacular. Over 63,000 acres ofcassava, 17,000 acres of cowpeaand green gram and 6,000 acres ofsorghum had been planted—all byindividuals working with hand tools,cultivating one to two acres each.The harvest was the best the regionhad known in over 15 years, andproduction of sorghum, green gramand cowpea from Masasi District wasdouble the target set for the entireMtwara region. Despite an attack ofmealy-bug, the cassava harvest wasalso very good, and most householdshave enough food to take themthrough the next season.

With this success, the districtbegan to expand the programme,and phase two began in October1989. UNICEF provided technicalassistance.for training in food cropprocessing and storage to ensurethat the bumper harvest is not lost topests. Funds have also beenprovided for additional cassavaplanting materials and seeds forcommunity-based multiplication plots.Closer linkage to ongoing csoprogrammes has been insuredthrough joint meetings and trainingsessions. Most important, however,UNICEF inputs have been kept smallto ensure that this local initiativecontinues on its own steam.

IN

Nutrition andfood security

UNICEF support in this area, criticalfor CSD, reflected the growing recog-nition that good nutrition is the out-come of a range of complementaryactivities that ultimately is influencedby three factors; household food se-curity, health facilities and a healthyenvironment, and child care. Impor-tant lessons have been learned fromthe INSP experience, WHO and UNICEF'Slargest programme of nutrition sup-port (see page 21).

Community-based' growth moni-toring: During 1989, community-based growth monitoring has beenextended from the original experiencein Tanzania to a number of JNSPcountries including Ethiopia, Mali,Niger and Peru, with encouragingresults. Other experiences of commu-nity-based growth monitoring, for ex-ample in Malawi, confirm that it isespecially promising in the context olarea development programmes. Else-where, emphasis has been placed ongrowth monitoring as a focus forintegrated MCH services (Brazil, To-go), and increasing attention has beengiven to the concept of extending thegrowth chart to a comprehensive childhealth record (India, Oman).

Food and nutrition surveillance:The special focus of UNICEF activitiesin food and nutrition surveillance hasbeen to encourage governments toreport on a few common indicators ina standardized and timely fashion sothat decision makers can be aware ofemerging problems and take appropri-ate actions to resolve them. Workingwith FAO and WHO under the umbrellaof the Inter-agency Food and Nutri-tion Surveillance Programme (IFNS)last year, UNICEF substantially expand-ed its activities in this area at country,regional and international levels.

Country projects became opera-tional in China, Madagascar, Tan-zania, Venezuela, Viet Nam and Zam-bia; and projects in Bolivia, Ecuadorand the Philippines are in the finalpreparatory stages. Projects are alsobeing developed in Botswana, Burki-na Faso, Ethiopia, Nigeria, Rwandaand Togo.

In China, the Academy of Preven-tive Medicine is collaborating withthe State Statistical Bureau to developnational food and nutritional surveill-

MfUtenrf a rital twl iu thetfi'tfrtWH af early malnutrition

ance in order to help shape nationalfood policy responses. In Madagascar,the National Food and Nutrition Sur-veillance Programme (PNSAN) wascreated in 1989 to identify food-\ailnerable areas and groups by mak-ing use of available information tohelp develop national policies, struc-ture programmes of action and targetscarce resources.

In Uruguay, UNICKF has co-operated with the Institute Nacionalde Alimentacion ( INDA) to completethe first national census of children'sheight in the first year of primaryschool. In Thailand, die UNICEF-assisted project. Strengthening Foodand Nutrition Surveillance for Nutri-tion-oriented Development Deci-sions, is seeking to maintain a down-ward trend in malnutrition amongyoung children.

Regional activities in 1989 includedan orientation workshop organizedby vvi 10 tor francophone West Africancountries and the development of aregional training programme in foodand nutrition surveillance for theAmericas, in close co-operation withCAHO.

At the international level, activitiesincluded the establishment of a net-work to develop and disseminate com-puter software for nutritional statusassessments; methodological work onappropriate indicators; developmentof a distance-learning course on as-sessing nutritional status in house-hold surveys; and advocacy for foodand nutritional surveillance for na-tional development. UNICEF has col-laborated with the World Banks So-cial Dimensions of Adjustment (SDA)programme at country and interna-tional level, and has strengthened itsties with the Demographic andHealth Survey (DHS) programme toincorporate nation-wide nutritionalassessments in as many countries aspossible.

The Report of the InternationalConference on Food and NutritionalSurveillance for National Develop-ment, Mexico, recommended thatcountries establish multisectoral foodand nutrition surveillance systems inorder to provide decision makers withtimely, accurate and easy-to-use dataon the nutritional status of popula-tions and on trends in food availabili-ty and consumption.

Infant feeding; One especially no-table event was die publication of ajoint WHO/uxicEF statement on the

! • - '

special role of maternity services inprotecting, promoting and support-ing breast-feeding. More than 35,000copies of the statement were distrib-uted in English, French and Spanish.The statement includes a LO-pointsummary of what every maternityfacility should do to support breast-feeding. An international survey of 35major hospitals in developed countriesfound that 23 of them implemented atleast nine of the 10 steps - a findingwhich confirmed the universal rele-vance of the statement. All 10 stepshave been endorsed by internationalhealth professionals, organizationsand brcast-tccding promotion groups.

It is apparent from country reportsthat there remains much misunder-standing about the importance ofbreast-feeding practice. This is espe-cially true of the concept of exclusivebreast-feeding for the first four to sixmonths, which current informationsystems do not distinguish. The train-ing of health workers is critical tochanging hospital practices. UNICEFsupported such training in severalcountries, including Botswana, Chi-na, Cote dTvoire, Ethiopia, India,Indonesia, Kenya, Swaziland andZimbabwe,

Proper weaning practice is likexviscof major importance in infant feeding.A study in Swaziland showed thatpoor feeding practices rather than lackof resources were the main factorleading to stunting before the age oftwo years, and the project to promoteimproved young child feeding ad-dresses this issue, with consultativehelp on the development of trainingmaterials provided by us AID. In Gha-na, the work-load on women wasidentified as a major constraint, andthe comparable project includes pro-vision of small grinding mills and en-hancement of income-generatingcapacity.

Household food security: Duringthe year, UNICEF aiso provided directsupport for household food produc-tion in several African countries. Inthe Masasi district of Tanzania, com-munities received UNICEF assistance toplant 100,000 acres of food crops, andthe harvest was generally excellent (seeprofile, page IS}. In Nigeria, im-proved seeds and planting materialswere distributed to farmers in twostates. In Malawi, UNICEF continuedits support to the national Food andNutrition Policy Unit in die Office ofthe President. The Unit monitors

20

Malawi's food and nutrition situationas well as area-based programmes tostrengthen production and storage athousehold level. Similar approachesare being applied in Angola, Botswa-na, Guinea, Madagascar, Mozam-bique, Tanzania and Zambia.

In several Sahclian countries, assist-ance has been given to food produc-tion, dry-season gardening and com-munity-based cereal banks. The im-portance of community-based pro-gramming has been stressed in Mali,where UNICHF is negotiating a jointproject with IFAI) to support foodsecurity, education and functional lit-eracy. In Burundi, Ethiopia andRwanda, provision of women's creditis an important component ol thefood security programme.

Micronutrient deficiencies: In thelong term, the best way to overcomemicronutrient deficiencies is throughimprovements in the quantity andquality of diets, but there is an urgentneed at present to continue to supple-ment diets in many countries withvitamins and minerals, especially forvitamin A, iron and iodine deficien-cies. The provision of dietary supple-ments for women and children is atraditional form of UNICEF supportwhich should be enhanced, and newmeans oi distribution are currentlybeing explored. Of particular promiseare attempts in Bangladesh and Indiato build on the outreach of immuniza-tion programmes.

UNICEF support for vitamin A defi-ciency control programmes more thandoubled during the year and a record105 million high-dose capsules weredistributed. Major programmes inBangladesh and Indonesia absorbedmost of these supplements, and homegardens were encouraged in Bangla-desh and elsewhere (see profile,pope 32).

UNICEF also needs to be more activein the area of iron deficiency anaemia(IDA). One successful promotion dur-ing the year was a workshop in Indiawhich was accompanied by a film. Putthe Iron Back Into Our People. Thepromotion encouraged managers in2,500 industries to adopt plans for thecontrol ot anaemia among women.

The International Council for Con-trol of Iodine Deficiency Disorders(iccinn) continued to receive supportfrom UNICKF, which now assists activi-ties related to inn control in 24 coun-tries - 12 of them in Asia. )\sr alsocontinued its support for inn control

f':f*^P^f j- - -<«K,W* ' - '

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vm

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cvmttwmty thar produces its ownfitod.

in the Andean countries ot" LatinAmerica. In Africa, Ethiopia has amajor programme in ion control. Aniodization plant was inaugurated atAssab in 1989, and iodized oil cap-sules were distributed in two otherareas.

WHO/UNICEFJoint NutritionSupport Programme(JNSP)Phase one of [Nsr has now ended, anda global evaluation undertaken during1989 has clarified the important les-sons that emerged from the JNSP expe-rience.

It has become clear that there canbe no pre-determincd set of interven-tions which will result in improvednutrition. To secure a significant re-duction in child and maternal malnu-trition one must make it possible forpeople at all levels of society to assessthe problems, analyse their causes, andplan and implement appropriate ac-tions to overcome them. A pro-gramme to improve nutrition is morelikely to succeed if it has a communi-ty-based nutrition information sys-tem, which, by making the problemsvisible, mobilizes people and serves asa tool for them to monitor the successol their actions.

During 1989 community-basedgrowth monitoring was extended in anumber of JNSP countries includingEthiopia, Mali, Niger and Peru.

The results of (Ksr have been veryencouraging and have been incor-porated into the UNICHF strategy forimproved nutrition in the 1990s. Thegeneration and discussion of nutritiondata by communities has resulted inan unprecedented mobilization forchild survival and nutrition. It hasgiven rise to a serious dialogue be-tween communities and the relevantsectors, and it has facilitated co-ordination among sectors.

The global component came to anend in December, and many of thecountry act ivi t ies arc also ap-proaching die end of their five-yearq-clcs. The US$85.3 million pro-gramme, which was funded by theGovernment of Italy, has contributedsignificantly to the understanding ofwhat constitutes a successful pro-gramme to improve nutrition. D

Childhood disabilityPoverty and disability travel hand inhand in the developing world. Inaddition to the millions of childrendisabled each year by birth defects,accidents and tragedies of war, manymillions more are blinded, mentallyhandicapped or physically stunted forwant of a little iodine or vitamin A.

Recent evidence points to a widespectrum of disabilities resulting fromsevere iodine deficiency, includingloss of hearing, goitre, impaired men-tal functions and cretinism. An esti-mated 800 million people live iniodine-deficient environments, ofwhom 600 million are in Asia, 100million in Africa, 60 million in LatinAmerica and the balance in isolated

groups in parts of Europe. About 190million of these 800 million peoplesuffer from goitre, three million fromcretinism and millions more frommental deficiencies. Iodized salt andiodized oil, taken either orally or byinjection, can safeguard populationsat risk for a small cost, and IINICEF hasbeen actively encouraging the use ofboth through programmes in over 20countries.

In Viet Nam for example, about200,000 women and children under15 years of age received iodated oilinjections in 1989, and three me-chanical salt iodation plants have be-come operational since 1986. By 1991it is expected that six plants, capableof producing 27,000 tons of iodatedsalt a year, will provide about 50 percent of the nation's needs. In Ban-gladesh in February 1989, Parliamentapproved legislation requiring univer-sal iodation of edible salt, and in thecourse of the year more than 400,000people in hyper-endemic goitre areasreceived iodated oil injections. In theremote hill districts of Nepal, wheregoitre affects about 80 per cent of thepopulation and cretinism about 10 percent, 3.5 million people have receivedinjections during a two-year projectfor the protection of everyone be-tween the ages of one month and45 years.

Vi tamin A def ic iency inhibi tsphysical growth and causes some sev-en million cases of non-corneal xerosisamong pre-school children every year.It is estimated that every hour about25 children in the developing worldarc permanently blinded for want of abalanced diet that includes vitamin A.

A nutritional blindness study inBangladesh in 1982-1983 estimatedthat each year 900,000 children undersix years of age suffered some form ofeye disease related to vitamin A defi-ciency and that 30,000 children losttheir sight altogether. Fifty per cent ofthose children who went blind re-ceived little care and attention and,already weakened and malnourished,died A few months later.

Women's groups have been the fo-cus of uNiCEF-assisted programmesthat provide nutrition education anddistribute vitamin A capsules tomothers soon after they deliver theirinfants. In Ethiopia, which reports a

2]

high incidence of vitamin A deficien-cy, managers have been trained inhigh-risk areas, and high-dose vita-min A capsules have been distributedto target groups. Other countries withUNlCEF-assistcd programmes to com-bat blindness from vitamin A defi-ciency include Bhutan, China, India,Indonesia, Malawi, Maldives, Myan-mar, Nepal, Pakistan, Tanzania andViet Nam.

Overall, 39 countries from Africa,Asia, the Middle East and LatinAmerica have reported programmestor the prevention of disabilities dueto vitamin A and iodine deficiencydisorders. In addition, early detec-tion, rehabilitation and special educa-tion programmes assisted by I'NICEFarc reported trom 27 countries inAfrica, Asia, the Middle East, LatinAmerica and the Caribbean region.

UNICEF-assistcd training activitiesfor village-level health workers em-phasize the need for early identifica-tion of children who are at risk ofdisability as well as the need to inte-grate and rehabilitate those childrenalready disabled. In Brazil, the empha-sis has beeit on training for teachersspecialized in disability preventionand early detection. In Mauritius,where about 12 per cent of childrensuffer from some form of mental orp h y s i c a l i m p a i r m e n t , U N I C E Fassistance has focused on the design ofa system for early identification andintervention in pre-schools, coupledwith a community campaign forteacher training and the integrationof disabled children in schools.

In Central America, a subrcgionalProgramme for the prevention, earlydetection, and community-basedtreatment of childhood disabilitieshas brought increased government at-tention to special needs, and a grass-roots approach involving parents andlow-cost technologies has developednew methodologies for providing carefor disabled children. This approachhas meant that disabled children arcoften "mainstreamed' in the regularschool system.

Each country in the region alsocarried out a systematic situation anal-ysis related to disabled children in1989.

UNICEF has been active through theFacts for Life initiative and otheradvocacy measures to build positive-social and economic environments fordisabled persons. Facts far Life haspresented prevention and rehabilita-

22

tion messages to families and com-munities in simple language to sup-port the integration of disabled per-sons into all aspects of life. Oneparticularly positive response in 1989came from Pakistan, where the massmedia introduced vital issues concern-ing c h i l d r e n and women in toeveryday current affairs, educationand entertainment programming.

In times of armed conflict, womenand children are usually the first tosuffer from the destruction of homesand social services infrastructure, andmany millions remain displaced,abandoned, orphaned and trauma-tized by these experiences.

