I9*S

nnual Report

w 1985

UNICEFAnnualHeport

ContentsIntroduction by the Executive Director, James P. Grant 3

UNICEF 1984-85: a review 5Hyjhigfhts of the year's projiramme co-operation, including frends andkey nTHts, illustrated by specific programme profiles from different countries.

Child health and nutrition 7Primary health care 7

Profile: Worth their salt (INDONESIA) 9Profile: A squeeze of toothpaste and much more (HAITI) 10

Child survival and development revolution 11Profile: "Shots" heard round the world (COLOMBIA) 14PtvJ'ile: "Sitting up and taking notice" (NIGERIA) 15

Child Nutrition 16Profile: The essential first steps (BANGLADESH) 18

Other community-based services for children 19Safe water supplies and sanitation 19

Profile: The how and why (TANZANIA) 20Formal and non-formal education 22

Profile: One thousand opportunities (MOZAMBIQUE; 23Urban community-based services 24

Profile: A crafty little character (MALAYSIA) 28Women's activities ; 29

Profile: An appetite tor change (NEPAL) 30Childhood disabilities 31Appropriate technology 32

Programme support activities 32Profiie: Broadcasting health (THAILAND) 34

Advocacy for children 35Profile: As the song goes (JAMAICA) 36

Emergency relief and rehabilitation 39Profile: "I want to go back home" (ANGOLA) 40

Map: UNICEF in action: programme commitments in die developing world . . . . 26

UNICEF's finances: income, commitments, andexpenditure 1984-85 43

Chan: UNICEF income 1980-85 43Map: 1984 governmental contributions 44Table: 1984 n on -governmental contributions 46Chart: UNICEF income, by source 46Chart: UNICEF expenditures 1980-85 47Charts: UNICEF expenditures on programmes by sector 1980-85 48

What UNICEF is and does 49AH otvnneiv of UNICEF's philosophy, polities, methods of programmeco-operation, and supporting activities.

UNICEF's ExecutiveBoard1 August 2984 to 31 July 1985

Officers of the Board:Chairwan (Exccntiw Httani):

Dr. Richard Manning (A astral ia)Chairman (Pniffiwnmc Committee):

Mr. Amvarul K. Chowdhurv (Bangladesh)

ChahtHflti iCoMHiiftcc on Admittistrationand Finance):Mrs. Hisami Kuruknchi (Japan)

first Vice-Clminaan:Mr. Jassim Buallay (Bahrain)

Second Vicf-Cbainnan:Dr. Mihaiy Simai (Hungan')

Third Vice-Chairman:Mrs. Bcmadcrtc Pallc (Burkina Fasu)

fourth Vice-Chainnan:Mr. Martti Ahrisaari (Finland)

Members of theAkjmnAustraliaBahrainifargjladesbtteltjiinnBeninBhutanBurkina Faai(. Atiadfli-ji/n-ul Ajiimn

IbpublKChcuiChileChinaColombiaCubaDenmarkFin/findFrance(imnntiv, Fcdt-ritl

Republic ofHiJHfjimIndiaIndonesia

BoardItalyJapanLesothoMadofrwfarMexicoNepalNcthn'fandsNujerVnnciMflliawanmSomaliaSwazilandSwTzci-imidThailandUnion «fSt>\'!fi

Socialist RepublicsUnited KityjHom

ofGnvtt Britainmid NorthernIreland

United Statesof America

VenezuelaYiufostctpia

Introductionby the Executive Director, James P. Grant

As I begin my second five-year term asUNICEF's third Executive Director,it's tempting to look back over whatwe have tried and what we haveaccomplished. But instead of catalogu-ing details, I'd like to review the basictenets of what we're about.

When J first took office in January1980, I shared with UNICEFs Staff*some ""first thoughts" about thefuture, drawn out of the experience ofthe past. I saw my period of ad-ministration as a time tor making themost of UNICEF's long-standing andextraordinary capacity to pioneer, toexperiment and apply the lessons ofexperience to the new and increasingdemands upon its limited resources.My first thoughts were horn out of adeep feeling for the responsibilitiesassociated with UNICEF, its missionto lessen the vulnerability of children,and the grim fact that some 15.5million children under five die eachyear, 12 to 13 million of whom wouldnot have died had they been born inmore developed countries.

The critical challenge that facedUNICEF was how to maintain andaccelerate the rather substantial pro-gress that had been achieved forchildren in the previous three decades."The central issue for much of theworld's population," I noted, "is stilllife itself-that is, sheer survival.Human survival is, after all, thenecessary foundation for all otherhuman development."

At the heart of this issue is thecrucial distinction between the tragic"loud" emergencies—natural and man-made disasters-and the much larger"silent" emergencies-the hunger,malnutrition and lack of essential serv-ices which stem from abject povertyand which doom millions of children

""/iwrf subsequently with the Exccutnf Board, inE/ICEF/Misc.340/&v. I

James P. Grant, Executive Director, withchildren hi Biinna.; on? of the wanv countrieshe wsited to ndwcatc tu'cclfmtiun of the Child

Survival and Development Rrt'olutwn. ,'•**

each year. I insisted then, as I insist to-day, that the worst aspects of absolutepoverty can be overcome i/more of uscare and if more institutional struc-tures and technologies are crafted thatare relevant to the particular eco-nomic, social and political circum-stances of different peoples.

UNICEFs financial resources, asconsiderable as they may seem in thepoorer countries, are in tact limited —both in relation to needs and in rela-tion to funds available from other

sources. I challenged UNICEF to relyprimarily upon helping others to makemore effective use of their resources inmeeting the most essential needs ofchildren. In the poorer countries inparticular, only programme ap-proaches designed around the idea offamily and community self-help per-mit the meeting of basic needs and theachievement of health for all by theend of the century.

The very limits of UNICEF's finan-cial resources make it imperative that

UNICEF direct all its activities to theend results they are designed toachieve. The value of human survivalitself dictates that all UNICEF acti-vities should he tested against the con-tribution they make toward achieving,by the end of this century, such resultsas an infant mortality rate of no morethan 50 deaths per thousand livebirths. Programmes clearly affectingsurvival rates should have the firstclaim on UNICEF's resources.

I also noted in January 1980 thatUNICEF's very special capacities incertain fields had evolved through aholistic concern for children and theirfamilies. Over the previous decades,UNICEF had become increasingly in-volved not only in programmes thataffect children directly, but in activitiesthat benefit them indirectly by provid-ing better health and education ser-vices to women, improving the eco-nomic productivity of poorer families,and increasing access to family plan-ning. I proposed that priority shouldalso be given to programmes such asthese, which contribute significantlyto improving the well-being of chil-dren by addressing family and com-munity needs.

UNICEF is unique in the UnitedNations system in its capacity to relateto people at the grass roots level, in in-dustrialized as well as developingcountries. The efforts of the NationalCommittees for UNICEF have beeninstrumental in realizing this. I urgedthat our pcople-to-people potential beenhanced not only because of thebenefits it brings to children, but alsobecause of the particular role UNICEFplays in the United Nations system asa whole. I also expressed my pleasureat the opportunity to work with anExecutive Board known for itsexperience, support, and the greatcontributions it has made to the pro-gress of UNICEF over the years.

F ina l ly , acknowledging tha tdevelopment progress is best achievedthrough approaches that recognizeexisting societal values and institu-tions, I committed UNICEF to fur-ther strengthening staff involvementwith first-hand knowledge of localvalues and ways-including the hiringof more staff from developing coun-tries, more women, and more youngpeople.

In the ensuing five years we've at-tempted quire a tot. Sometimes wemay have moved too rapidly. But risks

are part of the pioneer's challenge, andthe ability to learn from experienceand move forward, one of thepioneer's laudable traits.

WeVe remained true to our originalobjectives and faithful to UNICEF'sessential nature as an innovative, en-thusiastic, and efficient champion ofthe needs and rights of children. Theinformation presented in this Annual/fcpwf-the remarkable degree of suc-cess we've achieved in what we've at-tempted-is, I believe, convincing evi-dence of that consistency.

The potential for the Child SurvivalRevolution which UNICEF first arti-culated in its State of the World'sChildren report in December 1982 isclearly consistent with our objectives,deeply rooted in and made possible byUNICEF's tradition and experience,and a fitting commitment of UNICEFsenergy, imagination, and influence aswe move toward the 40th anniversaryof the United Nations which assignedus our mandate of protecting andenhancing the most valuable of theworld's resources: our children.

This Annual Report reviews the workwhich UNICEF has been doing tohonour that tradition and fulfill thatmandate.

CUv*-*-o in^st-James P. Grant

Executive Director

UNICEF1984-85: a review

Last year, 1984, saw impressive ac-celeration in child survival anddevelopment action; examples aresummarized in UNICEF\s 1985 State ofthe World's Children report. OtherUNICEF priorities, including theeducation of women and girls, self-reliant community-based services, andcommunication, arc equally and in-tegrally part of actions for child survivaland development. This Annual Reportprovides a more comprehensive over-view of programmes sector-by-sector,in the main areas supported byUNICEF. The positive developments,welcome as these are, should notdistract attention from the difficult,and in some respects worsening, en-vironment for children in which theytook place.

After tour years of deepening crisis,the world economy in 1984 began aslow recovery, but the situation variedtremendously from country to coun-try and region to region. In much ofthe world, especially Africa and LatinAmerica, the situation of children re-mained critical or even deteriorated.

In the developed market economiesit appeared that average growth rates inper capita gross domestic product(GDP) would reach tour per cent for1984, the highest rate in eight years. Acertain resumption of growth was alsoapparent in the centrally-plannedeconomies of Eastern Europe, and inthe People's Republic of Chinaeconomic growth was unprecedented.

But the North American economicrevival benefited only a l imitednumber of developing countries,mostly the middle-income countries ofeast and southeast Asia, where growthaveraged 2,5 per cent on a per capitabasis. Expansion of production in theindustrialized countries brought noimprovement to the economies of thedebt-ridden Latin American countries,where despite draconian stabilizationmeasures and renegotiation of foreignloans, per capita GDP was estimated tohave declined by about 0.7 per cent forthe year.

The situation of children worsenedmost dramatically in Africa. By the endof 1984, some 30 million people wereseverely affected by famine resultingfrom drought and disruption. Declin-ing prices of primary commodities, a

strained external payment situation,and widespread crop failures resultedin an average decline in GDP per capitaof about tour per cent.

Among developing countries, short-term prospects remained precarious.Moreover, the global economic crisisof the past four years has resulted inmajor setbacks to child welfare noteasy to repair. In several parts of theworld, improvements in the situationof children came to a halt at the end ofthe 1970s, and signs of deteriorationbegan to surface in 1983 and 1984.Resources to meet the needs of chil-dren have declined in most countries.Only in east and southeast Asia, as inthe Republic of Korea, and in a fewother countries such as India andCuba, has social sector progress beensteady.

The poorest households in mostcountries have seen tailing family in-comes and rising food prices severelyaffect the nutritional status of children.

Declining social sector expendituresand foreign exchange shortages haveseverely hampered the maintenanceand extension of services for health,water, sanitation, and housing, amongothers. Mostly, foreign exchangeshortages have cut into imports ofdrugs, vaccines, pumps, kerosene,petrol, and spare parts. Without fueland spare parts, even the little equip-ment available for health and otherservices soon stops functioning.

Scattered reports show that the com-bination of such factors has led to anincrease in the infant mortality rate(IMR) in 1983 and 1984 in areas asdiverse as Costa Rica, Peru, northeastBrazil, and the plantation sector of SriLanka. In addition, deaths have in-creased markedly over the past twoyears in the 22 African food emergencycountries.

Data for 1983 and 1984 indicate thatchild and maternal malnutrition havebeen increasing in a wide range of

The situation ofchildren \\wscncdmost dramaticallyin Aftitn and bythe end of 1984some 30 millionpeople Tverc severelyaffected by famineresu&ifjgfiumdrought and disrup-tion. A Mauri ta-nian riltye buriedby the sattd.

UNK 1.1- W« MUTO-IXI;

countries, including the Philippines,Bolivia, Brazil, Costa Rica, Peru,Botswana, Ivory Coast, and Malawi.In 1983, a substantial increase wasdetected in the number of malnourish-cd women in Chile. Even in a food-exporting country like Argentina, theeconomic crisis led to an increase in thenumber ot"children at risk. Ghana, ac-cording to data gathered by CatholicRelief Services, has seen, over theperiod 1980-83, an increase year-by-year in the rate of third-degreemalnutrition among children 7 to42 months of age.

These are sobering tacts that shouldnot be forgotten when considering theencouraging response in 1984 toefforts to extend child survival anddevelopment action.

This background notwithstanding,efforts to improve child survival anddevelopment by expanding andstrengthening national action withinthe frame of primary health care haveachieved considerable success. Progresswas most rapid in the fields of im-munization and oral rehydrationtherapy, with more modest gains inthe promotion of breast-feeding andgrowth monitoring.

Increasingly in immunization andoral rehydration programmes, newchannels of advocacy and support, in-cluding traditional political and com-munity leaders, were brought into use.New channels of health deliver)- werealso opened up, with several countries

making use, for example, of volunteersfrom the League of Red CrossSocieties, boy scouts and girlguides—as well as support fromministries and services beyond the for-mal sector. Mass media techniques in-creasingly sought not merely tomotivate parents, but to do so by pro-viding information that showed themhow they might, themselves, carry outchild health measures such as oralrehydration.

A number of heads of state gavestrong backing to the imperative ofreducing the rate of infant and childmortality. In Colombia, PresidentBelisario Betancur initiated andmobilized support for, the successfulimmunization drive, plus a five-yearprogramme of efforts to control diar-rhoeal diseases and acute respirator,'infections in young children, and in-creased attention to pregnant mothersand the nutritional status of womenand children. President Suharto of In-donesia, in a speech given in April,stated that "high infant mortality willreflect a failure on our part in achievingequity in development and improvingthe welfare of people". Indonesia'snew Five-Ycar Development Planrefers explicitly to the reduction of1MR and expansion of child survivaland development programmes, de-spite slower economic growth. Thelate Prime Minister of India, Mrs. In-dira Ghandi, addressing the AsianForum of Parliamentarians in Februarv

Increasitig access to family planning contributes to the mil-being ofnvttienatid children.

1984, said: "Parents are more likely torestrict their families if they havereasonable assurance of the healthysurvival of their two children. Theprevention and cure of childhooddiseases thus acquire importance". In-dia has reaffirmed its goal of universalimmunization by 1990; reduction ofinfant mortality is a specific goal of itslatest five-year plan.

UNICEF is fully aware that itshuman and material resources, evencombined with those of national gov-ernments, are entirely unequal to thechallenge of carrying out the requiredprimary health care and child survivalmeasures. Collaboration with otherscan also strengthen effectiveness, andin 1984 major attention was paid tostrengthening working relationshipswith WHO, WFP, UNDP, UNFPA,and the World Bank, as well as withother bilateral and multilateral agen-cies. UNICEF also formed strategicalliances with the league of Red Crossand Red Crescent Societies (whoseown "Child Alive"" programme waslaunched in 1984), the Holy See, theInternational Pediatrics Association,the International Confederation ofMid wives, and Rotary Internationalamong others. Alliances with privatevoluntary agencies, international andnational, have been particularly impor-tant in Africa in connection with thecurrent emergency.

UNICEFs "Infant Mortality Reduc-tion Fund", created by the ExecutiveBoard in 1983 has proven a useful andflexible means by which to initiatechild survival and PHC activities incountries ready to take action betweenregular funding cycles. Experiencesover the past few years haveunderscored the complementarity ofthe child survival and developmentemphasis endorsed by the UNICEFExecutive Board in 1983 and thePrimary Health C^are strategy endorsedby both WHO and UNICEF in 1978.As these strategic imperatives havebeen translated into country-1cvel pro-grammes, it has been demonstratedrepeatedly that action for child survivalcan serve as an entry point for thebroader primary health care effort;equally, it is clear that the PHC ser-vices and structures are the necessarybasis for sustaining the child survivaland development thrust. Both childsurvival and PHC are based on achiev-ing "health for all" through a multi-sectoral approach based on communi-ty participation and self-reliance. D

Child health and nutrition

» * " • »Primary health care

• *

This year was marked by steady pro-gress in the development of primaryhealth care and other community-basedsen-ices, but the pace of developmentfrom region to region was uneven.Progress was evident in southeast Asiaand the western Pacific; elsewhere inAsia tremendous resource needs werein part overcome through strength-ening PHC commitment and pro-grammes based on local self-reliance.In Latin America, where the recessionworsened the plight of the poor,greater interest was stirred in PHCand related programmes. In the Mid-dle East and North Africa the lack oftrained manpower was the greatestconstraint. Africa, menaced simul-taneously by economic recession, civilstrife, drought and famine, faced, andcontinues to face, the gravest prob-lems.

A number of country PHC progressevaluations were carried out in 1984,including Pakistan, Malawi, Oman,Zambia, and Zimbabwe, revealing thatmost countries were doing well in oneor more areas of PHC, but not across

the whole spectrum of activities.

With child survival measures as theleading thrust, UNICEF continued toadvocate PHC actively through inter-national conferences, workshops,meetings, and publications. Majormeetings in 1984 included an Interna-tional Seminar on "Health for AH" inSri Lanka, an Inter-country Workshopin Jamaica on Joint Support forPrimary Health Care, and a conferencein BeLlagio, Italy to discuss majorexpansion of immunization efforts.

Aid to training continued to be animportant and probably the mosteffective element in UNICEF's con-tribution to the development of PHC.Training programmes included coursesfor traditional birth attendants andother village level workers, the in-troduction of PHC concepts intoregular courses at health schools,refresher courses for health and com-munity development workers, andseminars to sensitize officials and com-munity leaders to PHC concepts. InPakistan alone, 2,500 traditional birth

Tmin'wff is one of the key clenmits in thedevelopment of Priwuiry Health Care.A nutrition floss for community healthwm-kers in India.

attendants were trained under a pro-gramme supported by the CanadianCommittee for UNICEF and Cana-dian bi-latcral aid. In large countrieswhere extensive numbers of villagehealth, workers are to be trained(670,000 in Indonesia, for example),UNICEF has concentrated its assist-ance on the training of trainers andsupervisors.

Another important area of assistancefor PHC is the development of simpleand manageable health informationsystems. In China such a system hasbeen worked out as pan of the "modelcounties" programme, while in Zam-bia, UNICEF and the Swedish Inter-national Development Agency (SIDA)are helping to simplify the 240 formsthat health workers have to fill out.

PHC programmes respond tospecific ecological and epidemiologicalsituations. Malaria, acute respiratoryinfections, and high neonatal mortalityare three of the outstanding problemsconfronting PHC workers. Malaria is aparticularly serious problem in tropicalAfrica and remains one of the top fivecauses of child mortality. In part,this is due to malaria control pro-grammes in developing countries be-ing dependent on imported oil-basedinsecticides and larvicides made un-affbrdable by increased oil prices andshortages in foreign exchange.

Most developing countries reportacute respiratory infection (ARI) assecond only to diarrhoea! disease incausing childhood deaths. ARImanagement is now a leading elementin the PHC programmes in China andSri Lanka. UNICEF and the PanAmerican Health Organization haveincluded ARI programmes in all theirCentral American projects.

In most developing countries,neonatal mortality (deaths during thefirst month of life) accounts for abouthalf the infant mortality. The principalcause is still neonatal tetanus, but alarge proportion of very early infantdeaths and disabilities is related to thehealth of the pregnant woman. In col-laboration with WHO, UNICEF istherefore strengthening its support forbetter maternal care and deliver)' prac-tices.

UNICEF continues to be a majorsupplier of medical and health equip-ment, and drugs and other consum-ables for basic health services. Itssupport has become critical in manycountries in view of current economicconstraints. In 1984, UNICEF fieldstaff were heavily engaged in resolvingthe management and logistic problemsin connection with the supply ofdrugs, vaccines, and equipment.

The provision of basic essential drugsis an absolute necessity not only to

Mobile clinics can provide health facilities m ivmotc areas. A child imitinfffor the clinicin the mountains of Haiti.

meet urgent mother and child healthneeds but to enable die health facilitiesto provide preventive and educationalservices. Providing 30-40 essentialdrugs to PHC facilities on a regularbasis will meet 80 per cent of the needsfor the treatment of common sicknes-ses in most communities at a cost aslow as under one US dollar per headper year. Unfortunately, many coun-tries are having great difficult)' in pro-viding even the minimal list of drugs totheir health services. Lack of converti-ble currency to pay for imported druj^is aggravated by internal transport andlogistical difficulties, so that ruralhealth services may receive little ornothing.

For several years, UNICEF has beena partner with WHO in a joint actionprogramme on essential drugs thataims to tackle these problems throughnational programmes. So for onlyabout a quarter of the countries inwhich UNICEF is active have-developed national essential drug pro-grammes, but a number of modelsshow what can be achieved despite theconstraints most countries face.

In Tanzania for example, a pro-gramme, funded by the DanishGovernment Agency, DANIDA, withoperational support from UNICEF andWHO, supplies monthly kits of essen-tial drugs to some 2,500 rural healthcentres and is training 3,500 healthworkers in the efficient use of thesedrugs. In a programme funded by Ita-ly, Ethiopia made rapid progress inexpanding its capacity to manufactureessential drugs and oral rchydrationsalts in Addis Ababa. In Asia, par-ticularly encouraging progress wasmade in Nepal, where, with UNICEFassistance, Royal Drugs Ltd. has nowexpanded its capacity to meet about70 per cent of the country's re-quirements for essential drugs.

