The ACSD Agenda

8/14/2019 The ACSD Agenda

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SITUATION SUMMARY

Preventative primary health care is the key to childsurvival. Achieving MDG 4 (reduction of child mortalityby two thirds) is impossible without a well-functioningExpanded Programme for Immunization (EPI) consis-tently reaching 90% coverage for measles and othervaccine preventable diseases.

Uganda has made significant strides since the intro-duction of the National EPI programme in 1983. Mor-bidity due to measles has declined by over 90% com-pared to 2000 with no confirmed deaths in 2004 and2005; the number of meningitis cases due to Heamo-philus influenzae type b (Hib) has declined by 95%since introduction of Hib vaccine in 2002; and neonataltetanus cases declined by 83%. In addition, Ugandahas been polio free since 1996 and has no reportedwhooping cough or diphtheria.

However, a recent stagnation and decline in routineimmunization threatens to reverse progress. In 2004,routine delivery of measles was just under 90%. In2005, the level stabilized at 87% and then dropped to79% in 2006, rising to 85% in 2007. District variabilityexists with some districts failing to achieve the set tar-gets for immunization and surveillance.

National level challenges include sustaining availabilityof current vaccines offered by the programme andplanning for introduction of new vaccines (adequatecold chain capacity); planning for and maintaining highimmunization coverage in the context of a rapidlygrowing population; and maintaining a high quality andsensitive disease surveillance system at all levels.

District level challenges include:

Stock-outs, decreased potency and/or spoiled vac-cines (due to late arrival of drugs, lack of gas for de-livery and operation of generator);

Closures of facilities and irregular/inadequate out-reach (due to lack of funds for transportation, super-

vision and mobilization, operation); High staff vacancy/attrition rate and low motivation

(lack of incentives, support, supervision, training);

Decreased social mobilization (due to lack of pay-ment to mobilizers);

Lack of attention to information systems manage-ment (lack of training and support leads to late andincomplete reports).

UNICEF SUPPORT TO IMMUNIZATIONINDICATIVE BUDGET FOR 2009

UNICEF works at the national level and in 23 focusdistricts to enhance the Governments capacity to de-liver life-saving services. UNICEF aims to ensure that:

Adequate resources for the EPI are mobilized, allo-cated and prioritized at various levels;

Children in all districts are protected against vaccinepreventable diseases by supporting strategies toscale up and sustain high immunization coverageincluding building capacity for health facilities toidentify and reach their catchments populations;mop-up activities in those districts not attaining 90%measles and OPV coverage; and engaging in socialmobilization activities to boost attendance at routineimmunization. A follow up measles campaign isplanned in 2009

Communities enjoy consistent access to vaccines

and essential medicines (supporting a drug supplychain assessment and monitoring programme);

Uganda as a whole benefits from an improved EPIsystem (through revitalization of the cold chain; ad-vocacy with Government to address recurrent costsand solve the problem of insufficient transportationand fuel; capacity building for support, supervisionand information management).

Budgetary Requirements: 6 million USD.

FOR MORE INFORMATION

PROTECTING AGAINSTIMMUNIZABLE DISEASE

Dr. Claudia Hudspeth

Chief, Child [email protected]

Karen Allen

Deputy [email protected]

Only about 1 per cent of deaths among children under-five haveunknown causes and two thirds of them are entirely preventable.

UDHS 2006: U5 Immunization Coverage

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IDPs North Karamoja Western

DPT3 Measles All Basic Vaccines

UNICEF Ugnada/ChulhoHyun

ACCELERATING CHILD SURVIVAL AND DEVELOPMENT 2009

Ugandas Battle Against the Top Childhood Threats


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SITUATION SUMMARY

Overcoming the deadly impact of malaria continues tobe the greatest development challenge affectingUganda today. The disease is endemic in 95% of thecountry and is the number one killer of children ac-counting for more than 32% of deaths of children underfive and contributing significantly to miscarriage andlow-birth weight of infants. It also the most frequentlyreported reason for illness among adults and accountsfor 50% of all outpatient department attendance and35% of all in-patient admissions. According to certainestimates, as many as 70,000 to 100,000 deaths can

be attributed to malaria every year in Uganda.

While MDG 6 directly addresses the need to consoli-date malaria control (to arrest and reverse the spreadof HIV and Malaria), it is clear no meaningful progresson MDG 4 (to reduce child mortality by two thirds) canbe made without tackling this disease. It is also the keyto breaking the cycle of extreme poverty that traps over30% of Ugandans. Some studies show poorer familiescan spend up to 34% of their income on malaria treat-ment. Tackling MDG1 (to eradicate extreme poverty)therefore, is also linked to the fight against Malaria.