UNICEF is collaborating with Reha-bilitation International in a study todetermine the rehabilitation needs ofdisabled children and women as aresult of armed conflict. Consultancymissions have been completed in An-gola, El Salvador, Mozambique,Nicaragua and Pakistan (for Afghanrefugees), A consolidated report withrecommendations is expected in1990. D

Social mobilization andprogramme communicationUNICEF policies and strategies on ex-ternal relations and social mobiliza-tion entered the review process in1989. The outcome will be reflectedin an external relations policy paper, a"Programme Policies and ProceduresManual' and a revised social mobiliza-tion training package. One anticipat-ed result is improved complementari-ty in the areas of programming, exter-nal relations and social mobilization.Some field offices have already raisedthe question of how best to poll shiftsin public opinion and how to adjustplanning to political will in the mosteffective manner.

The Facts for Life initiative and itscore health messages (see page H)have found broad support in mostcountries, and the thrust is now to-wards the adaptation or translation ofspecific messages to fit socio-culturalenvironments. The Facts for Life Sup-port Unit in New York has beenmonitoring these efforts.

The development of human re-sources to manage social mobilization

and communication at national levelalso received greater attention duringthe year. A communication trainingproject was financed by the Govern-ment of Norway in Bangladesh, Ethi-opia and Nepal; and long-term effortsrelated to radio and television areunder way in Chad, Central America,Egypt, Ethiopia, Guinea, Indonesia,Mexico, Nigeria, Philippines, Tan-zania and Turkey, among other coun-tries. A three-week-long course on'Advances in Family Health Commu-nication' was held at the Centre forCommunication Programmes atJohns Hopkins University (Balti-more) in the summer, and is beingadapted and translated for use in fran-cophone Africa and Latin America.The course will be delivered in closecollaboration with national schools ofeducation and public health. In Afri-ca, the course will be conducted inTunisia, and discussions on a coursefor the Latin American region arc-under way with Peruvian and Colom-bian institutions.

Water supply and sanitationAs the International Drinking WaterSupply and Sanitation Decade drawsto a close it is impossible not to reflecton its inability to achieve the numeri-cal objective of WATSAN services for allby 1990. An estimated one billionpeople arc still without access to ade-quate sate drinking water supplies andtwo billion (excluding China) live incommunities wi thout sani ta t ionservices.

Failure to cover their needs can beattributed mainiv to acute economic

hardship in the 1980s and populationgrowth rates that outstripped the ca-pacity ot governments and interna-tional agencies to deliver on the De-cade's promises. Questions also re-main as to the political commitmentof governments to their expressedideals, and this very large factor in theequation will continue to impact onWATSAN programmes.

Equally important in any assess-ment of the Decade is the extraordi-nary degree to which objectives were.

in fact, accomplished. The many ac-tors in this enormous undertakingimproved the lot of an average 102million people a year between 1981and 1990, and technologies and proce-dures were developed that shouldbring the goal of services for all verymuch closer to reality by the year2000.

Specific UNICEF inputs to this WAT-SAN partnership with governmentshave delivered low-cost services inalmost 100 countries to some 16 mil-lion people a year.

Highlights: There arc a number ofhighlights from the Decade whichbode well for the future. Amongthem: the growing sustainability ofcommunity management; the provencomplementarity of WATSAN and <.;nr>programmes; and a trend towardsgreater cost-effectiveness at field level.

More than 20 countries, includingBangladesh, Bhutan, Burkina Faso,Burundi, Cape Verde, Ethiopia, Gha-na, Guinea-Bissau, India, Indonesia,Liberia, Malawi, Nepal, Niger, Paki-stan, Somalia, Sri Lanka, Sudan,Uganda, Viet Nam and some CentralAmerican nations have, as a matter ofpolicy, established committees atcommunity level to manage mainte-nance systems. These committees havethe responsibility of organizing thetechnical skills and cost-sharing mech-anisms which guarantee the sustaina-bility of WATSAN systems. In Sudan,there is one committee for each of the800 beneficiary villages in Kordofan.Women have been actively involved inthis movement towards communitymanagement, and all of the five-person committees in Kordofan haveat least two women members.

Coft-sharityj: There has been sig-nificant resistance by some govern-ments to the idea of community cost-sharing in WATSAN programmes, andsocial communications have been animportant factor in mobilizing com-munities to accept cost-sharing mech-anisms. A number of successful expe-riences are now on record. At theMalange water project in Angola, 97per cent of the handpumps arc said tobe well maintained and in service atany one time, and reports from Bang-ladesh and Indonesia also claim effec-tive operation rates of 90 per cent andover.

Diarrhoeal diseases; CDD pro-grammes are expanding their curativecase-management approach to include

2 3

prevention focused on clean waterand sanitary excreta disposal. A num-ber of countries have, to varying de-grees, complemented ORT with WAT-SAN in their COD programmes. Theyinclude Bangladesh, Bhutan, Botswa-na, Cape Verde, Egypt, Mauritania,Nepal, Nigeria, Papua New Guinea,Sierra Leone and Sudan. Bangladeshconducted three studies of the healthbenefits of integrated water, sanita-tion and hygiene education within thesame community in 1989, and foundthat the incidence of diarrhocal dis-eases fell by 25 per cent. A similarstudy in Lesotho in 1988 recorded a24 per cent reduction. Cape Verde hasalso reported a very noticeable declinein the number of diarrhocal bouts incommunities with water supply andsanitary latrines.

Cost-effectiveness: There are signsof a growing consciousness of costs inWATS AN programmes in a number ofcountries.

Nigeria has reduced capital invest-ment costs through the use of appro-priate drilling equipment and meth-ods, and Sudan has linked incentivesto well-drilling productivity. The Ni-gerian approach has reduced the costof a handpump-equipped boreholefrom US$20,000 to less thanUS$4,000, and Sudan has cut its costsfrom more than US$9,000 to lessthan USS3,OOQ. It is significant thatwhile the Nigerian result took eightyears to accomplish, the Sudaneseapproach achieved its gains in justthree years. If both approaches wereexecuted simultaneously in the sameproject, the impact on cost-efficiencywould be even more dramatic, andmore easily sustained.

Burundi, Kenya, Liberia, Malawi,Mali, Niger and Uganda have alsodemonstrated a keen awareness ofcosts in their programmes.

Sanitation; The low point of theDecade has been very poor coveragerates for sanitation services, even incountries where performance in thewater supply sector was sound. InIndia, where rural water supply cov-erage is almost 100 per cent, onlyabout three per cent of rural inhabi-tants have access to sanitation facili-ties. Similarly, in Bangladesh, whereUNICEF has its second largest WATSANprogramme, rural sanitation coverageis just five per cent. By 1990, theaverage rural sanitation coverage of alldeveloping countries (excluding Chi-

24

na) will be 15 per cent - a figurewhich suggests that, in the 1990s,performance levels in terms of cov-erage rates will have to be 44 timesbetter than those of the past decade ifuniversal coverage is to be achieved bythe year 2000.

Poor national performances in thissector can be traced to public atti-tudes, traditional practices and limi-ted funding. Many countries allocateless than 10 per cent of their WATSANbudgets to sanitation. Also lacking is asystematic attempt to mobilize chan-ges in community thinking andbehaviour.

Manpower shortages: A lack oftrained profess ionals and sub-professionals has also been a majordrawback to the effective program-ming of WATSAN activities in almost alldeveloping countries. A few nationsare, however, attempting to overcomeinstitutional weaknesses throughtraining programmes. They includeBurkina Faso, Democratic Yemen,India, Kampuchea, Myanmar, Paki-stan and the Philippines.

Technical co-operation: In general,insufficient use has been made ofopportunities for technical co-opera-tion among UNiCEF-assistcd countries.

During 1989, Bangladesh trans-ferred its hand-drilling technology toViet Nam and was involved in the

introduction of its Tara handpump toChina, Myanmar, Nepal, Nigeria andViet Nam. In return, Bangladesh re-ceived WATSAN visitors from India,Nigeria and Viet Nam. Kampuchea ismanufacturing the Bangladesh No. 6suction handpump, and about 30 de-veloping countries are using the IndiaMark II handpump. Also during thepast year, the WATSAN Project Officerin Rwanda served a three-week-longconsultancy in Namibia and acted asan evaluator for Sudan's WATSANprogramme.

Collaboration: UNICEF collabora-tion with other United Nations agen-cies (UNDP, WHO, World Bank) hascontinued at headquarters levelthrough the Decade Steering Com-mittee. In the field, UNICEF Botswanaand UNni'/World Bank were involvedin a joint environmental sanitationproject; UNICEF Bangladesh, UNDWWorld Bank and others are jointlydeveloping a modified Tara hand-pump; and in Central America, UNICEHis collaborating with PAHO in ElSalvador and Guatemala, with us AIDin Belize, with the German Develop-ment Agency (ciTZ.) in Honduras, andwith a variety of national and interna-tional NCOS in these and othercountries.

Global effort: During 1989, UNICEFco-operated with 90 countries inWATSAN projects or activities, with anactual financial input of US$76 mil-lion (as against a projected estimate ofUS$82 million).

From 1986 to 1988, WATSAN re-ceived annual inputs of US$58.2 mil-lion, US$64.9 million and US$69million for each of the three years.This represented 18 per cent of totalprogramme expenditures in 1986 and1987, and 17 per cent in 1988.

Of the 90 countries with UNICEF-assisted WATSAN projects or activities,38 arc in Africa, 21 in Asia, 22 in theAmericas and the Caribbean, and 9 inthe MENA region.

Approximately 107,557 water sup-ply systems were completed, including95,630 drilled/dug wells with hand-pumps, 1,432 standpipes and 10,495systems of other types, such as pro-tected springs and rain-water collec-tion points. About 19,002,775 peoplebenefited from these activities.

Also completed in 1989 were432,245 sanitary excreta disposal fa-cilities, wh ich benefited about3,011,700 persons. D

Like a gift from heaven

Rancho Viejo: Pressed hard againsta hillside high in the CuchumatanesMountains of north-westernGuatemala, this isolated hamlet is acommunity in name and spirit only.There is no town centre or square, noschoolhouse, health centre oradministrative building—just acollection of small adobe housesstrung out across the slope. Thenearest road is an hour's walk away,and from there onwards the walkingis only marginally better. There is nopublic transportation.

Families work small plots of maizeand beans, and graze a few sheepfor their wool, but they rely mostly onthe income of their young men, whomove out of the mountains for atleast three months of the year towork on the coastal sugar-caneplantations. The women earn someincome from spinning wool andweaving lengths of cloth, but there isrelatively little time for light duties.Work begins at daybreak and endssoon after the sun goes down. Thereis no electricity to prolong the day,and candles are a luxury.

About 60 per cent of Guatemala'snine million people inhabit remotepueblos like Rancho Viejo, and morethan 80 per cent of them live inextreme poverty. Average lifeexpectancy is just 43 years, and the(MR of 65 deaths per 1,000 live birthsis one of the highest in thedeveloping world. Very few ruralcommunities have safe drinkingwater or sanitation facilities, and it iswidely believed that the IMR in placeslike Rancho Viego is closer to one in10. The main cause of infant deathsis diarrhoea, followed by ARI andimmunizable diseases.

In Rancho Viejo last year, however,there was a good deal to celebrate.The 330 inhabitants had a visit fromJorge Mario Hernandez Lopez,officer-in-charge of an EnvironmentalSanitation Project for the district ofHuehuetenango, who offered to helpbuild a gravity-fed water system if thepeople would provide the labour. Forthe women, who had to walk severalkilometres four and five times a dayto carry the water home, this was anoffer too good to refuse.

A fresh-water spring was identifiedsome four kilometres above the tineof houses, and a team of able-bodiedmen dispatched with bags of cementand a supervisor to build a protected

catchment at the source. Plastic PVCpiping was brought in, courtesy ofUNICEF, and a line was laid to a siteconvenient to all the houses. There,the community built concretewash-basins and installed taps.

"It is like a gift from heaven", saysFaustina Candelaria Jimenez, whowas born in Rancho Viejo. "Before,we piled up our laundry for two orthree days and spent one whole daywashing it."

Ms. Cruz Lopez Domingo echoedthose sentiments, adding that sheand other women in the communitywere finding that the hours saved onthe trips back and forth from the welleach day left them more time for theirchildren and for weaving.

Since 1979, UNICEF has provided

technical and financial support sothat communities of up to 500 peoplein rural Guatemala could build theirown water supply systems.Equipment for gravity-fed systemsand more than 1,100 handpumpsservicing more than 460,000 peoplehave been supplied to communityfacilities through the EnvironmentalSanitation Division of the Ministry ofPublic Health. With individualcommunities accepting responsibilityfor labour and maintenance chargesfor these systems, rural water supplycoverage in Guatemala hasincreased from 17 to 41 per cent in10 years, and supervisors like Mr.Hernandez report that the incidenceof diarrhoea and infectious diseasesis coming down.

25

Basic educationAs one of the four sponsoring UnitedNations agencies for the World Con-ference on Education for All (Jom-ticn, Thailand, 5-9 March 1990),UNICEF was deeply involved during1989 in preparatory arrangements forthat event.

Education in many parts of theworld is in crisis following a seriouserosion of financial and other com-mitments in the wake of economicrecession and structural adjustmentprogrammes. In many countries, therapid increases in school enrolmentand literacy rates that were achieved inthe 1970s 'and early 1980s have beenreversed. Today, almost one billionadults cannot read or write, and anestimated 100 million children in thedeveloping world have no chance ofschooling. The World Conference isbeing organized jointly by UNDT,UNESCO, UNICEF and the World Bank,and hosted by the Royal Thai Govern-ment, to promote a global educationalliance towards the goal of educationfor all.

An extensive investigation of thestate-of-the-art in education was con-ducted in many countries during1989, and UNICEF helped a number ofgovernments and their educationministries in this process with advoca-cy, technical co-operation and sup-porting seminars and workshops.

UNICEF support for basic educationhas focused on three main targets:» increased access to relevant, quality

education for children, with thegoal of education for all by the year2000;

» improved education opportunitiesfor adults, especially women andother disadvantages! groups, withthe goal of reducing illiteracy;

» mobilization of the modes of com-munication — radio, TV and othermedia — towards the end of wide-spread dissemination of knowledgeon health, nutrition and other ele-ments of child survival, protectionand development,UNICEF has also been responsive to

the particular needs of individualcountries in the areas of formal andnon-formal primary education, adultliteracy and training, special educa-tion for physically disabled children,and education tor children in de-pressed areas and especially difficult

circumstances. In northern Brazil,support has continued for a Saturdayand Sunday school project in Bahiawhich focuses on literacy and thetraining of young people and adults,most of whom are women.

In Angola, basic educational ser-vices for children in difficult circum-stances have been supported throughin-servtce training for teachers. InDemocratic Yemen and the YemenArab Republic, the main focus hasbeen on women's literacy and improv-ing school enrolment for girls.