UNICEF is making a great effort inpartnership with WHO and otheragencies to help developing countriespurchase essential drugs at the mostfavourable prices. Over the last twoyears, the process of internationalcompetitive bidding and consolidationof procurement orders has reducedprices for essential drugs by over 50 percent. UNICEF is currently working ona scheme that would offer govern-ments of developing countries improv-ed means of procuring essential drugsthrough LTNICEF's supply division inCopenhagen, thus taking advantage ofthe extremely low prices. D

Worth their salt INDONESIA

Twelve million children inIndonesia contract endemic goitreor childhood cretinism because ofa major nutritional problem:iodine deficiency'. In 1976, a pro-gramme to iodize salt was initiatedwith UNICEF assistance: by 1989all salt produced in the countrywill be iodatcd. At this point,however, the use of treated salt,particularly in endemic areas, isstill limited.

Among the reasons: villagers arcinsufficiently aware of the benefitsof iodatcd salt and accustomed tothe coarse salt produced by localfarmers. It has become clear thatonly a change at the grassrootslevel will change their habits; weresalt farmers themselves to iodatethe salt for example, peoplemight be more inclined to try it.

One such effort is being made inthe village of Krimun, in thedistrict of Indramayu, West Java.Even7 household in Krimun isinvolved in producing the coarsesalt briquettes usually found invillage markets. This is a poorvillage by national standards-nearthe poverty line by internationalstandards. The villagers supportthemselves by tilling ricerieldsduring the rainy season andproducing salt during the dryseason.

The experiment, part of aUNICEF-assisted programme todisseminate appropriatetechnology through the ten-million strong scouting organiza-tion in Indonesia, began in late1983. Fifty members of the localscout troop were trained in localtechnologies for salt iodafion.

Ipah Maspupah, a student ofthe local agricultural high school,along with eight others went intoKrimun village to teach the saltfarmers what they had learned,Coming from Krimun villageherself, she had strong personalinterest in the activity.

"I like doing this," she says asshe puts the iodated salt in plasticbags, "because I want to helpdevelop my own village." An

agricultural student, she feels thatshe has much to contribute. "But,what is important," Ipah notes,"is to help people build on whatthey already have!"

For the last three months Ipahand friends have been workingwith Abdul Rochim, a salt farmer,teaching him one method of ioda-tion. First, the coarse salt is pro-cessed to become crystal white.Then a regular mosquito sprayer isused to spray the potassium iodareon measured quantities of salt,Iodine content is checked throughsamples sent to a Department ofIndustry laboratory and themethod, while not ideal, is simpleand easy. Abdul Rochim is able toproduce about five kilograms ofiodated salt a day; three are soldlocally and two are marketed out-side the district.

"It's still more expensive thannon-iodated salt," he says, "butthe people here are finding ouriodated salt worth buying. Besideslooking much nicer, it also

prevents goitre,"The scouts will soon leave

Krimun village to work on itsown, like the neighbouring villageof Kertasari, which succeeded intaking over the salt iodationtechnology from another group ofscout youths.

"We provide the technology anda helping hand in getting theiodated salt produced andmarketed,'" sax's scoutmaster andschool teacher Amor Sudjono."Bur as soon as the tanners cantake over, we leave. This is whatcommunity development is allabout."

What the scouts do in Krimunand other villages in Indramayuregency will not make headlines-nor indeed have an immediateeffect on the total picture ofendemic goitre and cretinism inthe country. But in their ownsmall way, they are improving lifein their communities amplydemonstrating that they are, so tospeak, worth their salt.

UNKTKP ltl,!.< M4 X i l . r i . u M U

A squeeze of toothpaste and nutch more HAITI

External aid to Haiti totalledUSS167 million in 1983. Livingstandards, however, have barelyadvanced and in May 1984 thepoorest sectors of the countrywere the scene of bloody foodriots and other civil disturbances.

Almost half Haiti's 5.1 millionpeople are under 15. One nutri-tional survey in 1978 found73 per cent of children sufferedsome degree of malnutrition andaverage infant mortality remains atabout 124 deaths per thousandlive births. Almost half thosedeaths are caused by diarrhoea-anillness which can be combattedwith the cheap and simple oralrehydration therapy (ORT).

With UNICEF support, aNational Programme for OralRehydration and the Promotion ofBreastfeeding was launched at thePresidential Palace on 22 July,1983. Momentum in 1984 iucledhopes that child survival effortswould get the backing theyneeded to improve significantlythe health situation.

Co-ordinated by the Ministry ofPublic Health, the programmeaims to establish 7,000 sales postsnationwide and to mobilize51,000 field workers. These are tobe responsible for the distributionof Serum Oral, a commercially-produced oral rehydrationmixture.

Serum Oral is being manufac-tured in Haiti by Pharval, acommercial company which in-tends to boost production from200,000 to 2 million packets ayear by 1986. Pharval isdistributing the salts throughestablished connections with phar-macies and other wholesalers andretailers. The government'sAgence d'Approvisionnement desPharmacies Communautaires willbuy bulk supplies for hospitals andcommunity pharmacies.

In an uncommon example ofco-ordinated effort, governmentdepartments and social plannersappear to have united in pursuit

of the common goal. The cam-paign has been directed to alllevels of the community, fromwell-stocked city pharmacies tostreet vendors in urban slums,who commonly sell half a dozenmatches from a box or a squeezeof toothpaste for a customer'sbrush.

Even the country's 11,000scouts are involved. All scouts willreceive training in ORT and eachis pledged to pass this knowledgeon to five mothers, as well as tohelp set up sales points in theircommunities.

Scrum Oral posters can now beseen throughout the capital andsurrounding areas. A film byUNICEF showing the many facesof the ORT programme is beingused to complement radio and te-

levision commercials, reinforcingthe message that medical treat-ment need not be expensive orimported to be effective. Thisemphasis carries particular weightamong Haiti's poor, whoseincome averages some US$268a year.

In 1980, the State UniversityHospital in Port-au-Prince, apioneer in the effort to introduceORT, reported a case fatality rateof 40 per cent among childrenadmitted with acute diarrhoea anddehydration. In 1984, with ORTbeing adminstered by nurses andmothers, fatalities had dropped toan estimated 1 per cent of thecaseload. Before the programmebegan, the paediatrics ward wasalways jammed. Today there arebeds to spare.

10

Child survival and developmentrevolution

Monitoring children'sgrowth

During the child's early years, retardedgrowth is one of the clearest signs ofunder-nutr i t ion; the practice ofgrowth monitoring for nutritionalassessment and screening has been well

China began preparations for nationalscale monitoring, the potential ofwhich is quite promising. Amongother activities, UNICEF supportedtraining courses on growth monitoring-in Malawi, Pakistan, and Zimbabweand a workshop in China to develop anational strategy.

In Ghana, Indonesia and Thailand,

established for some time. Onlyrecently, however, has the use ofgrowth charts become part of primaryhealth care in developing countries.And only now is the even wider poten-tial of growth monitoring being real-ized, Growth monitoring can be usedto: target nutritional care on thehighest priority population; educateand motivate mothers on child care;organize primary health care systemswi th in communi t i es ; empowerwomen; increase demand for, and uti-lization of, community' services; pro-mote and popularize child growth anddevelopment issues.

There are as yet few countries wheregrowth monitoring is practisedcountry-wide, but Indonesia andThailand hope to have almost 100 percent of their child population coveredby the end of this decade, andBotswana, Guinea Bissau, Haiti,Uganda, Zambia, and Zimbabwe,among others, reported rapid expan-sion of growth monitoring in 1984.

Gwirth monitoring can be used topromote child (p-owtb mui developmentissues. A clinic in the Philippines.

the growth charts are being kept athome by mothers, who are taught toassess their children's growth and takeremedial action when growth rate fallsoff. In Indonesia and Thailand,growth monitoring is also being usedas a successful way of developing pri-mary health care systems. Wide use ofgrowth charts is, unfortunately, stillquite rare, and UNICEF will concen-trate on extending their use in thefuture. Among the constraints are alack of general understanding of thevarious uses of growth monitoring, in-adequate staff skills, poor institutionaloutreach, and lack of co-operationwirh institutions outside the healthsector. Accelerated application wouldbe possible through schools, ruraldevelopment programmes, religiousgroups, women's organizations, andinformal groups of mothers.

Oral rehydrationtherapy

The global effort to promote oraJrehydration therapy (ORT), the mosteffective treatment for diarrhoealdiseases in young children, gatheredmomentum in 1984. The advantage ofORT is that parents can treat their ownchildren when an attack of diarrhoeastarts. Using such home ingredients asstarchy rice or vegetable broth with alittle salt added, or a solution of saJtand sugar in the right proportion, theycan prevent the onset of dehydration.Severely affected children are treatedby a community health worker withthe packaged oral rehydration salts(OR5) formula; the worker may alsoprovide advice on breast-feeding,hygiene, clean drinking water, sanita-tion, and proper nutrition at weaning.Treatment is remarkably simple, low-cost, and effective at all stages. Anumber of research studies haveshown that the use of ORT for treatingdehydrated children at the communitylevel has decreased the number ofdeaths from diarrhoea as much as 50 to60 per cent over a one-year period.

UNICEF is promoting ORT in manycountries by enlisting the active sup-port of the medical profession, govern-ment officials, community and reli-gious leaders, and the media; develop-ing strategies to enable parents andcommunities to cope with diarrhoealdiseases themselves, especially throughthe use of home-made remedies; and,along with WHO, by supportingresearch and development of improvedoral rehydration solutions. In addi-tion, UNICEF in 1984 provided over65 million packets of oral rehydrationsalts and helped more than 20 coun-tries create the capacity to manufactureORS themselves. This local productionnow tops' 100 million packets a year.The overall availability today is quite aleap from the one million packets sup-plied in 1975, when UNICEF firststarted to produce ORS.

UNICEF assistance to various coun-tries in their national Control of Diar-rhoea! Diseases (CDD) illustrates its in-volvement. In Egypt, where the CDDprogramme started in January 1983,wide coverage has been attained bymounting an extensive mass mediacampaign integrating the ORT pro-gramme into existing health services.Bangladesh, a pioneer in oral rehydra-

U

OPT treatment is remarkably simple.Mothers in Burkina Fasogmqg theirchildren ORS.

tion, made significant progress, withtotal production of ORS approaching17 million packets. An ORT guide forhealth workers, developed by the In-ternational Centre for DiarrhoealDisease Research, Bangladesh, wasdis t r ibu ted count ry-wide wi thUNICEF assistance. Several millionleaflets on home preparation ofrehydration solutions and on domestichygiene were distributed through theprimary- schools. In Haiti, the ORTprogramme progressed satisfactorily in1984 with a five-fold increase in theuse of ORS in health centres and otheroutlets (sec profile page 10).

Despite these and other positiveachievements, there is still far to go:in as many as half the countriesUNICEF co-operates with, there isstill no national programme to controldiarrhoea! disease. The use of ORT bytrained health workers and informedparents is still the exception, reachingsome 20 per cent of the developingworld's children through ORS andperhaps one and a half times as manythrough home therapy. During 1984about four million children under theage of five died from diarrhoeal diseasesand associated states of malnutrition.At least half these lives could have beensaved by timely oral rehydrationtherapy and other simple controlmeasures.

CHILD HEALTH:In 1984 UNICEF

co-operated in child healthprogrammes in 109 countries:43 in Africa, 23 in theAmericas, 32 in Asia and 11 inthe Middle East and NorthAfrica regionprovided grants for training,orientation and refreshercourses for 75,700 healthworkers: doctors, nurses,public health workers, medicalassistants, midwives and tradi-tional birth attendantsprovided technical supplies andequipment for 105,700 healthcentres of various kinds —especially rural health centresand subcentrcssupplied medicines and vac-cines against tuberculosis,diphtheria, tetanus, typhoid,measles, polio and otherdiseases

Breast-feedingand better weaningpractices

In most less-developed countriesbreast-feeding is the rule, especiallyin rural areas, but recent studies showlittle cause for complacency. Thoughbottle-feeding is still largely confinedto the urban middle-class, its spread isbecoming alarming. In Mauritius, forinstance, 84 per cent of the babiesborn in hospitals and clinics arc bottlefed. In Pakistan, 50 per cent of the in-fants surveyed were wholly or partiallybottle fed. In some cases commercialmilk foods are introduced long beforethis is desirable; in other cases infants,who should be weaning, are given nosupplements at all for far too long.

New medical research findings showthat breast-milk may contain an-tibodies against cholera, that it affordsgreater protection against diarrhoealdiseases than other feeding modes, andthat it contains a substance that kills avariety of parasites responsible for in-testinal disorders, including amoebicdysentery. These and other findingshighlight the need both for the en-couragement and support of breast-feeding and for the appropriate andtimely introduction of supplementaryand weaning foods.

UNICEF continued to help coun-tries in the encouragement and sup-port of breast-feeding. To provide thenecessary data for national policies ininfant and young child feeding, some15 countries have conducted or areconducting national surveys on breast-feeding. Governments of these coun-tr ies have pa r t i c ipa ted inWHO/UNICEF sponsored regionalworkshops on the subject. In addi-tion, Fiji, Zambia, and Mauritius havecompleted surveys followed by pro-posals for action. Bangladesh andArgentina have established govern-ment bodies to monitor infant-feedingpractices.

Encouraging breast-feeding is an in-tegral part of Egypt's diarrhoeal diseasecontrol programme. Nicaragua'sbreast-feeding programme focuses oneducating mothers and training healthworkers in promotional techniques.Maternity units in more and morecountries are practising "rooming-in";re-orientation programmes for healthpersonnel have been undertaken in anumber of countries.

\2

In response to growing concernsabout the timely and appropriate in-troduction of weaning food, a WHOtechnical group is working out aguideline for fact-finding surveys, to beused by governments prior to launch-ing nature nutritional programmes.Some national actions arc already beingtaken. Sierra Leone has reactivatedits production of high-protein wean-ing foods. The Ivory Coast has launch-ed an information campaign for im-proved infant feeding practicesthrough the mass media. In Uganda,Mozambique, and Zimbabwe, guide-lines on appropriate supplcmentan-feeding have been prepared anddistributed.

UNICEF also devoted considerableattention in 1984 to helping countriesprepare promotional and educationalmaterials on breast-tceding. Slide-sets,films, and posters were made and usedin Mexico, Ethiopia, Thailand, Iraq,and Haiti. Short television spots wereaired in Turkey and the Philippines. Afilm including a segment on breast-feeding was produced in Ghana.

Education kits and training manualsfor field workers were also produced ina number of countries.

There was impressive progress in1984 in the implementation of the In-ternational Code on the AppropriateMarketing of Breast-milk Substitutes.By mid-year, the code was in force insix countries, in the final stages oflegislation in 16 countries, adopted as avoluntary measure in 7 countries andpartially implemented in 24 countries.Twenty-four other countries havedraft national codes under considera-tion.

Perhaps the most significant andwelcome development in the infantfood industry in 1984 was the endingof the Nestle Boycott. At the requestof The Nestle Company and the Inter-national Nestle Boycott Committee,UNICEF facilitated the final rounds ofnegotiation, leading to an agreementby The Nestle Company to abide bythe code and to the consequent liftingof the long boycott which the commit-tee had been leading against the com-pany.

AVjt> fitidityphighlight the needboth for theencouragement midsupport ofbrcast-Jvedsqg and for theappropriate andtimely introdtictwtiof'supplementary'weanimj foods. Amother breast-

fecftirifj her baby itiJSaMgktdesh,

UNICEF l)'4f«.\U khjn

Immunization

UNICEF is a full partner with WHOin the world-wide campaign to im-munize all infants and young childrenagainst six common infectious dis-eases—diphtheria, pertussis (whoopingcough), tetanus, measles, poliomye-litis, and tuberculosis. Women ofchild-bearing age and especially preg-nant women are being immunizedagainst tetanus, since the immunitymay be conferred on infants at birth.

UNICEF is not only the main inter-national supplier of vaccines todeveloping countries, but helps coun-tries to produce their own vaccines,participates in programme develop-ment and reviews, and supportsmanagement and technical training. In1984, UNICEF provided direct

.assistance to immunization activities in80 countries, supplying vaccines wortha total of US$7.5 mfllion, and con-tributed to a US$500,000 regionalrevolving fund for vaccine procure-ment in Latin America. It also providedsubstantial assistance to logisticalsystems in many countries, particularlyin support of the "cold chain" that en-sures vaccines remain effective. An ac-celeration in immunization activitiesled to a dramatic increase in demandfor vaccines-1984 supplies were twoto three times more than in previousyears, and a further increase is pro-jected for 1985. This sudden increasein demand for vaccines created short-term supply problems in some coun-tries, but it is expected that increasedsupplies will be available for sustainedoperations in 1985.

In March, the Bellagio Conferenceon Protecting the World's Children,sponsored by UNICEF, WHO, theWorld Bank, and the UN Develop-ment Programme, provided a majorimpetus to accelerating immunizationactivity. The conference established atask force to promote the reduction ofchildhood mortality and morbiditythrough key primary health care ac-tivities, concentrating first on supportto three countries: Colombia, Indiaand Senegal. Following the con-ference, Colombia, under the leader-ship of President Belisario Bctancur,mobilized widespread political andpublic support for immunization: onemillion children were immunizedagainst diphtheria, pertussis, tetanus,measles, and poliomyelitis, giving

13

f fShots" heard round the world COLOMBIA

President Belisario Betancur andhis Health Ministry led a minorrevolution this year which sawalmost a million children vac-cinated against five killer diseasesand found new ways of conduct-ing a campaign which could in-spire and instruct effortselsewhere.

President Betancur used thespirit and principle of the "ChildSurvival and Development Revolu-tion" to rally support for thenational immunization drive,which centred on three NationalVaccination Days-23 June,28 July and 25 August. The Presi-dent and First Lady personallyrequested the collaboration ofindividual governors. The Ministryof the Interior asked the mayorsof all 1,125 municipalities tosupport the volunteer effort.

Print and broadcast mediabacked the drive solidly. Provincialnewspapers like El Tietnpo and ElEspectadar carried health messagesand special feature articles. As eachof the National Vaccination Daysneared its climax, 84 radio stationstransmitted hourly messages onchild care and immunization.Television stations showed specialprogrammes in addition to newsitems on campaign preparations.

The cartoon character of a littleboy named Pitin, the campaignmascot, appeared everywhere -newspapers, posters, billboards,even T-shirts—urging mothers tohave their children vaccinated.Tens of thousands of volunteerswere mustered from the RedCross, Civil Defence Units, theBoy Scouts, and other publicservice bodies tor a nationwidedoorknock campaign.

Volunteers visited ever)' house-hold recording the name, age, sexand vaccination history of eachchild and encouraged parents tohave their sons and daughters atthe vaccination booths set up allover the country. The Ministry ofDefence provided air, sea and rivertransport for vaccines, cold chainequipment and materials to build

vaccination posts where necessary.On the day of the first round of

vaccinations, radio stations createdan election-day atmosphere and asense of competition betweenregions by announcing vaccina-tion counts and targets from allparts of the country on thehour. By the close of day one,810,000 children had receivedtheir first shots; on day two850,000 children were im-munized; on day three, 900,000.

To achieve these results, anarmy of over 120,000 volunteershad delivered vaccines againstdiphtheria, whooping cough,tetanus, polio and measles to10,000 immunization posts across

the country over a period ofnearly two months; and they vac-cinated between 88 and 93 percent of the most vulnerablepopulation group, children belowfour years of age.

The brightness of Colombia^achievement reaches far beyond itsborders. Elements of the campaigncan be picked up and appliedelsewhere. Observers fromBurkina Faso, Ecuador, ElSalvador, Guatemala and Haitihave carried away vivid memoriesof what they saw, heard andfelt in Colombia-governmententhusiasm and communityinvolvement at work together.

M

"Sitting up and taking notice>y NIGERIA

There was a ray of hope on theAfrican continent in 1984: in thewest Nigerian district of Owo,83 per cent of the children undertwo years of age were vaccinatedagainst six lethal diseases. Thisachievement contrasted sharplywith the average rate of coverageof 21 per cent.

National and state-level healthauthorities, together with WHO,UNICEF, and the new militaryadministration, joined forces inOwo for a year-long vaccinationprogramme. Now, a nationalimmunization campaign is underway to achieve countrywidecoverage of 80 per cent by 1990.

Owo's total of 19,000 childrenpales beside the target of 4 millionto be reached every year at the na-tion's current rate of populationgrowth. At present, only 40 percent of the rural population iswithin easy reach of healthfacilities and fewer than 40 percent use them. Nevertheless, theOwo experience suggests Nigeriacan achieve its goal.

Says Dr. Aladesawe, whodirected the Owo campaign, "As

far as I can see there are two keyelements in trying to reach the80 per cent target. The first is toconvince the mothers of the valueof immunization and the second isto ensure there are regular suppliesof vaccine. Our strategy for over-coming the first problem is tomake announcements in all chur-ches and mosques and to involveall the women's societies. For thesecond we are counting onUNICEF."

UNICEF has been involved inexpanded programmes of im-munization in Nigeria since 1978,providing vaccines andrefrigerators, and supporting thetraining of personnel in vaccinehandling. In Owo, UNICEFworked on programme implemen-tation directly with the govern-ment for die first time.

Owo was chosen as the pilot sitebecause of past failures with thekind of vaccination programmestypical for rural Nigeriancommunities. Previous efforts hadsuffered from a lack of organiza-tion: supplies were delivered tohealth centres randomly; schedules

were left to chance; and the coldchain was in constant danger ofbreaking down because of poorvehicle maintenance, brokenrefrigerators, and electric powerfailures.