Despite obvious human and financial losses, the 2006Uganda Demographic and Health Survey (UDHS) esti-mates that only 16% of households own an InsecticideTreated Net (ITN) and less than 10% of children under-five years sleep under them. In addition, only 10% ofpregnant women reported sleeping under an ITN andless than 16% received the proper preventative proto-col for malaria during their ante-natal care visit. Interms of treatment, coverage of Home-Based Manage-ment of Fever is expanding, but only 29% of childrenunder-five received anti-malarial drugs the same dayor next day of a fever.

THE REGIONAL PERSPECTIVE

In response to the overwhelming burden of the diseasein the Lango sub-region (transmission rates are the

highest in the world in Apac District), UNICEF and theGovernment of Japan distributed over 230,000 ITNsin late 2007, aiming to boost the coverage of house-holds with two ITNs to 70%. In response to the dismallevels of net ownership in the Karamoja sub-region,UNICEF distributed over 340,000 nets in late 2007,aiming to raise coverage of households with two ITNsfrom 3.4% to all families. Post-distribution surveys willdetermine the new levels of coverage.

MALARIA CONTROLINDICATIVE BUDGET FOR 2009

UNICEF works at the national level and in 23 focusdistricts to ensure that all children are protectedagainst malaria by:

Supporting the Governments policy to massivelyscale up distribution of ITNs to the level of two netsin every household. In 2009 control efforts will aimto scaling up net coverage in Western Uganda from3.3% (UDHS 2006) of households with more than 2ITNs to 80% with 2 ITNs.

Using Village Health Teams (VHTs), local councils,faith-based institutions, and radios to promote theuse of ITNs in all 23 districts;

Supporting the training and equipping of VHTs todeliver Community Case Management for malariausing the new Artemisinin Combined Therapy(ACT) in 10 districts.

Budgetary Requirements: 9.3 million USD

7 million procurement & distribution of 1million nets;

2 million for promotion of proper use in 23 districts;

300,000 to support VHTs for prevention and propertreatment of malaria.


CONSOLIDATINGMALARIA CONTROL

Dr. Claudia Hudspeth


Karen Allen


It would be a great shame to win the war for peace but losethe battle against child mortality. Above, children in Oyam Dis-

trict in northern Uganda begin their battle against malaria.

UDHS 2006: Key Malaria Control Indicators

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fhousholdscovered

At Least 1ITN U5 s leeps under ITN prompt treatment

UNICEF Uganda/2008/Chulho Hyun



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SITUATION SUMMARY

Malnutrition and micro-nutrient deficiencies are wide-spread in Uganda, despite the fact that it is a countrywith abundant food supplies and arable land. Goodnutrition is not just about food however, it is about get-ting the right types of food, having access to safe waterand sanitation, and about putting good health and hy-giene knowledge into practice.

According to UDHS 2006, some 12 % of Ugandan chil-dren are severely stunted, reflecting a lack of adequatenutrition over an extended period, or chronic illness.Some 16% of children are underweight, which meansthat they have been affected by both chronic and acuteunder-nutrition. Most concerning, 6% of children areconsidered to be wasted, having experienced a rapiddeterioration of food supplies.

Employing correct Infant and Young Child FeedingPractices (ICYF) can prevent malnutrition. ICYF consid-ers the timely initiation of feeding solid/semi-solid foods,the diversity of food and the frequency of feeding. Ac-cording to the UDHS 2006, less than one quarter (24%)of Ugandan children age 6-23 months were fed with theminimum standard of all three ICYF practices. Only 8%of children of IDPs and children in the Karamoja sub-region were fed according to minimum standards.

In addition to body-hunger, brain-hunger is wide-spread, with detrimental effects to the health and devel-opmental capacity of individual children and society asa whole. Almost three quarters of Ugandan childrenunder-five are anaemic, with 7% being severely anae-mic. Anaemia can impair cognitive performance, behav-ioural and motor-skills development. Meanwhile, ap-proximately 20% of children in Uganda have some formof Vitamin A Deficiency (VAD) which can seriously im-pair their immune system and vision.

