UNiCEF NEWSLETTEr ON THE SiTUaTiON OF CHiLDrEN iN maDaGaSCar

The Main issue

august 2011

LaCK OF HUmaN rESOUrCES

HEaLTH

CHiLDrEN ENDUrE THE CONSEQUENCES OF maDaGaSCarS CriSiS

HOUSEHOLDS

The erosion

primarY EDUCaTiON

Joint education sector review highlights gaps while FTi funding provides hope

UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

For more information :

Daniel Timme Chief External & Media Relations (MRE) Mobile: +261 (0)33 15 411 31 dtimme@unicef.org UNICEF Madagascar United Nations Childrens Fund Maison Commune des Nations Unies Zone Galaxy Andraharo

Madagascar Publication August 2011

Design & layout: Abela Ralaivita

UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

EDUCATION

Joint education sector review highlights gaps while FTi funds give hope

4 6 10 14 17 18 19

CHILD SURVIVAL

Lack of human resources threatens madagascars health centres

Summary

HOUSEHOLDS

Children endure the consequences of madagascars crisis

YOUTH PARTICIPATION & EXPRESSION

Youth & Biodiversity : Our future, our life, our voice

PRIVATE SECTOR

Telecommunication companies join forces for madagascars children

SANITATION

a new urban sanitation project will help antananarivo deal with unprecedented population growth

NUTRITION

Maternal education influences the childrens nutrition

UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

The Main issue EDUCATION

August 2011

Education

Joint education sector review highlights gaps while FTi funds give hope

An alternative joint review by the Ministry of Education and the technical and financial partners working in the education sector underlined a progressive erosion of the education system, especially at the primary school level. Since 2008, the primary school completion rate has fallen by 6 per cent, and the number of school drop-outs for children between the ages of six and ten has gone up by 138,000 between the 2008/2009 and 2009/2010 academic years a 53 per cent increase. To date, no social protection measures are in place to address this issue.

n 2010, none of Madagascars public primary schools received annual school grants, designed to alleviate the cost of schooling for parents. In 2011, these grants have been significantly reduced equivalent to just 800-3,000 ariary per child. Investment in education which exceeded US$82 million in 2008 has fallen to US$14.4 million. The number of community recruited teachers often with limited formal qualifications has almost doubled since 2007, reaching 52,000 in 2011. Meanwhile, teacher training has been almost non-existent since the onset of Madagascars political crisis in 2009. All that has put enormous strain on the countrys Education for All (EfA) plan, endorsed in 2008. This plan seeks to extend the primary school education cycle to seven years, to develop the curriculum and improve childrens learning outcomes Several international donors have shown enormous support for Madagascars EfA plan through Fast Track Initiative (FTI) funds: a global funding partnership between donors and developing countries. Created in 2002, it was designed to accelerate progress towards EfA targets in order to reach the Millennium Development Goals on education.

Facts & Figures

Since 2008, the primary school completion rate has fallen by 6 per cent, and the number of school drop-outs for children between the ages of six and ten has gone up by 138,000 between the 2008/2009 and 2009/2010 academic years a 53 per cent increase. (Joint alternative Review) In 2010, none of Madagascars public primary schools received annual school grants, designed to alleviate the cost of schooling for parents. In 2011, these grants have been significantly reduced equivalent to just 800 - 3,000 ariary per child. Investment in education which exceeded US$82 million in 2008 has fallen to US$14.4 million. (Joint alternative Review) The number of community recruited teachers often with limited formal qualifications has almost doubled since 2007, reaching 52,000 in 2011. Meanwhile, teacher trainings have been almost non-existent since the onset of Madagascars political crisis in 2009. (Joint alternative Review) Since 2009, the FTI funds for Madagascars government have been suspended as the international community awaits a solution to the countrys ongoing political crisis. As a result of intensive consultations led by UNICEF, a total of US$37 million of Fast Track Initiative funds was released for the academic years 2009/2010 and 2010/11. This fund was disbursed through UNICEF to avoid giving direct budget support to the internationally un-recognized government

However, since 2009, the FTI funds for Madagascars government have been suspended as the international community awaits a solution to the countrys ongoing political crisis. Putting children first Political turmoil has prevailed over childrens well-being for over two years now, a situation that needs to be reversed. It has been a priority for UNICEF and partners in the education sector to join forces and find a funding solution. These efforts have succeeded. As a result of intensive consultations led by UNICEF, a total of US$37 million of Fast Track Initiative funding was released for the academic years 2009/2010 and 2010/11. This money was disbursed through UNICEF to avoid giving direct budget support

to the internationally unrecognised government. This investment made it possible to pay thousands of community teachers. In addition, over 10,000 schools with more than 1.7 million school children have received funds to reduce the financial burden on families and to help ensure that children can enroll, stay in primary school and receive a quality education. The third tranche of FTI funds, amounting to $27m, will be disbursed later in 2011 and will include $10.5m for salaries for approximately 44,000 community teachers, $3m for school feeding operations in 850 schools, $3.3m for the construction of 177 classrooms, $3.4m for school kits for 1.8 million children, $4.6m in grants for 20,000 schools, and training for over 7,700 teachers

4 UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

The Main issue

August 2011

Education

Children are the innocent victims of the political crisis

anosy region, July 2011 (UNiCEF) - Classes have already begun at the new primary school in Zafimahavory, a village twenty kilometers from Tolagnaro, in southern Madagascar, but a group of children are playing in the yard outside. We are not going to school because our parents could not pay the tuition fees, says 7 year-old Clarisse, glancing enviously at the students inside. Clarisses education stopped a few months earlier when her parents ran out of money. They didnt have enough anymore to pay the school, so the teachers asked me to leave, she explains. For Robertin Razanasoa, the schools head, this is a difficult and recurring problem. Many families cannot afford to pay the 800 ariary (USD 0.40; forty cents) that the community agreed on as a salary for the teachers, he says. We could have continued to accept their children in class, but if we did, then other families would stop paying because they would discover that they too could send their children to for free. Among the five teachers working at the Zafimahavory primary school, Razanasoa, who also teaches at the preparatory level, is the only permanent civil servant paid by the government. The other four are supported by the Parent Pupil Association (FRAM), which can mean that their salaries are unreliable. Because many parents dont regularly honor their payment, we generally get half of what was initially agreed, between USD 10 to USD 15 per month, says Clovis Mosa Rabemananjara, one of the teachers. Like Clarisse, many Malagasy children have been forced to drop out of school since the beginning of the political crisis. The investment budget for education stood at 164.8 billion ariary (USD 82.4 million) in 2008, but has since dwindled to 28.9 billion ariary (USD 14.45 million) in 2010 primarily as a result of substantial cuts in the state budget, coupled with the suspension of financial aid by development partners. Public primary schools have not received full school grants, designed to alleviate the financial

burden on families of educating their children, and in 2011, these grants were lowered again, from 3,000 ariary (USD 1.5) to 800 ariary (US 0.40) per child. Fast Track Initiative funding has been released to the education sector through UNICEF vastly improving the situation. In March 2011, UNICEF also launched the Local Catalytic Funds initiative, designed to reach more than 17,700 schools. This aims to fill the gap caused by the reductions in the school grants, helping parents to keep their children in school. The final tranche of the FTI funding is due in late 2011, with funds earmarked for UNICEF to distribute school kits to pupils, build classrooms and train teachers