The Owo project replacedrefrigerators with cold boxes atone third the cost. A tightdistribution system was developed:using a fleet of six vehicles, anddrivers skilled in their maintenance,the vaccines were distributed fromcentral storage locations in Owotown to more remote areas. Chur-ches, schools, mosques, markets,and community halls served asvaccination posts. The eight-dayrange provided by cold boxes andcold packs was adequate to ensurefresh vaccines as needed.

"The military government islooking for tangible, affordable,rapid social gains, especially in therural areas," notes UNICEF'sRepresentative, Richard Reid. TheOwo project is proof this is possi-ble. Adds Reid: "People in othercountries and in the headquartersof international organizations aresitting up and taking notice,'1

IS

almost universal coverage against thesediseases (see profile page 14). The BCGvaccine against tuberculosis was omit-ted from the mass campaign sincecoverage of 80 per cent had alreadybeen attained. In Senegal the Ministryof Health has begun an intensive plan-ning process, with the aim of makingimmunization services available to allchildren. In India, following successfullocal campaigns in Delhi and Bidardistricts which raised immunizationrates from 20 per cent to 85 and 95 percent respectively, several states are nowpreparing to extend coverage to allchildren. The Government of Indiahas reaffirmed its goal of universalimmunization by 1990 and this effortwill be a major component in the nextcycle of programme co-operation withUNICEF.

Nigeria, following the remarkablesuccess in Ondo State in 1983, where83.3 per cent of the young childrenwere immunized (sec profile page 15),has launched a nation-wide drive,aimed at 80 percent coverage by 1990,under the leadership of the Head ofState. Indonesia, Pakistan and Zim-babwe, among other countries,reported significant progress in 1984.In Indonesia, although 80 per cent ofchildren have access to immunizationsen-ices, only about 30 per cent are be-ing reached. The Government has ac-cordingly accelerated its promotionalefforts and raised immunization topriority level.

In 1984, new support for immuniza-tion came from two sources. The ArabGulf Programme (AGFUND) provid-ed US$1 million to support im-munizat ion programmes in theEastern Mediterranean Region for twoyears beginning July 1984. Rotary In-ternational established a "Polio 2005"plan of action, working towards theimmunization of all children againstpoliomyelitis by the 100th anniversaryof the organization's founding.

During the past three years,UNICEF has been associated withWHO in country reviews in some 30countries. These established that inthe majority of countries, especially inAfrica, coverage remains very far belowthe 80 per cent target set in the globalcampaign, and in some countries im-munization is still limited to cities andadjacent areas. A characteristic sharedby the sufcessful programmes has beenmeticulous planning and organization,with detailed attention to all elements:training, preparation of facilities, use

] , ,

of mass media, etc. Political commit-ment from the highest levels has alsobeen an essential characteristic of suc-cessful programmes. Where commun-ity level health personnel arc under-paid, or lack supportive supervision,immunization coverage is low. Aboveall, it is evident that immunization isonly one of several components of anoverall primary health care strategy: allcontacts with health services shouldprovide opportunities for immuniza-tion, other necessary sendees, andreadily understandable healthmessages. P

The WHO/UNICEF Joint NutritionSupport Pwffmmmf addnsscs the mttri-tioml status of children atui mothers.

Child nutrition

The WHO/UNICEFJoint NutritionSupport Programme

UNICEF's main thrust for co-operation and assistance in the field ofnutrition in 1984 was the USS85.3million WHO/UNICEF Joint Nutri-tion Support Programme (JNSP), a"noted" project entirely funded by theGovernment of Italy. Drawn up in1982, the programme represents arenewed commitment by the two

agencies to tackle the problem ofyoung child malnutrition—a problemwhich has often appeared intractable.Impact objectives derive from thepriority concerns of child survival anddevelopment: 1) the reduction of in-fant and young child mortality andmorbidity; 2) better child growth anddevelopment; and, 3) the improve-ment of maternal nutrition,

The JNSP follows the community-based services/primary health care ap-proach-decentralized managementand community involvement at allstages, starting with project identifica-tion. It addresses the nutritmiaI statusof children and mothers-a more com-prehensive approach that includes oralrehydration and immunization, as wellas programmes that empower andenable women, through activities suchas income-generation and appropriatetechnology, to fulfill their key care-taking role in the family.

Early JNSP experiences in communi-ty involvement are of special interest.In Niger, a particularly striking case,the approach to community involve-ment can be described as "consultationand response". There is no trace ofdirection and control; indeed, it isimpossible to predict in advance ofcommunity consultation what the ini-tial project content in a particularvillage will be.

By the end of 1984 the entireUS$85.3 million had been committedto projects in 18 countries. In Haiti,the project concentrates on oralrehydration therapy and breast-feeding. An Andean project focusesspecifically on the eradication of goitre.All the others contain mutually-supportive elements including foodproduction, health measures, com-munity education, and women's acti-vities. In the Iringa region in Tanzania,for example, a multi-dimensional pro-ject is providing an opportunity to testa variety of ways to improve nutri-tional status. Launched at the end of1983 with an impressive campaign tocreate public awareness, the projectwas well established within a year in all167 villages of the project area, with atleast some involvement in two-thirdsof all the households.

The JNSP also provides support at avariety of levels to strengthen a coun-

CHILD NUTRITION:In 1984UNICEF

co-operated in nutritionprogrammes in 100 countries:38 in Africa, 21 in theAmericas, 32 in Asia, and 9 inthe Middle East and NorthAfrica regionhelped to expand appliednutrition programmes in27,200 villages, equippingnutrition centres anddemonstration areas,community and schoolorchards and gardens, fish andpoultry hatcheriesprovided stipends to train27,700 village-level nutritionworkersdelivered some 35,000 metrictons of donated foods(including wheat flour, non-fatdry milk, special weaning foodsand nutrition supplements)for distribution throughnutrition and emergencyfeeding programmes

try's capacity to plan, manage, andevaluate. In Nepal, where five districtsare included in the project, the nutri-tion cell of the Ministry of Health isbeing strengthened and plans are beingworked out to include nutrition unitsin other ministries. In Somalia the pro-ject co-operates with the Ministry ofHealth's new Primary Health CareDepartment in its support of decen-tralized health activities.

JNSP support can take the form ofstaff, consultants, training, materials,and sometimes construction. Financialassistance can be provided to establishrevolving funds, form women's co-operatives, and other activities. InAngola, international project staff wererecruited to train national counter-parts, short-term consultants helpeddesign training courses in health andnutrition, and two Angolans werechosen for post-graduate training inBrazil.

Eight of the JNSP projects are inAfrica—Ethiopia, Mali, Mozambique,

and Sudan, in addition to countriesalready mentioned. The drought andfood emergency in so much of Africaprovides a monumental challenge to anutrition programme that aims to bedevelopmental. The JNSP is not anemergency programme and its resour-ces are not meant to provide relief.Nevertheless, in Sudan and Mali,where JNSP project areas have beenaffected by severe drought, JNSP hasextended relief assistance and is pro-viding water, essential drugs and im-m u nization, More im portantly, theprogramme makes a permanent contri-bution to prevention and preparednessby helping communities build theirown capacity and by providing trainedpersonnel and a strengthened in-frastructure.

Other nutritionactivities

UNICEF continued in 1984 to sup-port a variety of nutrition activities aspart of its ongoing programme ofcountry co-operation. It assistedMadagascar, Lesotho, and Malawi todesign national nutritional surveillanceprogrammes and helped a number ofother countries strengthen theirsurveillance activities. Promotion offood production for family use andsupport to supplementary feedingschemes were part of programmes inUganda, Syria, and Papua NewGuinea, among other countries.

UNICEF support to nutrition train-ing and education continued on abroad scale. In Kenya, impressive pro-gress was made in introducing nutri-tion as a subject into the primaryeducation system. In Zimbabwe,volunteers in numerous feeding cen-tres were trained. In Iraq, Syria andOman, training courses tor healthofficers were organized. In Turkey,public nutrition education was pro-moted through the mass media and afree supplementary weaning food wasdistributed in co-ordination with anutrition education programme andthe distribution of growth charts.Education on child feeding during theweaning period was supported on a,large scale in Thailand. In the IvoryCoast, a fish-raising project, linked toeducation in child feeding and pro-viding increased income tor poorerfamilies, continued successfully.

i

The essential first steps BANGLADESH

Last year, about 25,000 Bangla-deshi children lost their eyesightbecause of vitamin A deficiency.Of these children, about hall'willdie before their sixth birthday; forthe rest there is no hope of cure.

Xerophthalmia, 'night blindness1

or 'raat kaana1 as it is knownlocally, was first identified during a1962-1965 nutrition survey. Thesurvey estimated that 5,000children under the age of five weregoing blind each year. It alsodemonstrated that balancing achild's diet with foods rich invitamin A could reduce the in-cidence of blindness. No actionwas taken, however, and thesituation continued to deteriorate.

In 1972-73 the World HealthOrganization conducted a surveywhich estimated that at least17,000 children were going blindeach year. Together withUNICEF, WHO helped theBangladesh Government launch anational blindness preventionprogramme. For more than10 years now, the programme hasaimed to administer one highpotency vitamin A capsule even'sis months to every rural childunder age six.

About 50 per cent of the20 million target population hasbeen reached and the incidence ofnutritional blindness has beenreduced. However, UNICEF'scurrent commitment to the pro-gramme will be exhausted in 1986and experts agree that long-termdietary solutions must be found.

A recent XerophthalmiaPrevalence Survey found that,while rates for Xerophthalmiawere lower among rural childrenwho received vitamin A capsules,about 30-40 per cent of thesechildren developed the diseaseanyway. The report concluded:"The total food economy of thehousehold and the child, as wellas exposure to diseases such asmeasles and gastroenteritis, needsto be taken into account."

The poor, who often cannotafford to buy foods like green-leaf

vegetables, are usually unaware ofthe nutritional value of thesefoods, the importance of a balanc-ed diet, and the fact that manylow-cost alternatives are available.The government, with financialsupport from UNICEF, is tryingco change this.

One three-year project aims todistribute 100,000 packets of seedfor 12 vegetable varieties to ruralcommunities nationwide. About5,250 people-half of themwomen-from 42 selected villages,have been trained for the intensiveproduction and conservation ofvegetables. Growing their own

vegetables will help meet familyfood needs at affordable cost.

Another more ambitious projectis part of the government'sintegrated rural development pro-gramme. It includes activities inpublic health, education, sanita-tion and water supply, as well asnutrition in 200 villages.

The UNICEF vitamin capsuleprogramme will still be needed fora while to keep 'raat kaana1 incheck. Project planners recognizethat reaching the entire targetgroup will take many years. Butthe essential first steps are beingtaken.

ta

Other community-based services for children

Safe water supplies and sanitation

Water and sanitation services, andhealth education activities associatedwith them, arc essential to a full-scaJeattack on infant and child mortalityand morbidity. In 1984, UNICEF co-operated with 94 countries in watersupply and sanitation projects, assis-tance totalling about SUS68 million,second only to child health and nutri-tion. The number of new beneficiariesamounted to 14.9 million people forwater supply and 2.1 million for sanita-tion facilities installed through theseprojects during the year. These figurescompare with 15.5 million water sup-ply beneficiaries and 1.3 million forsanitation in 1983.

The mid-point of the InternationalDrinking Water and Sanitation Decadeis approaching—and external fundingis still tailing short of expectations. Inmany developing countries, however,national commitments and inputshave gained considerable momen-tum-Egypt, Nigeria, Bangladesh, In-dia, and Indonesia are a few of diecountries with large programmes. InNigeria, for example, based on the suc-cess of the UNICEF-assisted watersupply and sanitation projects in Imo,Gongola, and Kwara states, the FederalGovernment, with its own resources,is undertaking similar projects in theother 18 states.

UNICEF's consistent advocacy ofmedium and low-cost technology iseven more critical given the globalrecession. High-powered dolling rigscosting US$250,000 to US$300,000arc being successfully replaced bysimpler, cheaper rigs, where rock andsoil conditions allow. Indonesia, withits predominantly soft formations, isusing 100 UNlCEF-supplied smallrotation drill rigs that can be carried orcarted over narrow paths or difficultterrain. These range in price fromUS$3,000 to US$11,000 each. InSudan, hand-held drilling augers cost-ing about US$1,500 each are used.The price of the popular and unprovedIndia Mark II handpump has beenlowered from about US$230 toUS$180 each. UNICEF continues toco-operate closely with the UNDP/

World Bank Global Project on Hand-pump Testing and Development. Onlyin operation for a few years, this pro-ject has already resulted in a noticeableimprovement in the quality and opera-tion of the most commonly usedhandpumps.

Maintenance, continuous operationand use of water and sanitation systemscontinue to be a serious challenge.Maintenance plans are now written in-to all projects, but provision of spareparts, transport, fuel, and appropriateremuneration for workers have allproved to be serious obstacles. Whencommunity motivation is strong.

however, countries report very en-couraging results. A recent survey inIndonesia shows that over 90 per centof the water supply installations are inoperation, maintained, and used. The"Malawi Concept" is one approachthat has proved successful: a group ofusers "owns'1 the water-post (hand-pump or standpipe), is responsible forthe post's maintenance, pays for itsupkeep and generally takes good careof it.

The sanitation component of waterprojects, formerly ignored or mini-mally represented, is now receivingincreased emphasis. Bhutan, thesoutheast Asian countries, Mozam-bique and Tanzania {see profile page 20)have all added sanitation componentsto their water supply programmes.

Maintenance, con-tinuous opemtwnand use of waterand sanitationsystems continue ti>be a seriouschallenge. Villagersoperating n hnnd-pitmp in India.

'NICE!- l)5>S.Vyr.jj«ii..-

19

The how and why TANZANIA

The people of Wanging'ombe arelearning that installing a goodwater supply is just a first stepalong the road to better health. Inthe late 1970s, UNICEF helpeddevelop a major gravity-fed watersystem which tapped the MbukwaRiver for the 43 villages of thisdistrict. More than 80,000 peopleparticipated in the trench diggingand pipe laying. Since then, theyhave taken responsibility for themaintenance of the system.

There is no doubt that the watersupply project is a success. In1980, when water holes, wells, andother traditional sources of waterbegan to dry up, the pipelinesfrom the Mbukwa carried thevillages through. And whendomestic supply points wereestablished in the villages, womenwho used to walk seven kilometresa day for water instead had it,literally on tap, within 400 metres.

But the Wanging'ombe watersupply project hasn't solved allproblems. As much as anything, ithas reinforced the message thatwater alone doesn't make a healthrevolution.

Dr. Marie George Mvungi of theIlembula Lutheran Hospitalattributes a decline in scabies to amore plentiful water supply-villagers bathe more often and c<mattend to personal hygiene. Butwater-borne diseases, whichaccount for over half of all patientvisits and are a major cause ofdeath in the area, have not beeneradicated.

The Mbukwa water is a littlecleaner once it passes throughsedimentation tanks, but it is stillnot safe to drink. Fuel beingscarce and expensive, it has provedimpossible to persuade people toboil their drinking water.Moreover, the hookworm anddiarrhoea prevalent in the area areof faecal origin. Without goodsanitation, the water supplyproject can only have a minimalimpact on health.

The people of Wanging'ombe

have latrines in their houses ornearby, but these are neither safenor secure. Flies can move easilyfrom latrine to kitchen. The bushtimbers used as squatting platesare often eaten away by termitesand the pit walls cave in when itrains. Children and old people,often afraid to use the latrine, usethe fields instead.

Local leaders and visiting techni-cians decided on a pilot scheme toconstruct pit latrines made ofbrick and cement in four villages.As with the water supply project,everything is being done on a self-help basis. The villagers make thebricks themselves. UNICEF sup-plies two bags of cement to eachhousehold and supports the localmanufacture of cement squattingslabs.

The next step for Wanging'ombeis health education. "When peopleare asked about the reason forbuilding a better latrine, most willsay it prevents diseases," says Dr.Mvungi. "But the)' are unable toexplain how or why a latrine doesthis. It is no use having someonebuild a good latrine if he is nottaught how and why to use it."

Furthermore, in a number of coun-tries, UNICEF-assisted programmesno longer limit sanitation solely toexcreta disposal, but have broadened itto include garbage disposal, foodhygiene, vector control, and otherefforts to keep the environment cleanand properly functioning. In a numberof countries, health and hygieneeducation activities have been initiatedwithin the framework of primaryhealth care, and UNICEF is takingsteps to ensure that this element is in-eluded in all new water and sanitationprojects by 1986.

Water supply and sanitation projectshave proved an effective entry point forhealth and community developmentactivities. Almost everywhere, thetraining of village-level workers hasprovided an opportunity to promotesimple health practices, like oralrehydration therapy. In Guinea,Sudan, Tunisia, and many other coun-tries water supply projects have sparkedhome gardening activities. Familiesable to produce their own fruits andvegetables have diversified their dietand improved their nutrition.

Community involvement has beenstimulated through the efforts ofmotivated specialists and village-levelworkers. In the Nepal project, theeffective communication of local tcch-

20

The sanitation component of water projecft, forflterfy ignored or minimally represented^ isnow receiving increased emphasis.

nicians has led not only to a 75 per centacceptance uf latrines by villagers, butalso to the inauguration of village soapproduction for better hygiene.

Training continues to be a major partof UNICEFs project assistance inwater and sanitation. Trainees includelocal-level technicians, drillers, plumb-ers, masons, sanitarians, village pro-moters, and water-systems operators(especially handpump caretakers).Practical on-the-job training is carriedout directly by UNICEFs 140 waterand sanitation project staff in the field,or indirectly, through thousands oftrainers who have been trained with

UNICEF support. On a more limitedscale, training at institutions and thebuild-up of training institutions is alsosupported by UNICEF. In Sudan,UNICEF contributes significantly tothe Wad Magboul Training Institutefor rural water technicians, whichserves not only Sudan, but Djiboutiand Yemen as well. In Maputo,Mozambique, UNICEF supports thetechnical training school. UNICEF isalso helping Bhutan in die develop-ment of its own in-country trainingfacilities, as well as assisting in thetraining of Bhutanese at institutions inIndia and the United Kingdom.

UNICEF pays particular attention tostrengthening the role of women inthe context of water and sanitationprojects, the results of which arealready evident in some project areas.In Pakistan, for example, in a bolddeparture from traditional practice,female as well as male sanitation pro-motors are being trained for the firsttime. This is part of a national effort totriple the percentage of adequate watersupply to rural populations from 20 to60 per cent, and to raise rural sanita-tion coverage from a quarter of one percent to 14 per cent by 1990.

In some parts of the world, popula-tion increase and the subsequentpressure on land, has led to deforesta-tion, erosion, and degradation of thesoil, accompanied by falling watertables, the drying up of springs, anddeteriorating water quality. Attemptsare presently being made to see howenvironmental education could be in-troduced or intensified in UNICEF'sother work in water supply andsanitation. D

WATER ANDSANITATION:In 1984 UNICEF

co-operated in programmes tosupply safe water and improvedsanitation in 97 countries:39 in Africa, 21 in theAmericas, 28 in Asia and 9 inthe Middle East and NorthAfrica regioncompleted approximately80,382 water supply systems,including 72,660 open/dugwells with handpumps,1,3^9 piped systems, with3,780 motor-driven pumps and2,593 other systems such asspring protection, rain watercollection and water treatmentplantsbenefited some 14.9 millionpersons from its rural watersupply systemscompleted 289,633 excretadisposal installations benefitingsome 2,147,300 people

I]

Formal andnon-formaleducation

Educational programmes provide themeans by which the individual poten-tial of the child can he fulfilled. Theeducation of women in particular, hasa powerful effect on child survival anddevelopment. Despite encouragingprogress over the last two decades, alarge proportion of children andwomen in the developing world stilllack a basic level of general education.Three critical factors stand out aspriorities for further advance: (1)reducing inefficiency and wastage inprimary education, (2) improving thequality and relevance of basic educa-tion, and (3) increasing the participa-tion of disadvantage^ groups, in-cluding women.

Even in developing countries with agross primary-age enrollment of 80 percent or more, it is not unusual to findthat only 20 per cent of a given age

group complete primary education.The appalling drop-out rate is relatedpartly to the socio-economic situationof the students and partly to factorswithin the schools.

UN1CEF has tried to help countriesdeal with some of the school-relatedproblems through better preparationof teachers (in Bangladesh, Ethiopia,and Nepal, among others); improvingcurricula and textbooks (Djibouti,Madagascar and Malawi); providingessential supplies or helping the coun-try to produce them (China and Laos);and providing training and transportfor supervisors (Bangladesh and Tan-zania).

It is proving much more difficult todeal with the socio-economic roots ofschool drop-out. A few pioneeringprojects assisted by UNICEF attemptto attune schools more closely to the

School limp-out rate in dcwlopiiiff countrieslias socio-economic roots. A school inMauritania.

student's out-of-school circumstances,as well as to involve the community inthe concerns of the school. For exam-ple, in Burundi, Ethiopia, and In-donesia, non-formal education pro-grammes have been developed as aroute to the higher primary schoolgrades. Other such projects are under-way in Bangladesh, Tanzania, Nepaland Syria.

The continuing African crisisdramatically underscores the need tomake basic education more relevant.In countries where large numbers ofpeople are engaged in a struggle forsurvival, community-based educa-tional programmes linked to theurgent tasks of food production, soiland water conservation, raisinganimals, and meeting the d a i l ynecessities of life are likely to be more

^tfTOEDUCATION:In 1984 UNICEF

co-operated in primary andnon-formal education in105 countries: 43 in Africa,22 in the Americas, 29 in Asiaand II in the Middle East andNorth Africa regionprovided stipends for refreshertraining of some 49,700teachers including 18,600primary-school teachershelped to equip more than64,300 primary schools andteacher-training institutionsand 800 vocational trainingcentres with teaching aids,including maps, globes, sciencekits, blackboards, desks,reference books andaudio-visual materialsassisted many countries toprepare textbooks locally byfunding printing units,bookbinding and paper

22

One thousand opportunities MOZAMBIQUE

Years after independence manyAfrican countries are haunted byattitudes and trappings of a col-onial past. Nowhere are foreigninfluences more pervasive and ofgreater concern than in educationsystems—the foundation of anation's culture and future.

