Situation of Children in Somalia A review of MICS data and UNICEF programming

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1 Situation of Children in Somalia A review of MICS data and UNICEF programming Preliminary Multiple Indicator Cluster Survey (MICS) 2006 data* Indicator Value Ref Year Source Child population (millions, under 18 years) State of the World s Children 2007 U5MR (per 1,000 live births) MICS 2006 Underweight (%, moderate and severe, MICS 2006 under five years of age) Maternal mortality ratio (per 100,000 live 1, MICS 2006 births) Primary school attendance (% net, 21.0 (male) 2006 MICS 2006 male/female) Primary school children reaching grade 5 (%) 17.5 (female) Primary Education Survey 2004/5 & 2005/6 Use of improved drinking water sources (%) MICS 2006 Adult HIV prevalence rate (%) < WHO Sentinel Surveillance Child work (%, children 5-14 years old) MICS 2006 *or alternate source where MICS data is not available Situation of Children and Women Somalia continues to be in a state of chronic emergency, beset by conflict and division and prone to natural calamities like droughts and floods which cause recurrent displacement. Large segments of the population are living in poverty and remain perennially vulnerable to both abuse and disease. The country is among the least developed in the world according to virtually all social indicators. The major political development since the beginning of the current Country Programme cycle (January 2004) has been the establishment of the Transitional Federal Government (TFG) of Somalia, after fifteen years of civil strife and the absence of a government at the country level. However, the TFG is yet to exercise its authority on the ground in different parts of the country. The predominant trend within Somalia is divergence - with some areas experiencing political development, economic recovery, and building up of institutional structures and others continually plagued by crisis and emergencies. Child Health. Child well-being varies greatly across the country; disparities between the northern zones and the Central/Southern zone highlight the peace dividend for Somaliland and Puntland, where the declines in child and infant mortality have been higher. The 2006 MICS preliminary results show a significant decline in mortality for both infants and children under five: rates stand at 96 and 156 per 1,000 live births respectively in comparison to previous estimates of 133 and 225 per 1,000 live births for the period (MICS 1999). The explanation of the decline is not immediately apparent, given that many other indicators of access to social services show few dramatic improvements; further analysis is underway. Malaria is one of the leading causes of death of Somali children under age five. It also contributes to anaemia in children and is a common cause of school absenteeism. Preventive measures, especially the use of mosquito nets treated with insecticide (ITNs), can dramatically reduce malaria mortality rates among children. Household availability of insecticide treated nets (ITNs) has risen to 22%, but survey results indicate that 18% of Somali children under the age of five slept under a mosquito net the night prior to the survey and only 9% slept under an ITN. Appropriate anti-malarial drugs for treatment of malaria include SP/Fansidar, artimisine 1 Note MICS estimates refer to a midpoint three years before the survey field work. 2 Note MICS estimates refer to a midpoint years before the survey field work. 1

2 combination drugs and chloroquine. Overall, 3% of Somali children who had a fever in the two weeks prior to the survey were treated with an appropriate anti-malarial drug within 24 hours of onset of fever. Immunisation. According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis and tetanus, there doses of polio vaccine, and a measles vaccination by the age of 12 months. Despite sustained immunisation programmes in Somalia, the 2006 MICS 3 found that 25% of children aged months had received a BCG vaccination by the age of 12 months and 20% had received the first dose of DPT. The percentage declines for subsequent doses of DPT to 17% for the second dose, and a mere 12% for the third dose. Similarly, 51% of children received their first polio immunisation by 12 months of age, but this declines to 34% by the third dose. The coverage for measles vaccine was almost 30% among children under two years of age, but only 18% of children had received it by their first birthday. As a result, the percentage of children who had received all eight recommended vaccinations by their first birthday is extremely low at only 5%. Maternal Health. The maternal mortality ratio in Somalia is still amongst the highest in the world. The estimate of maternal mortality 1,013 per 100,000 live births and an average number of 6.7 births per woman in her lifetime - translates into a lifetime chance of 1 in 15 for a Somali woman to die as a result of pregnancy and childbirth complications. Complications such as haemorrhage, prolonged obstructed labour, infections and eclampsia are the major causes of death at childbirth. Anaemia and female genital mutilation (FGM) also have a negative impact on maternal health. Poor access to quality antenatal, delivery and postnatal care, with an almost complete lack of emergency obstetric referral care for birth complications, further contribute to these high rates of mortality and disability. Nutrition. Children s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished. Weight for age is a measure of both acute and chronic malnutrition. Among Somali children under five years of age, more than 1 in 3 (35%) were found to be underweight. Rates of malnutrition in the northern zones are largely unchanged from MICS But in Central and Southern Somalia, malnutrition rates are alarmingly high by international standards, consistent with the recurrent droughts and the poor health /care status of children. Part of the problem is due to poor feeding practices. Many mothers stop breastfeeding too soon, which can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. Only 13% of Somali children are exclusively breastfed in the first four months of life. 'Exclusive breastfeeding' for the first six months of life is strongly recommended as it protects children from infection, provides an ideal source of nutrients, and is economical and safe. Water and Sanitation. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, and typhoid. In addition, access to drinking water may be particularly important for women and children in rural areas, who bear the primary responsibility for carrying water, often for long distances. The population using improved drinking water sources are those who use any of the following types of supply: piped water, public tap, borehole/tubewell, protected well, protected spring or rainwater. Overall, 29% of the Somali population has access to improved drinking water sources 58% in urban areas and 14% in rural areas. This shows only a slight improvement since the last MICS, but it should be noted that the survey was done during the drought. Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. Improved sanitation facilities include: flush 3 As a household survey, MICS data for immunisation differs from immunisation coverage figures tracked through health facility data (such as the information presented on the top of page 4). 2