5 UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

The Main issue HEALTH

August 2011

Child survival

Lack of human resources threatens madagascars health centres

Madagascars health system faces a chronic lack of human resources, especially in health centres in remote areas. Two hundred and fourteen health centres were closed in January 2011, and in 80 per cent of cases, this was due to a lack of health workers, despite the recruitment of 780 health workers in 2010 including 300 physicians and 480 paramedics. Monitoring of the situation in basic health centres has revealed that a lack of funding and qualified personnel are among the main obstacles preventing the delivery of basic health services.

adagascars health system has been severely affected by the ongoing political turmoil. Fragility at the operational level has left the system unable to meet the basic health requirements of the population, and has reduced access to quality health care. This deterioration is a result of many factors, including a 30 per cent reduction in the public budget allocated to the health sector compared to 2008. Among health centres, 45 per cent complain about the irregularity of supplies in health commodities. The sector has also lost foreign donor support, and increased poverty has made people unable to afford health care even in those instances where it is available. However, while it is clear that Madagascars health services are struggling, there remains a critical lack of detailed information on how the system is operating particularly at the decentralized levels. The lack of a coherent monitoring structure precludes the regular collection of data to help identify the most effective interventions in order to address the most pressing needs of the population. In the Anosy, Androy and Atsimo Andrefana regions of southern Madagascar, 19 out of 147 basic health

Facts & Figures

In Madagascar, more than 38,000 children die each year before their fifth birthday from preventable diseases, including diarrhea, acute respiratory infections and malaria. Two hundred and fourteen health centres closed up in January 2011, and 80% of the cases were due to lack of health workers. It still happened even if the Ministry of Health recruited 780 health workers in 2010, including 300 physicians and 480 paramedics. (Ministry of Health)

centres (13 per cent) have closed due to lack of human resources, depriving 11.6 per cent of the population of essential health care. In response to these issues, WHO, UNICEF, UNFPA and UNAIDS have put in place a monitoring system to gather more detailed data on the situation of health services in the south, within the context of the crisis. During the first quarter of 2011, three regional health directorates in Anosy, Androy and Atsimo Andrefana were visited, as well as seven district-level management of health and 15 basic health centres. Standardized tools for data

collection were developed at each level in order to provide all four UN agencies with relevant data. Through the Central Emergency Response Fund (CERF), UNICEF Madagascar, alongside WHO and UNFPA, and in partnership with the Department of Human Resources of the Ministry of Health, recruited 52 parttime paramedics. This has allowed 41 basic health centres in eight districts of these three southern regions to reopen. It also enabled free medical care and essential drugs for 320,000 people, especially children under five year old and pregnant women, between April to September 2011

Monitoring in Basic Health Centres revealed that lack of funding and persistent lack of qualified personnel are among the main obstacles which prevent them from delivering basic health services. Madagascar has shown limited capacity to respond to the pressing social needs of the population in view of its budgetary constraint. The Ministry of Health have seen their non-wage and capital expenditures (funded on their own resources) declined by 70% between 2008 and 2010. (Economic Update, World Bank, March 2011)

6 UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

The Main issue

August 2011

Child survival

in madagascar, UNiCEF and GaVi work to protect health gains for young children
aNKariEra, madagascar, 7 June 2011 (Unicef) It is late morning at Ankariera health centre. The small threeroom clinic the only facility in a 10 km radius is ready for a busy day. Mothers with small infants clutch their pink child health cards outside the centre, as they seek shade from the hot sun. Next to the clinic, older women and men gather with different produce they have brought to sell at the adjacent weekly local market. Standing amid it all is paramedic Hantamalala Ramanandraibe, the health centres sole health worker. Only in the job a few months, shes responsible for an estimated 4,600 people.She does everything from vaccinating adults and children to delivering babies. It is a tough job for this dedicated young woman. She has no running water or electricity at the clinic, and has very limited contact with the nearest referral hospital. As it is market day today, everyone comes to the clinic, says Ms. Ramandandraibe calmly. So today I am going to do consultations and family planning vaccinations all at the same time. Safeguarding child survival Over the last two decades, Madagascar has been one of a handful of countries to reduce its child mortality rate by 60 per cent. The mortality rate for children under the age of five has fallen from 167 deaths per 1000 live births in 1990 to 58 per 1000 live births in 2009. This has been achieved in part by the successful implementation of the countrys national immunization programme.Yet many of these gains are under threat and recent data indicates a downward trend. Political crisis has resulted in a government which is not internationally recognized and a subsequent drop in development assistance. The Ministry of Health have seen their non -wage and capital expenditure declined by 70% between 2008 and 2010. Government spending on healthcare reached a 10 year low last year of just $2 per person. If we dont manage to sustain the rate of coverage, were in danger of seeing the childhood mortality rate go up again, says Marie Therese Baranyikwa, UNICEF Madagascar Immunization Specialist. Equity-based efforts UNICEF, Global Alliance for Vaccines and Immunization (GAVI) and the World Health Organization are working to keep the national immunization programme operational and give every child the protection he or she needs from deadly yet preventable diseases such as tetanus and hepatitis B. This is particularly important for the poorest and most vulnerable children, as UNICEF makes a concerted effort to reach marginalized and disadvantaged communities in order to achieve the Millennium Development Goals with equity. GAVI a global health partnership funded by governments, foundations, the private sector and other agencies finances new, affordable vaccines for the worlds poorest countries. The reality is it is the poorest countries which need the most help, yet are often the most challenging as they have the weakest health systems and limited funding to afford new vaccines, says GAVI Media Manager Ed Harris. Yet immunization is one of the most straightforward and successful ways to save a childs life and reduce child mortality. In Madagascar, GAVI funding is promoting safe injections and introducing new vaccines such as the Pentavalent vaccine, which prevents five childhood killers including tetanus and diphtheria in one jab. With additional funding, a new vaccine against pneumococcal disease will be introduced next year. Vaccines to remote areas At the central vaccine warehouse in the capital city of Antananarivo, a dedicated team manages the countrys national distribution. Marius Rakotomomga, Head of Vaccination at the Madagascar Health Department, is grateful for the new two cold rooms provided by UNICEF that keep their central stock of vaccines safe and at the right temperature. But he worries about other logistical challenges they face in getting vaccines to the countrys 700,000 children under the age of one. We do not have sufficient resources, he says. We also only have one truck and have to rely on commercial flights to move the vaccines around the country. Funding from partners like UNICEF and GAVI has been critical in keeping the health system going and ensuring vaccines reach the remote health centres, like Ms. Ramandandraibes clinic in Ankariera. Shortage of funds means the capacity of health workers has also been stretched, leaving many health posts and clinics without staff. To help mitigate this, UNICEF and GAVI help support routine vaccination campaigns and bi-annual mother and child health weeks, where thousands of health workers go door to door to supplement vaccines offered weekly at health clinics. Critical investment UNICEF has doubled expenditure on immunization to cover the gap in national funding, arguing there is no choice but to ensure the system does not collapse. The consequences of an epidemic are very grave and complications for Malagasy children are severe, explains Ms. Baranyikwa. They are already vulnerable and poorly nourished. This critical investment in vaccines is helping ensure that Madagascars children are protected. Back at Ms. Ramandandraibes clinic, another young mother brings her baby in for vaccination. There is no doubt that this small life-saving intervention today will ensure a healthier life tomorrow