Throughout Africa Ministries ofEducation are importing sophis-ticated educational materials massproduced in the industrializedworld. Often such materials arenot only expensive, but also inap-propriate. Introducing a newscience textbook sponsored byUNICEF and UNESCO, oneMalawian Ministry of Educationofficial pointed out that"understanding science meansunderstanding your immediate en-vironment. Importing chemistrysets designed for western schoollaboratories, he noted, does nothelp. "Look around you," he toldteachers, "you will discover thatthere is all you need to be able toteach science.11

UNICEF has been involved in avariety of projects in Africa todevelop more appropriate reachingaids. In Mozambique, KeithWarren, a UNICEF consultant onteaching aids, is working with anEducation Materials DevelopmentGroup in the Ministry of Educa-tion which includes an artist, acarpenter, and a teacher.

One important aspect of thegroup's work is training teachersto instruct other teachers in themanufacture and use of ap-propriate teaching tools. Ar pre-sent 20 teachers are being trainedto make low-cost teaching aids.UNICEF has provided each in-structor with US$20 kit of toolsincluding two knives, a sharpeningstone, hacksaw blades, nails, files,and pliers.

Educational aids can be con-structed from the simplest andmost widely-available materials.An abacus is made from a bambooframe with clay beads. A model ofthe solar system is formed withpapier mache balls and wooden

discs. A light bulb filled withwater becomes a lens for amakeshift slide projector. SaysMr. Warren: "Although there area hundred problems, there are athousand opportunities."

Field testing is important. Thetypical schoolroom in Mozambi-que is an open shed with a dirtfloor. Teachers have neitherblackboards nor writing paper, sothe environment must become alaboratory for improvisation.

Although teachers-and evenchildren themselves-can makesome educational aids, productionunits are more efficient for majorquantities. A local branch of theMozambican Women's Organiza-tion, for example, started a co-operative which makes cfay tettersand animals for literacy classes cmconsignment by the Ministry ofEducation. The Government en-courages the establishment of such

small-scale enterprises: they rein-force the country's effort to con-serve foreign exchange.

Another money-saving initiativeis the use of factories currentlyoperating below capacity becauseof a shortage of raw materials. Thefactories also have valuable wasteproducts - small sheets of metal,tubing, plywood. 'To them it'srubbish," says Keith Warren, "tous it's prime material.'1 One fac-tory is already making rulers fromspare metal plates. The potentialfor such initiatives is almostunlimited.

Still old prejudices persist. Manyteachers were schooled under col-onial systems, where they learnedto look down on anything "home-made". "Designing the teachingaids is the easy part," he says."Persuading the teachers that theyarc nor second best is a muchmore difficult problem.1"

I ' M < H 1I).V,K-|-U ",u,

I -

effective rhan conventional schools.Experience in Africa and elsewhere,unfortunately, shows that such a prac-tical system will not be acceptable topeople as long as a parallel conven-tional system leading to privilege andhigh rewards for the elite is preserved.It takes political courage and creativeinnovation to break away from con-ventional patterns, a courage alreadyevident in programmes supported byUNICEF. In Indonesia, capital andtraining have been provided for smallbusiness activities to groups par-ticipating in non-formal programmes.In Thailand, Tunisia and Turkey, awork-oriented curriculum has been in-t roduced. In several countriesUNICEF is helping extend adultliteracy and training programmes toolder children who missed out on for-mal education opportunities.

Many country programmes havebegun to introduce child survival anddevelopment materials into primaryeducation and literacy programmes.Examples include a nutrition guidebook for primary teachers in Burundi;Arabic and French material on healthand nutrition for primary schools inMauritania; and a manual on water useand sanitation for Gambian schools.

Because women are the primary care-takers of children, educating them iscritical to the success of a child survivaland development programme. Family-life education projects, which combinegroup self-help activities with educa-tional subjects of particular concern towomen, are assisted by UNICEF in anumber of countries, including Egypt,Ethiopia and Haiti. In Nepal, awomen's education project helps sup-port the training of girls from ruralareas who choose to become primaryschool teachers in their own com-munities. In the Philippines, teachershave been trained and special instruc-tional materials developed for literacyclasses among children and women ofethnic minorities in nine of the mostisolated communities of Luzon andVisayas islands. Ethiopia has beenexperimenting with Basic Develop-ment Education Centres, a pro-gramme that combines education andself-help in remote areas withoutregular schools. A number of coun-tries, however, are finding it difficult toreach the most educationally disadvan-taged, usually those who have beenbypassed in other spheres of develop-ment as well. Only special and persis-tent efforts can reach them.

The Executive Board, at its 1984 ses-sion, endorsed a comprehensive ap-proach to early childhood develop-ment that included attention to thechild's cognitive and psychologicaldevelopment-particularly early child-hood stimulation-as well as healthand physical growth, UNICEF hostedan informal consultation in Octoberamong concerned international andbilateral agencies and foundations, andcollaborated closely with several coun-tries-including Haiti, Indonesia,Malawi, Venezuela, and Zambia—indeveloping and assessing policies to dowith early childhood programmes. InMauritius, UNICEF is co-operatingwith the United Nations Develop-ment Programme (UNDP) in insti-tuting a nation wide pre-school pro-gramme. Under the auspices of theNational Family Planning Board in In-donesia, a pilot project in earlychildhood stimulation is being carriedout in three urban and ten rural areasand is seen as a model for nation-widereplication. In the Philippines, an EarlyChildhood Enrichment Programme isabout to be substantially expanded,1000 day-care attendants and 2000rural improvement club leaders havebeen trained. All UNlCEF's earlychildhood development initiatives takeinto careful account UNICEF's othereducational and health policies. D

Urban community-ba s<

U N I C E F in 1984 suppor tedcommunity-based activities in theslums and shanty-towns of more than50 countries. New statistics highlightthe seriousness of rapid urbanizationthroughout the developing world. Forexample, in Africa urbanization is pro-ceeding much more rapidly than hadbeen previously realized. In Botswanathe annual urban growth rate is 15 percent; in Lesotho it is 16 per cent.Djibouti is now 74 per cent urban.Mauritius and Zambia follow closebehind at 52 and 44 per cent respec-tively.

Awareness of, and access to, birth-spacing methods by poor urbanwomen has become an urgent issue,not only on grounds of health andwelfare, but because more than halfthe urban growth in developing coun-tries is due to natural increase, ratherthan rural-urban migration as is com-monly supposed.

Malnutrition remains one of themost serious problems among urbanchildren. Food intake in slums and

Child SMvrral imd development measuresform the ccnv of most urban community-based fnvjp'ammfs.

24

sed services

squatter settlements in various cities isordy half to two-thirds that of the cityaverage. The decline in breast-feedingremains serious: working mothersoften find it difficult to continuebreast-feeding. Since the urban poorare directly involved in the casheconomy, the global recession has ex-acerbated their situation. In view ofthese factors, child survival anddevelopment measures now form thecore of most UNICEF-assisred urbanprimary health care programmes andhave generated a considerable degree ofenthusiasm.

Asia and Latin America are theregions with the most extensive andbest established UNICEF-assisredcommunity-based urban services pro-grammes. India now has UNICEFslargest programme of urban assistance,reaching more than 20 cities andtowns, and the government andUNICEF have been discussing astrategy for universal coverage in thetowns of two states. The Philippineshas three urban projects which focuson organizational development,leadership training, and communityparticipation. Particularly effectivecommunity-based health projects arebeing carried out under the auspices ofgovernment and non-governmentalagencies in Manila, in Quezon Cityand Davao City.

The sanitation project in Karachi,Pakistan, is an example of the catalyticeffect assistance can have: from 1979to 1983 UNICEF helped construct421 latrines in the project area; thepeople, on a self-help basis and usingdie UNICEF design, built another1,346, including 500 in the past year.

In Latin America, the urban com-munity-based sen-ices programme inHaiti has become fully operational, in-cluding a strong water and sanitationcomponent. The urban primary healthcare project in Guayaquil, Ecuador ex-panded its coverage this year. Par-ticipants in the Joint UNICEF/WHOConference on Urban PHC visited theproject. The project relies on pro-motwas, locally-recruited women whoreturn to serve in their own neigh-bourhoods after training. Jamaica islaunching an urban basic sen-ices pro-gramme in Kingston under a notedproject funded by Canada. Argentina

UNICEF attempts to n'coqnize and deal with the practical reality of working children incities. A child nwlter in El Salvador.

has formulated a project plan forBuenos Aires which will cover 300,000people.

As Africa becomes increasinglyurbanized, the need for community-based urban sen-ices projects has beenmade evident. The urban PHC projectin Addis Ababa, Ethiopia, is an idealmodel in its conception. Under theleadership of the Mayor and the CityCouncil and with the active participa-tion of the city's 284 communityorganizations, a programme is now inprogress to cut infant and child mor-tality' in half by 1988. Child survivaland development measures are theheart of the programme: immuniza-tion, oral rehydration, breast-feedingand improved infant feeding practices,and growth monitoring. Recruitmentand training of community healthagents and volunteer neighbourhoodhealth animators is under way and anetwork of health stations and clinics,backed up by referral jnd zonalhospitals, is being es tab l i shed .Already, with UNICEF assistance,100,000 children have been coveredby oral rehydration therapy and thereare plans to extend coverage to an addi-tional 200,000.

Current estimates place the numberof abandoned or destitute children in

the tens of millions. The problem isparticularly acute in Latin America andsome cities of Asia and Africa. Inresponse, UNICEF has developed ten-tative programme guidelines for workwith abandoned and destitute chil-dren . These emphasize preventivemeasures which can be carried out atcommunit)'-level and provide alter-natives to placing children in institu-tions. UNICEF has been supportingspecific programmes in Brazil, CentralAmerica, Mexico, Colombia, Ethio-pia, and the Philippines. In addition, ithas organized and supported a numberof meetings to explore the issue fur-ther. A study is being prepared andwill be incorporated in the report on"Children in Especially Difficult Situa-tions" t,o be submitted to the Exec-utive Board in 1986.

Another issue is children and work.W h i l e the International LabourOrganisation has promoted conven-tions controlling or eliminating childlabour, UNICEF has favoured pro-viding basic services to workingchildren while taking measures againsttheir exploitation. The UNICEF ap-proach attempts to recognize and dealwith the practical reality of workingchildren in cities. This issue is beingexplored further and also will bediscussed in the 1986 Board paper, n

25

UNICEF in action: programme con-<sa

The programme commitments shown on this map arc for multiyear ^periods, and are exclusively rhosc from UNICEFs general resources.Those commitments being proposed to the April 1985 Executive Boardsession .arc indicated in colour, and should be regarded as tentative.

In the case of certain countries, particularly those where a specialprogramme has resulted from drought, famine, war or other emer-gency, the level of already funded supplementary programme com-mitments is high enough to make a significant difference to the sizeof the overall programme. However, since many projects "noted"and approved for supplementary funding are not yet funded, onlythose programme commitments from general resources are shown.

Higher-income countries, where UNICEF docs not have aspecific commitment from general resources over a givenpcnod, but co-operates in flic provision of technical oradvisory services, are shown without programmeamounts or durations. The 1983Executive Board approved a blockcommitment of US$2 millionover a two-year periodfor these countries.

U9B&-»y

ogether, UNICEF current!in 117 coentries: 43 in Africa; 3'

r̂*-'̂ , 11 in the Middle Easi

\

COLOMBIA1984-87: S 5,790,000ECUADOR1984-85: $916,000GUYANA1981-84: $544,000SURINAME1975-79: $130,000PERU1982-85: $3,000,000PARAGUAY[985-89: $989,000

CHILE1985-87: $206,000

1-Includes Saint-Vincent and the Grenadines, SaintChristopher and Nevis, Grenada, British Virgin IslandsMonrsvirat and Turks and Cakos Islands.

2 In addition 1984-1987: $1,950,000 for Palestinians.

3 Dotted line represents approximately the Line ofControl in Jammu and Kashmir agreed upon by Indiaand Pakistan. The final status of/ammu and Kashmirhas not yet been agreed upon by the parties.

* Includes Cook Islands, Fiji. Kiribati, Niuc,Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu,Vanuatu, and Federated States of Micronesia,Marshal] Islands and Palau.

The boundaries and names on this map do not imply officialendorsement Of acceptance by the United Nations.

GUATEMALA1983-86: $2,518,000HONDURAS1984-86: $616,000EL SALVADOR1985-87: S852.000NICARAGUA1984-85: $315,000COSTA RICA1985-89; S24K.OOOPANAMAI98,v87: $147.000

CUBA1983-86: $178,000JAMAICA1986-88: $138,000HAITI1982-86: $5,114,000DOMINICAN REPUBLIC1984-87: $1,405,000

r EASTERNCARIBBEANISLANDS1

1984-88: $1,500,000

ANTIGUA ANDBARBUDA1983-85: $70,000DOMINICA1982-85: $83,000ST. LUCIA1983-85: $75,000TRINIDAD &TOBAGO

- BARBADOS

BRAZILIWWI7

52,h71.000

BOLIVIA19S4-89

V i . l H K M H i U

TUNISIA1983-86: $1.507,000MOROCCO1981-85:57.612,000

MAURITANIA1982-86: $1.995,000

CAPE VERDE1982-85: $252.000

LIBERIA1982-84: $1BURKINA1985-87: $3IVORY COAST1986-90: $1,998,GHANA1985-90: $8,5TOGO1984-88: $3.BENIN -

533

1985-88: $3,154,000

. 'i •&CBi ;

26

nmitments in the developing world

SYRIAN ARAB REPUBLIC 1982-84: $1,460,000^,— LEBANON 1980-82: S630,OOQ2

_ JORDAN 1982-84: $547,0002

ItiER -

iCHAD

EGYPT1985-89

.SI 3.371,000

SUDAN1981-85

AFGHANISTAN1978-82

$19,366

x>

ERIA3-85id.UOO

322,750,000

— K'UWAIT

BAHRACJ tJ*'1**

UNITEDARAB , •_ -i * \ v'

EMIRATES — O M A N: - > X S • ! " ' ' ( ) $3fHI,000

YEMEN1985-86:$!, 590.;

DEM. YEMEN1985-90: S3,550,000^

^tfjIBOUTIW 1986-90: 5206,000

ETHIOPIAW84-88

$2-7.956,000

ZAIREI982-K5

SOMALIAr 1984-87: $5,035,000

'UGANDA1987-90: 510,305,000

.JAflON

\NGOLA19S1-83

•-2,625,000

illJ.166.UUU. i_

BURUNDI—

S'8^-0()0 UNrtEDW J^PUBLIC Of-:' \TANZANIA

• | 1983-8P. '«J3.427,(M)ll

-KENYA1987-89: S6.366.000

RWANDA1983-85: $2,186,000

^x^ ;t

«

MALDIVES1982-87

5159,000

AMADAGASCAR

WHa-yu.083.000

SEYCHELLES1984-86: $124,000COMOROS1985-87: $178,000MAJLAWI1984-87: $5,724,000MAURITIUS1983-85: $420,000

ZIMBABWE1984-86: $4,260,000MOZAMBIQUE1985-90: $13,370,000SWAZILAND1985-88: 5594,000LESOTHO1982-85: $1,203,000BOTSWANA1984-86: $486,000

INDONESIA'/ 'l<*85-tjQ: SMiOK.OOO J

REPUBLIC OF KOREA1982-86: 52,716,000

BURMA1982-86: $27,000,000

BANGLADESH1982-85: $50,000,000LAO PEOPLE'SDEMOCRATIC REPUBLIC1982-86: $4,256,000THAILAND1982-86: $14,740^000PHILIPPINES1984-87: $,10,827,000KAMPUCHEA

aVffe: $2,020.000".VIETNAM1983-86: $27,142,000MALAYSIA1983-84: $1,062,000PAPUA NEW GUINEA1983-85: $591,000

East Timor

ZAMBIA 1984-86: $1,477,000

CONGO 1984-86: $334,000

SAO TOME AND PRINCIPE 1981-84: 5192,000

CAMEROON 1985-90: 82,747,000'"

EQUATORIAL GUINEA 1984-87: $374,165

CENTRAL AFRICAN REPUBLIC 1984-88: $2,294,00ft

XREGION*

-% r- PACIFIC,

1983-85$1,164,000

4o -,

V

UNICEFs programme expenditttft-iii diflcrcnt countries it.al|6catcd ac-cording to three criteria: iniant ri^oirtality rate (1MR; arm'uil number ofdeaths of infants under one year of age per 1,000 live birfns)1; income Itvel(GNP per capita); and the size of the child population.-fhft year, the IMRcriteria (1983 figures) is shown, as follows:

• IMR 150 and above (7 countries) IMR 50-99 {37 countries)• IMR 100-149 (44 countries) IMR under 50 (38 countries)

Developed countries arc not shaded but most have an IMR under 25.

27

A crafty little character MALAYSIA

The squatter women in Malaysiahave learned to speak torthemselves. At town meetings,they are not only seen, but heard.A few years ago this would havebeen unthinkable; men made allthe decisions and the womenstayed home. Now, through aUNICEF project named "SangKanciP, launched in 13 urbansquatter settlements, they havelearned to sign their names oncheques, do a bit of accounting,and earn their own money.

During the International Year ofthe Child in 1979, UNICEF join-ed forces with Kuala Lumpur'sCity Hall and the respectedgynaecologist, Khairuddin Yusof,and his wife, Khairiah, in an effortto supplement family incomes,provide pre-school education andimprove the health of childrenborn into the poorest communi-ties of the city.

Briefing sessions were held inthe chosen settlements. Eachwoman, Khairiah explained, couldearn about MRS3.50 a day for ahalf day's work binding books,sewing soft toys, or making pot-tery. Consciously designed to

attract only the poorest andkeenest of the women, the paywas relatively low. A nearbyfrozen prawn factor)' paid betweenMRS6.00 and MRS8.00 a day,but the women in the prawn fac-tory were expected to work a fullday and many were forced to locktheir children in the house for theentire time.

The UNICEF project, on theother hand, offered part-timework, special training byKhairiah-an arts and craftsteacher-and supervised day-careand prc-school training for theirchildren. Each day-care centrestands next to a health clinicwhich regularly monitors thechildren's health.

As its merits have become moreobvious, the programme hasgathered momentum. A companyhas been formed with all of theparticipating women asshareholders.

The book-binding works isdoing steady business; the toy fac-tory recently took a MRS4Q,000order from the Malaysian AirlineSystem for soft batik toys. Pro-fessor Yusof reports that the IQ

level of children enrolled in theday-care programmes was recentlyrecorded at 10 points higher thanchildren in similar communitieswithout clay-care.

As expected, the project hasprovoked some grumbling fromthe men in the community. Anumber of youths in onesettlement were outraged to bebypassed in favour of women foran income-generating scheme.Now, with plans for strengtheningthe potter;' works run by women,the 13 communities probably willemploy young men for the heavyduties.

The \Sang KanciP project hassucceeded to such a degree that itis no longer just another pilotproject. Planners and participantsare thinking about how to expandand strengthen activities. The pro-ject is named after a crafty littlefairytale character who can thrivein the jungle despite its size, andit is hoped that the children ofSang Kancil, armed with bettereducation, better family income,improved nutrition and healthcare, will do the same in theirconcrete jungles.

28

Women's activities

Wotnen play a primary role in food productionin African dtmjffht-stricken areas. A co-op&rttive ttiember watering her gardenChad,

co-;•*'

Strengthening women's ability to playtheir essential role in child survival anddevelopment continued to be an in-tegral element of UNICEF co-operation. An analysis of current pro-grammes reveals the following emerg-ing trends in UNICEF support: astronger emphasis on food productionand nutrition, and health-related pro-grammes in drought-stricken areas;combining income generation witheducation/literacy programmes; in-creasing support to national levelseminars and workshops; increasingco-operation with national women'sorganizations; and adopting a long-term development strategy in meetingemergency situation needs.

The food crisis in drought-strickenareas has rekindled an awareness of theprimary role women play in food pro-duction, as well as underscoring thatwomen and children are the prime vic-tims in times of food scarcity.UNICEF supported programmes in an u m b e r of count r ies aimed atstrengthening women's food produc-

tion capacity through access to im-proved agricultural techniques, andbetter credit and marketing facilities(see profile page 30). In Zambia,UNICEF helped the government to:monitor the drought situation; im-prove its collection of data on thenutritional status of women andchildren; re-orient functional literacyprogrammes to educate women inhealth, nutrition, and the planting ofdrought-resistant crops; and trainTraditional Birth Attendants andother health agents. UNICEF is alsoworking with the Zambian Govern-ment on plans to improve the cultiva-tion capacity of households headed bywomen, provide s u p p l e m e n t a r yfeeding programmes for pregnant andnursing women, and underweightch i ld ren , and back ag r i cu l tu ra ldevelopment programmes that in-crease food security at householdlevels.

UNICEF provided seeds and equip-ment for community market gardensin Senegal and Mauritania, where such

gardens are a source of income for alarge number of women, In Senegal,women were trained in managementskills, and food storage and preserva-tion. In Botswana, UNICEF-sup-ported clinics have planted vegetablega rdens to p roduce food formalnourished children and to helpeducate mothers about nutrition. InThailand, a revolving loan fund hasbeen established for community foodproduction and processing activities.