THE REGIONAL PERSPECTIVEIn northern Uganda, despite an overall improvement in

the nutrition situation over the last 3 years, there is stilla need for monitoring in the Acholi region, with a spe-cial focus on areas of return. With the exception of Kit-

gum, Pader and Gulu, prevalence of SAM in remainingdistricts is less than 1%. In north-western Uganda, per-vasive insecurity combined with a variety of social andenvironmental shocks to pastoralist livelihoods culmi-nated into an acute child survival and nutrition crisis in2008. With the arrival of rains and emergency interven-tions however, acute malnutrition dropped below emer-gency levels in most districts.

NUTRITION INDICATIVE BUDGET FOR 2009

UNICEF works at the national level and in 23 focusdistricts to ensure that all children realize their right tosurvival and health development. In 2009 the nutrition

programme will ensure: At least 50% of children with severe acute malnutri-

tion are identified and treated (by building the capac-ity of health workers to identify, refer and treat Se-vere Acute Malnutrition at HC 3 and 4 levels, includ-ing forecasting their supply needs for their pro-grammes and providing partners with adequate sup-ply, financial and technical assistance);

At least 25% of households have the required knowl-edge and skills to adopt IYCF practices to preventmalnutrition (by building the capacity of health work-ers at the HC 2 level and VHTs ).

At least 80% of children aged 6 to 59 months receive

vitamin A supplementation twice a year and at least80% of children aged 1 to 14 years are de-wormedtwice a year (through support to Child Health Days)

A nutrition surveillance system is functional in all 9counties in Karamoja and 2 districts in Acholi (bysupport District Governments and Nutrition Partnerswith financial and technical assistance).

Budgetary Requirements: 2,375,000 USDNational level USD 1,200,000District level USD 2,175,000


PREVENTING ANDTREATING MALNUTRITION

Dr. Claudia HudspethChief, Child [email protected]

Karen AllenDeputy [email protected]

Some 12% of Ugandan children are severely stunted; 16% areunderweight and 6% are considered wasted.

UNICEF Uganda/Roger Le Moyne

WFP/UNICEF: Nutrition Asses sm ents

by Sub-Region

6.7 5.98

1.81.6

1.5

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4

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10

Teso (WHO) Jul08

Acholi (NCHS)Jun 08

Karamoja(NCHS) Aug 08

G

lobalAcuteMalnutrition Moderate Malnutrition Severe Malnutrition


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UNICEF WASH PROGRAMME IN 2009

UNICEFs Water, Sanitation & Hygiene programme,works at the national level and in 23 focus districts tosupport the attainment of national standards, targetsand priorities for safe and sustainable water and sani-tation coverage, in pursuit of MDG 7 (ensuring safeaccess to safe water) for achievement of MDG 4(reducing child mortality). UNICEF works to ensure:

Children and their caregivers have increased andmore equitable access to improved water supply andsanitation by supporting districts and communities,

with financial, technical and supply assistance, toconstruct and/or rehabilitate, operate and maintainwater schemes and appropriate, gender segregatedsanitation facilities in primary schools, health facili-ties and other essential community points.

Children and their caregivers know and employproper hygiene practices as a result of effective com-munity-based behaviour change communication(including Community-led Total Sanitation ap-proaches and PHAST methods).

Local Governments have improved capacity to plan,implement, supervise, coordinate, and monitor sus-tainable WASH sector interventions through trainingand technical assistance.

Adequate resources are allocated from the nationalto district levels for WASH as a result of evidence-based planning, policy and standards development,as well as documentation of lessons learned.

INDICATIVE BUDGET FOR 2009

Budgetary Requirements: 11 million USD

10 million USD for interventions in 23 focus districts;

1 million USD to expand advocacy, leveraging anpartnerships at the national level.




SITUATION SUMMARY

Water is essential for life and safe sanitation andhygiene preserve it. However, despite progress in theprovision of safe water to rural parts of Uganda, thenational average has stagnated at 63% with a function-ality level of 83%. National latrine coverage stands at52%, almost no improvement over the last four years.In UNICEF focus districts, coverage levels are oftenbelow national averages (see chart below) and, insome cases, fall below 20% for safe water, and at leastfive district at 10% or below for sanitation.

This means that children remain vulnerable to a variety

of entirely preventable water-related diseases. Diar-rhoea accounts for almost 5% deaths of children underfive and pnemonia (or acute respiratory illness) ac-counts for 9.5%. Both pneumonia and diarrhea arelinked and/or aggravated by poor sanitation, personaland environmental hygiene, unsafe feeding practicesand/or contaminated water. According to some studies,improvements in safe water supply and storage, couldreduce the incidence of diarrhoea by about one fifthand simple hand-washing with soap by 44%.