In primary education, UNICEF co-operation has continued to focus onqualitative improvements in educa-tion through curricuiar reform, teach-er training and retraining, and theproduction and supply of teachingmaterials and aids. UNICEF has alsolent support to community-basedchild development centres in suchcountries as Guinea and Thailand. InBolivia, the Philippines, Sri Lanka andother countries which have attained areasonable level of literacy, an impor-tant part of UNICEF support is thetraining of multi-grade primary levelteachers in disadvantages! and remote-parts of these countries.

Health, nutrition, sanitation andother aspects of the CSD strategy havebeen incorporated in most basic edu-cation programmes at prc-school, pri-mary and adult literacy levels. A num-ber ol innovative methods have beenused to communicate csn messages,and UNICEF supports a variety of pro-grammes which are on the cuttingedge of developments in basic educa-tion. In Kenya and Sierra Leone,religious teachers were trained in CSD.In India, a video series entitled 'Khil-ti-Kalyan' has become an importantmotivational tool to increase the de-mand of women and girls for educa-tion, and to pass on knowledge ofMCH, nutrition and environmentalsanitation. In Bangladesh, projects arein place, to upgrade the skills of headteachers and to reach girls in ruralareas through satellite schools. InThailand, mobile teams provide inte-grated physical, mental and emotionaldevelopment services. In Mozambi-que, a project supports linkages be-tween schools, teachers and com-munities affected by w^ar.

By linking women's literacy pro-grammes with income-generating ac-tivities, some countries have been ableto reduce drop-out rates because stu-dents and tutors alike have valued the

26

opportunity to increase their incomes.Similar success has been reported inIndonesia where the Peoples Bank otIndonesia has a credit scheme to sup-port income-earning activities forUNICEF-assistcd learning groups.Credit incentives have proved to he aneffective motivation for poor illiteratewomen to attend classes.

Women in developmentThe needs of the girl child became thespecial focus of the South Asian andMENA regions in 1988-1989.

The South Asian Association forRegional Co-operation (SAARC),which includes Bangladesh, Bhutan,India, Maldives, Nepal, Pakistan and

Sri Lanka, declared 1990 as die Year ofthe Girl Child, and in the MENAregion, nations targeted the needs ofgirls as a priority for the 1990s. Bothregions, in spite of their socio-culturaldifferences, have paid attention dur-ing the year to problems which haveimpacted cruelly on the girl child as aperson in her own right.

Gender-differentiated data on chil-dren are inadequate, but with fewexceptions, the disadvantages sufferedby girls in the South Asia and MENAregions suggest that they arc generallyunwelcome at birth. From infancy,they usually have inferior nutritionand health care compared to theirbrothers. From early childhood, theyassume increasing responsibilities forthe household in the areas of waterand fuel collection, sibling care, cook-ing and cleaning, and they are expect-ed to help their mothers in agricultur-al or informal-sector activities. Atadolescence, they face early marriageand are locked into lives of hard workand risky child-bearing.

As a result, childhood death ratestor girls arc higher than for boys inseveral countries. In Bangladesh, thedeath rate among girls in the one-to-four-year age-group is reported to be58 per cent greater than for boys. Thetypical girl receives 20 per cent fewercalorics than her brother, is morelikely to be malnourished and is likclvto attend school for only one or twoyears. The school drop-out rate forgirls is twice as high as that for boys.

UNICEF staff and government coun-terparts in the two regions held meet-ings in 1989 to discuss this wastage ofhuman resources and possible re-sponses to it. Proposed actions in-cluded programmes to improveknowledge and statistics on the prob-lem through situation analyses andspecialized research on socio-cuJturalattitudes and practices, national poli-cies and legislation. Proposals havealso been made in both regions toplace the girl child on the agendas ofglobal meetings such as the WorldConference on Education tor All andthe World Summit for Children in1990. The adoption of the UnitedNations Convention on the Rights ofthe Child will reinforce these andother initiatives in the yeans ahead.

General UNICEF policy on women

27

Under-five mortality rate (U5MR)and number of births ^^^—^^— 1320

"D123

133

U8 119

The under-five mortality rate[ l ~ 5 M K | is j new index developedby the UN Population Division,with UNlCf-F support. L'SMK isthe number of children who diebefore the age of five forevery 1,000 born alive.

On rhis c.irr.ogramme the size ofthe country is determined by thenumber of" births and the shading.*,depict the U5M.R as follows:

Q Very high USMR countries(over 170)

0 High USMR countries (95-170)

Middle U5MK counrries (31-94)

£ Low U5MR countries (30 and under)

The countries on this cartogramme-ire listed in descending order of their1988 ujider-five mortalitv rate.

USMR Number ofbirths

(thousands)

OVER 170

1 Afghanistan 3002. Mozambique 298

3. Mali 2924. Angola 2925. Sierra Leone 2666. Malawi 2627. Ethiopia 2598. Guinea 2489. Gambia 245

10 Burkina Faso 23311. Niger 22812. Chad 22313. Guinea-Bissau . . . . 223

14 CentralAfrican Rep 223

15 Somalia 22116. Mauritania 22017. Equatorial

Guinea 2H18. Rwanda 20619. Kampuchea 19920 Yemen, Dem 19721. Bhutan 19722. Nepal 19723. Yemen 19024 Burundi 18825 Bangladesh 188

26. Benin 18527. Madagascar 18428. Sudan 18129. Tanzania,

U. Rep. of 17630. Namibia 1763 1 . Nigeria 174

843669444450!9l41920193053840434323939

12335389

18347319! I !5671436423646422265161062

129115

5286

The boundaries and names shown on thismap do not imply official endorsement oracceptance by the United Nations.

114

127

131HH?

136

122 124

92

32. Swaziland 174 . . . . 3533. Bolivia 172 . . . . 29734. Haiti 171 . . . . 215

95 - 170

35. Gabon 169 . . . . 4336. Uganda 169 . . . . 86837. Pakistan 166 . . . . 526338 Lao People's

Dem. Rep 159 . . . 15939. Togo 153 . . . . 14640. Cameroon 153 45141. India 149 . . . . 2644642. Liberia 147 . . . . 10943. Ghana 146 . . . . 62444. Cote d'lvoire 142 . . . . 59645. Zaire 138 . . . . 154246. Senegal 136 . . , . 32047. Lesotho 136 . . . . 6848. Comoros 129 . . . . 2249. Zambia 127 . . . . 40050. Egypt 125 . . . . 179951. Peru . . 123 . 719

52 Libyan ArabJamaluriya 1 1 9

53. Morocco 11954. Indonesia I I 1 '55. Congo 11456. Kenya 1 1 357. Zimbabwe 11358. Algeria 10759. Honduras 10760. Guatemala 9961. Saudi Arabia 9862. Nicaragua 9563. Myanmar 9564 South Africa 95

31-94

65. Iraq 94

66. Turkey 9367. Botswana 9268. Iran, Islamic

Rep. of 9069. Viet Nam 8870. Ecuador 8771. Brazil 8572. El Salvador 18773. Tunisia 8374. Papua New Guinea 8175. Dominican Rep. . 81

188830482284

1238379943I'M35355715012421062

751150257

21752057359406684

231145211

28

130

h-111

15

10

138

98

103102

109

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• IP

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-,«85 65 L

l lb !5~ h r•i^

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89

21

63 T•f*f28

1 69

. % nuo

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1

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67 "-H 32

64 H-

76 Philippines 73 . . . . 1 94777. Guyana 71 25

79, Colombia 68 . . . . 87880. Syrian Arab

Rep 648 1 Oman 64 63

8^ Mongolia 59 82

85 Lebanon 51 8286 Thailand 49 . 121887 Venezuela 44 569

89 China . 43 . . . . 2220290. Argentina 37 67291. Panama 34 . - - . 6192. Albania 34 . . . . 7493. Korea, Dem.

People's Rep. of 33 . 62394. Korea, Rep. of. ... 33 . . . . 790

. Fiji aZ . . . .

. Malaysia A2 . . . .97 United Arab

41 54

88

98 USSR . - 32 . . . . 510899 Bahrain 31 13

100 Uruguay 31 58

30 AND UNDER

101. Mauritius 29 . . . . 21102. Romania 28 . . . 356103. Yugoslavia . 28 . . . . 353

105. Trinidad and

108. Costa Rica 22 . . . . 79109. Bulgaria . 20 . . . . 1 15

111. Poland 18 . . . . 620

112 Cuba113. Greece114. Portug115. Czechc116. Israel1 1 7 USA118. Belgiu119 Germa

Rep.120. Singap121. NewZ122. Spain123. Dennis124 Italy125. United126. Austra127. Germa

Fed.128 Hong129. Austri130, Norwa131. France132. Irelan133. Nethei1 34. Canad135. Japan136. Switzt137. Finlaii138- Swede

up93

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135

i

76

1

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BO

7

6c,

74 |

D95

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L8 . . . . 16118 . . . . 121

al 17 . 140Slovakia . . . 15 . . . . 222

14 ... 9613 . . . . 3647

a Dem.12 211

ore 12 . 43tf.il.»iid 12 . . . . 52

12 . . . . 503jk 1 1 . . . . 55

.. . 11 .... 629Kingdom . 11 .... ~55

Lia 10 . . . . 243ny>Rep. o f . . . . 10 635Kong

y 10 . . , , 5210 . . . . 778

i 9 . . . . 67•lands 8 . . . 174a 8 . . . . 362

8 . . . . 1455rland 8 ....d 62o 7 .... 93

29

UNICEF programmes from general resources

IINICEF programmes arc afjprovcdtbr multi-year periods. Thoserecommendations being proposed todie 1990 Executive Board session areindicated in colour and should heregarded as tentative.

In the case or'certain countries,particularly those where a .specialprogramme has resulted fromdrought, famine, \varor otheremergency, die level of"alreadysupplementary funded programmesis high enough to make a significantdifference, to tht- size or"the overallprogramme. In addition 10 die.sclevels, there are supplementary fundstor long-term and emergencyprogrammes.

UNICEF programme expenditurein different countries is allocatedaccording to three criteria: under-fivemortality rate (USMK.; annual numberof deaths of infants under fKc vcar-of age per 1,000 live births); incomelevel ( i .NT percapita); and thesixeof the child population,

(1) Includes Antigua and Barbuda,British Virgin Islands,Dominica, Grenada,Muntserrat, Saint Kitrs andNevis, Saint Lucia, SaintVincent and die Grenadines,and Turks and Caicos Islands,

(2)lnaddition-1990-94:51,800,000 for Palestinians.

(3) Includes Cook Islands,Federated States of Micronesia,l-'iji, Kiribati. Marshall Islands,Nme, Palm, Samoa, -SolomonIslands, Tokelau, Tonga,Tuvalu and Vanuatu.

i 4 j Jvin«mccd from interregionalfunding only in 1989:Argentina, Barbados. Belize,Costa Rica, Gabon, Panama,Seychelles, Suriname, Trinidadaiul Tobago, Uruguay andVenezuela.

co-epjerates in programmes in 128 c&imtri &*in Asia; 35 in Latin'Atnwicki. 15 in the Middle East arid

AJtgho-.

-

Central AL

1990-9,1:, 510,000,000

1986-90: 51,665,00(1

1987-91: $5.924,000

_1989: SL-629,000

mid-iy88-mid-93:$65,000,000

1989: $135,000

_1989: 580,000

1990-94: $4,455,000

1986-91: $2,850.000

1989-93: $5,270.000

.1988-91: 55,800.000

.1989-92: 56,000,000

.1985-90: S2,747.{*OQ

.

.1989-93: $3,000.000

1989-90: S400.000

1990-94; $62,000,000

_1989-92: $5,000,000

19RS-92: 52.225,000

1989: 550,000

1990-91:51940.000

._

1989-93: $1,500,000

1988-91: $2,001.001)

1988-92: 52,250.000

1990-94: Sl"0()W.ono

1988-92: 51,638.000

1989-93: S475.I100

mid-1988-mid -93:S45,000.0(KI

1989: S50.000

]VH^-91 51,064.000

1985-90: .SX,574,000

J988-91: $2.5^7,00(1. 1987-91; 55,765,000

. J989-93: 51,500,000

Cuj-aiia^. 1990-94: 51,600,000

mid-95: Sr.pOR.OOO

mid-198"-tJ]: S2.0~~000

19N6-N9. S14(l.437,000

Indout;sia__Iran^l^lanMe

Rep, < A

'

Janiiiica,

Jor4an';*

•.1990-' "',01)0

.1990-94: 31,500,0110

.

1989-93- $15,000,000

1989-92: Sl.Or.0,000

:a,Rep. ttf.

Lebanon

M;^.

198--01. S4,«10,0(K)

_ 1^87-91: 52,570,000

_1986-9tl: S2,435,000

10,000

_|9SS-92: 59.150,000

_1989-91: 51,250,0(1(1

.

''3: $13.500,000._1989-93: 52,405,000

_1990-94:

Mexico, .

1980-90: S250.QOO

'. I 9N-01 ' s^.i)50.00(iMfwainhiqiir i

1987-90: 520,000.000

1989-90: 52,000,000

1988-92: Sr.SOO.OOONkn- . >,000

30

** es: 44 in Africa;d North Africa,*

1990-94: 57,500,000

1989-mid"91: 529,000,000

1990-91: ST^iO.OiKI

1988-9,2: $3,250,000I9SS-92: $35,000,000

1989: $340,000

1988-92^ $1,200,000

1989-93: $1,640,000

mid-1987-92: $5,950,000

1988-92: 512,500,0001988-92: 56,000,000

_1989-90: $500,000

1987-91; 57,479,000

1989: $50,000

Uganda

1988-92: SS.060,0001989-93: $5,300,0001987-91: 315,500,000

1989: $50,000

1989-93: 5805,000

1987-91: $23,825,0001989-93:512,500,000

1990-94: $4,250,000

..1989: $50,000

1987-91: $2,477,000

1988-92: $1,800,000, '2,800.000

_1989: $212,000

1989: $520,000

1988-91: $24,000,000

1987-91: $6,250,000

1987-91: 521,500,0001987-91: S2,950,0001987-91: $6,150,000

and girls, which calls for the incorpo-ration of their needs and concerns intothe mainstream of its programmes,was defined by the Executive Board in1985 and 1986, and an implementa-tion strategy was approved in 1987(E/ICEF/1987/L.1). A review of ac-tion in line with that policy wasendorsed in • a Progress Report onAchievements Made in the Implemen-tation of UNICEF Policy on Women inDevelopment (E/ICEF/1989/L.1).

The strategy is aimed at women'sneeds in a developmental, rather thana welfare sense. Operational guide-lines to systematize a women's dimen-sion in programme planning and im-plementation (CF/PD/PRO-1987-003) were issued in 1987, andelaborated in Programme Guidelineson Women's Programmes [Vol. 4),which was distributed to all offices aspart of the field manual in 1989.