UNICEF support to food produc-tion programmes in Zimbabwe hasbeen extensive. Funds have beenallocated to assist women's groupsengaged in food production, train ex-tension workers and NGO .represen-tatives to treat malnourished children,and supply simple educational aids to

fit SOCIAL SERVICESFOR CHILDREN:In 1984 UNICEF

co-operated in social sendeesfor children in 97 countries:43 in Africa, 23 in theAmericas, 20 in Asia and 11 inthe Middle East and NorthAfrica regionsupplied equipment to morethan 28,500 child welfare andday-care centres, 23,100 youthcentres and clubs and23,700 women's centresprovided stipends to more than13,000 women and girls fortraining in child care,homecrafts, food presen'ationand income-earning skillsprovided stipends to train some97,900 local leaders to helporganize activities in their ownvillages and communitiesprovided equipment andsupplies to 1,000 traininginstitutions for social workers,and training stipends for20,200 child welfare workers

.:"

home economics demonstrators whoprovide nutrition information towomen's groups,

UNICEF continued to supporttraditional income-generating activitiesfor women in many countries. InEgypt, tor example, activities includedsewing, poultry breeding, and sheep-raising. Assistance also has combinedincome-generation with education andliteracy programmes. In Zimbabwe,UNICEF granted funds to participantsin a literacy programme to initiate theirown economic activities. In Indonesia,support strengthened the productioncapacity of rural groups involved inself-help literacy and income-generation efforts.

UNICEFs growing commitment tonon-traditional income-generating ac-tivities for women is evident inPakistan, where it supports stone-carving, candle-making, and the con-struction of low-cost ovens. In Laos,UNICEF is financing a tour to Indiafor a women's group that wants tolearn how to manage village-levelweaving co-opcrativcs. These andother programmes represent a shiftaway from the ^welfare" approach inwomen's income-generating activitiesto one that emphasizes productionsystems and self-reliance.

Support for child care is another im-portant area of programmes forwomen. In a number of countriesUNICEF is providing supplies andequipment to child care centres andgrants for the training of child-minders. In parts of Ethiopia, child-care centres, by freeing mothers fromfull-time child care, have enabledwomen to become members of localproducers1 co-operatives. The centresalso provide an entry point tor the in-troduction of other community-basedsen-ices.

In Morocco, the Foyers feminins offerchild care services, while trainingmothers in income-generating skills.In the Dominican Republic, China andThailand, UNICEF has been suppor-ting the training of pre-school educa-tion promoters-training which en-courages the development of leader-ship skills among rural women. InThailand, UNICEF is assisting anexperimental programme to develop anation-wide system ot pre-school care.

Increasingly, co-operation with na-tional women's organizations is beingemphasized, as they are effectivevehicles through which to promotechild survival and development prac-

An appetite for change

Women are the backbone of thisharsh mountainous country. Onerecent survey showed that women

loan. Now, with UNICEFs help,this programme has been expand-ed to include women.

contribute half die householdincome, men 44 per cent, andchildren aged 10 to 14 theremainder. Yet barely 5.6 per centof Nepalese women have time oropportunity for an education;only rarely does a woman ownproperty in her name; and almostnever does she make a decision onimportant matters such as moneyor community needs.

A number of women in fiveNepalese communities have era-barked on a process aimed atredressing some of these ine-quities. Since the mid-seventies,Nepal's Agricultural DevelopmentBank (ADB) has spearheaded ascheme to make commercial loansavailable to groups of poor farmerswho can, collectively, guarantee a

At first, it was difficult topersuade women to form activeself-help groups. Sri Laxmi, amiddle-aged mother of fivechildren who lives on a small farmoverlooking Budhanilkantha,recalls the initial reaction of localwomen to Bhisma Ojha, awomen's group organizer.

"When Bhisma Ojha asked us toborrow money we tira of all saidthis was the business of the men.They are the people with time togo to die bank. Women have toomuch work to do. We do notknow about writing or filling thebank's forms. But Bhisma kept oncoming up here; she brought theforms here. She wrote on them forus. She told us we could use thebank's money to buy goats and

30

NEPAL

chickens and she said that hermoney was cheaper than the villagemoney lender's. She did alj of thisfor us, so in the end we agreed."

The group of women formednaturally. For years they'd workedside by side in each other's paddyfields, sowing and reaping rhe riceharvest. They'd gathered woodtogether, collected water together,and watched their children growup together.

Using the loan money thewomen have raised goats andchickens, bought beehives and fer-tilizer, and materials for makingpaper files they subsequently soldto the local ADB office. Theoriginal loan has been fully repaidand they even have a group sav-ings account in the ADB thatBhisma set up for them. TheADB is quite satisfied: repaymentrates from the women's groups aresignificantly higher than from themen's groups.

The economic successes of thewomen's groups helped breed anappetite for further change. Loansat each of the project sires nowcover a multitude of communityneeds, including a drinkingwater system, latrines, and a com-munity centre where literacyclasses can be held. UNICEF hasprovided trained support staff tohelp establish community projects.A special consultant has been con-tracted to develop a health com-ponent which will integrate themain elements of the Child Sur-vival and Development Revolutioninto everyday village life.

Bhisma Ojha says: "The womenin Budhanilkantha say that thebank has changed their lives. Theydid not believe that they couldtalk about money the way they donow. They did not think theycould have such ideas about howto change things. When I camehere four years ago, I could notfind a single woman who was inte-rested in joining our 'small far-mers' group. Today, the womenare beginning to come to me."

tices. In 1984, UNICEF establishedcontact with women's organizations inIraq, Indonesia, Syria, Somalia, andLaos among other countries and isproviding technical support to suchorganizations to strengthen theircapacity,

Workshops and seminars in anumber of countries explored suchmatters as the impact of the economicrecession on women's programmes;women and health; women and themedia; and strategies and programmepriorities for women.

UNICEF field offices continued toreport various problem areas in im-plementation and management: short-age of technically-qualified staff; poorsu pervision and monitoring; slowrelease of government funds; and, inhardship areas, decline in communitycontributions. In addition, some pro-grammes fail to recognize the need todraw women into the mainstream ofdevelopment. Ul t imate ly , forwomen's programmes to succeed, theymust equip women to play a full partin community life. D

Childhood disabilities

Prevention andrehabilitation

UNICEF-assisted activities for theprevention and rehabilitation ofchildhood disabilities have increasedsignificantly since 1980, when theExecutive Board broadened UNICEFsapproach after re-examination of thepolio' on childhood disabilities. Manycountries already supported immu-nization against infectious diseases,provided vitamin-A and other nutri-tion supplements to children, and

trained traditional birth attendants.UNICEF's policy was expanded to in-clude the need for more effectiveprevention of childhood impairments,the need to reduce the effects ofdisability through early detection andintervention, and the need to use thefamily and the community as the pri-mary means of service delivery.Accordingly, UNICEF is working tohelp countries implement the policy'and, within the framework of primaryhealth care, to devise affordable familyand community services for childrenwho arc handicapped.

UNICEF is working to devise affordable family and community s&vicesjvr distillledchildren. A blind child at school in Mali.

3]

A few examples will illustrate the in-tegrated approach UNICEF is helpingcountries pursue. In Sri Lanka,prevention and rehabilitation are partof a district development project. Asmany as 20 per cent of the schoolchildren surveyed had acquired disabl-ing impairments, in most cases becauseof inadequate immunization. Trainingfor community level workers hasbegun. Workers in the programmehave concluded that a change in theJevcl of childhood disabilities will be apowerful indicator of the success orfailure of other UNICEF-assisted pro-grammes. In India, together with theMinistry of Social Welfare, UNICEF isworking with more than 30 non-

governmental organizations to in-tegrate community-based preventiveand remedial measures into the In-tegrated Child Development ServicesProgramme, which covers a popula-tion of more than 100 million people.

In Botswana, UNICEF is supportinga project which includes training inchildhood disability detection torprimary school teachers. In Nicaraguaand the Philippines, teachers, healthworkers, and community workerswere trained in disability detec-tion , intervention and prevention.Assistance was also provided forteacher training materials related tochildhood disabilities in Sudan, Syria,and Mauritius. D

Appropriate technology

Appropriate technology is an integralpart of a community-based pro-gramme strategy with the goal ofenabl ing people to control andimprove the i r own lives. Oversixty UNICEF-assisted country pro-grammes, representing all regions ofthe developing world, now includeappropriate technology components;Chile, Ethiopia, Kenya, India, In-donesia, Mexico, Nepal and Senegalhave s u b s t a n t i a l a p p r o p r i a t etechnology components. The EasternMediterranean and North Africaregion has just begun an appropriatetechnology programme. Activities in-clude developing technologies relatedto food production processing andstorage; health and sanitation; waterresources, building materials; and newand renewable sources of energy.

In several countries, new fuel-efficient stoves have been introducedto address the problem of the high costand scarcity of firewood. Metal-working artisans in Rwanda have beentrained to make improved traditionalcharcoal stoves and these are sellingwell in the shops. Fuel-efficientsmokeless stoves are being introducedin several countries, including Ethiopiaand Nepal.

Unsold fresh fish from the day'scatch in Ghana are preserved in theimproved traditional fish drying and

smoking units, the "chorker", thensold in the cities. It is a useful sourceof protein in special foods for youngchildren, including weaning food. InThailand, an innovative project forfish breeding and distribution hasresulted in the increased availability ofhigh-protein food for children and im-proved breeding techniques.

Over 200 dicscl engine-driven small-scale cereal and legume milling unitsset up in rural areas in several Africancountries are not only reducingwomen's food preparation time, butarc also providing valuable businessopportunities for the women's groupsthat run the majority of the mills.A few management and accountingproblems exist, but the initial technicalproblems have been resolved. Poten-tial exists to mill local grains andlegumes for the production and pro-motion of special foods for youngchildren.

As a result of a UNICEF/WHOevaluation of midwifery kits andmaterials provided for pregnancy andperinatal care, equipment is beingeliminated or changed for moreefficient use. A system of periodic fieldassessments is being instituted.

In autumn 1985, a global workshopon appropriate technology for primaryhealth care will meet in Sri Lanka tochart future developments. D

Programme sup]

ProgrammecommunicationThe use of communication forms anintegral part of advocacy and pro-gramme implementation, and is criticalto successful programm ing at thecountry level. This is achieved throughinternational, national, and commu-nity mobilization and educationthrough the use of mass-media andinter-personal communication and itsuse is evident throughout this report.

In Colombia, UNICEF assisted a na-tional immunization campaign inwhich an estimated one million smallchildren were immunized against tourmajor childhood diseases. Without theintense involvement of the print andbroadcast media., such numbers wouldnot have been reached (see profilepage 14).

In Nigeria, UNICEF staff workedwith media and communication orga-nizations, as well as with governmentauthori t ies and local traditionalleaders, to involve mothers in animmunization campaign in the Owoarea. The objective: to make mothersaware of simple technologies thatreduce infant mortality. The impactwas profound-the number of fullyimmunized children rose from under10 per cent in August 1983 to over80 per cent in August 1984 (see profilepage 15).

In Oman, a communication surveywas conducted in co-operation withthe Ministry of Information and othergovernment bodies. An overall com-munication strategy to launch pro-grammes focusing on ORT, immuni-zation, and growth monitoring wasdeveloped. In Bangladesh, UNICEFcollaborated with governmental andnon-governmental agencies in launch-ing an ORT campaign covering42 districts. A multi-media marketingplan was adopted to disseminateknowledge on home preparation oforal rehydration solutions. Media cam-paigns to promote breast-feeding werecarried out in Ivor)' Coast, Haiti, andthe Philippines. In Indonesia, co-operation continued with governmentauthorities in, the production of apopular television puppet scries.

In Mozambique, the social cnmmu-

32

port activities

»

nications programme started withUNICEF assistance some years ago wasextended to 83 villages in six of the na-tion's 10 provinces. The objective is toestablish village-level expertise invarious areas, particularly health, andro assist in the development of localplanning capacity. Village-level train-ing is coupled with a mass media cam-paign, operating through nationalbroadcasting networks, the pr in tmedia, and mobile teams usingvehicles equipped with loud speakers,film projectors, photographic exhibitsand puppet theatres. Many of the ac-tivities have been successfully im-plemented through the Mozambicanwomen's organization. This pro-gramme is creating a network throughwhich to earn' child survival anddevelopment messages to all levels ofthe society, particularly to the villages.

Monitoring andevaluation

In 1984, the Executive Board reaf-firmed the importance of evaluation ac-

Cofwttunfcation helps promote simpletechnologies to reduce the IMR.

tivitics. UNICEF moved to strengthenits own capabilities and those of its na-tional partners, assist in the collectionand analysis of programme relatedevaluative information, and improveretrospective and on-going evaluation.

Most field offices gave high priorityto strengthening their monitoring andevaluation capacity- In NepaJ, for ex-ample, a system to monitor up-to-dateinformation on project output andnumber of beneficiaries was intro-duced. In Kenya, a social impactappraisal system is currently beingrefined; in Thailand, a village-basedsystem to monitor the health status ofpregnant women and pre-school chil-dren is being tested.

Several offices experimented withmicro-computers to track project in-puts and results. At Headquarters, atask force has been developing a systemfor the storage and ready retrieval ofproject information from existingfinancial and supply records.

At the national level, several trainingprogrammes have helped strengthen

the capacity of UNICEF staff andgovernment officials in evaluation. Forexample, primary health care evalua-tion workshops were held in Bangkokand Hargeisa (Somalia). Other effortsarc underway within the context ofprogramme implementation. In SriLanka, for example, UNICEF is help-ing to strengthen the government'scapacity to monitor the impact of childsurvival and development interven-tions. In Egypt, a proposal is beingdeveloped that will lead to die creationof a child health status monitoringsystem.

Mortality studies have been con-ducted in Afghanistan, Zaire, IvoryCoast, Chile, and Tunisia and areplanned elsewhere. The Social Assis-tance Secretariat in Mexico is beingassisted to study ways in which labour,legislative, economic and other factorshave influenced the decline in breast-feeding. These are just a few of themany evaluative activities now incor-porated in UNICEF-assisted pro-grammes.

Most of the evaluations undertakenduring 1984 concentrated on priorityprogrammes related to Child Survivaland Development. EPI evaluationswere conducted in many countries,including Liberia, Sao Tome and Prin-cipe, Ivor)' Coast, Zaire, Comoros,Rwanda, and Syria, The results em-phasized the need to increase coverageand address deficiencies in cold chainsystems, training, health education,and transportation.

Evaluations are also being conductedin other sectors, including evaluationsof a cash-for-work project and an out-of-school education project in Ethio-pia; the impact of social communica-tions on basic health practices inBurundi; a primary education projectin Madagascar; and small industrialprojects and training of traditionalbirth attendants in India. Projects arebeing reformulated to address deficien-cies identified by die evaluations.

Many evaluations are being con-ducted jointly with other UN agenciesand other donors. In Angola, forexample, a joint evaluation of the firstphase of a water project includedUNCDF, UNDP, UNICEF, and theGovernment. UNICEF's assistance tothe essential drugs programme inBangladesh was reviewed w i t hSIDA/DANIDA. In Indonesia,Malawi, Lesotho, Haiti, Tanzania,Burma, Dominica, St. Vincent,Ethiopia, Sudan, and Mozambique

33

Broadcasting Health THAILAND

Twice a day, villagers fromMacha 3 and Maeha 5, two smallnorthern Thai settlements, can hefound in front of the local temple-discussing crops, children, andcommunity activities. IntongIntarawero, the Buddhist monkwho runs the temple is pleased tosee them there, although heknows that they have not comefor his blessings alone.

Before and after the day's workin the fields, the temple loud-speakers carry the familiar voicesof Boworn Buttawajana and SawatPankeon, graduates from ChiangMai University, who have cometo Macha with some otherteachers to launch this pro-gramme. They relay a host ofmessages from the outside world,including hints about cropmanagement, animal husbandry,cooking, food preservation, nutri-tion, and child care. They also talkabout subjects tike personalhygiene and family planning, sub-jects which young health workersarc sometimes reluctant tointroduce in their tace-to-facecontacts with villagers.

Since 1977, UNICEF has sup-ported government efforts to trainmore than 380,000 Village HealthCommunicators (VKCs) and39,500 Village Health Volunteers(VHVs) to introduce primaryhealth care methods in three-quarters of the nation's villages.At first,, many volunteers andcommunicators are still unsure ofthemselves and of how their newideas will be received. By reinforc-ing health and nutrition messages,and promoting the status of thehealth care workers, Boworn andSawat help open the villagers'minds and doors to the VHCsand VHVs.

This kind of support might wellbe crucial to the success of thenational primary health care effortin Thailand. One UNICEF surveyfound that although the drop-outrate of health trainees has beenvery low—around 7 per cent—asmany as 30 per cent did little or

no work when they returned tothe field after training.

Watana Tunwai, one of the fourVHVs in Maeha 5, says thebroadcasting programme has madea lot of difference to her. Watanabelieves that ignorance, not foodshortage or poverty, is often thereason for poor health in hervillage. "Some people are just notaware of the need for a balanceddiet," she says, "some of thepoorest families in the villagenever suffer malnutrition becausethe mothers have the skills tobalance a diet even with small in-comes. These mothers have a lotto offer others," The broadcastshave already stimulated discussionin the village. Watana is hoping touse the broadcasts to form discus-sion groups and encourage peopleto share their experience.

In addition to the broadcastingprogramme, the teachers fromChiang Mai have set up a readingcentre in a small thatched hutnear the temple. They gathereddozens of magazines and comicbooks to establish a library.Posters on nutrition, messages on

the need for clean water, andother subjects cover the hut walls.

Mrs. Prance Thaiwatananont,who trained these teachers atChiang Mai and heads the adulteducation extension programme,pioneered both the broadcastingsystem and the reading centres.She is convinced of the importantrole they can play in educationand development.

Although there is one primaryschool for every two villages inThailand, UNICEF has found thatalmost one third of those whograduate from primary schoolrevert to functional illiteracywithin three years, largely for wantof materials or other incentives tocontinue reading. In Maeha therewere no newspapers or booksbefore the teachers arrived. Nowinterest is picking up and parentsand their children have begun tovisit the reading centre.

"The teachers and the broadcastscan help to change many things,"says Watana. "To get things go-ing, everyone must be thinkingand talking about the issues all thetime."

I ' N I l H MON.1 S m i i l i

;>4

other examples of collaborative evalua-tion abound.

To improve the use of knowledgegained from evaluation, the followingproblems must be overcome, includ-ing the diversity of evaluation reportswhich makes comparability difficult;the absence of systemic reporting pro-cedures; the lack of an adequatestrategy for disseminating informationderived from reports; and the lack ofadequate staff and financial resources.UNICEF is addressing these problemsin 1985,

Technical co-operationamong developingcountries

In 1984 UNICEF actively supporteddeveloping countries in the exchangeof knowledge, experience and tech-nical skills relarcd to health, nutrition,and other needs of children.

In August/September, along withWHO and UNDP, UNICEF spon-sored an inter-regional seminar in SriLanka on "Health for All." Theseminar, attended by 28 ministers andsenior decision-makers from 13 coun-tries, explored how Sri Lanka, despiteits relatively low GNP, had been ableto obtain significant reductions in itsinfant and maternal mortality rates.

UNICEF arranged, organized, andfinanced many study tours betweencountries such as the reciprocal visits ofsocial statisticians between Tanzaniaand Ethiopia. Participants from tendeveloping countries attended aUNlCEF-supported training course indistrict management of primary healthcare held in Zambia.

UNICEF also supports the provisionof technical assistance from key institu-tions in developing countries. For ex-ample, the International Centre forDiarrhoea! Disease Research,Bangladesh, has provided technicalassistance and training to staff notonly from Bangladesh, but also from33 other developing countries.

Technical co-operation amongdeveloping countries is one of themost effective ways to promote the ra-tional and efficient use of resources.Because of the proven success ot suchco-operation, UNICEF hopes to in-crease its support in coming years.

Inter-agencycollaboration

Links between UNICEF and otherUN bodies were intensified in 1984.The Executive Director had a scries ofmeetings with the heads of a numberof agencies, including the World Bank,IMF, UNDP, WHO, and WFP to ex-plore opportunities for further col-laboration.

A close working relationship withUNDP in the field continued withUNDP's involvement in country pro-gramme previews and reviews.UNICEF continued ro participate ac-tively in all inter-agency Water Supplyand Sanitation Decade act ivi t ieschaired by UNDP.

The four-agency Joint ConsultativeGroup on Policy, comprised ofUNDP, UNFPA, WFP, andUNICEF, continued to meet regular-ly, concentrating on opportunities forgreater collaboration in health andnutrition.

Contacts were established with anumber of agencies and institutions,including the World Bank, IMF, andILO, on the impact of the world reces-sion on children. The Bank and theILO agreed to collaborate directly withUNICEF in assessing the child-welfaremi plications of various adjustmentmeasures governments are taking.

The long-standing and very close col-laboration between UNICEF andWHO was deepened during 1984. Theheads of the two organizations had in-tensive consultations to ensure thatUNICEF's advocacy of the Child Sur-vival and Development Revolutionand WHO's objective of "Health forAll in 2000" reinforce and comple-ment one another. In Jamaica and SriLanka, both agencies jointly convenedtwo important inter-country con-ferences on continuing advocaq' ofprimary health care at senior policylevel. Currently, WHO is assistingUNICEF in a comprehensive revisionof the basic UNICEF guidelist for pro-grammes of health training and equip-ping basic health facilities. D

Advocacy for children

A revolutionbeginningAn extremely successful 1985 State ofthe World's Children report acceleratedsupport to African nations in emer-gency situations, and involvement inmajor children's programmes reaffirmedthe importance of the communica-tion and information elements inchild survival and development activ-ities this year.