3 toilets connected to sewage systems, septic tanks or pit latrines, ventilated improved pit latrines and pit latrines with slabs, and composting toilets. More than one third, 37%, of the population of Somalia is living in households using improved sanitation facilities. This ranges from 76% in urban areas to 16% in rural areas. Education. Universal access to basic education and the achievement of primary education by the world s children is one of the most important targets of the Millennium Development Goals and A World Fit for Children. Based on the annual Primary Education Survey, Somalia s Gross Enrolment Rate has increased to 27.9% (33.6% for boys and 22.1% for girls) in 2005/06, up from 17% (22 for boys and 12% for girls) in 2002/03. However, the primary school attendance rate based on the MICS 2006 is only 19% overall (34% in urban areas and 13% in rural areas) and10% in Central and Southern zone. For every 10 boys in school, there are only 8 girls and the gender parity ratio drops further to 10:5 for secondary education. HIV/AIDS. Currently, prevalence of HIV remains low in Somalia (<1% among ANC attendees in 2003), but misconceptions about HIV are common and hinder prevention efforts. Approximately 4% of young Somali women (age 15-24) have comprehensive correct knowledge of HIV and this knowledge is correlated with their level of education and urban residence. Protection. Many children and adolescents in Somalia have known nothing but conflict and hardship, are out of school and illiterate or semi-literate, have suffered displacement and have observed, experienced and sometimes participated in violence, use of weapons, drugs and other social ills. Violence against children, child labour and recruitment, and harmful traditional practices such as early marriage and Female Genital Mutilation (FGM/C) all feature in Somalia s landscape of child protection violations. Compounding these issues is the diminished community capacity to protect the rights of women and children as a result of prolonged civil unrest. The International Convention on the Rights of the Child states that every child has the right to a name and a nationality and the right to protection from being deprived of his or her identity. Birth registration is a fundamental means of securing these rights for children. Due to the lack of formal Somali registration systems, the births of a mere 3% of children under five years in Somalia have been registered. A major underlying cause of the poor status of women and children is the weak capacity of the duty bearers to meet their obligations. This is attributed to a number of factors, including: a lack of national policies and legal instruments limited knowledge, skills and commitment - across the continuum of duty bearers, from parents to ministers - to meet obligations lack of technically qualified staff to provide services and lack of formal infrastructure In addition, the Somali population is widely dispersed and mobile, making interventions complicated and limiting access for a segment of population. Against this backdrop, the Joint Needs Assessment (JNA) process was underway during 2006 to assess needs and develop a prioritised set of reconstruction and development initiatives. The resulting Reconstruction and Development Framework (RDF) will support Somali-led efforts to promote peace, thereby laying foundations for the establishment of an effective governance and sustainable recovery process in order to provide a platform on which to re-energise the country s advance to the Millennium Development Goals (MDGs). Parallel to this process, the UNCT utilised the JNA/RDF outcomes to take further steps towards the development of a common UN country programme (the UN Transitional Plan) due to commence in UNICEF has invested considerably in this overall process, both intellectually and financially, throughout the year, committing staff and operational resources to support joint office and programming initiatives. 3