The UNICES strategy identifies threemain directions for programme ac-tion which would:

» ensure that programme interven-tions include not only infants butyoung children under age five, girls,adolescents and women of ah" ages,regardless of maternal status;

» emphasize approaches at the grass-roots level which help women de-fine their problems and becomedirectly involved in the planning,implementation and evaluation ofUNlCKF-assisted projects;

» see that, in the longer term, womenare not treated as a separate targetgroup in the development process.During the year, several countries

(Brazil, Colombia, India, Malawi,Morocco, Myanmar, Somalia, Togo,Uganda, Venezuela) commissionedstudies on the needs of girl schooldrop-outs, pregnant adolescents, ruralwomen, women farmers, female-headed households, and the issues ofaccess to credit and primary school-ing, unemployment, migration andthe impact of economic crises andadjustment programmes on women.Seven case-studies, sponsored by theRegional Office for the Americas andthe Caribbean and published in TheInvisible Adjustment: Poor Women andthe Economic Crisis, underscored someof these issues.

One measure of national responsesto UNICEF policies on women is thearticulation of objectives for girls,adolescents and adult women in coun-try programmes. Brazil, Cuba, Ethio-

) tifVffofmtent policies areulatt-fi. Their needs and canrfnirlii lit- fijuatrty in the maimr,

' pflapmnit prflc-

- ' • I

Eating straightfrom the garden

Honiara: Kally Kausimae has sevenchildren to feed, and like a growingnumber of Solomon Islanders whohave chosen to live in the capital, shesometimes finds it difficult to makeends meet. The population ofHoniara is growing at a rate of 10 percent a year—almost three times thenational birth rate—and the need toimport food from the outer rural areashas pushed prices beyond thebudgets of average wage-earners.

But, while some have cut back onpurchases of staple fruits andvegetables, Kally has made adetermined effort to maintain abalanced family diet by 'farming' herback yard. She has plantedcabbages, tomatoes and beans andhas not had to compromise at thedinner-table, but it hasn't been easy.The thin topsoil in the White Riverarea where she lives is waterloggedmost of the year, and Kally has hadto improvise. Her garden is acollection of old rubber tyres, biscuittins, fish floats and any othercontainer that will hold a richhome-made compost and a fewplants. Using natural fertilizer andash to control the worms, she hasestablished a steady rotation ofvegetables so that there is somethingready to be picked every day.

A neighbour, Evelyn Hu, took adifferent approach. She dug a long,wide trench alongside her house,filled it with vegetable cuttings andcovered it over with soil and a layerof coconut husks to keep the groundcool. She put up a fence to keep outthe chickens, and planted corn,beans, taro, snake gourd, tomatoesand slippery cabbage. "My childrenlike to eat them straight from thegarden", she says.

Kally and Evelyn are graduates ofHoniara's unique Sup-sup Gartenprogramme, which sponsors dailyworkshops on small-scale mixed-foodgardening for women. The pro-gramme was initiated in 1986 by Dr.Helen Paton, who was the TownCouncil Medical Officer at the time.Dr. Paton was concerned at thegrowing number of patients withnutrition-related diseases andconducted a survey. She found thatchild malnutrition was rising, togetherwith 'white men's diseases' includingdiabetes, hypertension, heart prob-lems, obesity and dental caries—problems which were associated with

imported foreign foods and abreakdown in traditional agriculture.

Dr. Paton rallied some nurses andother concerned residents andstarted a gardening club. They calledit Sup-sup after a local stew, andinvited women to join.

The Sup-sup gardeners soondiscovered what many traditionalfarmers had known all along. Thehard coral-based soils are thin, dryand vulnerable to erosion, and mostrural people practise shifting culti-vation rather than persevere with onepatch of ground season after season.Promoters of the garden concept alsofound that squatters and renters werereluctant to develop land which wasnot their own.

The Honiara Town Councilprovided land for the gardening clubon a hillside near the centre of town,and UNICEF was asked to providetechnical support for classes oncultivation and nutrition. The landwas steep and arid—typical of theSolomon Islands and therefore idealas a demonstration site.

Classes were popularized throughradio advertisements, a songcompetition, posters, a magazinecalled Sup-Sup Nius. and notice-boards in clinics.

"We try to share skills on terracing,crop rotation, natural pest control,mulching, composting and containergardening, which help make the bestuse of small areas", says ProjectOfficer Sarah Osiabu. "Thesetechniques allow gardeners to usethe same land over and over again, aconcept unfamiliar to SolomonIslanders. We try to encouragepeople to grow nutritious vegetablesand not just fancy crops. Our slipperycabbage, for example, is more

nutritious and easier to tend thanChinese cabbage."

Emphasis throughout the pro-gramme has been on traditionalherbaceous crops such as kumara(sweet potato), pumpkin, pineapple,papaya and slippery cabbage, whichpeople know how to cultivate andprepare, are easy to grow and arehighly nutritious.

Daniel Ho'ota, Chairman of theSup-Sup Gaderis Board of Trustees,sees a long-term future for the pro-gramme as more and more ruraldwellers move into town. And SarahOsiabu believes many of the mes-sages learned in Honiara will also bevaluable elsewhere. She says manyislanders are already finding thatpopulation growth and limited nationalland resources are restricting theirslash-and-burn style of agriculture.

"It will take time for people to getused to cultivating the same patchyear after year", she says. "But manywomen and their families now inHoniara will eventually go back totheir villages and will take Sup-suptechniques with them."

32

pia, Indonesia, Kenya, Panama, Peruand the Philippines have incorporatedwomen-related objectives in all sector-al programmes. And women's partici-pation, income-generation., access tocredit, employment, reduction ofwork-load, non-formal education andthe provision of child-care facilitiesfor working women have been speci-fied in the programmes of Brazil,Burkina Faso, Colombia, DemocraticYemen, Mauritius, Mexico, Nepal,Sierra Leone, Tanzania and Venezue-la. Several countries (Bangladesh,Burkina Faso, Burundi, Egypt, Nepal,Pakistan, Thailand) have supportedcredit and revolving Joan funds asincentives for women to join healthand literacy programmes.

Programmes have targeted preg-nant adolescents in the Caribbean,school drop-outs in China and Thai-land, female-headed households in theCaribbean, Cape Verde, Malawi andMozambique, women farmers inMalawi and widows of violence inGuatemala and Lebanon. From 1986to 1989,UNICEF assisted a project inLebanon that provided rehabilitationand vocational training for 650widowed mothers and family-basedcare for 5,000 orphans.

Many countries have integratedgender concerns in sectoral pro-grammes for health, education, waterand sanitation, nutrition and house-hold food security.

In Mozambique, under conditionsof war and destabilization, an area-based strategy was effectively used tosupport the Mozambican Women'sOrganization (OMM) and the NationalDirectorate of Rural Development tointegrate projects covering householdfood security, health, child care, adulteducation and training. In the BeiraGreen Zone project, a core of 400women promoted activities whichbenefited 27,000 people. The MaputoGreen Zone women's co-operativeproject, which has 92 per cent femalemembership, has covered some 11,000families. Another project in MassingaDistrict reintegrated 20,000 peoplewho were internally displaced.

It is women who often earn thecredit for successful health and waterand sanitation projects. Country ex-amples inc lude Bolivia, Ind ia ,Indonesia, Iraq, Nigeria, Peru,Somalia and Sudan. In Iraq, the Gen-eral Federation of Iraqi Women mobi-lized a network of 1.2 million womenand 30,000 community volunteers for

CSD activities, and provided healtheducation which contributed to a dra-matic decline in infant mortality- Themobilization of women for CSD inPeru has involved more than 500,000women in 84 grass-roots organiza-tions. In Djibouti and Somalia, na-tional women's organizations have ef-fectively advocated for the eliminationof female circumcision and otherharmful practices that affect women^health. In the Lao People's Demo-cratic Republic and Viet Nam, wom-en's unions have promoted mother-hood training and strengthened CSDactivities through the use of videos.

Many countries (Ethiopia, Ghana,Guatemala, India, Sierra Leone, Viet

Nam and Zimbabwe) have strength-ened training within safe moth-erhood programmes for TBAS, mid-wives and village health workers.Progress has also been made in thecoverage of tetanus toxoid immuniza-tion for women of child-bearing age.

It must be noted, however, thatnon-maternal health needs have re-ceived little attention overall. Only afew countries have focused on femalechildren and adolescents for healthsupport. If the individual develop-ment and productivity of women is tobe increased, attention will have to begiven to their non-reproductive healthneeds from the earliest age. D

Sustainable development —the environmentDirect interventions to protect theenvironment have not been a part oftraditional UNICEF co-operation, butactivities to promote sustainable de-velopment through a better environ-ment for children can be found in arange of long-standing UNiCEF-sup-ported operations.

Most obvious is the global expendi-ture bv UNICEF of US$70 million a

year for WATSAN projects, US$3 mil-lion a year for social forestry and devel-opment of energy-efficient cookingstoves, and the promotion of US$120millions* worth of unfunded supple-mentary projects in areas related to theenvironment. The Board has approvedexpenditure of USS3 million for addi-tional work on the environmental di-mensions of UNICEF projects.

13

The UBS programme complementsgovernmental efforts to improve en-vironmental conditions in small andmedium-sized towns, and the sanita-tion programme has been working tosafeguard against the pollution ofwater sources and the erosion of ruralcropland. UNICEF also continues towork through women's developmentschemes to promote social forestry inthe context of income-generating ac-tivities.

In Nepal, these concerns are reflect-ed in efforts to provide ProductionCredit for Rural Women (PCRW), aswell as the Small Farmers Develop-ment Programme (SHDP). Both dealwith such things as the planting ofcommunity woodlots and forest pre-servation, fuel-efficient stoves, low-cost water turbines to drive grainmills, biogas plants, environmentalsanitation and other appropriate tech-nologies.

Many Latin American countries,and Brazil and Guatemala in particu-lar, have focused on environmentaleducation, and project proposals inthis area are expected to come beforethe 1990 Executive Board for ap-proval.

In Africa, food security issues are ofcrucial interest, and UNICEF is review-ing its inputs to community produc-tion. UNlCEF-supported WATSAN pro-grammes are closely involved withefforts to eradicate guinea worm, andin Kenya, UXICHF is co-operating withUNEP on a report on 'Children and theEnvironment1.

In response to instructions fromthe United Nations General Assemblythat organizations of the UN systemshould recast their policies with aview to sustainable development,UNlCHF presented a policy reviewdocument to the Executive Board inApril 1989. It concluded that in orderto ensure the sustainability of allUNICEF programmes, environmentalconsiderations must be incorporatedinto the programming process. Hav-ing focused for many years on 'silent'environmental emergencies affectingchildren and mothers in the areas ofWATS AN, UBS, social forestry and avariety of fuel-efficient technologies,the challenge now is to find wayswithin the mandate and resources ofUNICEF to consolidate these activitiesin response to 'loud' environmentalemergencies.

Urban basic servicesWith war, internal strife and a de-teriorating economic situation con-tinuing to affect many countries, ur-ban centres are less and less capable otcoping with the needs of their ownpopulations and new immigrants. In1989 special guidelines were producedfor acceleration of EPI in urban areas.

Sfrvtfcyc&vty no.but also >ICH>

Other CSD goals continued to be partof the basic UBS strategy.

UBS programmes in Asia and LatinAmerica continued to expand. Theprogramme in India has reached 118cities supporting community develop-ment officers m city governments,community organization and basicservices including PHC, immuniza-tion, early childhood development,and water and sanitation. The pro-gramme has now become nationalpolicy and is supported by other ex-ternal donors.

The urban programme in Thailandnow reaches all major secondary cities.In B a n g k o k , PHC i s now in-stitutionalized and has achieved 88per cent immunization coverage forall antigens, except measles, which isat 67 per cent. The urban programmehas been extended to cover a workingand street children project.

In Indonesia, the Philippines andSri Lanka, UBS programmes are alsoimportant components of UNICEFcountry programmes and reach sig-nificant numbers of the urban poor.In Bangladesh, the slum improvementis beyond the pilot stage, but is ham-pered by the lack of a national urbanpolicy. A pilot project in urban PHChas started in five townships in Myan-mar using voluntary health workersand micro-plans prepared by the ex-isting health infrastructure.

Based on new definitions of urbanareas, the urban population of Chinais now 50 per cent of the total popula-tion. Although child survival indica-tors such as LMR, UaMR and nutritionalstatus show that urban areas in Chinaarc still relatively better off, a specialinvestigation on the situation of Chi-nese urban children is needed.

In Latin America, UBS achievedgood results in Guatemala, Hondurasand Nicaragua in die areas of commu-nity development, water supply andbasic services respectively.

UBS is gradually taking hold inKenya, Liberia, Nigeria, Mauritaniaand Sudan, but as Africa is the mostrapidly urbanizing region more exten-sive programme development is re-quired. The PHC programme in AddisAbaba has established a model forother cities in the region, particularlyin reaching high levels of immuniza-tion coverage. n

U

Children in especially difficultcircumstancesThere is a growing international focuson the needs of children in urbanareas and on working and street chi l -dren in particular.

Child labour is more widespreadevery year. India alone has millions ofworking children- UNICEF is continu-ing to work with ILO on the questionof child labour and supported atripartite meeting on child labour inAfrica, held in Cairo in September.Egypt, the Philippines, Thailand andseveral Latin American countriesstarted programmes to provide pro-tection and services for working chil-dren in 1989, and a meeting of thesecountries has been proposed as onemeans of reviewing experiences andproviding guidance tor training mod-ules being prepared by UNICEF andILO. A UNICEF staff working paper on'Protecting Working Children1 waspublished in September.

UNICEF continues to expand its co-operation with national and interna-tional NC.Os to raise public awarenessand concern on child abuse and ne-

glect. This, together with a growingpopulation of working children, isalso a large and growing problem inindustrialized countries.

Concern for street children in thepast has been most pronounced inLatin America, where major effortsrelate to the promotion in Brazil ofchildren's and adolescent rights,juvenile justice and labour laws. Asubregional Central American pro-posal concerning children in espe-cially difficult circumstances is beforethe 1990 Executive Board.

UNICEF also gives support to streetchildren programmes that arc beinginitiated in Africa and Asia. In 1989Childhope, the international NGO thatdeals specifically with the needs ofstreet children, organized the firstAsian Regional Conference on StreetChildren, which did much to promoteawareness of the deprivation and risksthat children in increasing!}' urbanthird world countries share. The Con-ference also opened the door to amuch wider sharing of agency experi-

ences in working with street children.Despite an casing of tensions in

some parts of the world, armed con-flicts in Africa, the Middle East, Asiaand Central America continue toplace children in especially difficultcircumstances.

There arc many new or ongoingUNICEF responses to these situations.The Executive Director's leadership inestablishing 'corridors of tranquillity'in Sudan reinforced the concept ofchildren as a zone of peace. In Leba-non, summer youth camps have at-tempted to promote peace and under-standing among young people fromconflicting factions. Projects have-started in order to expand servicesavailable to children in the Philippinesaffected by armed conflicts.

In Central America and in thefront-line States of southern Africa,research is under way on the psycho-social impact of conflict on children.In Mozambique, a unique social reha-bilitation programme deals with thedctraumarization of children whowatched their parents die or wereeven forced to participate in theirdeaths.