7 UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

The Main issue VACCINATION

August 2011

Child survival

madagascars tenth mother and Child Health Week underlines the importance of immunization
Over seven days in April, Madagascars tenth Mother and Child Health Week reached millions of women and children across the country with a package of integrated interventions including vaccinations, vitamin A supplementation and screening for malnutrition in children. Coinciding with Africas Vaccination Week, the campaign underlined the importance of the slogan: Vaccinated population, healthy population.

ince 2006, UNICEF and partners, including the World Health Organisation, have supported bi-annual Mother and Child Health Weeks (MCHW) as part of a strategy to reinforce delivery of routine basic health services targeting children and women in remote and difficult to reach areas In April, around 7,000 health workers, 16,000 community agents, and 35,000 volunteers were active during the week, with more than 2,900 fixed sites and 5,100 outreach and mobile sites operational in order to reach even the most remote areas. High impact interventions: immunizations Without a doubt, immunizations remain one of the most successful and cost effective public health interventions globally helping to protect millions of children from needless disability and death. In Madagascar, the Expanded Programme of Immunization is identified as one of the key interventions for reducing child mortality, ensuring that children are provided with immunity against often deadly but vaccine preventable diseases. Mother and Child Health Weeks are essential in delivering these vaccinations especially in Madagascar

where 40 per cent of the population are not covered by the existing health system. Madagascars under-five child mortality rate has fallen in recent years from 168 deaths per 1000 live births in 1990, to 72 deaths per 1,000 live births in 2009. However, everyday an estimated 104 children still die before their fifth birthday this number is likely to rise if vaccination rates in Madagascar fall. Strengthening the countrys vaccination system is now critical. During a joint UNICEF-UNFPA study carried out in 2011, just under 20 per cent of health centres visited reported having no stocks of vaccines available at the time of the survey. Insufficient storage capacity, limited transport means, ruptures in the cold chain (due to a lack of kerosene), and lack of vaccine availability at the central level are the main challenges. Reinforcing the system is essential in preparation for the introduction of new vaccines for pneumonia in 2012 and the rotavirus vaccine (against diarrhoea) in 2013. These illnesses are among the three biggest causes of under-five child deaths in Madagascar, and ensuring the efficacy of vaccines protecting children against these illnesses is vital.

Nutrition More than 228,000 children under five were screened in the regions of Androy, Anosy and Atsimo Andrefana. Among them, 1,308 were admitted to health centres for outpatient treatment of severe malnutrition, while 54 were admitted to specialized intensive therapeutic feeding centres, found only at hospital level. The second phase of the MCHW for 2011 is scheduled to run from October 24th

to 30th 2011. It will target around 3.5 million children under five years old and 1 million pregnant women. The operational cost of this week is estimated at 1.1 million USD; only fifty percent of these funds are available leaving a financial gap of six hundred thousand USD. Without filling this financial gap, it will be impossible to reach the planned target population with a package of mother and child survival interventions during this week.

8 UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

The Main issue

August 2011

Child survival

Strengthening the cold chain system to preserve vaccines in madagascar

UNICEF hands over new cold chain storage facility to Madagascars Ministry of Health

UNICEF handed over two new cold rooms to the Madagascars Ministry of Health, as part of their efforts to prepare for the introduction of pneumococcal vaccine in early 2012 and to ensure a continuous availability of safe and effective vaccines. These new cold-chain stores will be used in the storage of vaccines for routine immunization and national campaigns against child-killer diseases, including pneumonia, and will provide much needed storage capacity as the government works towards introducing new vaccines into its routine immunization schedule. Immunization is a key intervention for promoting child survival for the children of Madagascar, said Paul Ngwakum, head of UNICEFs Child Survival programme in Madagascar. A strong cold chain is one of the building blocks of a successful immunization program, so that the life-saving vaccines remain potent until they reach the eligible children. New vaccines can be stored in the facility in large quantities, allowing Madagascars vaccination system to address the rising demand for immunization that are key to achieving the Millennium Development Goals related to child survival.

The systematic roll-out of vaccines against childhood illnesses is strongly linked to the reduction of child mortality, and is a key pillar of UNICEFs work for children in Madagascar, Africa and globally. Todays opening of this new cold room ahead of the introduction of the pneumococcal vaccine against pneumonia is particularly important. It means that the new vaccine can now be used to help prevent one of the major causes of death among children under five in Madagascar, said Ngwakum. It is exciting that through innovative partnerships and funding mechanisms, children in countries like Madagascar will soon have access to these lifesaving technologies. Through vaccination, we have the ability, the opportunity and the responsibility to protect the children of Madagascar and the region from pneumonia and other deadly diseases, explains Bruno Maes, UNICEF Madagascar Representative. In Madagascar and throughout the region, UNICEF continues to work closely with health sector partners to ensure that all children are reached with immunization. In addition to supporting the cold-chain, UNICEF supports the procurement of vaccines, health worker training, and local level planning and community mobilization to ensure that children receive the immunizations they need

9 UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

The Main issue POVERTY

August 2011

Households

Children endure the consequences of madagascars crisis

To be poor is to live on less than 468,800 ariary or US$234 a year. Today in Madagascar, such poverty affects 84.5 per cent of children under five years old and 82.1 per cent of children aged between 5 and 14. Madagascars persistently high poverty rate the product of decades of poor socio-economic development is made worse by the countrys recurring political crises. In 2005, 68.7 per cent of the population were living in poverty, according to Madagascars National Household Survey. Today, this figure stands at 76.5 per cent.