The 1985 State of the WatWs Childrenreport focused on how the lives of anestimated half million children hadbeen saved by oral rchydration therapyeven though less than 15 per cent ofthe world's families were using thistechnique to prevent diarrhocaldehydration. Supported by in-depth,world-wide research, especially indeveloping countries, the report for1985 appeared simultaneously inEnglish, French, Spanish, Arabic andPortuguese, and was translated in partor in whole into metre than 40 otherlanguages. Over 10,000 copies of the

complete press kit and 135,000 indi-vidual reports were dispatched fromfive main translation points to themedia, UNICEF offices, and NationalCommittees. Long-term promotionwill be enhanced by the commercialpublishing and distribution of thereport in English, French and Spanish,which is intended for audiences such aseducational and research institutions,

In large part, the success of thereport derived from the follow-up ac-tivities undertaken by a number ofcountry offices and National Commit-tees. UNICEF Tanzania, for example,designed' an advocacy pamphlet inKiswahili on the state of the Tanzanianchild, for distribution to teachers andcommunity leaders around the coun-try. In India, special endorsementswere widely broadcast on locallanguage sen-ices around the countryand made available for showing in thenation's 46,000 cinemas. Around theworld, the report was endorsed by na-tional leaders, ministers, and otheropinion leaders.

Reports from Europe, North Amer-

(5

As the song goes JAMAICA

"When de baby reach tourmonths old

There are things you should betold

Give the thick porridge from aspoon and dish

And den you will get all youwish. , ."

These words are sung byprimary school children in thepoorest neighbourhoods ofSt. Thomas, where developmentplanners have found that childcare is very often children's work.

In large Jamaican families,mothers commonly rely on theireldest children to help care for theyoungest. UNICEF has beenworking with a number of schoolsin St. Thomas to turn that situa-tion to a unique advantage.

UNICEF, with the Health andEducation ministries and theTropical Metabolism ResearchInstitute of the University of theWest Indies, is helping to trainprimary school teachers in youngchild nutrition, environmentalhealth, and child development.All three subjects have beenintegrated into a Grade IVcurriculum tor 9 to 11 year olds.

The jingles, which teach aboutbreastfeeding, weaning, personalhygiene and emotional support,are signature tunes for the pro-gramme, UNICEF's Project Direc-tor, Jennifer Knight, reports thatthe words and Caribbean beat arecatching on in the children'shomes.

Illiteracy has prevented manyJamaican parents from learningany more about child care thantheir own parents were able topass on to them. Now schoolchildren can introduce newmethods to their parents andyounger sibling?, as well as usethem when they become parentslater in life.

"We are getting there slowly,"says Ms. Knight. "Our long-termgoal is to integrate child healthand development into the nationalschool curriculum."

The child-care courses are

designed for readers and non-readers, placing emphasis on song^and messages in pictures whichcan be equally appreciated by theparents.

In the first semester, studentsare taught the importance of foodfor the young child's growth. Inthe second, they are taught howto -make their environment a safeand healthy place. The thirdemphasizes play, and the need toencourage young children. As thesong goes:

"Praise him when he is rightThen he will be bright . . .Praises mck him learnNever to be too stern."

More than 300 school childrenare currently involved in the pro-gramme. A preliminary evaluationindicates programme success, soUNICEF has decided to extendthe programme to other locations.Parents and teachers report thatthe classes have helped manychildren come to terms with dailylife. Teachers say the childrenawait these lessons eagerly. Oneschool reported that if a lessonwere missed, the children wouldchant—"we want child care, wewant child care."

ica, and regional centres in the devel-oping world indicate that virtually allmajor newspapers gave the reportprominent coverage, often in editorialas well as news columns. Severalnewspapers timed the coverage ofissues concerning children to coincidewith the publication of the report.This trend is invaluable because it pro-motes the adoption of the essentialconcerns which underline the childsurvival and development campaign.

Audio-visual activities in support ofthe 1985 State of The World's Ch'Mmireport were intensive this year. Videotapes were disseminated through aninternational television news agency toapproximately 100 affiliates world-wide. Many UNICEF country andregional offices successfully initiatedlocal co-productions on child survivaland development themes, and thesewere screened in December to coincidewith the launching of the report inLondon by the Executive Director,The launch received massive broad-casting support; for example, theBBC's World Sen-ice prepared pro-grammes for world-wide distributionin 18 languages.

In addition, 1984 audio-visual ac-tivities included a film on the advan-tages of breast-feeding produced in co-operation with WHO and designed forhospital administrators and medicalstaff'; a film examining the success ofcommunity participation in a Nigerianwater project; and a wide range of co-

36

productions with television networksin Europe, Japan, Africa, andelsewhere.

The information support given toAfrican countries in emergency situa-tions accelerated dramatically in thelast month of 1984, as world-widepublic concern about the gravity of theAfrican crisis took hold. There wereencouraging signs in the media of theindustrialized countries that attentionwas finally being focused on the under-lying causes of the situation and long-term needs, as well as on the most im-mediate crisis needs. UNICEFs role inAfrica received considerable attention.The United States National Commit-tee alone reported logging over 4,600press articles referring to UNICEFactivities in Africa. National Commit-tee staff, through visits to Africa andactivities at home, made a major con-tribution to the level of awareness inindustrialized countries. They assistedprint and electronic media staff onnumerous occasions in Africa, andthrough materials issued on theirreturn were able to increase publicawareness and frequently sparked ma-jor fund-raising campaigns. Film andvideo materials were widely distrib-uted, including a successful satellitefeed to [he United States that resultedin direct transmission of footage onEthiopia to 85 local stations. Specialmaterials were produced for the AfricaConference held in New York in Oc-tober; UNICEF Nenv and Ideas Fontmdevoted special issues to Africa.

International YouthYear

The world youth population-definedby the UN as persons 15 to 24 years ofage-was 738 million in 1975 and is ex-pected to rise to 1,180 million by theyear 2000. 1985 has been designatedby the UN General Assembly as Inter-national Youth Year (IYY)-a year inwhich the world focuses on the pro-blems and aspirations of youth andseeks to provide them with greater op-portunities for participating in thedevelopment process. The themes ofthe year are: Participation, Develop-ment, and Peace.

UNICEF's main IYY thrust is"Youth in the Service of Children". Anumber of imaginative activities have-been initiated at countrv level-and, in

some cases, on a country-to-countrybasis. In the Philippines, ifor example,a community-based health programmein Davao City is being expanded to in-clude the training of older children as"health scouts". They will monitor thepersonal hygiene of their younger sibl-ings, help prevent accidents in thehome, and dispense simple remediessuch as oral rehydration solutions. InAfghanistan 400 youths aged 14 to 18will assist Kabul health workers in im-munization, oral rehydrarion, andother child-survival measures. Insouthern Chile, UNICEF, along witha private regional development group,is helping implement a "CHlLD-to-child" programme. Sixty young peopleare being trained as health monitors towork with families in poor com-munities.

In Burkina Faso and DemocraticYemen, school children arc participat-ing in campaigns to wipe out illiteracy.Youth of Burkina Faso will spend theirvacation months of July, August, andSeptember helping launch literacy pro-grammes in all the country's writtenlanguages, under the banner "Alfha-bctisons les autres"— roughly, "Let'sMake the Others Literate". In Demo-cratic Yemen, the "Youth in Servicefor Youth" campaign actually startedin 1984, when more than 20,000 boysand girls from the country's secondaryschools began teaching classes of 10 to12 literacy students each.

Youth from Ethiopia's secondaryschools have volunteered in largenumbers to help out in the reliefcamps. In Batti Camp, for example,they register newcomers, help themobtain food, shelter and medical help,and cook food for distribution to theweakest. In Kampuchea, where adecade of war left thousands of or-phans, about 5,000 children from 8 to18 are now being taken care of by anetwork of 30 orphanages. The olderchildren arc being trained to providefor the younger ones by raising food,making clothing, and building andrepairing houses.

Several National Committees forUNICEF have taken the lead in co-operation between youth in differentcountries. The UK Committee, for ex-ample, has teamed up with the UKScout Association in a "Scouts forWater" project. For some time, SriLanka's Scouts have been helping outon a UNICEF-assisted water supplyscheme in Kalutara District. Scouts

and Cub Scouts in the UK are nowraising funds to support die Sri LankanScouts in this work, and exceptionalUK Scout units will visit Sri Lanka tolend personal help.

The German Committee is organiz-ing German youth in an effort to col-laborate with the urban basic servicesprogramme in Colombia, which has alarge youth action component. TheCommittee hopes to establish directlinks between youth groups in theFederal Republic and youth groups inColombia. The Norwegian Commit-tee is inaugurating a school-to-schoolpilot project between schools inBergen and three schools in Uganda.With the help of information materialssupplied by the Ugandan children,Bergen children will raise funds for awater supply project in Uganda.

Tetsuko Ktiwyanqgi, UNICEFs GoodmllAmbassador, visitirig East Africa.

UNICEF's "goodwillambassadors" andspecial fundraisingevents

The plight of Africa's children was theleading concern of many special eventsin 1984. When Goodwill AmbassadorTersuko Kuroyanagi, one of Japan'sbest-known television personalitiesand novelists, visited East Africa, hertrip sparked widespread TV publicityand a successful fundraising appeal onher return home. Liv Ullmann con-

37

tinucd her many public appearancesfor UNICEF and in January andFebruary visited UNICEF-assistedprojects in Egypt, Yemen ArabRepublic, and the Sudan. Followingher visit to Mali in April, she addressedthe Executive Board in Rome on thegrowing crisis in West Africa. Hermedia tour of the United States inDecember culminated with public ap-pearances in Washington on the datethe State of the Wen-Id's Children reportwas launched.

The Puerto Rjcan teen-age pop-music group, Menudo, recently ap-pointed Youth Ambassadors forUNICEF, gave a successful benefitconcert in Washington and supportedUNICEF in Latin America. GoodwillAmbassador Peter Ustinov par-ticipated in a number of high-levelbriefings and media interviews. DannyKaye highlighted his support forUNlCEF's work when he washonoured by the Kennedy Center inWashington in November 1984.

Special events in developing coun-tries also ignited interest in UNICEF.A successful concert benefiting nutri-tion programmes for needy childrenwas held in Bangkok, in January. Thaisingers and musicians were joined byartists from Japan and the Vienna Art-Ore hestra.

A major CSDR exhibit, with em-phasis on water supply and sanitation,was featured at the Louisiana World'sFair and other CSDR exhibits wereprepared for conferences inWashington and Cuba, as well as forUNICEF offices in Angola, Haiti,Manila, Addis Ababa, and Nairobi.

Taking advantage of an annual salescampaign that extends to 130 coun-tries, the Greeting Card Operation in-cluded Child Survival and DevelopmentRevolution messages on millions ofgreeting-card brochures, corporate kitsand card display albums, posters,shopping bags, ad sheets, informationleaflets, and decals. Ten thousandchild survival revolution kits weredistributed worldwide, along with200,000 sets of a special photo-noteseries showing the four Child Survivaland Development Revolution priorityactions. A poster showing that the netprofit of one UNICEF card is sufficientto provide vaccines to immunize achi ld against five of the six tm-munizable child-killing diseases helpedboost both card sales and publicawareness.

UNICEF's SpecialEnvoy

In 1984, HRH Prince Talal entered hisfifth year of dedicated service as SpecialEnvoy for UNICEF, For the first time,he addressed UNICEF's ExecutiveBoard during its 1984 session in Rome.In a frank and vigorous statementreflecting his concern for children, heconveyed to Board members first-handimpressions gained during his exten-sive travels in the developing countrieson UNICEF's behalf. He called uponthe industrialized countries to increasetheir assistance to the Third World,and at the same time asked thedeveloping countries to strive for self-reliance and efficiency in the use oftheir available resources.

HRH Prince Talal Bin Abdul Aziz AlSand, UNICEFs Special Envoy, im oneof his many missions.

The Prince's travels in 1984 includedEgypt, the People's DemocraticRepublic of Yemen, the Netherlands,Belgium, Yugoslavia, and Pakistan.

In a forceful statement to the par-ticipants at the programme strategymeeting for the Middle East andNorth Africa Region in Amman inSeptember, the Prince underscoredthe potential impact of UNICEFassistance in the region.

He drew attention to the highaverage infant mortality rate in the

Arab countries including the higher in-come ones-and stressed the need forintensified co-operation for socialdevelopment between Arab countriesand UNICEF.

In December 1984 Prince Talal an-nounced that he was relinquishing hisfunction as Special Envoy to devotegreater attention to his other respon-sibilities, especially those relating toAGFUND. In a statement issued atthis time, UNICEF Executive DirectorJames P. Grant said: "I would like totake this occasion to express the deepgratitude we in UNICEF feel for theefforts HRH Prince Talal has made onbehalf of the world's children for nearlyfive years—and to look forward to acontinuation of this support indifferent forms in the fu tu re . , .We appreciate the assurance fromHRH Prince Talal that the concernsof children will continue to receivethe priority they now enjoy withAGFUND and that he personally willcontinue to be involved in private-sector fundraising locally, regionallyand internationally. He has proven amost eloquent spokesman on behalf ofchildren and the importance of theirwell-being to the future of all of us."

AGFUND

The Arab Gulf Programme for theUnited Nations Development Organi-zations (AGFUND) has entered itsfourth fiscal year (September 847August 85). At its meeting in October1984, AGFUND approved, amongother contributions, US$3 million fora number of UNICEF projects.UNICEF is expecting further alloca-tions to its projects during the re-mainder of this fiscal year. In order tobetter record contributions with fiscalyears, UNICEF began, in 1984, torecord AGFUND income on thebasis of specific project allocationsrather than on the basis of pledges forthe entire fiscal year, as was the practisein the past. Due to this accountingchange, there will be a one-time lowerincome level from AGFUND in 1984.

In early 1984, ILO became theeighth United Nations organization tobenefit from AGFUND assistance.This list now includes: FAO, ILO,UNDP, UNEP, UNESCO, UNICEF,UN Trust Fund for the InternationalYear of Disabled Persons and WHO.

LJNICEF has been co-ordinating aninter-agency effort to provide informa-tion to AGFUND and two inter-agency meetings have been held. Along-term workplan has been approv-ed by all agencies and submitted byUNICEF for consideration by HRHPrince Talal and AGFUND.

AGFUND was established in April1981 on the initiative of" HRH PrinceTalal Bin Abdul Aziz AJ Sand, whowas elected its President. Its Adminis-tration Committee—the equivalent ora Governing Board-is composed ofAGFUND's seven Member States:Bahrain, Iraq, Kuwait, Oman, Qatar,Saudi Arabia and the United ArabEmirates. A comprehensive bookleton AGFUND and its operations wasproduced in the summer of 1984 byUNICEF on behalf of AGFUND.

Emergency relief andrehabilitation

The Africanemergency

Disaster relief efforts overshadowedlong-term development projects inmany parts of Africa and a few in Asiaand the Middle East last year. But thedrought, floods, and political conflictwere dramatic reminders of how vul-nerable the poorest countries are.

Africa remains the most tragic exam-ple. In good seasons today, the conti-nent grows barely half its food needs.Population has been growing faster

than domestic food production for atleast a decade. More people raisingever-larger herds of cattle, goats andcamels on marginal dry lands, destruc-tive farming practices, and thesystematic cutting of wood for fuel,have exposed millions of acres ofotherwise productive land to erosion,making it vulnerable to the spreadingnorthern deserts. Geologists reportthat the Sahara has been expandingsouthwards at a rate of six to twelvemiles a year for more than a decade.

When drought and famine reachedalarming proportions in the Sahel in1983 and 1984, victims, donors and

The Belgian SurvivalFundEstablished in October 1983, theBelgian Survival Fund for the ThirdWorld (BSF) aims to ensure "the sur-vival of persons threatened by hunger,malnutrition and under-developmentin regions of the Third World whichregister the highest mortality rates dueto these causes." The Belgian Govern-ment is channeling part of BSF'sresources through a group of UNagencies: WHO, UNICEF, UNDPand IFAD (International Fund forAgricultural Development), withIFAD as the focal point.

The first countries selected for BSFprojects arc Kenya, Uganda, andSomalia. The projects will be im-plemented over a period of five to sixyears at a total cost of US$56 million.They aim to enable rural populationsto become self-sufficient and to pro-mote their own deve lopment .UNICEF has actively co-operated inthe missions which framed these pro-jects, and will play a major supervisor)'and procurement role in the first pro-ject to be launched: a Farmers' Groupsand Communities Support project inKenya. D

Of the 1984 emergencies,, Africa remained themost tragic example. Victims waitiiys for food

supplies iti Ethiopia.

39

agencies were ill-prepared. Obstaclesranged from the mobilization of aid tothe transportation, storage anddeliver\T of emergency supplies inland.By the time help arrived, thousandsalready had perished and millions morewere abandoning their fields andvillages for relief shelters and swellingshantytowns.

While substantial relief efforts helpedmillions survive in more than a dozencountries in 1984, African nations willnot recover from their present plightand achieve some measure of self-sufficiency unless these efforts are ac-companied by long-term commit-ments to domestic food production,self-sustaining, community-based serv-ices, and development of humanresources. An estimated 11 to 14thousand African children under fiveyears of age were dying every day fromeasily preventable causes beforedrought and famine reached their pre-sent crisis proportions-the needs oftoday's survivors will continue longafter the drought passes.

The African situation was one of themain concerns of the ExecutiveBoard's regular meeting in Rome.With the crisis swelling to un-manageable proportions, the Ex-ecutive Director launched an interna-tional appeal for about US$50 millionto support actions in 13 seriouslyaffected countries (Angola, BurkinaFaso, Cape Verde, Chad, Ethiopia,The Gambia, Ghana, Mali, Maurita-nia, Mozambique, Niger, Senegal andZimbabwe) and in eight others,(Botswana, Djibouti, Guinea, Kenya,Lesotho, Sao Tome y Principe, Sudanand Uganda). A further meeting washeld at the end of October and theappeal raised to US$67 million. By theend of February 1985 US$28 millionhad been raised, with another US$14million in prospect.

The Board endorsed accelerated pro-grammes in the region, as well as theallocation of USS2.8 million from theEmergency Reserve Fund for Africaduring the first three months of 1984,and the earmarking of USS7.2 millionfrom the Infant Mortality ReductionFund for child survival and develop-ment actions in Africa. It also ap-proved US$23.6 million in new pro-gramme commitments from generalresources and US$15 million in newnoted projects for 12 countries.

A major effort was made in 1984 tostrengthen staff in UNICEF field

f f l want to go bach bome'-L- ANGOLA

Ten-year old Maria Eduardo wasworking in the fields when hermother, father, and five smallbrothers and sisters were killed inan attack on their village. "I hid inthe tall grass," she told a UNICEFworker at an orphanage inHuambo. "When the attackersleft, I came here. I don't want togo back. I have no one to stayw i t h . . . no more family."

Since gaining independence in1974, Angola has been beset byintense hostilities. Over the pastfour years, an already difficultsituation has been exacerbated bysevere drought in the central andsouthern provinces.

At least one million people havebeen forced off their land by failedcrops and fighting. Most haveconverged on the traditionallyricher agricultural provinces ofHuambo, Bie, and Huila. It isestimated that almost half aremothers and children; most ofthem are undernourished andvulnerable to disease. Hundreds,like Maria, are abandoned ororphaned, living in overcrowdedinstitutions around the country.

A recent survey by the Interna-tional Committee of Red Crossreported 30 per cent severemalnutrition among under-fives inBenguela Province, 24 per cent inHuambo City.

These problems compound thealready serious consequences ofunder-devclopment. The estimateof infant mortality rates averaging160 per thousand is consideredoptimistic. One third of Angola'schildren die before their fifthbirthday. In parts of Angola,almost as many children die beforefive as survive.

Food shortages have beenexacerbated by sabotage attacks onthe Benguela railway which carriesrelief stocks from the port ofLobito to the central provinces.Transportation by road fares littlebetter-shortages of manpower,

trucks, and spare parts havedrastically decreased the numberof vehicles on the road.

Rain in February and Marchshould have been a blessing-instead, it came in torrents.Heavy flooding destroyed seed-lings and young plants, inundatedpastures, and swept away roadsand housing.

Despite the severity of its prob-lems, Angola has not attracted theattention of the mass media, orassistance on the massive scale itneeds. UNICEF has been one ofthe few agencies helping from thestart. On 25 August 1983, theExecutive Director launched anappeal for US$4.75 million toprovide 220,000 Angolan mothersand children with drugs and otherbasics, like clothing, blanketsand soap. The needs grew rasterthan the response and in 1984the appeal was increased to$7.5 million, while by year'send contributions amounted to$1.2 million.

The invasion in December1983-January 1984 displaced anadditional 127,000 people-mainof whom fled their homes withonly the clothes on their backs.Pending the internationalassistance which is the only realhope of improvement, Angola hasdone what it can to organize helpfor the displaced and affectedpopulations. For many of thechildren and mothers, assistance isa matter of life or death.