The extent and diversity of theseactivities suggest a need for an inter-regional exchange of experiences. D

. - • :

Emergency relief and rehabilitationUNICEF responded to natural and man-made disasters in 39 countries duringthe year and continued to operaterelief and rehabilitation programmesin Iran, Iraq and Lebanon. The or-ganization also supported initiativesof the United Nations Secretary-General to mobilize extra resourcesfor victims of drought, famine andconflicts in sub-Saharan Africa, Af-ghanistan and Namibia.

In Africa, the Americas and theMiddle East, 15 countries fully uti-lized the Executive Director's Emer-gency Reserve Eund's annual alloca-tion of USS4 million. And with theagreement of governments, UNICEFfunds for long-term programmes werediverted to immediate relief activitiesin 14 countries of Africa, Asia anddie Middle East. Special contribu-tions for specific-purpose emergencyoperations in 21 countries totalledUS$46.9 million.

For much of the year, the mainoperational focus of UNICEF was onthe special emergency in southern Su-dan where Operation Lifeline Sudan(OLS) addressed the needs of manythousands of victims of flooding,drought, food shortages, epidemicsand a prolonged conflict which haddisplaced a large segment of the popu-lation, destroyed infrastructure andimpeded the delivery of relief.

It is estimated that in 1988 some250,000 people died in southern Su-dan as a result of hunger and disease,and when the Government requestedemergency assistance, the United Na-tions Secretary-General responded on27 October 1988 with an appeal to theinternational community. His appealwas followed by a joint Government/United Nations high-level meeting inKhartoum (8-9 March 1989), atwhich all parties endorsed an emer-gency plan of action.

UNICEF Executive Director James P.Grant led the United Nations delega-tion in Khartoum, and on 23 Marchthe Secretary-General appointed himas his Personal Representative forOLS. A United Nations OperationsGroup, including representatives ofthe International Committee for theRed Cross, was set up at New YorkHeadquarters at the same time, to-gether with an internal UNICEF inter-divisional task force. UNICEF strength-

ened its offices in Khartoum andNairobi and seconded internationalstair" to provide support. More than80 UNICEF star!" have served in thesefield operations to date.

As of 30 September, more than106,000 metric tonnes of food andnon-food assistance, including medi-cal supplies, had been delivered. Thiswas about 88 per cent of the priorityneeds estimated at the time of theMarch conference. By 8 December, aUNICEF emergency appeal for south-ern Sudan was just US$4.4 mill ionfrom its US$20.5 million target.

Mr. Grant's mandate as PersonalRepresentative of the Secretary-General ended in October, and phaseone of OLS was completed on 31October. The new Personal Represen-tative during phase two is MichaelPriestley, who is also UNDP ResidentCoordinator and Resident Represen-tative in Sudan.

OLS established a precedent byopening "corridors of tranquillity' sothat relief convoys could pass throughcontested territory. It demonstratedthat impartial humani ta r i an pro-grammes can be a catalyst for peace,and it is to be hoped that this lessoncan be replicated in other nationssimilarly affected by war.

Elsewhere, there was a strong focuson emergency preparedness and pre-vention. Greater attention was di-rected to means of strengthening na-tional early warning systems, of build-ing local capacities to co-ordinateemergency responses, and of develop-ing self-sufficiency at household andcommunity levels.

During the year, UNICEF supportedpreparedness initiatives in Angola,Bangladesh, Ethiopia, Mozambique,Sudan and Zimbabwe and strength-ened its collaboration with otherUnited Nations agencies. It is a mem-ber of the Steering Committee of theUN International Decade for NaturalDisaster Reduction. UNICEF collab-oration with FAO, UNDRO, UNHCR,WFT and WHO is particularly close andincludes joint programming in nutr i-tional monitoring and surveillance,joint needs assessments in Lebanon,Mauritania, Senegal and Sudan, activeparticipation in inter-agency taskforces, and consultation meetings onpolicy and programme formulationfor displaced persons.

Despite peace initiatives and en-couraging cereal harvest prospects,the African continent faces acute

36

Fragile peace — a remarkable change

Modest UNICEF inputs can sometimesbring dramatic changes to areas tornby poverty or conflict, and the Hedistrict of Zambesia Province,Mozambique, was one of thoseplaces where UNICEF made a differ-ence in 1989. UNICEF field officer lainLevine filed the following report aftera visit to the district capital InSeptember:

"As our aircraft approached thetown the pilot made a stomach-churning drop into his landingapproach. 'I don't want to risk beingshot at by the bandits', he explainedby way of apology. 'It's best to landas quickly as possible.'

"As we descended towards the dirtlanding strip, green hills rolled intothe distance and all appeared peace-ful - no sign of the 14-year-long warwhich had devastated the districtand its people.

"We were met at the airport, asalways, by government soldiers. Butthis time they were smartly dressed

in new uniforms and shoes - a starkcontrast to the ragged half-nakedsoldiers I was used to seeing. Theonly working vehicle in the district,a truck, transported us the 12kilometres to town where evidenceof the struggle between governmenttroops and the guerrilla forces of theMozambique National Resistance -better known as Renamo - wasunmistakable. In recent years lie hasbeen overrun by the rebels five times- twice in the 10 months prior to mylatest visit. Destroyed and damagedbuildings testify to the violencewreaked on the town and its thou-sands of inhabitants who have fledtime and again, abandoning theirmeagre possessions.

"He has become one of UNICEF'Smain areas of work in the war-tornprovince. In a February attack,62,000 displaced persons wereforced to flee along with the rest ofthe population. The rebels stole ordestroyed everything they could lay

their hands on, and when peoplewere able to return they weredependent on outside assistancewhich could only be delivered by air.Hundreds of people died from hungerand disease before a governmentairlift, with support from UNICEF,could meet their needs.

"When I visited the district in earlyMay the scenes were pitiful. Thinchildren with swollen bellies andstaring eyes sat motionless in frontof pathetic hovels, and one mantold how he had lost three of his sixchildren in the previous five months.Everywhere we went the story wasthe same: no food, no clothing, nomedicines, no soap, no seeds, notools.

"During my September visit I wasamazed by how much had changed,

"Two convoys of vital supplies hadnegotiated the journey overland withmilitary escorts, and the InternationalCommittee of the Red Cross wasrunning a supplementary feedingcentre with goods that had beenflown in. At one centre for displacedpersons, the children were still self-conscious in new clothes which hadbeen provided by UNICEF anddistributed by the government reliefbody. All had schoolbooks, and theyhad just left their little mud-and-thatchschool for the day like normalchildren in a normal village.

"All, however, were acutely awarethat the peace was fragile. Peoplepointed out the various paths thebandits used, and they knew theycould wake early in the morning tothe sound of gunfire and cryingchildren and have to flee oncemore into the bush.

"It was obvious, however, thatUNICEF had made an important impacton their lives. In addition to financialhelp with the airlift, UNICEF has sentclothes, soap, cement for recon-struction, and chickens to replace lostlivestock. Carpentry tools are await-ing transportation together with clothwhich local tailors have agreed to cutand stitch into clothing in return forthe material and supplies of threadand needles. Seeds and agriculturalimplements are on the way, and,most important, UNICEF has startedto build close working relationshipswith the people and the districtgovernment officials, in anticipationof a time when longer-term,development-oriented programmingwill again be possible."

¥»

"/" • >

38

emergencies in some countries. Thesix most affected are Angola, Ethio-pia, Mozambique, Somalia and, re-cently, Mauritania and Senegal. De-spire a noticeable slow-down in donorresponse to emergency appeals,UNlCEF launched renewed appeals forAngola, Ethiopia and Mozambique.The Executive Director approved allo-cations from the Emergency ReserveFund for Benin, Ethiopia, Mauritaniaand Senegal. In all. UNICEF providedemergency assistance to 16 Africancountries.

The third edition of Children on theFront Line, with an additional chapteron Namibia, was launched simulta-neously in Harare and London inApril 1989, and shows that children insouthern Africa continue to be severe-ly affected by war and destabilization.Recurring droughts, floods andepidemics, underlined by violence andwar, brought about the movement ofhundreds of thousands of peoplewithin countries and across bordersbe tween Ma lawi , Mozambique,South Africa, Swaziland, Tanzania,Zambia and Zimbabwe, generatingone of the biggest refugee and retur-nee problems in the world.

The situation in Ethiopia is criticalin the northern regions, especially inEritrea and Tigren where the impact ofdrought and population displacementis estimated to be more severe than in1984-85. The failure of the 1989 har-vest and die widening factional hos-tilities have gravely affected over twomil l ion people. Aside from thedrought besieging the northern re-gions, international refugees continuein western Ethiopia (350,000 Sudan-ese) and in eastern Ethiopia (300.000Somali).

The north-west region of Somaliaremains inaccessible, hamperingemergency assistance and l imiting op-erations to relief and rehabilitationactivities. UNICEF is trying, however,to continue its development pro-gramme in accessible areas.

The conflict between Senegal andMauritania has left a total of 300,000people displaced, with serious socialand economic repercussions for bothcountries.

About 25 per cent of all refugees inthe world are in Africa, and, in addi-tion, 10 million people have beeninternally displaced by drought andconflict, resulting in higher malnutri-tion rates and increased incidence ofdisease. D

Monitoring and evaluationEvaluations of UNK;EF field activitiesincreased by 47 per cent during theyear from 220 to 320 for the periodfrom October 1988 to September19S9. The number of action-orientedstudies increased by 26 per cent overthe same period.

Countries in MENA conducted 141evaluations and 66 studies, followedby ESARO (52 and 88), WCARO (38 and76), EATRO (34 and 81), TACRO (32and 77), and RQSCA (25 and 23).

• ~V •**?*• *V*2"X-~r ^r- _* ..

Over 65 per cent of country andannual reports indicate that theseevaluations had an impact on projectdesign and implementation. Follow-ing an evaluation in Bolivia, emphasiswas placed on women's education asan incentive to early child stimula-tion. In Brazil, an ORT evaluationconvinced programme managers tomake greater use of the media tospread messages on ORS preparation.Information gathered in Sudan castdoubts on the sustainability of mobileF.PI teams. A study of traditional birthpractices in Pakistan revealed a poten-tial cause of nco-natal tetanus.

The capacity of field offices toconduct evaluations in a timely wayremained weak, however. Only 48 percent of the evaluations planned for1989 were completed on schedule,although it should be noted that 67per cent of the year's evaluations wereunforeseen.

In late 1988 the Executive Directorasked for studies of social mobiliza-tion tor UCt in six countries. Theexperiences of Nigeria, Pakistan andSenegal have been assessed and docu-mented, and studies for Colombia,India and Turkey are planned for1990.

Evaluations ot the first group ofcountries found, among other things,that:» most mobilization activities centred

around the mass media, which car-ried information on target diseasesand the timing and location ofvaccination services:;

» little advance work was done togauge user knowledge, attitudesand perceptions, or to design mo-bilization activities around them.There was also little evidence thatthe efforts made to mobilize fami-lies were aimed at long-lastingchanges in attitude;

» insufficient use was made of for-mal, traditional or private healthproviders as communicators;

» health structures outside the publicsector were not fully involved;

» countries which made provision foraccelerated activities in their corebudgets, ensured sustainability.Those that did not often remaineddependent on donor support.At the request of the Executive

39

Board at its 1989 session, the Directorof the Evaluation Office used internaland external staff' to complete an in-depth evaluation of external relationspolicies and functions.

The Evaluation Office continuedto encourage an exchange ot fieldexperiences through its newsletter andother channels. Circulation of thenewsletter three times a year has ex-panded to include several academicinstitutions and United Nationsagencies, some of which have asked tocontribute to it.

A workshop was held in Florence inJune for 60 field staff who act asevaluation focal points. They sharedcountry experiences and discussednew evaluation techniques such asrapid assessment procedures (RAP) fornutrit ion and 1'HC, sentinel sites, costanalysis and rapid assessment of childmortality. They also reviewed the1988 draft Evaluation Manual, and arevised version is being prepared.

The first regional staff trainingworkshop for the integration of pro-gramming and evaluation was held inMexico in March for 30 people fromTACRO, and a regional training work-shop for technical officers was con-ducted in Abidjan in October.

Co-ordination and the exchange ofinformation continued with sisteragencies of the United Nations, andthe Evaluation Office continues tomaintain contacts with other evalua-tion bodies inside and outside theUnited Nations system, }

Inter-agency co-operationUNICEH extended and strengthened itspartnership with sister agencies of theUnited Nations system and NC.OSthrough a number of high-profile ini-tiatives for 1989 and 1990, as well asthrough ongoing field operations.Among those initiatives were:» The United Nations Convention

on the Rights of the Child, with theUnited Nations Centre for HumanRights, and the UN Department ofPublic Information;

» Operation Lifeline Sudan, withUNDP, FAO, WFP and ICRC;

» The Task Force for Child Survival,with WHO, UNDP, the World Bankand the Rockefeller Foundation.The Task Force continued to focuson the development of vaccines andvaccination technology, and UNICEFinitiated a technology introductionpanel with WHO and USAID to devel-op and promote low-cost appropri-ate technologies for PHC. The TaskForce organized a meeting to beheld in Bangkok in March 1990 aspart of the drive to meet UCi goalsfor the decade;

» PolioPlus, with Rotary Interna-tional. Rotary has been a powerfulforce behind social mobilization,raising over USS240 million, espe-cially for the supply of vaccines toeradicate polio. UNICEF is alsoworking with Jaycees Internationalin the hope of developing a similarcampaign model for ORT;

» Facts for Life, with WHO andUNESCO;

» The International Drinking Waterand Sanitation Supply Decade,with UNDP, WHO, the World Bankand task forces;

» The World Conference on Educa-tion for All, with UNDP, UNESCOand the World Bank. Preparationsfor the Conference {Jomtien, Thai-land, March 1990) were well ad-vanced in 1989.During the year, UNICEF was also

closely associated with FAO and WHOon food and nutrition surveillance;with WFP, UNHCR and several otherpartners on emergency' and rehabilita-tion work; with the United NationsDevelopment Fund for Women(UNIFKM), UNDP, UNFI'A and WFP OUwomen in development; and withUNEP on the environment.

ICGP, which comprises UNDP, UNFPA,WFP, IFAD and UNICEF, met regularlyduring the year under the chairman-ship of WFP. In May, a high-levelmeeting was held to explore ways ofincorporating the environment di-mension in the programmes of allmember organizations.

UNICEF continued to pursue its con-cern with regard to the impact ofadjustment programmes on childrenand to stress nutrition and humanissues in UNDP round tables and WorldBank consultative groups. UNICEF wasalso engaged in a fruitful dialoguewith IMF on these matters. UNICEF andWHO are investigating the impact ofrecession and adjustment, and healthfinancing.

UNDP and UNICEF continued theirpractice of previewing and reviewingeach other's programmes.

UNICEF co-operation with theWorld Bank extends into the fields ofhealth, nutrition, education, WATS AM,urban development, women in devel-opment and safe motherhood.