ith a real economic growth rate that is generally lower than the population growth rate of 3.1 per cent, Madagascar is among the poorest countries in sub-Saharan Africa with one of the highest poverty rates oscillating between 70-75 per cent of the population, and reaching as high as 80 per cent in times of political crisis. Children are among the first to feel the impact of such poverty. Of the 84.5 per cent of children under five that live below the poverty line existing on less than US$234 per child per year 9 per cent live in extreme poverty. These children survive on less than US$58 a year, or 117,200 ariary. A further 61.1 per cent of children under five who live in poverty live on between US$58 and US$174 per child per year (National Household Survey (NHS), 2010). Among children between 5 and 14 years old that live in poverty, 8.5 per cent live in extreme poverty, and the greater the number of children living in a household, the greater the number among them who live in poverty (NHS, 2010). Further analysis of 2010 NHS data shows that nearly 90 per cent of people living in families of more than seven people live below the

poverty threshold. Disparity between rural and urban population is evident. According to the 2010 NHS, in rural areas the poverty rate is 82.2 per cent, while in urban areas it is 54.2 per cent, with a national average of 76.5 per cent. In addition to a population growth rate that outstrips Madagascars gross domestic product (GDP) growth, frequent natural disasters often related to climatic hazards including drought and cyclones significantly contribute to continuing poverty. Losses in education Madagascars poverty rate has risen markedly in the aftermath of the 2009 political crisis, reflecting a similar situation following the crisis of 2002. Between 2001, prior to the onset of political turmoil, and 2002, poverty rose from 69.9 per cent to 80.7 per cent. At the same time, GDP growth plunged into negative figures, falling to -12.4 per cent. The population growth rate remained stable at around 3 per cent. For children, an almost immediate impact of such economic instability is reduced access to education. According to a report by Madagascars Ministry of Education, between the

2008/2009 and 2009/2010 school years, the number of children out of school aged 6 to10 years rose by 53 per cent. The drop-out rate at primary school level is 6.3 per cent, with evident regional disparities (NHS, 2010). Most children outside of the education system enter the world of work at a very young age. In rural areas, nearly 30 per cent of children are involved in economic activities, while one in 10 children aged five to 10

years have a job. According to data from the 2011 State of the Worlds Children report, 28 per cent of children aged between five and 14 years are involved in economic activities. The situation is clear. As a result of chronic poverty, Madagascars children find themselves enduring extreme hardship: poor nutrition, homelessness, loss of schooling, a lack of basic health care and little or no access to water and sanitation

10 UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

The Main issue

August 2011

Households

poverty exposes children to violence, exploitation and abuse

aNTaNaNariVO, madagascar, July 2011 - Standing among the cars and engines that fill the training centre for mechanics, Rinah Tojoarimalala, 18, shares his life story as a former street child. I lived on the streets for seven months. I did not want to live with my stepfather. He always kicked me at home. I also felt I was a burden for a family with nine children. Having nowhere to go, he decided to live and work in the streets of Antananarivo, Madagascars capital, to survive. I was cleaning cars every day, but with so many of us children in the street, informal jobs were not easy to find. When I did not earn money, I did not eat anything, explains Rinah. At night I slept on the street. When it rained, I tried to stay dry in shop doorways . Rinahs daily struggle illustrates the lives of many children living on the streets due to poverty or domestic violence. Their exact number remains unknown, and is difficult to assess at this time without a functional monitoring mechanism in place. However, with UNICEF support, a Child Protection Data base has been established at central level. To support this, data collection tools have been developed and capacity built among members of Madagascars Child Protection Networks helping them to gather data that will be used to feed the database. According to Madagascars National Household Survey, poverty affects more than 80 per cent of children under 14 years old. Madagascars persistently high poverty rate the product of decades of poor socio-economic development is made worsened by the countrys recurring political crises. In 2005, 68.7 per cent of the population was living in poverty. Today, this figure stands at 76.5 per cent. Since the onset of Madagascars political crisis, social protection mechanisms have been weakened and the risk of children and women being exposed to violence, exploitation and abuse as they try to meet their survival needs has increased, explains Bruno Maes, UNICEF Representative in Madagascar. To address this, UNICEF is working to identify those children that are the most vulnerable to abuse, and in partnership with social service counterparts, is designing strategies to better reach them with vital interventions. UNICEF reinforces access to adequate psycho-social, medical and legal services for child victims of abuse, exploitation and violence by strengthening child protection mechanisms. Currently, UNICEF provides direct support to 450 Child Protection Networks, established in 55 communes; and is building the capacity of institutions such as the police, the judiciary and medical doctors to respond to cases of violence, abuse, neglect and exploitation. Child Protection Community Networks play a key role in identifying and responding to acts of child abuse, and to raising awareness of child protection issues at a community level. They also play a vital role in gathering sufficient data on which to build evidence-based advocacy and interventions that address issues related to child rights. In response to Madagascars political crisis, UNICEF is documenting its impact on the functioning of the Child Protection Networks ability to continue to provide the services needed to protect the most vulnerable children. Private sectors partners have also joined UNICEF and Madagascars police force to provide a free child protection helpline. This helpline is designed not only to improve the reporting of incidents, but also to improve the responses of the police and social services. In addition UNICEF has initiated a cash transfer project to families facing to extreme poverty, an alternative which aims to break the vicious circle in which they are imprisoned. UNICEF continues to support child-friendly spaces and is coordinating the taskforce on social protection programming within the United Nations System. Many children who suffer abuse are afraid to tell anyone, and parents often remain silent even when they know a child is being abused, if a family member is responsible. In cases of sexual exploitation among young girls, whole communities are often complicit. All too often, children are left with nowhere and no-one to turn to for help and support, says Anita Ingabire, head of UNICEFs Child Protection in Madagascar. Rinah, however, has found a way out. Today, with the support of UNICEFs field partners, he is the proud recipient of a scholarship to train as a mechanic. I have already learnt a lot of skills and expertise that can help me find a decent job. When I find a formal job, I can help my parents to take care of my eight brothers and sisters, says Rinah. I do not want them to experience what I did

11 UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

The Main issue HOUSEHOLDS

August 2011

Households

Vulnerable households on the rise in antananarivo and Toliary

Since the beginning of the 2009 crisis, UNICEF and its partner agencies have carried out periodic surveys on the vulnerability of households in Toliary and in Antananarivo Madagascars capital. In 2011, findings show a striking shift among households previously categorized as mildly vulnerable, to very vulnerable between May 2010 and June 2011.