Lucas and Clementine, 15 and9 years old respectively, are stayingin the same orphanage as MariaEduardo. Both children wereinjured when their \illagc wasattacked. They managed to get tothe Central Hospital at Chi tern bo,and were evacuated to Huambo.They have no news of theirfamilies. Clementine feels the painof the bullet still in her left leg.When asked what she will do, shesays: "I want to go back home.11

40

offices in Africa. Over the year, staff inposts were increased by almost onethird in East Africa and by about twothirds in West Africa. Programmestrategy was also clarified andstrengthened. A special strategymeeting in Nairobi in February 1984brought together Headquarters,regional, and country representatives.Working relations with national andnon-governmental organizations havebeen intensified. Inter-agency co-operation was strengthened throughseveral appointments made by theSecretary-General. Particularly impor-tant ar the end of 1984 was the ap-pointment of the UNDP Administra-tor, Mr. Bradford Morse, to be theDirector of the Office of EmergencyOperations in Africa, to co-ordinatethe work of UN agencies involved inemergency operations in Africa. Overthe year, UNICEF has worked closelyand strengthened its co-ordination.

In the AJi-ica crisis child sunmd^ftmeii a new urgency. A child suffmng fi-om infectionand nialnutritwn in a clinic in Mali.

A% EMERGENCIES:In 1984 UNICEF

assisted 21 countries hit bydisasters: 14 in Africa, 5 inAsia, 1 in the Middle East andNorth Africa, and 1 in theAmericasexpended US$4.3 million fromthe Executive Director'sEmergency Relief Fund andchannelled specialcontributions amounting toUS$25 million for shelter,medicaments, water supply,equipment, food supplements,and other essentialssupported the initiative of theUN Secretary General inmobilizing extra resources forvictims of drought, famine, andconflict in Sub-SaharanAfrica; and continued toco-operate in a major UNprogramme in Lebanonprovided relief for typhoonand flood victims in thePhilippines, Thailand, Laos,Kampuchea, and Argentina;and helped contain epidemicsof meningitis in Nepal.

notably with the World Food Pro-gramme (WPP), to help meet the fojdand nutrition needs of the mostvulnerable population groups, in par-ticular, infants and children.

The Executive Director and seniorstaff visited Burkina Faso, Ethiopia,Ghana, Mali and Tanzania with repre-sentatives of other United Nations andbilateral agencies. In Angola, ICRCsupports a national vaccination pro-gramme with equipment and vaccineprovided by UNICEF.

In the Africa crisis child survivalgained a new urgency: UNICEF inten-sified its response to activities designedto combat or prevent infection andm a l n u t r i t i o n together with thedelivery of basic sen-ices.

Flexibility, innovation and ingenuityare critical to success in emergencysituations.

In Ethiopia and Mali, for example,UNICEF provided support to near-destitute families by buying cattle un-saleable under the prevailing marketconditions, and arranging for the meatto be dried and distributed throughsupplementary feeding centres.

In Mozambique, emergency fundswere used to provide fiiel to keep WFPfood convoys running. For the longer

term, a transportation expert is draft-ing a plan for the maintenance andmaximum utilization of the local fleettrucks.

In Mali and Senegal, funds were usedto hire local relief vehicles and airlifthigh-protein biscuits to food distribu-tion points.

Technical assistance was provided forfood and nutrition planning inBotswana, Lesotho and Zimbabwe.

By year's end, Sudan was added toUNICEF's list of most seriouslyaffected countries; in all of themUNICEF is working closely withbilateral agencies and non-governmental organizations to providemedicines.

In Chad and Mali UNICEF helpedarrange mobile medical reams financedby Italy, Sweden, Switzerland, and aNorwegian church aid group. Ingeneral the flow of medical suppliesand equipment, plus vehicles and sup-port for the training of health workers,has significantly increased both thecapacity and reach of health services inmany emergency countries.

Immunization efforts have beenstepped up in Angola, Chad, Ethiopiaand Mozambique through the provi-sion of "cold chain" equipment, pcdo-

ti

jets, and transportation for govern-ment medical teams.

Assistance to water and sanitationprojects in the most seriously affectedcountries has been accelerated. Therewas a marked increase in the delivery ofdrilling rigs, pipes and pumps.

In Ethiopia, UNICEF helpedpioneer a cash-for-food communitywork scheme that has far-reaching im-plications for the way emergency reliefand rehabilitation might be approach-ed in the future. The cash support hashelped to avoid starvation by stimulat-ing supplies from the local market. Thecommunity work has activated small-scale cultivation, particularly the use oflocal water sources for micro-irrigationat the community level. Conservationpractices and measures, such as ponds,mini-dams, dykes and terracing, arepart of an effort to improve local watermanagement.

An analysis of previous famines sug-gested that lack of money to buy foodrather than the absence of food itselfwas the problem. Pressure on the poorto sell their farming tools for money tobuy the food they could no longer pro-duce resulted in increasingly large-scaledestitution.

Even in regions where food stocksexisted close to areas of crop failure,,peasants suffering the cumulativeeffects of several years of drought oftenhad no alternative but to leave theircommunities for relief shelters becausethey could no longer afford to buyfood. It was assumed that it would becheaper to make small monthlypayments to tide over such needyfamilies, rather than undertake expen-sive and complex large-scale relieffeeding in camps. This has been doneon an experimental basis and theassumption has proved correct.Moreover, the approach has been notonly somewhat cheaper, but also in-comparably more effective.

In 1984, 1,500 families at four pro-ject sites in the regions of Gondar andShoa were each given 35 Birr (US$17)a month for a six-month period, tobuy food at local markets, togetherwith tools and seed so they could worktheir land.

In one community, the farmersworked on terracing hillside land andlearned to plant vegetable gardens andgrow drought-resistant crops. Able-bodied recipients work one or twodays a week on community projects.So far, thcv have built a road, a health

clinic, a children's playground, and anirrigation system for a barley crop. In-struction was given in basic hygieneand sanitation, and with the help ofoutside expertise, two springs havebeen capped to give the communityclean drinking water. Health recordsfor 255 children under five show thatthe number of underweight childrenin the community has been halved.

Direct cash assistance to each familyhas enabled them to get food withoutdelay, cut transport costs, and remainin their community-some have evenput aside some of the money to buylivestock and farm implements for thefuture. Several families among thepoorest have been reunited: thirteenfamily heads at one project sitereported that they had brought homea total of 31 children sent away towork for wealthier farmers or to staywith relatives because their parentscould not feed them.

Cash-for-food schemes can only beapplied where a marketable surplus offood exists, but last year's experience inGondar and Shoa suggests that in thesecircumstances cash support can pro-vide faster, cheaper, and more produc-tive relief.

Other emergencyassistance

Worldwide, the Executive Director'sEmergency Reserve Fund last year re-sponded to 21 emergencies affectingchildren and mothers. Other emer-gency activities were supported fromcountry programme budgets andspecial contributions.

Two-thirds of those emergencieswere in Africa; however, typhoons andflooding in Asia and the Americas, andcontinued fighting in Lebanon alsotested UNICEFs response capacity lastyear.

A typhoon which swept through thesouthern and central provinces of thePhilippines on 2 September cut offmore than 135,000 families from foodsupplies and services and left morethan half of them homeless.

The destruction of health centresexacerbated the situation. UNICEFresponded to a request from theMinister of Health by importingUS$116,000 worth of medicines,vitamins, oral rehydration salts, waterpurification tablets and health centre

equipment, and made arrangements tosupply Surigao City, one of the mostseverely affected areas, with pipes,fittings and pumps to restore a safesupply of drinking water.

Roofing, lumber, cement and othermaterials were provided for thereconstruction of 55 health centresand about 100 water supply systems;supplementary food supplies werebrought in for prc-school and primaryschool children.

Because virtually all food crops weredestroyed, UNICEF investedUS$84,000 in an innovative com-munity gardening programme. About3,000 gardening kits containing seeds,fert i l izer and basic tools weredistributed to schools and communitygroups in the affected areas. Each kitcontained a selection of 10 differentvegetable types which would providefor the balanced nutrition of growingchildren.

UNICEF provided US$50,000 eachto Thailand, Laos, aitd Kampuchea formedical supplies, basic drugs, vitaminsand oral rehydration salts, after atyphoon caused extensive flooding andtriggered widespread outbreaks ofmalaria, dysentery, diarrhoea' andrespiratory diseases among children.

A joint effort was also launchedwith WHO in Nepal to help avert anepidemic of meningitis. Vaccines,syringes, needles, and spare parts forpedo-jets were airlifted from UNIPACat a cost of US$50,000.

In South America, flooding leftthousands of Argentines homeless inthe outer provinces of Formosa,Chaco, and Sante Fe, and caused arapid decline in the health and nutri-tion of children. UNICEF providedORS and an t ib io t i c s cos t ingUS$33,000 to combat diarrhoeal,respiratory and skin diseases.

In Lebanon, UNICEF and otherUnited Nations agencies, under theUnited Nations Assistance forReconstruction and Development ofLebanon (UNARDOL), played a ma-jor role in the repair of damaged pipes,wells and sanitation facilities in 300centres in Greater Beirut, when waterand electricity supplies were once againdisrupted by fighting. UNARDOLprovided emergency power generatorsand helped to truck water to displacedfamilies in 37 centres while UNICEFprovided 100 kits of emergencymedical supplies for a total operationalcost of US$210,000. [1

42

UNICEF's finances; income, commitments,and expenditures 1984-1985

Income

UNICEFs income is comprised ofvoluntary contributions from bothgovernmental and non-governmentalsources.

Total income in 1984 came toUS$332 million. A decision was taken,beginning in 1984, to delay recordingthe income of certain donors by oneyear, so that it would accord betterwith their fiscal years. This has ledto a one-time decrease of about US$20million in 1984.

In a d d i t i o n , the con t inuedstrengthening of the US dollar in rela-tion to other currencies has decreased1984 income by about US$20 million.

Without the effects of the account-ing change and exchange rate fluctua-tion, 1984 income would have beenhigher than the 1983 level. The 1984income figure included USS24 millionof contr ibut ions for the AfricaEmergency, a response to the Ex-ecutive Director's appeal for US$67million.

In 1984, income from governmentsand inter-governmental organizationsaccounted for 80 per cent ofUNICEF's total income; non-governmental income accounted tor20 per cent, five per cent less than inprevious years. These proportionswere affected by the recording delaybut are expected to regain former levelsin the next fiscal year. The pie charts onpage 46 show the division betweengovernmental and non-governmentalincome for the years 1980 and 1984.The map on pages 44 to 45 shows in-dividual governmental contributionsby country for 1984; a list of non-governmental contributions by coun-try appears on page 46.

UNICEF's income is divided be-tween contributions for generalresources and contributions for sup-plementary Minds and emergencies.General resources arc the fundsavailable to fulfill commitments for co-operation in country programmes ap-proved by the Executive Board, and tomeet programme support and ad-ministrative expenditures.

UNICEF Income1980-85(In millions of US dollars)

(«(.)

General resources include contribu-tions from more than 150 govern-ments; the net income from theGreeting Girds Operation; Rinds con-tributed by the public, mainly throughNational Committees; and other in-come.

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

As illustrated by the bar chart on thispage, about 30 per cent of UNICEF'stotal income over the period1980-1984 was contributed as sup-plementary runcis and for emergencies.

Projects funded by sup piemen tan-funds contr ibut ions arc normallyprepared in the same way as thosefunded from general resources. Mostare in countries classified by the UnitedNations as "least developed" or "mostseriously affected".

As a result of pledges at the UnitedNations Pledging Conference forDevelopment Activities in November1984, and pledges made subsequent!)',UNICEF's income for generalresources in 1985 is expected to totalUS$270 million. Some of the larger in-creases pledged in national currency sofar are from Austria, Belgium, Den-mark. Finland, German DemocraticRepublic, Hungary, Italy, Poland andSwitzerland. Certain governmentshave yet to pledge.

Expenditures

The Executive Director authorizesexpenditures to rulfill commitmentsapproved by the Board tor programmeassistance and for the budget. Thepace of expenditure on a countryprogramme depends on the speed of

General resources SupplementaryFunds and Emergencies

1984 governmental contributions

Contributions to UNICEFs general resources are shown at right;additional contributions tor supplementary funds and emergenciesarc shown in colour, at left.

f i n thousands of US dollars)

Samoa . . . . . . . . 1,0Tonga 5,9

NORTH AMERICACanada6,729.6 12,321.3

United States of America1,046.0 52,500.0

44

The World on rhc Azimurhal Equidistant Projectioncentered at Nt\v York Citv.

AST A

Afghanistan30.0

Bangladesh72

Bhutan3.6

Brunei1 !)()() (j

EUROPE

Austria168 1 702.3

B.S.S.R.70.2

Belgium-94 866.7Bulgaria

60.9

Czechoslovakia82.6

Denmark11,613.0. . .5,044.9

MIDDLE

Arab GulfFund575 0 . 3 926 3

Algeria142.0

Bahrain. . . . 15.0

AFRICA

Benin9.0

Botswana9.7

Burkina Faso6.4

Burundi

Cameroon68. 5

Brazil7S X 100 0

British VirginIslands

0 2

ChileSO I ) . . ..50.0

Burma

China

Hong Kong

India1,

EuropeanEconomicCommunityi vk> y

Finland1,245.7 5.

France239 5 4,

Germany,DemocraticRepublic

EASTCvprus80 6

DemocraticYemen

Egyp*

Congo

Djibouti

Ethiopia

Ghana

Guinea

Colombia

Costa Rica

Cuba

Dominica

204.5

350.0

,14.5

671 4

919.6

074.1

107.7

. .7.0

.82.2

.12.8

. .2.11

.49 3

. 1 . 0

394.3

.34.4

117,0

..1.0

Indonesia

JapanAy. 4 . iLao People'sDemocraticRepublic

. .537.0

2,428.1

. ,5.0

Germany, FederalRepublic of1.353.6 5,327.9GreeceT tt 1.150

Holy See

Hungary

Iceland

Ireland

Iraq

Israel

Jordan

Kuwait

Kenya

Lesotho

Madagascar

Malawi

Mauritius

DominicanRepublic

Ecuador

Guatemala

.1.0

8 3

. .446 3

96 8

, . . 50.0

26 5

.200.0

. . .17.7

2.0

. . .11.0

3.3

, . . . 2 .0

25 4

. .45.2

Malaysia

Maldives

Mongolia

Nepal

106,0

. . 3.0

. 3.5

.15,8

Italy19,179.*, . 13.934.1

Liechtenstein2.0

Luxembourg

Malta

Monaco

Netherlands3,095.1 6

32 3

4 6

.3,3

,797,4

League of ArabStates51 5

Lebanon6.102.1

Morocco288.6

Nigeria

Rwanda

Senegal

Sierra Leone

Somalia

Guyana

Honduras

Jamaica

Mexico

.50,0

100.0

289.0

40

60

.37.9

. . .2.3

4 5

20 0

4 3

355. 5

Pakistan. . . .51.0

Philippines458 7

Republic of Korea147.0

Sri Lanka10.1

Norway5.752.0. . .15,457.3

Poland56.9

Portugal15.0

Romania12.2

Spain440 0

Sweden8 ,424 .8 . . . 20,121.2

Oman50.0

Saudi Arabia1,000.0

The Opcc Fimd655,0Tunisia

105.5

Sudan35.3

Swaziland3.7

Togo1.1

Uganda1.8

Nicaragua109

Panama22.0

Peru 120.0Saint Vincent andthe Grenadines

. .0.8

Thailand

Viet Nam279 6

6.0

Switzerland5.JV8 I t . . . . 3,947. 2

Ukrainian S.S.R.

U.S.S.R.

UnitedKingdom1,31.10.5

Yugoslavia

Turkey

Yemen

7584

8,020. i

. .247.3

. 93.3

. . 22 2

United Republic ofTanzania

16 7

Zaire

Zambia

Zimbabwe

Trinidad &Tobago

Uruguay

Venezuela

. 2 0

...11.7

. 22 9

199.7

45

1984 non-governmental contributions (in thousands of US dolLirsl

Countries where Hop-governmental contributions exceeded $10,000 (figures include proceeds from greeting card sales)

AlgeriaAngolaArab Gulf FundArgentinaAustraliaAustriaBahrainBangladeshBelgiumBrazilBulgariaCanadaChUeColombiaCosta RicaCubaCyprus ,CzechoslovakiaDenmark -Dominican Republic . . . .EcuadorEgyptEthiopiaFinlandFranceGerman DemocraticRepublic

237.3209. 1751.460.1

1.723.4845.268.725.1

1.019,3690.1572.3

12,834.236.5

161.725.174.766.2

169.8672.7

39.844.831.519.5

1,098.67,605.0

77.1

Germany, FederalRepublic ofGhanaGreeceGuatemalaGuineaGuyanaHondurasHungaryIndiaIndonesiaIraq

IrelandItalvIvory CoastJapanKenyaKuwaitLebanonLuxembourgMalaysiaMexicoMonacoMoroccoMozambiqueNetherlandsNew Zealand

6*577.137.6

371.726.712.317.911.977.5

650.4164.21 58.466.9

2,300.720.3

4.327,911.621.563.3

170.121.0

128.214.029.080.6

4,224.3139.4

Nigeria.NorwayPakistanPanamaParaguayPeruPhilippinesPolandPortugalQatarRepublic of KoreaRomaniaSaudi ArabiaSenegalSingaporeSpainSri LankaSudanSweden

SwitzerlandSyrian Arab Rep.ThailandTrinidad & TobagoTunisiaTurkeyUnited ArabEmirates

60.4854.452.319.452.3

132.048.4

196.163.414.025.536.5

168.126.811.7

1,908.821.013-6

1.190.35,015.9

13.568.026.215.3

104.7

57.6

implementation in the country con-cerned.

In 1984, UNICEFs total expen-ditures amounted to US$345 million.

Of this total, expenditures for pro-grammes came to USS244 million:US$109 million in cash assistance forproject personnel, training costs and

other local expenses and US$135million for supply assistance. The costof programme support services wasUS$60 million. Other administrative

1980,73%

'S227raTotal income trum yovcrnmenEs

.ind intergovernmentalorganizations

Totalincome$313m

UNICEFIncome

26%

27%

47%

SupplementaryFimtts .ind

Emergencies

198480%,

$264nTTotal income from governments'

and intergovernmentalorganizations

24%

Non-gm enimcnu] 20%income

GcntT.i]n-'M mixes

56%

Totalincome$332m

46

United Kingdom ofGreat Britain andNorthern Ireland . .United Republic ofTanzaniaUnited States of

AmericaUruguayVenezuelaViet NamYemen Arab Rep. . .YugoslaviaZambiaContributions fromUN Staff .Contributions under

$10,000 .

1,310.9

66.1

6,046,0

52.122.210.616.1

418.311.6

86.1

189.8

TOTAL 67,309,7

Less costs of GreetingCard Operations* . .

Net available forUNICEF assistance

(20,010.3)

47,299.4

•Gists of producing cards, brochures;freight, overhead, adjustments.

costs amounted to USS41 million.The bar chart on this page shows

expenditures on programme assistancefor 1980 to 1984. The bar and piecharts on page 48 show programmeexpenditures by sector from 1980 to1984, by amount and proportionrespectively.

Financial planand prospects

The effects of the global recession aremosr acute among women and chil-dren in the developing world, but theamount of development assistance-available to help them has been re-duced.

UNICEF is striving to maintain thelevel of its resources in real terms at atime when support to multilateralagencies is still affected by the globalrecession of the early eighties and bydramatic currency fluctuations. In this

UNICEFExpenditures1980-85(In millions of US dollars)

situation, UNICEF is endeavouring topersuade donor governments to main-tain their social development assist-ance, and to increase the level of theircontributions to UNICEF in realterms. UNICEF is also encouragingthe non-governmental sector, throughthe National Committees and NGOs,to further expand their important con-tributions.

At the April 1985 session of theExecutive Board, proposals for new orextended multi-year programme com-mitments in 25 countries will be sub-mitted. UNICEF current ly co-operates in programmes in 117 coun-tries. The proposed new commitmentstotal US$303 million from UNICEFsgeneral resources and USS223 millionfor projects deemed worthy of supportif supplementary funds are forthcom-ing. Programme commitments fromgeneral resources for all the countrieswhere UNICEF co-operates are shownon the map on pages 26-27. It also in-dicates countries for which commit-ments from general resources are beingproposed at the 1985 Executive Boardsession.

A Medium Term Plan covering theyears 1984-1988 will be submitted tothe Executive Board at its April 1985session.

The biennial budget1986-1987

In the preparation of budgetary pro-posals for the 1986-1987 biennium,UNICEF completed an extensivereview of all its field offices. TheBudget Review G)mmirrec travelled toeach of the six regions to analysetogether with regional directors andcountry representatives the proposalssubmitted. Budgetary requirementsfor human and financial resources werereviewed in light of programmepriorities, office structures, and officeworkplans. The overall objective of

' In ]<>S2 iht definition* l"r "programmi- nuppim" juJ • " j , l n i i i i i - . n , » . \ i^i.sr-." '--, [n-niiirures were -illcrcJ

Cash assistance

Supply assistance

Programme support

Administrative costs

I

Expenditure on Programmes by Sector

BasicHealth'

WaterSupply

Nutrition

SocialServices forChildren

Formal & • •non -formal r̂ - f^p-Education -̂̂ ̂ ~l^

PlanningB \JK\ A& Project lsaj«^kSupport ™^

EmergencyRelief

Mi 1 - . S2Mm S30m Mllm S50 S6(lm S7l)m S80m

68.1

'Family planning component is included in basic health.

this budget exercise was to find themost effective and efficient means toredeploy budgetary resources to meetincreasing and changing work re-qui rements and to s t rengthenUNICEF capacity in the Africanregions.