The best place to learn model behaviour and life-skillsis at school. But with less than 40 % of primary schoolsproviding adequate water and sanitation facilities, stu-

dents cannot put good knowledge into practice. Only 1in 5 primary schools sampled by the Ministry of Educa-tion in 2005 provided at least 5 liters of safe water perday, per pupil and although there has been a steadyimprovement, the pupil per stance ratio of 61:1 is stillabove the standard 40:1. Segregated toilets are pro-vided in only 72% of schools which means that the girlchild, children with physical disabilities, the youngestchildren and staff have inappropriate access. Further-more, only 39% of schools have hand-washing facili-ties. Without improvement to facilities in this formativeenvironment, proper health and hygiene practices willnot be imparted to the next generation.

THE REGIONAL PERSPECTIVE

WATER, SANITATION ANDHYGIENE (WASH)

Chander Badloe

Chief, WASH [email protected]

Karen Allen


Simple hand-washing with water and soap can reduce the inci-dence of diarrhea by 44%.

UNICEF Uganda/Chulho Hyun

WES Sector Performance Report 2007/8:

Rural Safe Water and Sanitation Cover age

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Karamoja Acholi Western Lango Teso

s av e wat er co verage lat rine co verageNational average National average


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SITUATION SUMMARY

According to the recent 2007 Uganda Child VerbalAutopsy Study carried out by the Uganda Bureau ofStatistics, HIV/AIDS accounts for close to 6% of deathsfor children under-five. Approximately 110,000 childrenare living with HIV, of which 50,000 are in immediateneed of life-saving treatment. Tragically, however, only10,000 (


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SITUATION SUMMARY

A close look at the MDGs in Uganda shows that not asingle Goal can be achieved and sustained in an equi-table manner unless the protection of children is anintegral part of programming strategies and plans. Vio-lence, abuse and exploitation can lead to death anddiminished developmental capacity not only at infancy-but all through childhood. Failing to protect childrenfrom such issues as conflict, violence in schools, childlabour, harmful traditional practices, sexual violence,neglect or recruitment into armed groups, squandersthe potential of every child to reach their full capacity.

Major protection risks facing children in Uganda today:

Continued association of close to 3,000 childrenand young women with armed forces and groups;

Reintegration of those children released (evidenceindicates that 10% of returnees have faced stigmati-zation; 18% have problems with family and a further18% face injuries and health problems related totheir time with the LRA);

Separation of children and other extremely vulner-able individuals from primary care-givers during themovement out of the camps to areas of return;

High levels of abuse and exploitation (including traf-ficking) experienced by children in north-easternUganda, exacerbated by both physical and foodinsecurity, inter-clan violence and a dearth of socialprotection systems;

Abuse faced by children using basic services facili-ties such as schools and health facilities as well aslaw enforcement and care institutions;

A variety of protection risks heightened by the lackof birth registration certificates (only 21% of Ugan-dan children have their birth registered).

Regardless of the threat, UNICEF has reformulated itschild protection response away from a focus on cate-gories of children to a systemic response that focuseson the multiple causes of vulnerability faced by all chil-dren. For the Child Protection community in Uganda,child protection system at sub-county level is com-prised of Structures (both government, non-governmental and community based), Mechanisms

which coordinate the work and information sharing(such as referral networks, reporting and monitoring)and Staff or members of these structures must havethe required capacities to handle cases with full appli-cation of protection and care standards. At the end of2008, access to the bare minimum of child protectionsystems was as low as 11% in Teso sub-counties and3% in Karamoja sub-counties. Data for the westerndistricts is not available. (See chart for details).

PROTECTING THE VULNERABLEINDICATIVE BUDGET FOR 2009

UNICEF works at the national level and in 23 focusdistricts to build the capacity of the Government ofUganda to protect and further the rights of childrenunder the Convention on the Rights of the Child. In2009, the Programme will ensure:

Children increasingly realize their right to protectionfrom violence, abuse and exploitation as 40% ofchildren identified as vulnerable receive care andsupport, through child protection systems;

Children increasingly realize their right to protectionfrom sexual and other forms of violence and exploi-tation, in particular, through the Safe School Initia-tive in 30% of primary school.