4 Key results and lessons learned: UNICEF Country Programme Despite the security situation UNICEF maintains a large operational presence throughout Somalia, partnering with local and international NGOs, CBOs, women s and youth groups, counterparts and other UN agencies. The design and programme strategies have followed the principles of flexibility and decentralisation by taking into consideration of the diversity of zonal contexts and the sudden changes in the political and security context. Child Survival Health, Nutrition, Water, Sanitation and Hygiene. In the area of Health, one of the achievements has been the prevention of outbreaks of cholera during the last three years. Although Somalia s recurrent cycle of acute-on-chronic emergencies continues to impact negatively on the performance of the health sector in general and immunisation activities in particular, UNICEF maintained the support to the entire Maternal and Child Health care network throughout the country. Preliminary results of routine immunisation coverage from vaccination centres throughout the country for 2006 are: BCG =35%, DPT3 =20%, Measles = 60%, TT2+ pregnant women =34%. However, the number of children receiving DPT 3 has been steadily increasing since 2003, up from 79,937 in 2004 to 89,577 in 2005 and 60,398 in 2006 (pending 4th quarter results) with 80% reporting from partners. As an alternative strategy for protecting children from measles, mass vaccination campaigns targeted children between six months and 15 years of age in 2006 with a reported coverage ranging from 60 to 67%. Polio eradication experienced a serious setback with the outbreak of Wild Polio Virus (P1) in Mogadishu in July 2005 after a two year polio-free status. In 2005, 185 cases were confirmed, followed by 33 in 2006 (as of 14 December 2006). In partnership with WHO, one round of Sub National Immunisation Days (SNIDs) and 8 rounds of NIDs were conducted between January and December 2006 targeting an average of 1.4 million children under five in each round, with a reported coverage ranging from 63 to 95%. Annually an estimated 1 million children between six and 59 months of age received Vitamin A during measles campaigns, routine EPI activities and the Polio NIDs from Despite these efforts, household survey data from MICS 2006 shows that only 36.2% of children 6-59 months had received a high dose of Vitamin A. Low dose Vitamin A supplementation for pregnant women was provided for an estimated 109,405 pregnant women during 2005 and During , ongoing monitoring of the nutritional status of children and women was coordinated amongst local authorities, UN agencies and NGOs across Somalia with FSAU publishing monthly updates. In responding to recent Horn of Africa drought response, 17 surveys were carried out to assess the status of the populations in various high risk areas. Based on these assessments, UNICEF provided support to partners for the treatment of 24,102 moderate and severe malnourished children through supplementary, therapeutic, community based therapeutic feeding centres in In combination, the feeding programmes had a 75% cure rate, meeting the SPHERE standard. From over 668,000 people have gained access to clean water, including 263,000 people who received life-saving support through water trucking during the drought response. Each year, alongside the construction of latrines and hand washing facilities, UNICEF and partners conduct training on hygiene education for school teachers and community education committees. In combination, these interventions have contributed to a significant increase of good hygienic practices. The 2006 MICS results show that 54.87% of households are practicing handwashing, up from 23.1% in the 1999 MICS. To build institutional capacity, technical support was provided to the authorities and a water policy, strategy and act were been adopted by Somaliland authorities in 2005; the same process is ongoing in Puntland. Wherever possible, UNICEF has placed strong focus on public-private partnership as a successful model for managing water systems which benefits from legal and political certainty. Education, Protection and Participation. A total of 107,048 additional Somali children, including 42,793 girls, gained access to basic formal primary education from 2002/03 to 2005/06, bringing the total number of children enrolled in formal primary school to 393,856 by the end of 4

5 2006. Total enrolment and girls enrolment increased by 37% and 40% respectively during the country programme period, exceeding planned targets. However, the 2005/06 Primary School Survey results show that the retention rate to grade 4 is only 59.8%. In addition to these figures for formal primary school, UNICEF and partners are using other methods to help children fulfill their right to education. Currently, a total of 70,343 children between ages six and 13 are benefiting from primary/basic education through Primary Alternative Education (PAE) learning centres. Non-formal education (NFE) opportunities were extended to an additional 16,000 youth aged of whom 65% are girls. More than 10,000 out of school youth aged were reached with awareness raising skills training in leadership and organisational development, FGM/C, civics and local governance, HIV/AIDS prevention and conflict resolution. This outreach initiative led to an 18-month process of youth policy development with an in-depth element of child participation. More than 350 communities created a more protective environment for children by ensuring that disabled children have access to school, reunifying street children with their families, protecting children from exploitative labour, and referring victims of violence for medical and psychosocial care. UNICEF initiated a full-fledged approach to Community Driven Recovery (CDR) from a rights based programming perspective. This initiative aims to strengthen communities participation and contribution to their own social recovery and development process. With the Human Rights Based Approach to Programming as its central strategy, the project is designed so that claim holders, not duty bearers, set the recovery agenda by developing capacity at community level to fulfill, respect and protect women s and children s rights. The positive results of converging service delivery in health, nutrition, education and safe water provision through this approach have resulted in a partnership with UNDP, World Bank, DFID and UNHABITAT to scale up the initiative. UNICEF has spearheaded the components of community capacity development, decentralised social service delivery, and district-based social policy planning. 5

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