The budget proposed for 1986-87represents a significant redeploymentof 22 core posts (21 international pro-fessional and 1 general service) fromheadquarters locations. Excluding theproposed increase in posts for Africa,there is a net overall reduction of33 core posts for the remainder of theorganization. The proposed overallcost of the administrative and pro-gramme support budget for the 1986-1987 biennium is S251.2 million. Ex-cluding additional activities plannedfor Africa, incremental rent costs forheadquarters, and a continuation ofinvestment in computer equipment,the remaining budget growth will be0.7 per cent below the calculated infla-tionary costs of 5 per cent per annum.

In the proposals for the 1986-1987biennium, the limited number of addi-tional core posts required to upgradeten sub-offices to the country officelevel in Africa arc in line with estimatesmade in the "Medium-Term Plan for

1980

* M

1984

s^^

the Period 1983-1987" (E/ICEF/1984/3): 16 compared to 15 interna-tional professional posts, 43 comparedto 22 national professional posts and67 compared to 64 general serviceposts. This proposal representsUNICEFs response to die crisis inAfrica and the Executive Board's con-cern that, to the extent possible, thestrengthening of the African regions isoffset by redeployment from head-quarters and other field offices.

Liquidity provision

UNICES? works with countries toprepare programmes so that com-mitments can be approved by the Ex-ecutive Board in advance of major ex-penditures on these programmes.UNTCEF does not hold resources tocover the cost of these commitments,but depends on future income fromgeneral resources to cover expen-di tures . The organization does,however, maintain a liquidity provi-sion to cover temporary imbalancesbetween income received and spent, aswell as to absorb differences betweenincome and expenditure estimates. D

48

What UNICEF is and does

Origins and currentmandateUNICEF was created as the UnitedNations International Children'sEmergency Fund on 11 December,1946, by the first session of the UnitedNations General Assembly. In its earlyyears, UNICEF resources were largely-devoted to meeting the emergencyneeds of children in post-war Europeand China for food, medicines andclothing. In December 1950 theGeneral Assembly changed UNICEF'smandate to emphasize programmes oflong-range benefit to children of devel-oping countries. In October 1953,the General Assembly decided thatUNICEF should continue this workindefinitely and its name was changedro "United Nations Children's Fund",although the well-known UNICEFacronym was retained.

In 1976 the General Assembly pro-claimed 1979 as the International Yearof the Child (IYC) and made UNICEFlead agency within the United Nationssystem co-ordinating support to IYCactivities, most of which were under-taken at the national level. At the endof 1979, the General Assembly gaveUNICEF the primary responsibilitywithin the United Nations system forIYC follow-up. UNICEF thus becameresponsible for drawing attention toneeds and problems common to chil-dren in both the industrialized and thedeveloping worlds. While extendingUNICEF areas of concern, the newfunct ion did not diminish theOrganization's overriding preoccupa-tion with the problems of children indeveloping countries.

Combin ing humani t a r i an anddevelopmental objectives, UNICEFco-operates with developing countriesin their efforts to address the needs ofchildren. This co-operation is expectedto be part of national developmentefforts, and its ultimate goal Is toenable every child to enjoy the basicrights set out in the General Assembly'sDeclaration of the Rights of the Child.The Declaration emphasizes the rightof children to protection and upbring-ing in a family and community envi-ronment designed to promote theirhealth and well-being. The Declara-

tion recognizes the intrinsic value ofchildhood, and of nurturing the imagi-nation and spirit of the child.UNICEF believes all children shouldhave the opportunity to reach their fullpotential and contribute to their coun-try's development.

UNICEF is unique among theorganizations of the United Nationssystem in its concern for a particularage group rather than a sectoral con-cern such as health or education.UNICEF not only seeks support for itsprogrammes of Go-operation, but alsotries to increase public awareness ofchildren's problems by advocacy—withgovernments, civic leaders, educators

and the public at large. For this reason,UNICEF places great importance onits partnership with the NationalCommittees for UNICEF and its rela-tionships with non-governmentalorganizations.

Organization

While an integral part of the UnitedNations system, UNICEF's status issemi-autonomous. The Fund has itsown governing body, the ExecutiveBoard, and a secretariat.

The Declaration ofthe Rights of theChild realizes theintrinsic value ofchildhood, and ofnurturing the ima-

gination and spiritof the child.UNICEF believesall children shouldhave the oppor-tunity to reachtheir full potentialand contribute totheir county's de-velopment. A lit-eracy and nutritionclass in India.

UNICEF/051/83/Spague

49

The Board is composed of 41 mem-bers, elected on the basis of annualrotation for three-year terms bythe Economic and Social Council{ECOSOQ to give "due regard togeographical distribution and to therepresentation of the major contrib-uting and recipient countries". Themembership includes: nine Africanmembers, n ine Asian, six LatinAmerican, twelve Western Europeanand others, and four Eastern Euro-pean. The 41st seat rotates amongthese regional groups.

The Board establishes UNICEF poli-cies, reviews programmes, and approvesexpenditures for UNICEF work in thedeveloping countries and for opera-tional costs. Except for extraordinarysessions, the Board meets for twoweeks each year; it constitutes itself asa Programme Committee to considerprogramme recommendations, and asa Committee on Administration andFinance for operational matters. Exe-cutive Board reports are reviewed byECOSOC and the General Assembly.

The Executive Director, who isresponsible for the administration ofUNICEF, is appointed in consultationwith the Board by the United NationsSecretary-General. Since January 1980,the Executive Director has been Mr.James P. Grant.

UNICEF field offices are the keyoperational units tor advocacy, ad-visory services, programming andlogistics. Under the overall respon-sibility of the UNICEE Representativefor the country, programme officershelp relevant ministries and institu-tions to prepare and implement pro-grammes in which UNICEF is co-operating. In 1984, UNICEF main-tained 87 field offices serving morethan 110 countries, with 427 profes-sional and 1,075 clerical and othergeneral service staff posts.

In 1984, 226 professional and 345general service staff posts were main-tained in Headquarters locations (NewYork, Geneva, Copenhagen, Tokyoand Sydney) to: service the ExecutiveBoard; develop and direct policy;manage finances and personnel; auditthe organization's operations; provideinformation; and to conduct relationswith donor governments. NationalCommittees for UNICEF, and non-governmental organizations.

Although directed from New York,most of UNICEFs supply operationsare located in Copenhagen where

a new fac i l i t y , the U N I C E FProcurement and Assembly Centre(UNIPAC), was opened by Denmark'sQueen Margrethc in September 1984.

UNICEF co-operationwith developingcountries

UNICEF co-operation is worked outwith the government of the country,which administers and is responsibletor the programme, either directly orthrwugh designated organizations.

UNICEF gives relatively greater sup-port to programmes benefiting chil-dren in the least developed countries.In apportioning UNICEF's limitedresources among countries, the 1983Board decided that the infant mor-tality rate (IMR} should help "guide-both the level and content of UNICEFprogramme co-operation". Now IMRis one of the principal determinants ofthe extent of UNICEF countryassistance.

The problems of children require aflexible, country-by-country approach,and UNICEF endeavours to suit its co-operation to the development, and thecultural, social, geographic and admin-

istrative structure, of the country orarea.

UNICEF seeks to help improve andextend community- level servicesbenefiting children and the family,including water supply, health andnutrition, education and improve-ment in the situation of women. Helpis given, for the development of politythrough advisor\r services or inter-country exchange of experience,through stipends for training andother orientation of national personnelfor work at community level, as well asthrough procurement and delivery ofsupplies and equipment.

Programme co-operation is providedthrough a range of sectoral ministriesor authorities, typically includingthose responsible for health, educa-tion, social services, agriculture, ruraldevelopment, community develop-ment, and water supply and sanita-tion .

At community level, however, thecauses of problems are often a com-bination of factors spanning thetechnical competencies of severalministries. Child malnutrition, forexample, usually results from somecombination of poverty, inadequatehealth services, and food shortage.Contributor}' causes range from inade-quate birth spacing to impure water

/« the drought-stricken Sahel, locally organized co-operatives dig wells and irrigate larjjegardens. UNICEF seeks to focus particularly on community self-help projects.

50

and rudimentary sanitation, or simplyan improper diet. Since efforts in anyone sector may fail without correspond-ing efforts in others, UNICEF recom-mends a muhisectoraJ approach-onemoreover which encompasses not onlythe technical elements but also thesocial dimensions of the problem beingtackled.

Community-basedservicesAs already noted, UNICEF seeks tofocus particularly on services based inthe community itself, planned andsupported by-and responsible to-thepeople of that community.

Within that strategic focus, the over-riding priority is for efforts whichattack the continuing high rates ofinfant and young child death anddisease. UNICEF believes it possiblefor the world to reduce the rate ofinfant and young child death anddisability by at least half within adecade, an annual saving of perhapsseven million young lives worldwide.A major reason for this possibility isthe growth of community-based ser-vices and the spread of community-level workers-paid or voluntary—whomake those services work.

The community-based services ap-proach derives from the experience ofdeveloping countries and is predicatedon the conviction that progress is mostrealistically achieved where it is evenlyspread and equitably shared by asmuch of the population as possible.

The conventional pattern for theexpansion of services which benefitand protect children, the socialdevelopment process, is a gradualspreading outwards from the centres ofeconomic growth to the periphery,associated with-and paid for by-thateconomic growth. In most developingcountries that model is unlikely towork for the majority of the popula-tion in any foreseeable future. Theinevitable consequence is perpetuationof undcr-devclopment and the unne-cessary- death and disability for tens ofmillions more children every year.

The alternative is to centre thedevelopment process instead on thecommuni ty and the indiv idual ,through services based and maintainedin the community—with support andencouragement from the peripheral

and intermediate-level governmentservices.

Typically under this model, the vil-lage or neighbourhood selects one ormore of its members to serve as com-munity workers after comparativelybrief practical training, repeated andextended through refresher courses.Usually the connecting levels ofgovernment services also need to bestrengthened, particularly with para-professionals, to provide the properlevel of support.

The strategic focus on community-based services has particular relevancefor the most cost-effective and prac-ticable means of saving children's livesand protecting their health andgrowth.

Such means exist-better growthmonitoring and weaning practices todetect malnutrition and to takeremedial steps before it becomesserious, oral rehydration therapy toreplace body fluids lost during diar-rhoea, the encouragement of breast-feeding, and universal immunization—but they depend absolutely on theinvolvement of parents and com-muni t ies . Parents , par t icular lymothers, are the child's first and mostdependable line of defence.

Under this community self-helpapproach, the role of government andnon-governmental organizations as wellas of external co-operation, is toencourage communities to assess andhelp meet their childrens1 needs,to strengthen technical and adminis-trative support for family and com-munity efforts, and to match com-munity initiative and effort withmoney, appropriate technical help,supplies and training.

Relations within theUnited Nations system

UNICEF is part of the pattern ofco-operative relationships linking thevarious organizations of the UnitedNations system. UNICEF also workswith bilateral aid agencies and non-governmental organizations. Havingfinancing from several such sources anddrawing on different technical andoperating skills in design and imple-mentation can strengthen the effec-tiveness of a programme. Such rela-tionships also help make maximum use

of the funds at UNICEF's disposal,Indeed, while this financial contribu-tion may be modest, the effect is fre-quently catalytic, providing a basis forlarger-scale effort by testing and provingan approach, and thereby triggeringsubstantial investments from othersources.

Collaboration within the UnitedNations system ranges from country-levcl sharing of expertise in thedevelopment of programmes requiringan inter-disciplinary approach, tosystematic exchanges on policies andrelevant experience. These exchangesoccur through the machinery of theAdministrative Committee on Co-ordination (ACC), as well as throughperiodic inter-secretariat meetings.Such meetings regularly taJte place, forexample, with the World Bank, theUnited Nations Development Pro-gramme {UNDP), the Food and Agri-culture Organization (FAO), and theUnited Nations Educational, Scientificand Cultural Organization (UNESCO).Agencies also discuss common con-cerns through the Consultative Com-mittee on Policies and Programmes forChildren which succeeded the inter-agency advisor)' group established dur-ing the IYC in'1979.

UNICEF benefits from the technicaladvice of UN specialized agen-cies-most notably the World HealthOrganization (WHO), but also includ-ing FAO, UNESCO, and the Interna-tional Labour Organisation (ILO).UNICEF does not duplicate servicesavailable from the specialized agencies,but works with them, ar the countrylevel, to support programmes, partic-ularly where social development min-istries such as health and education areinvolved. In addition, the specializedagencies from time to time collaboratewith UNICEF in preparing jointreports in particular programme areas.A Joint UNICEF/WHO Committeeon Health Policy meets annually toadvise on policies of co-operation inhealth programmes and undertakesperiodic reviews.

UNICEF co-operates in country pro-grammes with other funding agencies ofthe United Nations system, such as theWorld Bank, the United Nations Fundfor Population Activities (UNFPA),and the World Food Programme(WFP). The Children's Fund alsoworks with regional developmentbanks and regional economic andsocial commissions on policies

••'

and programmes benefiting children.Increasingly UNICEF also collaboratesat field level with bilateral agencies toencourage the channelling of moreresources into programmes whichUNICEF cannot Mind by itself.

When emergencies strike, UNICEFworks with the Office of the UnitedNations Disaster Relief Co-ordinator(UNDROJ, WFF, UNDP, the UnitedNations High Commissioner forRefugees (UNHCK), and other agen-cies of the United Nations system, aswell as with the International Commit-tee of the Red Cross and national RedCross or Red Crescent Societies or theirinternational body the League of RedCross and Red Crescent Societies.

UNICEF representatives in the fieldwork with the UNDP Resident Rep-resentatives, most of whom aredesignated by the Secretary-General asresident co-ordinators for operationalactivities. Although UNICEF is notan executing agency of UNDP, itexchanges information with all theagencies involved in UNDP countryprogramme exercises.

Greeting cards

UN ICEF's popular greeting cards,calendars and stationery items are asignificant source of funds-US$14.8million in 1983. The collaboration ofNational Committees for UNICEF,together with NGOs, banks, postoffices, business firms, schools, super-markets, and co-operatives, amongothers, is a significant part of theGreeting Card Operation's success.Such partnerships are the channels bywhich volunteers and the public at largecan participate and contribute time ormoney to efforts for children. In 1983more than 113 million cards were soldin some 130 countries.

Since 1949, more than 2,650 artists,photographers, leading museums andchildren from 140 countries have con-tributed reproduction rights for carddesigns.

The product line has broadenedto include diaries, note paper andother stationer,' items, including someunique to the Greeting Card Opera-tion, such as the handmade pressed-rlower cards from Mauritius and thehandcrafted cards made in Nepal.Local production of cards by moreconventional means is now underway

What Would You Like to beWhen You Grow Up?

in Canada as well as Brazil.The Greeting Card Operation also is

undertaking more advocacy, printinginformation and messages on child sur-vival themes on products, as well asfocusing promotional materials on thechild survival campaign. The GreetingCard Operation is currently seeking toexpand sales significantly through anInter-regional Sales Development Pro-gramme (ISDP). This effort aims torecruit, develop and strengthen fieldsales organizations and volunteer net-works in potential card sales areas.GCO's Marketing Section will provideprofessional marketing counsel andseek to increase demand through anexpanded programme of marketing ac-tivities.

Relations withnon-governmentalorganizations

LTNICEF has always worked closelywith the voluntary sector. Over theyears, the organization has developeddose working relationships with inter-national non-governmental organiza-tions (NGOs) concerned with the situa-tion of children. Many of theseorganizations (professional, develop-ment assistance, service, religious,business, and labour among others)have become important supporters by

UNICEPs Greeting Card Operation isfoctisinff promotional materials on the chillisurvival and development revolution.

providing a channel for advocacy forchildren by raising funds and by directinvolvement in programmes.

National and local NGOs also arcplaying an increasingly important rolethrough the emphasis on community-based services and popular participa-tion. Many such organizarions aremore flexible and freer to respondto community-level needs, or arerepresented in places where services arceither inadequate or non-existent. Suchorganizations, unlike UNICEF, canwork directly with local communitiesand thus constitute a link between thecommunity and government author-ities, tn certain situations, NGOs aredesignated by governments to cany outpart of the programmes in whichUNICEF is co-operating. Because oftheir access and flexibility, NGOs cantest innovative projects which oftenprovide a basis for expansion or adapta-tion.

NGOs also provide UNICEF withinformation, opinions and recom-mendations in fields where they havespecial competence, and in somecases undertake studies for, or with,UNICEF. Following one such specialstudy on childhood disability under-taken by Rehabilitation International, acontinuing partnership between thetwo organizations is reinforcing theefforts of both.

As a result of IYC, many NGOs-not all of them traditionally child-oriented—expanded efforts for children,including fund-raising and advocacy.UNICEF fosters these relationships byproviding information and by encour-aging joint programmes on issues affect-ing children in the developing as well asthe industrialized world.

National Committeesfor UNICEF

The Nat iona l Committees forUNICEF, predominantly organized inindustrialized countries, play an impor-tant role in helping to generate a betterunderstanding of the needs of childrenin developing countries and of the workof UNICEF. The committees, of whichthere are now 33, arc concerned with

52

increasing support for UNICEF, eitherfinancially through the sale of greetingcards and other fund-raising activities,or in other ways through advocacy,education and information.

UNICEF generally receives about asixth of its income from funds col-lected by the committees and from theGreeting Card Operation, for which thecommittees are the main sales agents.

Nevertheless, the priority for child sur-vival, and the need for support-moraland political as well as financial - fromfhe industrialized world, is causingcommittees to place new emphasis onthe advocacy, education and informa-tion dimensions of their work. This isevident in the attention to substantiveissues now being made availablethrough the Greeting Card Operationand reaching out through the net-works of committee volunteers. It isalso manifest in the work of GoodwillAmbassadors Liv Ullmann, DannyKaye and Peter Ustinov, lately joinedby Tetsuko Kuroyanagj in Japan andPuerto Rican pop group Menudo-

•***.*

UNICEFs first "Youth Ambas-sadors"-all of whom work with thecommittees to raise public con-sciousness as well as considerable sumsof money.

The committees1 advocacy for chil-dren has been greatly helped in recentyears by a closer relationship withUNICEF field operations. Committeemembers from many countries haveundertaken collective study tours todeveloping countries to strengthentheir first-hand knowledge of thedevelopment process and the specialneeds of children within that process.Committee advocacy with their owngovernments for increased assistance tomeet these needs is an important func-tion and benefits considerably fromthe personal experience gainedthrough such missions.

FundingAll UNICEF income comes from

The Puerto EiconpopgroupMenudo-UNICEFsfirst"Youth Am-bassadors*' have,in collaborationwith the NationalCommittees forUNICEF, helpedto mise publicconsciousness aswell as consid-erable sums ofmoney.

UNICEF 980/84,'Mcra

voluntary contributions-from gov-ernments, organizations, and indi-viduals. Most contributions are forUNICEF general resources. Othersmay be earmarked for supplementaryprojects approved, or "noted", by theBoard, or for emergency relief andrehabilitation.

Although most of the funding is con-tributed by governments, UNICEF isnot a "membership" organization withan "assessed" budget. Nevertheless,almost all countries, industrialized anddeveloping, make annual contribu-tions, which together account forsome three-quarters of UNICEF'sincome.

As already noted, individuals andorganizations are also an importantsource of funding, but they representmore than the sum of their contribu-tions. As the "people to people" armof the United Nations, UNICEF en-joys a unique relationship with privateorganizations and the general publicaround the world. Material supportfrom the public comes through greet-ing card sales, individual contribu-tions, the proceeds from benefit events(ranging from concerts to footballmatches), grants from organizationsand institutions, and collections byschool children. Such fund-raisingefforts often are sponsored by theNational Committees.

UNICEF-modest financial resourcesnotwithstanding—is one of the largestsources of co-operation in nationalservices and programmes benefitingchildren of the developing world.Nevertheless, its Rind-raising is onlypart of a larger objective, namelyencon raging a greater share of nationaland international resources to bedirected to services bearing on the well-being of children of the developingworld. It is in this sense thatthe long-standing and well-establishedreservoir of public support in theindustrialized world constitutes aresource for advocacy and policydevelopment more valuable than anyfinancial importance it has or may-attain .

UNICEF is working to increase fund-ing both from traditional donors andother potential sources.

Information on the funds contrib-uted by the recently created Arab GulfProgramme for United Nations Devel-opment Organizations (AGFUNDJappears in the main Review chapter ofthis report. D

Further information aboutUNICEF and its work maybe obtained from:

HIM 44145

•

B.P 443, Abidjan 04Ivory *

UNICEf Regional •

Lsuand Pakistan

P.O. Box 2-154, Bangkok 10200. Thailand

I- Region*] .

-lahj!, Amm .

mill CentralAsia

•.'. IVlhi I I "

UNICKF Office for Australia and

S.VV 2001, Australi.i

UNICI : lapjincA> Unircd Ninoas Im

MA Building Niihikdii1-J , j M t i i - i i i ' 'ine

Jflfwn

Information may also be obtainedfrom the following Committeesfor UNICEF

Czechoslovakia: Poland:

:1 • - , ' ; ! - • • . . ' til . . ; \ustr.ilia

15<S CaKtlcrcdgh Street

Aii'• i i a l Centre

(UNO-',unimcr Strassc 9

ana

^SHI JJeljp.in Cumni;1, me Joseph U-Boitc 9

1040 Bnj' •

Bulgarian Naporwl Ct>

i.1" Mmmrv ttrTuhli t Health5 I^cnin .

-Sotia

Qnadian V"- uninee,uir Road

.pro , Onuno M4S 2L8

Federal Republic of Germanv:

miincc

1 In ' iruJ

•me

tEu•

dcrlandi Ownnmtcc

Bankj\

iihage

New Zealand:

NZ-1

Paljt.. •

iaison Offices

Norway: orwcgjan Ommiii'Kr.i-