hose households that have made this shift are generally large (more than seven people), and headed by young (15-24 years old), unmarried men, living with a partner, whose average income ranges between Ariary 50,000 and Ariary 100,000 per month. These households now fall into the category of very vulnerable, a category that has previously been dominated by households led by women with low incomes (less than Ariary 100,000 per month), the majority of which have more than four household members. A combination of indicators including access to revenue and job market, access to balanced nutrition and health services, protection against violence, affiliation to a social group, education for children, human rights protection and respect of rights and freedom is used to assess household vulnerability. Data on economic activities show that from May 2010 to June 2011, the unemployment rate remained consistent at a high level. However, the number of households that live with a revenue generated from informal trade generally small informal sales has significantly increased from 46 per cent to a 52 per cent. Likewise, the number of households that provide

personnel and housekeeping services has risen. The number of households with members working in public administration and the private sector has also increased, but to a much lesser degree; while the number of people employed formally in commerce has fallen. As Madagascars crisis has persisted, the number of households that previously reported having difficulties in finding work has fallen from 26 per cent to 17 per cent, a result of the fact that many of these households are now earning income through informal activities and are no longer looking for work. School enrolment, especially among the most vulnerable households, has shown an increase between November 2010 and June 2011. However, this increase is misleading because of late enrolments made after the school year officially began in November 2010. Many households surveyed were not able to enroll their children in time for the beginning of the school year as a result of financial difficulties, or because of illness. The absenteeism rate has increased dramatically, notably among primary school children (in June 2011 it was more than four times greater than the rate recorded in May 2010). This is largely associated with illness, a lack of teachers,

and a lack of household revenue. As the crisis continues, households are becoming more and more concerned about the future education of their children, with education now among the greatest worries reported by households. In June 2011, 35 per cent of households reported being worried about the long term education of their children a figure that stood at 23 per cent in May 2010. Elsewhere, survey data show a reduction in food insecurity among households. However, this conceals the fact that a growing proportion of households are buying and consuming street food (54% in May 2010, rising to almost 64% in June 2011), making the indicator used for food security less responsive, as it is less sensitive with regard to recording the quantity and quality of street food consumption. Data on water and sanitation show that the use of improved sources of water is decreasing as a result of the increasing use of traditional wells. In June 2011, 92 per cent of the households surveyed reported having access to improved sources of water, compared to 95 per cent in November 2010 and 93 per cent in May 2010. The number of households with washing facilities has dropped significantly from 62 per cent in May 2010 to 37 per cent in June 2011. Houses with bathrooms are

more expensive than those without, putting a strain on the household budget, and forcing some households to relocate. Although the majority of households can afford soap, its regular use to wash hands has progressively fallen since May 2010. In May 2010, 70 per cent of the surveyed households reported the systematic use of soap for hand-washing, compared to 65 per cent in November 2010 and only 59 per cent in June 2011 a decrease that is result of lack of money, or because hand-washing with soap is no longer habitual. Finally, even where households manage to mitigate the impact of their precarious financial situation, an increasing number among them (almost 70 per cent) express a desire to live in better quality housing, and are more and more pessimistic about the future. In May 2010, 40 per cent of households surveyed expected their situation to improve, in June 2011, only 35 per cent maintained such optimism

12 UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

The Main issue SOCIAL SECTOR

August 2011

Households

Falling budgets hit social services

Falling budget allocations are taking their toll on the quality of basic social services available to Malagasy citizens, and data from the Ministry of Finances and Budget reveal that health and education have been hardest hit. This leaves teachers unpaid and children without access to education, and means that many of Madagascars most vulnerable women and children no longer have access to basic health care.
hile the ministries saw their budget allocations, as a percentage of the state budget, increase slightly in 2009, this has been followed by significant reduction in 2010. In particular, the Ministry of Education saw its budget allocation fall from 24.4 per cent in 2009, to 18.6 per cent in 2010; and funds for the Ministry of Public Health fell from 9.4 per cent of the state budget in 2009, to just 6.2 per cent in 2010. In the first six months of 2011, the Ministry of Education has engaged 35.6 per cent of its annual budget allocation, while the Ministry of Public Health has engaged 28.9 per cent. The Ministry of Water has engaged only 6.7 per cent of its annual budget, a budget that is already tiny, standing at just 0.91 per cent of the state budget. In a country where 59 per cent of children do not have access to safe water and where diarrhoea continues to be among the biggest causes of morbidity and mortality among children under five, such limited sectoral engagement is a concern. Between 2008 and 2010, expenditure on salaries rose in most ministries, with the exception of the Ministry of Decentralisation (see graph 1), but data show that in most instances operational spending has fallen and in the ministries of Education and Decentralisation, between 2009 and 2010 this fall has been dramatic (see graph 2). The Ministry of Health has seen less of a decline, but in a health system that is under-funded and already struggling to cope, the impact of any decrease in spending is marked, reducing access to basic health services as a result of a lack of essential medicines, qualified health staff and infrastructure. Operational spending in the ministries of Water and Population ministries that already receive only a very small budget allocation from the state has remained largely unchanged between 2008 and 2010. Expenditure on investments by the ministries of Health and Education, which was low in 2008, saw a boom in 2009, before falling sharply in 2010 (see graph 3). In 2010, public investment in the health sector was eight times less than in 2009, and in education investment was just a third of what it had been in 2009. Public investment in the water sector has also fallen by 22 per cent. Such a lack of investment can have a potentially huge impact on Madagascars social infrastructure and in the fragile context of Madagascars ongoing crisis, the impact of deteriorating services on an already vulnerable population is increased. Data available in mid-2011 indicate that much needed public investment in the health sector has begun to rise but much work needs to be done to repair Madagascars key social services in order to bring Graph 1 quality basic health care, education and water and sanitation to the countrys most vulnerable women and children

Graph 2

Graph 3

13 UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

The Main issue

August 2011

Youth participation & Expression

Youth & Biodiversity : Our future, our life, our voice

e are the youth from Madagascar; environment is our life, our future, give us our right, listen to our voice is the maxim of the Malagasy Youth Network for Environment (MYNE), an emerging grassroots movement of young climate action advocates launched with support from UNICEF in June 2011. Lately, Madagascar has been identified as one of the countries that will suffer the most from issues related to Climate Change in the next 30 years. This risk is a major concern of Malagasy youth, and is driving them to action. Forest is part of our life here in Ranomafana, said Tahiry, a Junior Reporter from Ranomafana, located in the South-East of Madagascar; it attracts tourists and gives employment opportunity to our community. If it disappears how will we live? Youth in Madagascar have long been involved in environmental protection activities, both at school and at home, and they know how dangerous changes in the environment can be if steps arent taken soon. While significant awareness-raising efforts have been undertaken by youth-led organizations to ensure that their peers are informed about the causes and consequences of environmental destruction and biodiversity loss, more needs to be done to engage youth actively in the processes of biodiversity conservation and climate change adaptation. Its time for us now to engage in discussion about our future declared Herilala, an 18-year-old girl, member of Mpanazava eto Madagasikara.