No children recruited/accepted into the ranks of themilitary or security services and all Ugandan chil-dren returned from association with armed groupsand re-integrated into their communities;

Children realize their right to identity and protectionas 80% of children aged 0 to 8 in 23 programmedistricts are registered and have birth certificates.

Budgetary Requirements: 6.4 million USD

1.2 million USD for national level advocacy, lever-aging and technical assistance.

5.2 million USD for actions in 23 focus districts.


THE PROTECTIVEENVIRONMENT

Cornelius Williams


Karen Allen


Coverage of Child Protection Systems (structures, staff andmechanisms) in the Karamoja sub-region remain below 5%.

UNICEF Uganda/Chulho Hyun

Proportion of Sub-Counties with Functional

CP Systems and Community Officers (CD0)

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Acholi Lango Teso Karamoja West

% sub-counties with CP system % of sub-count ies with CDO


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SITUATION SUMMARY

Education is the key component of poverty eradicationand development. Primary schools not only providestability, normalcy and empowerment, but they arealso the best place for reaching future mothers andfathers with essential services and life-skills training.The 2006 UDHS found that women with education aremore likely to utilise health facilities for delivery; fullyimmunize their infants and have well-nourished chil-dren. In fact, the infant morality rate for children whosemothers had primary education is 20% less than that of

infants whose mothers had no education (see chartbelow) Meeting MDG2 for Universal Primary Educa-tion, therefore, is key to the survival and healthy devel-opment of the next generation.

Despite this, approximately 20% of the population 15years and above in Uganda have had no formalschooling. Since the introduction of Universal PrimaryEducation, enrolment has increased, but 15-20% ofprimary school-aged children are not currently enrolledin school and approximately 7% of 6-12 year olds havenever attended school at all. Furthermore, of those thatdo attend, only 40% actually complete their studies.

The majority of children missing out on school are inthe Karamoja sub-region. While attendance at primaryschool is approximately 83% in the rest of Uganda,only 43% of school-aged children in this semi-arid re-gion attend class and only 11% register for final Pri-mary Leaving Exams. However, access to educationfacilities and relevance of the curriculum for communi-ties living in remote and semi-nomadic pastoralist com-munities is currently limited.

At the national level, the most common reason whychildren drop out of primary school is cost. AlthoughUPE should be free, there are hidden costs which canbe prohibitive for families. A significant portion mayalso drop out due to the risk of various forms of abuseprevalent in the school system. Raising Voices andSave the Children in Uganda conducted a study in

2005 which indicated that more than 98% of childrenreported experiencing physical or emotional violenceand 75.8 reported experiencing sexual violence. In thislatter category, forced sex, touching and exposurewere more prevalent in school than outside school.

Also potentially explaining absenteeism is that only 1 in5 primary schools sampled by the Ministry of Educationin 2005 provided at least 5 liters of safe water per day,per pupil, while the pupil per stance ratio of 61:1 is stillabove the standard 40:1. Gender segregated toilets areprovided in only 72% of schools and only 39% hadhand-washing facilities. Lack of privacy (16%) and un-

sanitary toilets (51%) were the main reasons cited bygirls for missing school during menstruation.

THE RIGHT OF ALL CHILDREN TO EDUCATIONINDICATIVE BUDGET FOR 2009

UNICEF works at the national level and in 23 focusdistricts to ensure all children progressively realize theirright to primary education. In 2009, UNICEF will:

Advocate for allocation of adequate resources forexpansion of facilities to absorb all 6 yr olds in P1and sustain the Go-to-School, Back-to-School, Stay-in- School Campaign to boost enrollment;

Support the development of appropriate approaches

to education for pastoralist children, expanding thescale and relevance of the system in Karamoja;

Improve completion rates by ensuring implementa-tion of the Safer Schools Initiative and dropping thepupil to stance ratio from pupil 61:1 to 40:1 and in-creasing school safe water access from 58% to 70%.

Budgetary Requirements: 15 million USD

USD2.5 million for national level technical assis-tance, advocacy, leveraging and partnerships.

USD 12.5 for interventions in 23 districts.


PRIMARY EDUCATIONTHE KEY TO A SUSTAINABLE

REDUCTION IN CHILD MORTALITY

Sheila Wamahiu

Chief, [email protected]

Karen Allen


Meeting MDG2 for Universal Primary Education is key to thesurvival and healthy development of the next generation

UNICEF Uganda/Roger Le Moyne

UDHS 2006: Influence of a Mother's Education

Attainme nt on Early Childhood Mor tality

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The ACSD Agenda

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