The long-standing collaborationbetween WHO and UNICEF currentlyspans programme fields ranging fromEPI, ORT/CDD and AIU to malaria, fami-ly health and nutrition, safe moth-erhood, breast-feeding and MCH, AIDSand essential drugs. The joint 'State-ment on Protecting, Promoting andSupporting Breast-feeding: the spe-cial role of maternity services' wasissued during the year, and agreementwas reached on a revised statement onmalaria control to be issued in 1990.UNICEF, together with WHO, USAID andthe Swedish International Develop-ment Authority (SIDA) will organize ameeting on breast-feeding in 1990 tofurther protect and promote breast-feeding practice.

UNICEF and WHO also continuedtheir close, working relationship onthe implementation of the BamakoInitiative.

40

eternalrelations

Mobilizing for childrenUNICEF continued its collaborationwith a wide range of" partners thathelped to focus attention during theyear on development issues affectingchildren.

The Organization worked closelywith the Centre for Human Rights onthe United Nations Convention onthe Rights of" the Child; with UNnrithe World Bank and UNESCO onpreparations for the World Confer-ence on Education for All. to be heldin Thailand in 1990; and, with UNK.Uon a report on Children and theEnvironment, Preparations also be-gan on information support for theWorld Summit for Children.

The 1990 State of the World's Chil-dren report was launched by the Ex-ecutive Director in Washington, D.C.on 12 December. The launch wascarried live via satellite to press brief-ings in Geneva, London and Toronto.Press materials prepared tor the reportincluded videotaped interviews andstatements from world leaders. Anumber of European and NorthAmerican journalists who had visitedUNicEF-supportcd programmes in Af-rica during the year also used mate-rials they had gathered for featurestied to the report.

Adoption of the United NationsConvention on the Rights of the

Child attracted major media atten-tion. A press kit, produced joint lywith the Centre tor Human Rights,and a media seminar held in Genevafour days before the Conventionsadoption, were instrumental in pro-moting extensive European coverage.The Convention will remain a majorfocus for information support in 1990as attention shifts to the need for itsratification by individual nations.

Significant resources were devotedto the preparation of" the World Con-ference on Education tor All, includ-ing production of a UNtCEF informa-tion kit and an electronic bulletinboard, EFABASE, providing back-ground information on the Confer-ence and issues to be addressed.

UNICE1-" remained a key source ofinformation about Operation LifelineSudan. The emergency in Afghanistanwas the subject of an information kitto assist fund-raising by NationalCommittees, NGOS and other donors.Overall, U N I C E H produced timelyEmergency Information Notes forNational Committees on the situationin more than a dozen countries duringthe year.

The Facts for Life booklet on basichealth and education needs and itscompanion resource booklet All forHealth were launched at a press con-ference in Paris in July by U N K K l ,WHO and UNESCO to coincide with the19th International Congress on Pae-diatrics. More than one mill ion copiesarc now in circulation in some 40languages.

Electronic media coverage ofUNICEF increased in North Americaand Europe, with television networkstories on OUT, children and AIDS, OLS,chi ld soldiers and various child rightsissues, as well as on the activities ofU N I C E F Goodwill Ambassadors.U N I C H H also expanded its co-pro-duction of programmes about its pro-jects with networks in Europe. New-video productions by UNICF.F in 1989included the 20-minute 'Invest in theChildren" and 'Parliamentarians forChildren', both of which addressedthe questions of 'adjustment with ahuman face1 and debt relief for chil-dren. Another UNICEF production,'Chain of Tears', which documentschildren's lives in the African front-line States, has been broadcast inman}' countries. A new edition of thereport Children on the Front Line* witha section on Namibia, was launched ata news conference in Harare on 4

dertitn1 and a tbrenteitedenvironment. Their rujftt? have hernjintnafly declared in Tht Convention

the R&bt?af'tltf Child. The'orlti Summit for Children, nectinff of foods of State ta tie held

1 September tWO, will irriiijj theiccial needs of children to world

42

A p r i l wi th a satellite l i n k to London.tn .mother venture, UNICEF and thePanos Institute are producing Chil-dren in the Sahcl for publication in1990. L NK:HI- produced 12 radio spotsand ,1 15-niimite feature on breast-feeding tor global distribution, andmore than 2,000 videos and 900 au-dio programmes were sent to Nation-al Committees, country orifices, NUOSand broadcast media.

There has been considerable discus-sion within UNICEF on ways in whichpublications can better serve the Or-ganization, and, through a survey,views were sought from 17 NationalCommittees as a guide to the plan-nine; of information materials for1990.

The number of users of the elec-tronic information network grew in1989, and more than 2,000 messages amonth were transmitted. An evalua-tion of the network was conductedand will be used in conjunction wi ththe publications survey to improvethe outreach of electronic services.

The Division of Information hasbeen made responsible for develop-ment education, and in March a meet-ing of development education officersfrom National Committees was heldin Bossey, France. A senior-level postfor development education has beenestablished in New York and will bestaffed in 1990.

In Nairobi, Kenya, 30 senior Afri-can journalists attended a Tan AfricanNews Agency/UNiCEF training work-shop on the special needs of children(10-16 December). In two other jointventures, UNIC:KF and the U.S.-basedCenter tor Foreign Journalists spon-sored a journalist to teach health andeducation writing; and a seminar washeld in Bangkok in May with theInter-Press Service to expand journal-ists1 understanding of issues affectingchildren.

A number of additional informa-tion products were printed during theyear including the Annual Report andSupplement, Facts and Figures, a pam-phlet on the Bamako Initiative, threeissues of African Kora, and the reportof the 3rd Pan-African Symposium onArtists and Intellectuals for AfricanChildren.

Photo coverage of UNICEF activitieswas organized in 20 countries ofAfrica, Asia and Latin America, andabout 30,000 prints and slides weredistributed to National Committees,regional oft ices, NdOs and the media.

There were major photo series on OLSand the visit of Goodwill AmbassadorAudrey Hepburn to Bangladesh (seeprofile, papie 44). The Dakar office setup a photo library with help from thePhoto Librarian in New York, andUNICEF is working with die UnitedNations Photo Section on the prepa-ration of a video laser disk photocatalogue containing 100,000 imagesfrom various us agencies.

United NationsConvention on theRights of the ChildThe Convention was adopted by theGeneral Assembly on 20 November,and a number of country programmesto be presented to the 1990 ExecutiveBoard already reflect its provisionsrelating to survival, protection anddevelopment.

Before and after the adoption of theConvention, the U N K ' K F secretariatwas asked bv the Executive Board to

provide information supporting itsratification and to report on thoseefforts in 1991. Several meetings wereconvened, and, in most cases, resolu-tions and statements strongly en-dorsed the adoption, ratification andimplementation of the Convention.Among the year's main events -featuring heads of State and Govern-ment, parliamentarians, NGOS andFirst Ladies — were meetings inBudapest and Paris (March); Tunisand Helsinki (June); Kampala andLondon (Ju ly ) ; and El Salvador andParis (September). Field offices andNational Committees supportedthese and other gatherings and pro-duced a series of information supportmaterials encouraging the legislativereview of children's rights as well aspublic debate on the Convention's im-plementation.

Media productions were importanttools in the public information cam-paign leading up to the adoption.They included a video documentary,an animated film, a BBC radio seriesand an innovative audio learningpackage, all produced in associationwith usin-i .

- .

Self-help — an example to the rest of the world

UNICEF Goodwill Ambassador AudreyHepburn made a special request in1989 to be sent to Bangladesh — acountry that she felt had been unfairlylabelled by many outsiders as a'basket case'.

While recurring disasters hadreduced an area once known as'Golden Bengal' to the secondpoorest country in the world afterEthiopia, Miss Hepburn believedstrongly that there was another sideof the story to be told, so shetravelled to Asia in late October tosee for herself. She spent sevendays in Bangladesh visiting schools,self-help organizations, and projectsin villages and slum settlements.

"No other country in the developingworld has ever been written offbecause of natural disasters or a lackof basic services", she said. "Theeconomy of this young, 18-year-oldnation may have been impoverishedby war, famine and floods, but it hasuntold wealth in the resilience andresourcefulness of its people, and itsstrength lies in their unity. Familiesand community spirit remain intact,together with the people's willingnessto help themselves."

Since the birth of the nation in1971, UNICEF has supportedprogrammes in priority areas ofhealth, education and economicdevelopment. It has helped to;» dig 750,000 tube wells which give

access to safe drinking water;» provide schools with 45 million

textbooks;» implement a vast immunization

programme against the five mainchild killer diseases and polio;

» distribute large amounts of vitaminA to combat blindness;

» provide iodized salt and oilinjections as protection againstiodine deficiencies which causegoitre and cretinism.On her return from Bangladesh,

Miss Hepburn wrote of the efforts ofBangladeshis at all levels to fight thepoverty, diseases and hardship whichclaim a million young lives every yearand plague the lives of the vastmajority of the country's 109 millionpeople.

"The self-help institutions ofBangladesh are an example to therest of the world", she wrote.

"The Bangladesh RuralAdvancement Committee (BRAG)

provides education for a few hours aday to children in rural areas so thatthey can have some formal schoolingwhile continuing to work at home oron the land with their parents.

"The Grameen Bank — theso-called 'barefoot bank' — makes

small loans to the landless poor andto women in particular. These loansmight be as small as one or twodollars (us) with which a borrowercan buy a chicken and sell the eggs,or purchase silk thread to maketapestries; the maximum loan is

-H

US$200. The founder of the Bank.Dr. Muhammad Yunus, was thoughtto be crazy when he started lendingmoney to the poor 13 years ago.Bankers told him thai poor andilliterate people would never pay himback. But he started lending moneyout of his own pocket, and todaythere are 500 Grameen Banks for thepoor in Bangladesh, and 98 per centof all loans are repaid. Dr. Yunus hadihe vision to see that a little can go along way in Bangladesh and thatpeople need only a chance toimprove their lives.

"Then there is the Kumudini Trust,which provides a hospital service freeof charge for the poor and a boardingschool for a thousand girls forminimal fees.

"There are handicraft centres forthe underprivileged women of theslums who embroider beautifultapestries. The centres provide acreche for the women's babies andsmall children, and primary educationfor the older ones. The mothers aretaught to read and write, andeveryone gets three meals a day.

"In one of the slum improvementprojects which I visited, UNICEF haddug 11 tube wells to provide safedrinking water for about 250 families.UNICEF had also given support forhealth care, including immunizationfor the children. In just three yearsthe infant mortality rate had beenreduced to zero. The nationalaverage is 110 deaths for every1,000 live births, and in the slums it isalmost double that rate.

"One can see reforestationprojects almost everywhere inBangladesh. The countryside ispeppered with saplings — treeswhich have been planted to replacethose torn away by the floods andcyclones of 1988 and previous years.

"All of this is being achieved at lowcost with a little assistance from theinternational community and from themany, many dedicatednon-governmental organizationsthroughout the country.

"The lesson here is that there is noreason why this nation should not getback on its feet, In spite of theirongoing battle with poverty andagainst nature's most disagreeableforces, the people of Bangladeshhave the courage and determinationto restore their land to its 'Golden'days."

Celebrity supportersand special eventsPublic advocacy by celebrity support-ers and participation in special eventshave continued to play a significantrole in advancing UNICEF concerns.

During the year. Goodwill Ambas-sador Audrey Hepburn travelled tomore than a dozen countries to ob-serve the condition of children andmet with high government officialsincluding the Presidents of El Sal-vador and Honduras. She also at-tended a dinner at the White House,testified before Committees of theUnited States Senate and House ofRepresentatives, and gave numerousinterviews and speeches.

Other Goodwill Ambassadors con-tributed similarly in the diffusion ofUNICEF messages and in winning newpartners.

Liv Ullmann addressed severalNCOS and incorporated t:sD issues in afilm she made in France. She also con-vinced the European Cinema Societyto reflect child rights in their statutes.Peter Ustinov supported various Na-tional Committees and made state-ments on behalf of UNICEF in Canada,Italy and the United Kingdom. SirRichard Attcnborough gave the key-note speech to the United NationsAssociation of the United Kingdom.Harry Belafbnte promoted UNICEF'Sconcerns at his concert tour in NorthAmerica. Tetsuko Kuroyanagi organ-ized a media mission to Angola thatresulted in considerable local advocacyas well as a major information andfund-raising campaign in her homecountry, Japan. Sports AmbassadorKatarina Witt arranged special ice-skating performances for the benefitof the National Committees of theGerman Democratic Republic andSweden. Imran Khan, who was ap-pointed UNICEF Special Representa-tive for Sports in December 1988,visited CSDR projects in his nativePakistan and also assisted the EPIcampaign in Bangladesh.

In March the Spanish singer JulioIglesias was appointed UNICEF SpecialRepresentative for the PerformingArts and agreed to give benefit con-certs for UNICEF for the next fiveyears.

At the United Nations, other spe-cial events generated substantial sup-port for the Convention on theRighrs of the Child. The celebration

toientx OH bcbtil,Katnriiui Witt±performances and Julio tyleruisconcerts. Audrey Hepburn travelledto Asia, Africa and Ltititi A nicricain support of children in distress.

'.--

of World Children's Day at the UnitedNations on 23 April was attended bychildren from around the world whoexpressed their support tor the Con-vention. A children's celebration washeld on tlic occasion of the adoption

of die Convention. And a group ofchildren from several countries sailedfrom Nantes in France to Nc\v Yorkthrough Dakar and Martinique alongthe former route of the slaves, tosupport the Convention.

optcti ~.iurt-Ttilirr, 5W children frmit ttrtmiidhe wHt'tffjfartwrd at rhi- Unitedinlioni lit celebrate. Children ttfthcW Intt'rnatwfwi School presented itnvfl, eniii fix childn-n —form

Kuiiria. Cnxtn Ricn, Cypnts, Nepal.IMairiad and tbc USSR —

, ititty fad children from ~5touiitrics, rend attmdspcrial messagesexpffjyinff fhe rifu'i itf'thr children of

torte

National Committeesfor UNICEFNational Committees generatedabout 20 per cent of the resources ofUNICEF, and structural changes tostrengthen their collaboration withthe secretariat continued in 1989, ANational Committees Section was es-tablished in New York, the GenevaOffice provided operational supportto Committees in Europe, and, inseveral Eastern European countries,National Committees which were ofgovernmental nature were in theprocess of becoming private entities.

Highlights of the year included theparticipation of National Committeesin an open dialogue on the challengesof the 1990s; a Paris round table onthe subject, "Today's Children - To-morrow's World1; and the involve-ment of three National Committeemembers with a group that carriedout an evaluation of uxic.'EK externalrelations.

The annual meeting of NationalCommittees was held in Geneva inMay; the Standing Group met regu-larly to strengthen links with thesecretariat; and Committee leaderscame together for several workshopsto improve and share informationrelated to fund-raising and develop-ment education, and for the promo-tion of sales of greeting cards andother products.

All National Committees were in-volved in major drives for the adop-tion of the Convention cm the Rightsof the Child, and all supported theidea of a World Summit for Children.

Non-governmentalorganizationsCollaboration with national ,sx;os andthe affiliates of international NCOSexpanded significantly in 1989 andwas most evident in efforts to secureadoption of the United Nations Con-vention on the Rights of the Child.

Among UNICF.F'S most active part-ners during the year were RotaryInternational, Jaycees Internationaland the scouting movements, whomobilized their members at nationaland local levels to support immuniza-tion efforts and the fight againstdiarrhoea! diseases. UNICEF also bene-fited from the continued support of

46

such bodies as the Internat ionalPediatric Association and the Interna-tional Council of Nurses, and forgednew links with La Leche League topromote breast-feeding.

The 10th anniversary of ire and thepassage of the United Nations Con-vention on the Rights of the Childoffered a special opportunity to ex-pand co-operation with NGOS in theoverall area of child rights. Defencefor Children International, the Inter-national Catholic Child Bureau andSave the Children played leading rolesin support of the Conventions adop-tion. At regional and country levels,UNICEF worked closely \vith individualSave the Chi ld ren organizations,Childhope, the International Societyfor the Prevention of Child Abuse andNeglect and other bodies.

Two important contributions dur-ing the year were the publication of"Caught in the Cross Current1, ananalysis of progress for children .sinceivc, and the forward-looking interna-tional NGO Forum, "Challenge for the1990s...Planning for Children'.

Parliamentarians andreligious leadersDuring the year, UNICEF establishedsolid working relations with theworlds three largest organizations ofparl iamentarians: the Inter-Parlia-mentary Lniiun,, the Global Commit-tee ot Parliamentarians on Populationand Development, and the Common-wealth Parliamentary Association.The Global Forum of Spiritual andParliamentary Leaders on HumanSurvival and the World Conference onReligion and Peace also confirmedtheir commitment to the advocacy ofchildren's rights by including relatedissues as key agenda items in theirinternational conferences.

Also during the year, UNICEF helpedto promote the establishment of aParliamentary League on Children,Population and Development in theDemocratic People's Republic ofKorea, with the support of seniorpolitical leaders, and the Africa Parlia-mentary Council held national work-shops in Sierra Leone, Liberia and theGambia for parliamentarians and me-dia representatives, This was a follow-up to a successful gathering of parlia-mentarians and the media in Botswa-na in 1988.

National ('owtititcecspoit i>r r.ffi)tt\ t,m hcbalfafirf (fritrfrrn.

Fund-raisingDespite world-wide economic diffi-culties and the tendency of somedonors to cut or freeze developmentassistance, total income for UNICEF in1989 is US$667 million, includingsupplementary funds, emergency as-sistance and Greeting Card Operationproceeds.

The Governments of Finland andthe Soviet Union Jed other donors inthe size of contribution increases forthe year. Their total inputs in 1989were US$31 million and USS19 mil-lion respectively. The United States,Sweden and Italy maintained theirpositions as the top three contributorsto I'NICKF, and India remained thelargest donor to general resourcesamong programme countries.

Of the US$667 million total, aboutUS$423 million is from general re-sources, and US$244 million froms u p p l e m e n t a r y funds i n c l u d i n gUS$57.3 million for emergencies. Ifone excludes from general resourcesthe LISS43.5 million that occurred in1988 as a result of a one-time account-ing adjustment from GCO, generalresources in 1989 would show anincrease of 7.4 per cent. The level ofsupplementary funding, however, re-mained 9.5 per cent behind the 1988figure, which resulted largely from anextraordinary mobilization of fundsto meet the needs of Operation Life-line Sudan in its first year. If however,one takes into account the approvedfigures in the medium-term plan ofUSS428 million for general resourcesand USS210 million for supplemen-tary funds, income from general re-sources in 1989 was 1.2 per cent lessthan the medium-term plan figure,and supplementary funds were 16.2percent higher.

Especially note-worth)' in 1989 wasthe success of the UNICKF proposal ondebt relief for CSD. While the fundsreceived (US$300,000) were modest,this approach set a precedent whichwas well received in many quartersand will spur greater efforts from alarger number of partners in 1990.

Another effort which will continueinto 1990 is the push to maintainmomentum for Uc;i through fund-raising support from UNICEF NationalCommittees.

Emergencies remained high on thefund-raising support list, with Opera-tion Lifeline Sudan at the top, fol-

t

lowed by Mozambique, Afghanistan,Iran, Iraq and Ethiopia. Some US$16,6million has been raised for oi.s so faragainst estimated needs of USS20.5million.

Greeting CardOperationThe mandate of GCO was expanded in1989, and its role and position withinthe structure of UNICF.F'S external rela-tions were more precisely defined.Following an intensive review, t;coactivities arc to be closely co-ordi-nated with other UNICEF divisions andwith National Committees and fieldoffices (E/ICEE/1989/AB/L.5).

The CiCO mandate was enlarged tocover activities in four areas. They are:the traditional area of product sales;exhibits and promotion; private sec-tor fund-raising support to NationalCommittees and field offices; andspecial fund-raising events and newinitiatives. A new set of rules amiregulations governing the administra-tion and financial operations of GCOwas approved by the Executive Boardand took effect on 1 January 1989.The new rules take account of theenlarged mandate and make it possi-ble for GCO to operate as a businesswithin the United Nations system.

A specialized department has beencreated wi th in GCO to deal with spe-cial fond-raising events and new ini-tiatives (SEM). A Special EventsHeadquarters Advisory Committee(SEHAC), comprising representativesfrom all external relations divisions,has also been established to evaluateproposals, monitor their implementa-tion and ensure high-quality cost-effectiveness.

In the 1988-89 season, tico con-tributed US$43.2 million to UXICETgeneral resources — a 13 per centincrease (US$4.8 million) over theprevious year, driven by major im-provements in sales volume and grossproceeds. During the season, sales of139 million cards generated revenuesof US$98.9 million, and indicationsarc that the 1989-90 season will beeven more successful.

Surveys and focus group studieswere conducted in a number of mar-kets during the year to establish cur-rent market positioning and potentialas well as strategic options for the

future. Highlights of this activity in-cluded the further testing of newproduct lines and their adaptation tonew markets; the completion of aclearer policy on new products; theexpansion of the European retail storeprogramme; initiation of a project tostrengthen the greeting card salesprogramme in the United States; theapplication of cost controls to supporta 50 per cent profitability goal; andthe computerisation of productioncentres in Singapore and Brazil.

The Danny Kaye Visitors Centre atUNICEF House hosted numerousgroups of visitors, and negotiationsare under way with the United Na-tions to develop a joint 'children'stour1 of the United Nations andUNICEE

GCO continued to serve as theUNICEH focal point tor the NationalCommittees' working group on directmail fund-raising. GCO has provided anumber of direct mai l packages whichhave been adapted to specific coun-tries for use by National Committeesto raise additional funds. Close to

US$5 million net was raised throughthese campaigns in 1988, and theresults for 1989 are expected to beconsiderably higher. A similar grouphas been established to exchangeknowledge and experience on privatesector fund-raising in the Asia andPacific regions.

GCO also leads a headquarters taskforce for private sector fund-raisingfor UCI. Working with other UNICEFexternal relations divisions and theUnited States Committee for UNICEE,i t will provide information, documen-tation, technical advice and fund-raising suggestions for NationalCommittees and field offices whichwant to raise additional funds forchild immunization between 1990and 1995. An annual target of US$20million has been proposed, and anumber of National Committees havealready confirmed their interest insetting up task forces to raise aware-ness and funds for this purpose. d

48

UNICEF's finances: income,commitments and expenditures1988-1990

Income

UNictFs income consists of voluntarycontributions from governmental andnon-governmental sources.

Total income for 1989 was US$667mil l ion (compared with US$711 mil-

lion for 1988). This includes USS57million in contributions for emergen-cies (US$39 million in 1988) of whichUSS16.6 million was donated for theemergency in Sudan. Total income tor1989 was" less than 1988 total incomedue to the fact that 1988 incomeincluded a one-time gain of US$44

UNICEF income by source 1989

Total income$667 million100%

7 5%-$49$^

o

Generalresources

Supplementaryfunds

Emergencies

*,'*.°OVERN***

'IS/COM^25%. $169^

!"

million in GCO income caused by achange in accounting policy.

Income from governments and in-tergovernmental organizations ac-counted for 75 per cent of total in-come (70 per cent in 1988), the bal-ance being non-governmental in-come. The pic chart on page 49 showsthis division. Pages 52 and 53 showestimated individual governmentalcontributions by country for 1989,and a list of estimated non-govern-mental contributions by country ap-pears on this page.

The income is divided between con-tributions for general resources (63per cent), for supplementary hinds(28 per cent) and emergencies (9 percent). General resources arc availablefor co-operation in country pro-grammes approved by the ExecutiveBoard, as well as programme supportand administrative expenditures.

General resources income includescontributions from more than 120governments; net income from thesale of greeting cards; funds contrib-uted by the public (mainly throughNational Committees); and otherincome.

Contributions arc also sought byUNICEF from governments and inter-governmental organizations as sup-plementary funds to support projectsfor which general resources are insuf-ficient, or for relief and rehabilitationprogrammes in emergency situationswhich by their nature arc difficult topredict.

As a result of pledges at the UNPledging Conference for Develop-ment Activities in October 1989, andpledges made subsequently, UNICEF'sincome for general resources in 1990is expected to total USS479 millionwhich would represent an increase ofapproximately 13 per cent over 1989.

1989 non-governmental contributions (in thousandol

ExpendituresThe Executive Director authorizes ex-penditures to meet recommendationsapproved by the Board for pro-gramme assistance and for the budget.The pace of expenditure depends onthe speed of implementation in anycountry.

Countries where non-governmental contributions exceeded 510,000

.•\lgrriaAngolaArgentinaAustraliaAustriaBahrainBangladeshBelgiumBoliviaBrazilBulgariaBurkina FasoCameroon, Rep. ofCanadaCentral African Rep.ChileChinaColombiaCongoCosta RicaCote d'lvoirc, Rep. ofCuba .... .CyprusCzechoslovakiaDenmarkDjibouti

1,190.047.9

289.2.. 1,872.2. . 1,403.8

101.231.6

. . 2,539.762,6

. . 4,580.121.829.316.3

. . 14 . l l2 . f i26.946-840.1

382.719.116.873.186.7121.1

487.1. . 1.670.2

21.7

Dominican RepublicEcuadorEgypt..El SalvadorEthiopiaFinlandFrance ,German Dem. Rep.Germany, Fed. Rep. of . . , .Ghana ,GibraltarGreeceGuatemala. .GuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalv

38.4126.138,4U.K.

499. . 3,445.0, . 13,133.4

278.8.. 21,054.5

20418.4

990 .432.026.818 -18.5

185.8259.2

29.".. 1,8X2.0

143.0842.4465.35311.1

12.75.440.0

—

UNICEF income 1988-90(in millions of US dollars)

$711

(esi.j

tt&a

$235

$437

oEmergencies

Supplementaryrunds

Generalresources

50

(figu

famajJapanJordaKcnyKoffiaKuwjLebaiLiberLUXCTMadaMalaiMala)MaurMaurMcxiMomMoraMozaMyarNcthNewNicarNJgaNigerNonOm a

res include proceeds from greeting card sales)

63 7 Peru

96.7 Poland33 0 Portugal .42 8 Qatar

295 S13 1 S

10.4 S10 7 S

347 9 Sri Lanka33 9 Sudan

234 9 Sweden

35 5 S25.3 S

witzerlandvrian Arab Rea . .

12.6 USSR.. 1 ft42.fi3X.I

10S 1

106.4

United Kingdom 3J1K IUnited States of America 2.S.3n2 ~ITriioiiav \~'''i

943.3 Venezuela 50.5389.0 'Yemen Arab Republic "4

26.2 Yugoslavia 1 207 723.2 Zaire 131 1

232.6 Zambia . . . 23.7[12.6 T.imhahw.-f IS 7

16.3489132

74166

Contributions fromUN Staff 265.6

Contributions under$10,000 141.7

21 4 TOTAT 1A7.435.9459 6

2,267.49,215.0

163.4Plus GCO fiscal period

12,268.5 Tanzania, United Ren. of. 122.4 Less costs of Greeting646.3 Thailand 519 Card Oncrarinns* <Z?,RJS4\

36.0 T234 1

Vinidad & Tobago . .

IV-t (•> Turkey1406.6 ITtranda .

394 IJnitcd Arab Emirates

2D.U80.4

r

Net available for

36-i x35.1

106,2

UNICEF expenditures 1988-90(in millions of US dollars)

Biv $si_y^$63 ^

$187

$215

v__/

M -*"

$245

^-— _ — -^

S259

I

lest.)mnn

f $721

^fcg^P

$278

$292

r~>i(^JAdministrative

services

Programmesupport

•Cashassistance

Supplyassistance

'Coils aj'jmiiliicinjj iwrfi «"rf liiwJjum, fntffltt,Mt-i-ktaii, atijustnunii.

In 1989, L'NK'HF's total expendituresamounted to US$633 million (1988US$516 million], summarized as;

Procfiwnmf

1988 US$402 million1989 USS504 million

Cash assistancefir pryjea petyonnel

1988 USS62 million1989 US$74 million

Training costs andlocal expense

1988 US$125 million1989 US$171 million

Supply assistance

1988 US$2 15 million1989 USS259 million

Prqfji'awmc support

1988 US$63 million1989 US$71 million

Administrative services

1988 US$51 million1989 USS58 m i l l i o n

31

1989sfovewimental contributions (in thousands of us dollars)

Australiaft.OlH.5 . ...2.H44.8

Fiji0.7

New Zealand4.W 5 512.6

NORTH AMERICA

CanadaW,W8.4 12,831.7

United States of America111,582.9 57,400.0

The World on the Azimuthal Equidistant Projectioncentered at New York City.

52

-—ASIA

Afghanista n35.0

Bangladesh9 7

Bhutan5.8

China60(1 ()

EUROPE

Austria1,241 S

B.S.S.R.

Belgium401 1.0 . ...I,73.i 3Bulgaria

42 7

Czechoslovakia100 0

Denmark13.14" 6 .. .13.315.0

— MIDDLES.

Arab Gulf Fund811.0

Algeria 30.0

DemocraticYemen 8.9

AFRICA

Angola3.0

Botswana7.4

BurkinaFaso

0.8

Burundi20

Hong Kong

India1

Indonesia

JapanIO,22,S.5...2()

EuropeanEconomicCommunity4. "230

Finland4,IW ~ . . . 2 6

France

GermanDemocraticRepublic

\ST

Djibouti

Egypt

Iraq

CentralAfricanRepublic

Comoros

Cote d'lvoire

F,thiopia

— LATIN AMERICA

Argentina150.0

Bahamas6.2

Barbados20

Bolivia.=W.(l . . .3.0

Brazil

BritishVirginIslands

Chile

. 24.3

850.9

300.0

430.0

995.3

,156,0

40" n

. . 1.0

. 26.3

. 96. S

. .4 ,6

. 3.0

47 *

.49,3

1(101)

.0.3

70.0

Korea,DemocraticPeople'sRepublic of

Korea,Republic of

Germany,Federal 'Republic of,1.25". 9 . . . .

Greece

Holy See

Hungary

Iceland

Israel

Jordan

Lebanon*' 3 . . .

Ghana

Kenya

Lesotho

Liberia

Madagascar

Colombia

Costa Rica

Cuba

Dominica

-2? 7

330.0

8,465.6

. . 150.0

. . .2.0

35,8

. . 26.4

. . 50.0

. . 18.5

. . . . 5.0

. . . IX. n

1 3

5 0

. . . 2.2

.454.3

. . . U.S

. ~5 2

..0.7

Lao People'sDemocraticRepublic

Malaysia

Maldives

Ireland

Italy2~ "61 ..35

Luxembourg

Malta

Monaco

. . 5.0

.84.3

. 41

172.3

442.6

. 60.2

. . 5 8

.94

Netherlands.vllll.S ... 12.651.4

Morocco

Oman34. X

OPEC Fund,11)0(1

Mauritius

Niger

Nigerian O.S4 l>

Rwanda

Sierra Leone

Ecuador

Guatemala

Guya na

Honduras

, 66.8

The

.3.7

. . Y.9

''«)(! 0

.2 y

. 25,0

.3.8

1 5

.20.0

Mongol ia

Myanmar

Nepal

Pakistan

...8.0

n l «S 0

49

172 9

Norway15.425.7 ..32,200.5Poland

Portugal

Romania

San Marino

Spain

Saudi Arabia

Syrian Arab

Tunisia . . . . .

Somalia

Swaziland

Tanzania,UnitedRepublic of

Uganda14 ? .

Jamaica

Mexico

Nicaragua

Panama

. . 25.0

. 98

14 1

1.710.9

1.000.0. 10,2

. . 22.3

. . 56.2

. . U.'

2 7

6 1

. . 2 7

, , 3 1

69 2

4 7

. . 25.0

Philippines244 1

Sri Lanka15 0

Thailand273 3

Vtct Nam70

Sweden31.6676 ..44,35(1.4

SwitzerlandS. 336.6 ....9,940.1Ukrainian S.S.R.

, 1 626 0U.S.S.R.

16 003 ~United Kingdom2.6494 ...13,029.7Yugoslavia

250.0

Turkey50 0

United ArabEmirates . . . 570 ~

Yemen22 3

Zaire2.0

ZambiaT) ^

Zimbabwe

Saint KittsandNevis

0.9Saint Lucia

$2

Uruguay. . 15.0

. . •

UNICEF expenditures on programmes by sector 1985/1989SlOm S20m S30m .S40m S50m $60m S7(lm SMOm

ChUdhealth

Water sfit sanitation

Childnutrition

Community &family-basedservices forchildren

Formal &non-formaleducation

Planning& projectsupport

Emergencyrelief

S3Hlm

J,203

1985: Total expenditure$280 million

1989: Total expenditure$501 mil l ion

74

The chart on page 53 shows ex-penditures on programme assistancefor 1988 and 1989, and estimated1990. The bar and pie charts on thispage show programme expendituresbv sector in 1985 and 1989, by amountand proportion respectively.

Financial plan andprospectsRased upon the results of the 1989Pledging Conference and recent trendsUNICEF expects to maintain and ex-pand upon its current level of contri-butions from governments tor bothgeneral resources and supplementaryfunded projects. UNICEF is also encour-aging the non-governmental sector,through the National Committees andNGOs, to further expand their impor-tant contributions. The benefits ofother forms of fund-raising are alsobeing examined.

At the April 1990 session of theExecutive Board, proposals for new orcxtc nded m ult i -yea r programme co-

1985

1989

A% " • *f*

^ **m

operation in 25 countries will be sub-mitted. L NK KF currently co-operatesin programmes in 128 countries. Theproposed new recommendations totalUS$250 million from UNICHF'S generalresources and US$674 million forprojects deemed worthy of support ifsupplementary funds are forthcoming,Programme recommendations, fromgeneral resources tor all countries in-cluding those for which recommenda-tions from general resources are beingproposed at the 1990 Executive Boardsession, are shown on the table onpages 30 and 31. A medium-term plancovering the years 1989-1993 will besubmitted to the Executive Board at itsApril 1990 session.

Biennial budget1990-1991The goal of the most recent budgetexercise was further consolidation andstreamlining through the restructur-ing of regional offices and headquar-ters offices outside New York, as well

54

as upgrading country offices and es-tablishing new ones so as to achievethe greatest savings while maintain-ing the effective delivery of pro-grammes. The 1990-199J biennialbudget represents an increase of 5.6per cent in real terms from the 1988-1989 revised budget. The relativelylow level of real growth can be attrib-uted to a moderate growth in generalterms. Budgeted expenditures againstthe 1990-1991 bicnnium amount toUS$302 million: US$149 million for1990 and US$153 million for 1991.

In addition to these streamliningefforts, the 1990-1991 budget ad-dresses the issue of the central finan-cial and accounting system, whichreflects the Executive Directors equalconcern for sound financial manage-ment and accountability. The pro-posed budget also calls for substantialstrengthening of the staff develop-ment and training component in theOrganization since the most valuedresource UMCEF can offer to the coun-tries with which it co-operates is oftenthe knowledge, skills and expertise ofits staff.

Liquidity provisionIJNICEF works with countries to pre-pare programmes so that recommenda-tions can be approved by the ExecutiveBoard in advance of major expendi-tures on these programmes. UNK.'EFdoes not hold resources to full}' coverthe cost of these recommendations inadvance, but depends on future in-come from general resources to coverexpenditures. The Organization does,however, main ta in a l iquidi typrovision to cover temporary imba-lances between cash received and dis-bursed, as well as to absorb differencesbetween income and expenditureestimates.

UN1CEF maximizes planned generalresource programme expendituresbased upon the requirements of theliquidity provision and upon the levelof projected general resource contribu-tions.

AGFUNDThe Arab Gulf Programme for theUnited Nations Development Organ-izations (AGH'ND) continued its as-sistance to developing countries,mainly through United Nations agen-cies as well as some Arab Nuos. UNI-c 'HF received an important share ofAGFUND contributions. The persistinggeneral economic difficulties in the

Gulf are still forcing AGFUND to re-duce the volume of its assistanceacross the board.

AGFUND was established in April1981 by Bahrain, Iraq, Kuwait,Oman, Qatar, Saudi Arabia and theUnited Arab Emirates on the initia-tive of HRH Prince Talal Bin AbdulAziz. Q

Information resources managementIn 1989, Programme Division andfield office staff formulated revisedprocedures for programme codingand programme budget control to gointo effect beginning 1990. This re-quired corresponding changes in thestandard field office computer sys-tems and related headquarters systems.

As part of the revision of centralfinancial systems, a new Treasury Sys-tem has been acquired, and work isproceeding on new headquarters pro-

gramme budget control, fund-raisingand contributions receivable systems.The Supply Division in Copenhagenwill, in 1990, introduce new systemsfor order registration and processing.

A review is being conducted ofUNICEF'S electronic information net-work, which provides National Com-mittees and LJNICHF offices with elec-tronic messaging and bulletin boardservices.

Human resources managementAt the end of 1989, UNICKF numbered4,466 staff members, including 1,074international professionals (518 core,494 non-core, 62 government-spon-sored), 552 national professionals(190 core, 362 non-core) and 2,840general service staff (1,404 core, 1,436non-core).

These staff were assigned ro 196locations in 106 countries (includingHeadquarters, regional and countryoffices, sub-offices and outpostings,and GC;O). Out of the total L'NICEFstaff, 79.4 per cent served in the field.

A number of steps ro strengthenhuman resources planning and per-sonnel management have been imple-mented, including improvement inpersonnel procedures and support sys-tems. Major progress has been madein putting in place a computerizedand integrated personnel system, in-cluding personnel records, candidates'roster, vacancy monitoring, rotationand recruitment processes.

A global staff training and careerdevelopment strategy is being imple-mented and will further evolve tosupport the goals of the 1990s. In1989 new training packages were de-veloped on the Bamako Initiative,Control of Diarrhoea! Diseases, Nu-trition, Management II, Training ofTrainers, Personnel, Writing Skills andEffective 'Presentation. Building onthe experience gained and feedbackreceived on previous packages, the1989 training packages have betterlayout and are more self-explanatory.

A new planning process has beenintroduced through which individual,office and organization-wide trainingneeds were analysed and appropriatetraining programmes identified or de-veloped to meet those needs.

Between 1986 and 1988, the totalnumber of staff members who partici-pated in some form of staff trainingincreased from 753 to 2,690. In 1989,while there was no substantial in-

55

crease in the number of staff trained,there has been an improvement in thequality of training which resultedmainly from an organization-wideTraining of Trainers programme, im-proved training packages and greaterinvolvement of Training Section staffin the implementation of trainingprogrammes.

Within the areas of professionalexpertise of its .staff and visiting fel-lows, the International Child Devel-opment Centre in Florence, Italy, w i l loffer UNICES staff, and professionalsin partner institutions, more intensivestudy opportunities and experienceexchange. One of the major activitiesorganized by the Centre in collabora-tion with the Training Section in1989 was the Early ChildhoodGrowth and Development Seminar.

UNICF.F is committed to increase therepresentation of female staff to one

third in the professional category byDecember 1990, and to increase theproportion of women at the seniorlevel. Since March 1985, the overallproportion of women in internationalprofessional posts rose from 24.7 percent to 33.5 per cent. In the nationalprofessional officer category, the pro-portion ot women increased from29.4 to 34.3 per cent during thisperiod.

The Executive Director appointedone woman to the Assistant Secre-tary-General (AM.;} level, one womanto the D-2 level and nine women tothe D-l level since mid-1985. In addi-tion, reflecting the increasing numberof women in management of L'NU'.EFfield offices, two out of six RegionalDirector posts, 14 out of 69 Represen-tative posts and 11 out of 28 sub-offices are occupied by women. tH

Ktti

SupplymanagementUNlCEF-supported programmes in de-veloping countries are provided withsupplies and equipment purchasedmostly by the Supply Division, whichis located in Copenhagen and NewYork. Standard items, such as essentialdrugs, cold-chain equipment and sy-ringes for vaccinations, arc stockedand set-packed in the Copenhagenwarehouse. An inventory valued .itsome US$25 million is maintainedwhich provides the opportunity topurchase in bulk while improving de-livery to programmes and customers.Other items, for example vaccines,rigs for drilling water wells, and vehi-cles, are purchased from suppliers fordirect shipment to the countries inwhich they will be used. An increasingamount of programme supplies is pur-chased locally by UNH:BF field offices.

The total value of purchases madedur ing 1989 was approximatelyUS$273 million, an increase of 10per cent over the previous year. Otthis amount, approximately USS78million was procured in developingcountries for use in country pro-grammes. The purchase of vaccines insupport of uci increased from US$35million in 1988 to US$39 million.Increased demands continue to beplaced on the Supply Division forservices as a procurement agent togovernments and N'GOs, with theseprocurement services amounting toUSS44 million.

The value of purchases made bySupply Division continues to increase,and as a result the continued pressurein the markets of interest to LINK hihas ensured that manufacturers' pricesare held at an acceptable level. Con-tinuous attention has been given toensuring the efficiency of UNICEF'Sworld-wide purchasing activities, d

56

Glossary

acquired immunodeficiency syndromeacute respirator) infectionscontrol of diarrhoea! disease*child survival and developmentEasr Asia and Pakistan Regional Office (L'NK i i ,Economic Commission for Africaexpanded programme on immunizationEastern and Southern Africj Regional Office ( L NK n il-ood and Agriculture Organization of the United NationsGreeting Card Operationgross national producthuman immunodeficiency virusInternationa! Committee of the Red Crossiodine deficiency disordersInternational Fund for Agricultural DevelopmentInternational Labour OrganisationInternational Monetary Fundinfant mortality rareInformation Resources ManagementInternational Year of the ChildJoint Consultative Group on PolicyI'NKiFl- 'AvHO Joint Nutr i t ion Support Programmematernal and child healthMiddle Easr and North Africa regionnon-governmental organizationNew York HeadquartersOrganization of African L 'n i rvOperation Lifeline Sudanoral rehydrarion saltsoral rehydr.irion therapyPan American Health Organisationprimary health careRegional Office for South Central Asia i rxu I i iThe Americas and Caribbean Regional Office ( i MI ! itraditional birth attendanturban basic servicesuniversal child immunizationunder-five mortality rareUnited Nations Conference on Trade and DevelopmentUnited Nations Development ProgrammeOffice of the United Nations Disaster RidtefCo-ordinatorUnited Nations Environment ProgrammeUnited Nations Educational, Scientific and Cultural

OrganizationUnited Nations Population FundUnited Nations Children's FundUNICHH Procurement and Assembly CentreUnited States Agency ror International Developmentwater and sanitationWest and Central Africa Regional Office 1 1 ' \ i< h i iWorld Food ProgrammeWorld. Health OrganizationWHO Regional Office for Africa

Kampuchea: Cambodia as of 3 February 1990Mv.mmar: fonnerlv Burma

Further information aboutUNICEF and its work maybe obtained from

•, V L0017J

1

•

( : N K i ! • K . . L ; i i i ! i , - . !S I P L I C .

I'O. IV.\4414S

tral

K.I ' - I ! . ' AUJi.

I'M1

-mJ du < .n-iN'.Ap.irr.v1 " i i i l ' i . i

L ' M fand I ' . iki ' -Mn

i : Urn I

I'o i t , - s s i i " 2 l Ammai I

' An .1 South C cntr j l

SvUn . . -'ODD. AUMI

: . | l I1U Ni - s l l lUl l

Min.ii.

Information may also be obtainedfrom the following Committeesfor UNICFJ

, i r . i l i . i"t I ' l l ! '

Ausin.in ( '.iniiin. un.i lnui •

i.in N'.mon-il i ninnniii'i.-

<- " M i i M S i r v .ir I ' u h l i v 11<

. i .u l i in 1 ' ^ ^ 1 -louni

Slovakia:

Intcrtt.

liilk-J n f l lciiO

1 ninp.li l.omnir

Democratic Republic:

•

HW4 riiThn

.Hi t nninii

imrnirtce

I f . . : '

-

•

Hmm i

• !:.l

[ [ - n

•tin 2

•

u

I t . i l i . i n (". . in i iui!

|.i|-.

. i Od

•

•Lnm

•

•NK-V

Norwa-

ul V

1'iirr u:1 , ' fN.t

l i m u l i n u i l l l l l .,, in M " !"•

|.4-||

-

! 14

mini

I in!

itcd Kingdom:

rt'klat , H I.ond

Yugoslavia:.

Liaison Offices

... ...-

L'II

•./uri-li ,10I S - l u -

Al l i . i iH ' - "I Ri.-J :

Kcii '1. * l i t :