In the spirit of the call-toaction captured in Herilalas words, UNICEF recently supported a summit of 60 young people selected from different regions and youth-led & youth-serving organisations throughout Madagascar, with the aim of defining how youth can be meaningfully involved in climate action for Madagascar. Such opportunities are really crucial, I have never been outside my town and meeting other young people who are sharing my passion makes me feel so powerful said Joelson, a 16-year-old boy from Andavadaoka, at the conclusion of this first in a series of youth networking

and advocacy workshops supported by UNICEF. Through series of such workshops and exchange visits, UNICEF is equipping young environmental activists with communication and advocacy skills, while also giving these youth the opportunity to come together and define a better future-for themselves and for their country. Sessions on youth participation were welcomed by the participants, as youth recognize their participation as a non-negotiable right. See, its not a favour we are asking the adults; we are asking for something which is already ours said Herilala. during the session.

Perhaps the most important result of these sessions has been the realization by young people that they are already undertaking significant activities in their communities, but that these efforts have limited focus and impact when executed in isolation. To broaden their impact in a sustainable and coordinated way, youth participants realized that they must work as a network. We thank UNICEF for giving us this opportunity to sit together and discuss and see how we can work together said Tafita, a member of a WWF youth club. The result of these discussions was the formation of MYNE, comprising 15 major national youth organisations at the time of its founding and poised to expand its membership significantly in the months ahead. We came here as youth clubs and we go home as a strong network said one of the participants at the workshop; we are together to inform our peers, build our capacities and shout out to say what is not fair, we are no longer a problem, we will bring solution

14 UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

The Main issue

August 2011

Youth participation & Expression

Connecting Classrooms, Communities, and Youth for Biodiversity Conservation

The Connecting Classrooms, Communities, and Youth for Biodiversity Conservation and Sustainable Development in Madagascar initiative, coordinated by the Communication for Development (C4D) team in collaboration with the Education section, integrates environmental education, new technology (ICT4D), youth media, and social mobilization & networking to empower Malagasy children and youth to understand, cope with, and respond to their rapidly-changing environment. Over the initial three-year implementation period (2011-2014), the program aims to engage an estimated 75,000 children and youth in environmental education, social mobilization & participation, and biodiversity conservation activities.
iCTE-Centre VaLBiO (CVB) - ICTE-Centre VALBIO (CVB) has been involved with research, education and outreach since before the creation of Ranomafana National Park (RNP), in May 1991. CVBs permanent, long-term presence and commitment to the region makes it a hub for integrating the local community, officials and national and international organizations working in the realm of scientific research, conservation, management, education, health and sustainable development in RNP and the peripheral zone. Rural communities within villages surrounding Ranomafana National Park (RNP) are hindered by poverty, population growth, low education, and traditional practices of unsustainable agriculture (tavy) and natural resource exploitation. As such, CVB has worked through the years to help identify sustainable conservation priorities for the surrounding community that also respond to urgent human needs--helping toensure poverty alleviation, treatment and prevention of common diseases, forest protection and reforestation. By coupling conservation education and opportunities for sustainable development, CVB works in partnership with the local population to preserve the natural ecosystem and unique biodiversity within RNP while promoting the value of the forest and biodiversity as critical factors in human well-being. Blue Ventures (BV) - Blue Ventures (BV) is an award-winning marine conservation organisation dedicated to conservation, education and sustainable development in tropical coastal communities, and its team has over 10 years of experience working with local communities in Southern Madagascar. The Velondriake zone where BV and UNICEF will collaborate on the project exhibits some of the largest and most healthy coral reefs in southern Madagascar. These habitats are critical to the livelihoods and income of the regions coastal Vezo population, a semi-nomadic people whose cultural identity and way of life is characterised by a fishing and seafaring existence. The regions lack of transport or communications infrastructure, coupled with the dry, arid climate and lack of agricultural productivity, mean that communities have few economic or subsistence alternatives to traditional fishing and reef gleaning. Since 2006, Velondriakes 24 coastal villages have been working together with technical support from BV to manage their marine and coastal resources, improving the sustainability of traditional fishing livelihoods and to protect the regions biodiversity. As part of this vision, Velondriake has pioneered an integrated Population, Health and Environment (PHE) programme, in partnership with UNFPA, to improve sustainability of fisheries, protect biodiversity, provide economically viable alternatives to fishing, and provide access to sexual and reproductive health services. Lessons learned to-date from this programme will inform the different components of BVs collaboration with UNICEF. In addition to CVB and BV, UNICEF is finalizing partnership agreements with Wildlife Conservation Society and Madagascar Fauna Group to support this important initiative. Together, UNICEF and these four new NGO partners will implement the CCCYBC programme, connecting classrooms, communities, and youth at multiple levels to promote community-based conservation and sustainable development in pursuit of MDG 7 in Madagascar

15 UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

The Main issue

August 2011

Youth participation & Expression

recreation or exploitation? Jiromena in analanjirofo and atsinanana

iromena are popular parties regularly organized in the regions of Analanjirofo and Atsinanana. Magnets for young people, the parties are places to meet friends and seek enjoyment and are opportunities for young people to express their personalities and sexuality away from parental observation. According to a UNICEF study on Jiromena in the two regions, 90 per cent of partygoers are young people and among them, 60 per cent are under 18 years old. Nine parents in 10 say that Jiromena events have no positive influences on their children. Nearly a quarter of parents surveyed in Analanjirofo and just under a third of parents in Atsinanana reported that their children had experienced some kind of problem at a Jiromena party with fights accounting for 38 per cent of incidents. The survey highlights the issues that underlie the Jiromena phenomenon especially with regards to young people. Sexual promiscuity at the parties is among such issues: 79.8 per cent of young people surveyed know about girls who have been pregnant as a result of an encounter at a Jiromena event; and 59.3 per cent know about girls who have had abortions as a result. response strategy In response, UNICEF and partners have drawn up an evidence-based strategy that seeks not to put an end to Jiromena entertainment, but to limit the negative consequences by reducing risky sexual behaviour among young people. Developed in participation with local authorities and communities, the strategy will support young people in understanding the dangers they face, and improve access to information that allows them to make positive decisions regarding their behaviour. For Madagascars young people, such information is key to improving their sexual and reproductive health, and to ensuring that their rights as children and youths are respected. According to Madagascars 2009 Demographic and Health Survey (DHS), 11.6 per cent of girls between the ages of 15 and 24 in Atsinanana and 21.7 per cent in Analanjirofo had their first sexual experience before they were 15 years old. At a national level, an astonishing 35 per cent of 15 to 19 year old girls consider it normal for a man to sexually abuse a woman

A film workshop gives Malagasy children the opportunity to express their hopes and dreams
n March 2011, sixteen children between the ages of 12-19 gathered in the Albert Camus Cultural Centre to participate in the One Minute Junior film workshop. Working on the theme of Challenges, Hopes & Dreams, the teenagers learned how to tell their personal stories in 60-second videos. For UNICEF, supporting initiatives that encourage young people to speak out about their rights is a priority. In Madagascar, 50 per cent of the population - or nearly 10 million people - are under 18 years old. However, most adolescents and young people have poor access to training in life and vocational skills, and have limited economic prospects and little exposure to media and other sources of information. This often leaves them unaware of their rights and with limited means through which they can speak out about abuse and injustice. Through the One Minute Junior film workshop, the students learned how to use basic filming and editing equipment, develop scenario and create narratives. And each of them produced their own 60-second film. The One Minute Junior training team also trained local film producers in teaching techniques, enabling them to continue to teach children and young people through workshops throughout Madagascar. The One Minute Junior initiative is supported by the European Cultural Foundation and UNICEF. Since 2003, eighty workshops for children across the world have been

organised giving young people access to a creative platform for expression. puppets for child rights Meanwhile, during a week-long workshop in Madagascars capital, Antananarivo, 20 children from across the country learned not only how to make life-sized puppets for the stage, but also produced

five short plays on child rights. The performances covered the themes of education, nutrition, health, child protection and birth registration. It gave the young artists a chance to express their thoughts on issues affecting their lives, upholding their right to participation and expression as enshrined in the international Convention on the Rights of the Child

16 UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

The Main issue CHILD PROTECTION

August 2011

private sector

Telecommunication companies join forces for madagascars children

irtel Madagascar, Orange Madagascar and the Telma Foundation have joined UNICEF and Madagascars police force to provide a free child protection helpline with a common number across telephone networks. The free helpline dial 147 is designed not only to improve reporting of incidents, but also to improve the responses of the police and social services. The line will be operational in 10 towns where evidence shows cases of violence against children to be highest. Incidents of child abuse in Madagascar are underreported and the magnitude remains hidden. Many abused children are afraid to tell anyone, and parents often remain silent even when they are aware of the fact that a child is being

private sector, police and social services, UNICEF hopes to encourage and facilitate the reporting of abuse by both witnesses and victims, and improve inter-sectoral co-operation at a national level. In so doing, UNICEF is strengthening partnerships with the private sector, promoting a growing culture of social responsibility among businesses that allows ever more resources to be leveraged to help realize child rights in Madagascar. UNICEF has been implementing its corporate social responsibility strategy since 2009, working with private sector partners to develop initiatives that promote child rights and encourage positive corporate attitudes towards children

abused, particularly when the abuser is a family member. In cases of sexual exploitation among young girls, entire communities are often complicit. Faced with such realities, children are too often left with nowhere and no-one to turn to for help and support. In other cases, violence

against children is not reported simply because it is not seen to be unusual, or because there are no secured mechanisms through which to report the abuse. involving the private sector In providing and publicizing an anonymous free helpline that brings together the

PARTNERSHIP BETWEEN COLIS EXPRESS AND UNICEF MADAGASCAR

a milestone in Corporate Social responsibility in madagascar

n order to foster Corporate Social Responsibility in Madagascar, UNICEF has worked to engage businesses in a wide range of activities since September 2009. This process is designed to promote behaviour change and business practices and to co-develop strategic partnerships with corporates in an effort to promote child rights in pursuit of reaching the Millenium Development Goals in Madagascar. delivering up to 5 tons of wash kits every year during emergencies and during the Global Handwashing Day; (iii) actively involving its 600 employees and clients by raising their awareness on healthy drinking water, hygiene and adequate sanitation. Colis Express will print and disseminate in its 86 agencies communication materials during WASH Special Advocacy Events such as World Water Day in March, Globalhandwashing Day in October, and World Toilet Day in November

Among UNICEF Madagascars existing partners, Colis Express is one of the few 100%

Malagasy owned companies to enter in an agreement. The partnership will run until December 2013 and covers three main components: (i) setting an internal policy which develops a child

friendly business practices within Colis Express, with the technical support of UNICEF; (ii) providing support to UNICEFs water, hygiene and sanitation (WASH) programme and

17 UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

The Main issue URBAN SANITATION

August 2011

Sanitation

a new UNiCEF / World Bank urban sanitation project will help antananarivo deal with unprecedented population growth
Madagascars capital, and biggest city, Antananarivo, is home to nearly 2 million people or approximately 10 per cent of the countrys total population. Yet, while only 30 per cent of Malagasy people live in towns (SOWC 2011), rural to urban migration is accelerating, and the urban population is growing at a rate of 3.9 per cent annually (SOWC 2011) putting huge strain on Madagascars urban infrastructure.
n 2008, 2.4 million people were living in Madagascars six largest urban centres Antananarivo, Fianarantsoa, Toliara, Toamasina, Antsirabe and Antsiranana (World Bank). By 2025, the World Bank estimates that over 10 million people will be living in these cities a rate of urban growth that is among the fastest in Africa, according to UN Habitat. In Madagascar, these cities are unprepared to deal with such a rapid population growth and in Antananarivo, there are challenges ahead. Clearing the canals The citys population is growing faster than the infrastructure needed to provide new residents with adequate water and sanitation facilities. Since 1985, Antananarivos population has increased 16fold. However, no coherent urban plan has been effectively implemented to deal with such growth, and the municipality lacks the capacity to deal with collecting and disposing of the citys daily waste. Among residents standards of hygiene are often low. Addressing this, UNICEF is working with the World Bank and the citys authorities to undertake major work to improve sanitation and access to clean water in some of the citys most vulnerable areas. The improvements will reach more than 64,000 people, helping to reduce illnesses caused by inadequate sanitation and unclean water in particular diarrhoea, which remains one of the main causes of death among children under five in Madagascar. Work includes cleaning the numerous drainage canals that criss-cross the lowlying areas of the city, where annual flooding displaces thousands of people from their homes; building sanitation works; installing water points; and clearing refuse. Launched in March 2011, work is being carried out through a cash-for-work scheme that provides local residents with jobs to help raise household incomes in parts of the city where food insecurity has been linked to poverty. Access to safe water and sanitation remains critically low across Madagascar, with the Joint Monitoring Progress report of March

2010 documenting a recent downward trend. In 2008, 47 per cent of households had access to improved water facilities; by 2010, only 41 per cent had access. Only 2 per cent of Madagascars 10 million children in the country have access to safe sanitation facilities, a total of 49 per cent of children do not use sanitation facilities at all, and 59 per cent of all children do not have access to safe water sources

about Community-Led Total Sanitation (CLTS)

Community-Led Total Sanitation is an innovative methodology for mobilising communities to completely eliminate open air defecation. Communities are facilitated to conduct their own appraisal and analysis of open defecation and take their own action to become open defecation free. The approach was introduced in Madagascar in October 2008, and started with a training of trainers in the region of Amoroni Mania with the technical support of the WASH section of UNICEFs regional office and the CREPA (Centre Rgional pour lEau Potable et lAssainissement). New capacity building and employment opportunities in the east coast of Madagascar In this area, the CLTS campaign is in full swing, and many villages are showing interest in constructing quality latrines in their homes. This trend has made obvious the need to train local technicians in masonry and carpentry to respond to the local needs. At the end of their training, well-trained local technicians are able to build different models of quality latrines in rural areas where this kind of facility is still rare. The different types of required materials and equipment are available in the villages now thanks to the new sanitation market. This allows local technicians to build latrines according to the needs, purchasing power and soil conditions of every village. From now on, quality latrines can be built locally, which will therefore create thousands of new employment opportunity in the region. As almost everything can be dealt with locally, the cost is kept at the minimum, yet good quality latrines are built. To help the residents have a better standard of personal hygiene, and environmentally friendly behaviour and habits, UNICEF and its partners have funded three sanitation complexes in the area. With the contribution of the urban commune of Toamasina and the local people, the project will soon be functional. Three womens associations will be in charge of the management of the structures

18 UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

The Main issue NUTRITION

August 2011

Nutrition

Maternal education influences childrens nutrition

Maternal education has the biggest impact on the nutrition of children between the ages of 0 and 5, significantly influencing habits and feeding practices, according to a survey carried out in September 2010.

Facts & Figures

alnutrition among children is often a result of a potentially lethal mix of bad habits and poor feeding practices. However, according to a food security vulnerability assessment (CFSVA+N) carried on in September 2010, these bad habits and practices are not just found in poor households or those facing food insecurity, but are more strongly linked to maternal education. While the survey data show that acute malnutrition varies according to the season in the different places surveyed, they also show that it is higher among those children whose mothers have not received any education, or have only completed primary school studies. The spread of acute malnutrition for example is 7.2 per cent if the mothers have not received any education, falling to 5.3 per cent if they have completed some primary school studies, and 1.7 per cent if they have completed secondary school studies. Stunting, an indicator of chronic malnutrition, is also shown to be more prevalent when the mothers have received no, or limited education. According to the survey result, stunting is 47.5 per cent where mothers are not educated, compared to 42.3 per cent if they reached the level of secondary school. This difference is emphasized in Madagascars central highlands, where the

With regards to nutrition, Madagascar is one of the 20 countries in the world with the highest burden of under-nutrition Lancet Nutrition Series 2008. Recent data shows that Madagascar ranks 6th globally in relation to stunting levels among children under five State of the Worlds Children 2011. Madagascar ranks 6th behind Afghanistan, Yemen, Timor-Lesete, Malawi, and Ethiopia, with 50.1% of under-five yearolds suffering from stunted growth. Anaemia affects 35.3% of women of child-bearing age and 50.3% of children under-5 DHS IV 20082009. Madagascar suffers from peaks in acute malnutrition as a result of natural disasters (drought, flooding and recurrent cyclones), with global acute malnutrition in children under-5 ranging from 10% to 20% in the most vulnerable areas SMART Survey (Standardized Monitoring and Assessment of Relief and Transition) 2005-2010 and 26.7% of women and underweight, as a result of its poor nutritional security. The latest DHS (20082009) survey shows only small changes in the prevalence of stunting in children under-5 over the last 17 years from 56.4% in 1992 to the still very high level of 50.1% in 2008. Nutrition related factors contribute to 35% of child deaths globally (Lancet Maternal and Child Under nutrition Series, 2008)

spread stunting is 78.2 per cent among children whose mothers have not received any education, compared to 38 per cent among those whose mothers received secondary school education. Feeding practices Acute malnutrition is also linked to feeding practices, with survey results showing that acute malnutrition is higher among children aged 6 to 23 months old, an age range that covers childrens transition from breastfeeding, the exploration of their environment, and the maturity of their immune system. The high rate of acute malnutrition for children younger than 6 months (4.1 per cent) is very alarming, as this is the period during which infants should be exclusively breast-fed. Among all infants younger than 6 months affected by acute malnutrition, 28.9 per cent are not exclusively

breast-fed, while only 19.7 per cent are. Survey results show that exclusive breast-feeding, which has a major impact on a childs health and growth, is more adopted by mothers who have gone to secondary school (82.6 per cent) than by those who have not gone to school (71.2 per cent), or have just reached the level of primary school (73.4 per cent). In addition, the diversity of food given to children from 6 to 24 months is better when mothers have a level of secondary school education. The proportion of children receiving enriched micro nutrition is also higher when mothers are educated (33.6 per cent). This proportion is respectively 10.9 per cent and 11.5 per cent if mothers have not received any education, or if they have not gone beyond primary school studies.

19 UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

The Main issue

The study shows also that mothers with a higher level of education tend to better take care of themselves and of their health during pregnancy, and this has an impact on the health and growth of their child. Thus, the weak weight of an infant at his birth does not solely concern small mothers. It could equally touch those who have not attended prenatal consultations; not taken any iron/ folic acid supplements during pregnancy; or those who have not taken any vitamin A during the post-natal period. Counselling cards The survey results clearly highlight the importance of concentrating on girls education, but for mothers above school age, all is not lost. Parental education can equip parents with the necessary knowledge to provide the best health and nutrition care for their children. The SEECALINE program focuses on that. SEECALINE (Surveillance et dEducation des Ecoles et Communaut en matire dAlimentation et Nutrition Elargie) is a communitybased nutrition program initiated in 1998 as a World Bank financed project, and scaled up over time to a national level. Currently, 5,550 sites across Madagascar are covering 56 per cent of 0-36 month old children. Community nutrition workers carry out monthly growth monitoring of children, parental education, cooking demonstrations and home visits in these sites. However, the World Bank funding is expected to end on July, 30th 2011, and the future of this wellestablished network of community nutrition sites remains uncertain. In an effort to help these community nutrition

August 2011
workers carry on with their work, UNICEF will provide newly designed and visually appealing counselling cards based on the optimal preventive and curative health and nutrition practices within the life cycle: from pregnancy to adolescence. These counselling cards which are designed to promote

Nutrition
community dialogue and local level problem solving is expected to be used by the community nutrition workers to facilitate parental education

Unicef in action
UNICEF Madagascar Representative, Bruno Maes, visits the Nutrition Centre in Amboasary Atsimo, southern Madagascar. The community management of acute malnutrition UNICEFs nutrition programme ensures the appropriate treatment of children suffering from severe acute malnutrition. Community health workers were trained for early detection of malnutrition at the community level. In 2010, 16,599 children with severe acute malnutrition out of 26,600 expected cases were supported by UNICEFs nutrition programme.

20 UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR