UNICEFnnufit Re port

1986

UNICEF's Executive Board1 August 1985 to 31 Jtdy 1986

Officers of the Board:Chamnan (/-JwrHft're Hoard):

Mr. Anwarul Karim Cliowdhury (Bangladesh)

Chairman (Proqrawmt CMtntHittee):Mr. Gabriel Rcstrepo [Colombia)

Chairman (Gnuttiittee w Admmtftfttfion mid Fituutct);Mrs. A. P. Maruping (Lesotho)

firyi Vke-Chairtnan:Mr. Gaetano ZuL'coni (Italy)

Second Vicc-Chainnan:Ms. Poliana Cristcscu (Romania)

Third Vice-C.haimian:H. E. Mr. Bcrhanu DinkJ (Ethiopia)

fourth Vke-Chnirwan:Mr. Hector Terry Molinert (Cuba)

MembersAigeminaAustraliaBangladeshRctcfiuwBeninRhntnnBrazilKukjariaCanadaChikChina< j>li»ulmiCtnttjaCubaI),-iinitirl;Djibouti

of the BoardEthiopiaFinlandPntaeeGabon(icnuanv. Federal

lifpnblii' of'IndiaIndonesiaItalyfopttnLesothoMaliMexicoNetherlandsN$erOman

PakistanRumaniaSwitzerlandThailand7 'wiisiaUnuni of'Stnwt

Sin:wli.fifa-publics

United Kingdomof Great Britainand NorthernIreland

United StatesafAMifrica

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(10)

(9)

(2) (3)

(8) (7)

(4)

(5)

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Cover photographs

1I) ICtE 9027/83/Tht«nas(2) LTNICEF l(M4/84/Murray-Lcc(3) UNICfiF 1157/84/MBJiay-Lce(4) ICEF 9515/Murray-Lcc(5) ICF.FQlOS/'Wolff(6) 1'NICF.F H)41/84/Mumiy-Lcc(7) UNICEF 8917AVt>lff(8) UNICEF 1273/85/GambUn(9) ICEF 9230/lsaaL-(10) UNICEF 116/83,Tajon

UNICEF^Lnnual Report

1986Contents

Introductionby the Executive Director, James P. Grant 3

Programmes1985—a review 5Child survival and development 6

Towards universal immunization 8Oral rehydration therapy 9Breast-feeding, weaning and other nutritional priorities I IWHO/UNICEF Joint Nutrition Suppon Programme 12Monitoring children's growth 14Primary health eare 14Essential drugs 17

Formal and non-formal educationSafe water and basic sanitation 19Women at work 21Urban basic services 24Preventing childhood disability 26Responding to emergency , 31Inter-agency collaboration 35Monitoring and evaluation 37Programme communication and social mobilization 38

Advocacy and fundraising

Global mobilization for children 39Publications 40Radio, television and film 40Media relations 40Electronic Information Network 41Special events and fundraising activities , 41National Committees 42Non-governmental organizations 43International Youth Year • 43Greeting Card Operation 44AGFUND 44Italian Aid Fund 44

ResourcesFinances: income, commitments, and expenditures 1985-86 . . 45Human resource management 51Information resource management 51Strengthening UNICEF*s delivery capacity 52

What UNICEF is and does5:3

ProfilesFaith moves millions (TURKEY) 7Leaving little to chance (BANGLADESH) 10Key to a healthier future (DOMINICA) 13One for ten (BURMA) 16Good things come free (INDONESIA) 20Women on the way (BRAZIL) 22Sound of learning (INDIA) 27Life begins anew (MALI) 30Restoring broken ties (MOZAMBIQUE) 34Breaking out of a shell (THAILAND) 36

Maps and chartsMap: UNICEF in action: programme commitments

in the developing world 28Chart: UNICEF income by source 45Table: 1985 non-governmental contributions 46Chart: UNICEF income 1984-86 46Chtm: UNICEF expenditures 1984-86 47Map: 1985 governmental contributions 48Chans: UNICEF expenditures on programmes

by sector 1981-85 50

ntroductionby the ExecutiveDirectoryJames P. Grant

The year 1985 saw the world moveto the threshold of what later may becalled the greatest mass breakthroughfor the health and survival of childrenin recorded history. And the worldbegan to step across that threshold.

Massive efforts in many countries lastyear-and an extraordinary global col-laboration among international insti-tutions, governments, organizations,the media and leading individualsresulted in bringing the protection ofimmunization against disease to morechildren (and a higher proportion ofchildren) than at any time before. Andthe simple materials and procedureswhich can protect babies against thedehydration that results from diar-rhoea was brought to the awarenessand within the reach of more mothersthan ever before. Over a two-yearperiod, world-wide delivery of im-munization vaccines tripled, anddelivery of oral rehydration sachetsmore than doubled.

The progress made on these twofronts in 1985 alone resulted in a sim-ple fact: more than one millionchildren survived to see 1986 whowould not otherwise have survived.

This progress was made despitewidespread and frequent 'loud1

emergencies—particularly the droughtand famine which affected so manyAfrican countries, as well as earth-quakes, volcanic eruptions, and warand other civil disruptions.

While a year is only a short time inwhich to assess a social process,I believe that in 1985 we witnessed thefirst forward thrust on a truly world-wide basis of a broad new developmentinitiative launched two years before toimprove the nutrition, health andeducation of all the world's children,particularly those who face the greatestrisk.

Support of that initiative to capturethe potential for a child survival anddevelopment revolution is part of themandate assigned CNICEF by the UnitedNations General Assembly to be theworld's agency-its advocate and aprincipal actor-for children. Thereport which follows outlines ourstewardship of that trust during theyear.

We see these recent achievements asdie beginning of a grand strategy ofcommunity mobilization, throughwhich the world's vulnerable andheretofore powerless will be enabled tobetter undertake their own improve-ment. Once motivated with the helpof their societies, they will need thesupport of governments and theinputs of professional workers.

Most developing countries have en-dorsed UNICEF'S community-basedapproach for building and maintainingbasic services for the rural and urbanpoor. The application of this strategyto the fields of health and nutritioninvolves the implementation of themany-sided concept of primary healthcare. The strategy has been enunciatedjointly by the World Health Organiza-tion and UMCEF and has been widelyendorsed by the countries concerned.

These countries face extensive pov-erty, increasing population, economicrecession, limited governmentresources for social services and, inmany, a deterioration in the environ-ment and in the quality of life. In sucha context, greater reliance on 'self-health' is not only a logical choice, it isoften the only choice if there is to besignificant improvement in health andnutrition in the years immediatelyahead. The imperative is to empowerfamilies and communities to takegreater responsibility for their ownwell-being, to order their ownpriorities, and to organize communityworkers, while building links with thewider service networks and profes-sional systems.

UNICEF is convinced that this processmust begin with child survival anddevelopment. Children cannot waitfor conventional development pro-

cesses to take hold. Countries whichdelay actions on behalf of theirchildren will do so at the cost of theirown future. And very often, 'for thesake of the children1 is the primary in-centive which does motivate people toaction . . . and can open the door foraddressing a broad array of additionalproblems.

In country after country, that door isbeginning to open. And the possibilityexists in many more. Moving forwardcould well bring us toward reducingthe infant mortality rate to a level of50 per 1,000 or less for all countriesbefore the end of the century. Theexperience of the past year demon-strates that this is an achievable target.It has become feasible because thepolitical leadership in so many of thecountries concerned has declared war

Jame.s P. Grant, Executive Director,on the first national immunization dayin El Salvador.

H

on one or more of the principal causesof childhood death and disease.

As this report shows, some 40 coun-tries arc moving towards the UnitedNations goal of universal chi ldimmunization by the year 1990(uci-1990). Many countries arc alsomaking major progress on increasingthe use of oral rehydration therapy(ORT), and one major country (Egypt)has achieved already the 1990 goaJ ofvirtual universal awareness of OUT andits use by at least 50 per cent offamilies. UNICEF, for our part, hassought to foster the political and socialenvironment in which these nationalinitiatives can be undertaken. This wehave done through advocacy andthrough our support for the achieve-ment of well-defined goals. We haveencouraged the exchange of relevantinformation and better communica-tion; we have supported learning andtraining for parents and voluntaryworkers, for paraprofessionals andprofessionals, for managers and ad-ministrators.

In the process, UNICEF has assisted inbringing practical knowledge to thepeople, introducing them to scientific,up-to-date, yet simple, affordable andsafe techniques for a healthier life forthemselves and, above all, for theirchildren.

The gathering momentum of thepast year represents an unprecedentedadvance. Its impact stems from thesystematic attempt to relate the fruitsof science to the needs of society . . .from the mobilizing of whole com-munities to enable them to take theprocess of change into their ownhands , s tar t ing with the mostdesperate needs-namely the survivaland development of children. It issignificant that this design for devel-opment appears equally valid to peopleacross the spectrum of socio/politicalsystems.

The year's trends demonstrate ad-vances on several fronts of the struggle,powered principally by the "twinengines' of uci-1990 and ORT. Beforethe goal of Universal Child Immuniza-tion by 1990 is reached and sustained,further great strides will be necessary.Both targets and achievements varygreatly from country to country. Near-ly one million child deaths are now be-ing avoided as a result of immunizationagainst six diseases, but three and one-half million children are still dyingfrom those causes each year, Dehydra-

tion induced by diarrhoea is still thebiggest single killer of children-morethan four million each year. Theestimated saving of half a millionchildren by means of oral rehydrationtherapy in the past twelve monthsmust now spur the world to fullutilization. For the fact is that four-fifths of the world's mothers do not yetknow enough about oral rehydrationtherapy to start practising it.

Diarrhoea and allied diseases willrecur unless safe water and hygienicpractices support the life of the poor.This represents another longstandingpriority for UMCEF.

The worldwide campaign whichbegan earlier in this decade to promoteand prolong breast-feeding is in dangerof flagging. We have received manynegative reports, particularly regardingreduced breast-feeding among poorurban families. The knowledge andpractice of proper weaning practicesmust be extended, to prevent thewidespread malnutrition occuring inthis most crucial phase of the child'sdevelopment.

Recent studies indicate that damagefrom a lack of vitamin A may gobeyond the child's eyesight, to affectthe alimentary and respiratory systems.The good news is that the deficiencycan be cheaply and easily made goodwith either Vitamin A capsules or, aswith ORT, through low-cost homeremedies. Other nutritional shortages,like iron and iodine which affect hun-dreds of millions, can also be overcomeat a price which is negligible in relationto the enormous social costs of doingnothing.

Low birth weight is even moreextensive, a sad commentary on mal-nutrition during pregnancy. The pointis that better knowledge of the higherdietary needs of pregnancy can lead toan improvement, even for poormothers. Similarly, being made awareat an early stage-through growthcharts-of a child's failure to gainweight can enable parents to preventirreversible consequences, frequentlythrough measures within their owncontrol,

These and similar concerns are cen-tral themes of UNICEF'S collaboration.Some of them are of global applica-tion; others are relevant to particularregions or countries.

While the breakthrough of the pastyear makes us optimistic, the challen-

ges which remain are formidable. Yetthe lessons learnt, particularly in socialmobilization, involving effective com-munication and pilot activity, shouldmake them less intractable in the com-ing years.

There have been exceptions to thegeneral trend of gradually declining in-fant mortality rates, particularly inAfrica. The historical development gapbetween Africa and the rest of theworld has widened, due to the recentfamine and other crises. Consequent-ly, die relevance of community-basedservices and of child survival anddevelopment interventions in par-ticular has visibly increased on the con-tinent. UNICEF gives the highest priorityto helping stem die tide of adversitywhich is threatening Africa's children.

Among the most hopeful signs ofthe recent past has been the responseof the international community,especially the publics of the industrial-ized countries, to the articulated needsof the world's children. Sustained aswe are by voluntary contributionsfrom governments and peoples, UNICEFdrew immensely upon this source ofmoral and financial strength. In this wehave been particularly aided by theunique institution of our NationalCommittees for UNIC:I-:F, drawing ontheir strengths for fund-raising, forinformation-sharing, for sensitizingpublic opinion and for influencingpolicy.

By assisting in extending the reach ofbasic services to all children, ratherthan to just some, UNICEF is a factor notonly of development but also of justiceand hence of peace as well. Perhaps it isno accident that the year in whichUNICEF will celebrate its 40th Anniver-sary is a year which the United Nationshas particularly dedicated to the strug-gle for 'Peace'.

Our objective today is to continue tosupport families, communities andgovernments in helping children toEve and to develop. As we enter diisYear of Peace—and, for UNICEF, ofqu ie t celebration in our work of40 years—we rededkate ourselves tothat paramount commitment.

CLw-t*_s <!.&-&James P. Grant

Executive Director

UNICEFT77 tfK

7rqtframmes

1985—A reviewProgramming for children is necessar-ily a parr of the development process ineach country. The situation ofchildren and the resources required toimprove it are influenced by the stateof the economy as well as by politicaldecision and public support.

For the developing world, 1985 hasbeen the sixth consecutive year ofnegative or negligible increases inincome per capita. The rate of growthof the gross domestic product in theindustrialized market economies

The acute physical, economic and politicalproblems of Africa are shared by mostdeveloping countries.

declined from 4.5 per cent in 1984 toaround three per cent in 1985, with itsconsequential impact on the economyof the developing world.

The situation varied widely betweendeveloping countries. South and EastAsia, including China, India andPakistan, generally maintained thegrowth momentum, while a few coun-tries {Republic of Korea, Nepal, Philip-pines and Singapore for example)recorded a decline. Modest or no im-provement have been the rule in LatinAmerica, already racked by heavy ex-ternal debts. Even more disturbing hasbeen the precarious situation in Africa,where for most countries, the growthof real per capita income was nil in1985, while the number of peopleaffected by hunger and starvation re-mains large, despite massive reliefefforts.

The situation in sub-Saharan Africais particularly grave. Infant and childmortality rates have increased byaround 25 per cent during the year,beyond the pre-existing high levels.Malnutrition among children underfive has sharply increased. Though therains have returned after a longabsence, more than in any other partof the world, economic recovery andthe very survival of millions ofAfricans depends heavily on aid flows,levels' of lending and volumes andprices of exported primary com-modities. Presently, aid flows, exceptof food, are stagnating, with a numberof countries no longer qualifying forassistance because of payment arrearsand non-compliance with conditionsfor aid disbursement. And, interna-tional prices of primary commoditiesare expected to remain low.

While in most parts of Asia some im-provements are seen in the situation ofchildren due to a favourable economicclimate, political stability and thegradual introduction of low-cost, high

efficiency health and nutr i t ionmeasures, in Africa and Latin Americathe situation has stagnated or furtherdeteriorated.

With tew exceptions, resources forchildren have continued to decline inthese regions. While reductions infamily incomes and rising food priceshave eroded the nutritional status ofchildren in poor households, the com-bined effect of declining governmentexpenditures in the social sector andscarcity of foreign exchange havehampered maintenance and extensionof services in health, education, water,sanitation and housing. And, theshortage of foreign exchange hasreduced the availability, by import, offood, basic drugs, vaccines, hand-pumps, learning and teachingmaterials, liquid fuel and machinespares. Even external assistancesuffered as the lack of counterpartfunds substantially slowed the pace ofaid programmes.

In the 22 drought affected countries,1985 death rates, in particular infentmortality and child death rates, haveremained abnormally high-althoughfewer deaths were reported in the sec-ond half of the year, The area wherethe negative effect of economic reces-sion is most evident is nutrition. Thereis evidence that child malnutrition isrising not only in countries affected bydrought, war and civil strife, but alsowherever economic recession and in-discriminate economic adjustmentpolicies are part of daily life. Ironically,this rise in malnutrition is taking placeat a time when world food stocks arehighest in history.

The need for a broader and longer-term approach to developmentpriorities, beyond short-term policiesfor stabilizing the economy, is ob-vious. The neglect of the 'humandimensions' of development-of thecontribution that individual men andwomen could make—has to be cor-rected. Basic services, particularlyprimary health care, water supply andbasic education, have to be expandedand improved upon. The concept offood emergency has to make way forfood security. The key role of womenin social-economic development has tobe recognized. Steps have to be takento protect the physical environment tomake it safe for children. All this willbe possible only by promoting theresponsibility and capability of localcommunities for their own develop-ment. And, not the least, there is need

for economic "adjustment with ahuman face1 policies, at the nationaland international levels, which sup-port these priorities.

The acute problems of Africa areshared by most developing countries.

The answers too have therefore a widerrelevance. It is to be hoped thatpolitical leadership as well as publicopinion in the developing and in-dustrialized countries will be increas-ingly active in applying them.

UNICEF continued to protnote, with renewed commitment and encouraging results,specific interventions which are essential and feasible in the short-term for child survivaland development.

Child survival and developmentHealth and nutrition of infants andyoung children has been a field of thehighest programme priority for UNICEKthrough 1985. The effort was firmlyguided by the primary health care(PHC) strategy.

Reduction of the infant and childmortality rates is an imperative againstthe fact that some 15 million childrenunder five die each year, a large major-ity of them avoidably. This is theperspective in which UNICEF continuedto promote, with renewed commit-ment and encouraging results, specificinterventions which are essential andfeasible in the short-term for child sur-vival and development (CSD). These

efforts are discussed in the paragraphsthat follow.

As implementation progresses indifferent countries at different speedsand in a variety of approaches, the im-pact has begun to be reflected in lower-ing morbidity and mortality of infantsand children in at least some of thecountries, A revitalizing of the healthinfrastructure leading to a betteroutreach of primary health care is anallied outcome. Interestingly, the up-trend in the immunization pro-gramme, as outlined below, providesvaluable practical lessons, as well as apowerful stimulus to other CSD/PHCactivities.

Faith moves millions TURKEY

The peasants called her the'Matron of Manisa', a small butenergetic 84 year old widow whocared. During the rounds of anationwide immunization cam-paign aimed at protectingfive million young Turkishchildren against five diseaseswhich could kill or cripple them,Selma Karaosmanoglu travelledthe cotton fields and mountainvillages of Izmir Province urgingparents to have their infantsvaccinated.

The tiny white-haired lady in ablack silk dress was one of manywell-known and ordinary peoplewho joined in an unprecedentedexercise of national purpose andpower —beginning with informinga largely rural people about theadvantage and availability ofimmunization. Why does thisFrench-educated lady from a land-owning family care enough to bea self-appointed campaigner forimmunization? Some 80 childrendie each day in Turkey from easilyand inexpensively preventablediseases. Of every 1,000 childrenborn in the country, 110 do notcomplete their first year of life.

In Moslem Turkey, imamsplayed a crucial promotional rolein getting a majority of thecountry's under-fives immunizedagainst measles, diphtheria,whooping cough, tetanus andpolio, through the three-partnational campaign's ten-dayspells In September, October andNovember 1985. Sermons on thetheme of the Moslem's obligationto protect the lives of childrenwere given in every one ofTurkey's 54,000 mosques. Atseveral campaign centres, imamshelped to rally parents to bringtheir children to be immunizedand, on occasion, held babies intheir arms while they werevaccinated.

Several remarkable contribu-tions lent colour and strength tothe mundane process of mobiliz-ing people. A young fine-artsgraduate, Fethiye Avsar Delior-manli, created a delightful mascotfor the campaign with whichpeople could identify: a young girlin a spotted dress, ankle socks, aribbon in her hair, her armsaround a baby brother. Two

popular comedians, Zeki Alasyaand Metin Akpinar, used theirfame to put the immunizationmessage across to the public, byIncluding brief skits on vaccina-tion in their routines. A marchby Turkey's leading classicalcomposer, Yusuf Nalkesen,became the campaign themetune.

A travelling children's theatregroup toured the country pro-moting the cause. With a livelyscript written and staged by theone-year old Anatolian ArtChildren's Theatre and titled TheDeeds of the Microbe', theplayers succeeded in amusingand informing their audiences.

Turkey started the campaignwith only 22 per cent of itschildren immunized. Initial reportsshow that the campaign aim ofimmunizing 80 per cent of themhas been achieved not fully but in

substantial measure. The factthat every household knew aboutthe national aim and effort toimmunize all children holds thepromise of even greater participa-tion and better coverage andmaintenance in the coming year.

As the impressive returns of thecampaign are gathered andanalysed, the talk turns fre-quently, even in Ankara, thecapital, to the Matron of Manisa,the familiar sprightly figure,laughing with the older folk,gently teasing and cajoling theyoung, never wasting an oppor-tunity to drive home the messagethat a dose of vaccine couldmean a young life saved. Thisremarkable example of the self-appointed campaigner in thecause of immunization says:"I had to help in some way. I feltit was my duty".

Towards universalimmunization

1985 marked a watershed for UNICEF,as country after country showed thatthe goal of the Expanded Programmeon Immunization-universal child im-munization by 1990—may not be animpossible dream.

UNICEF has been an active partner inthe Expanded Programme on Immu-nization (EPI) since it was launched in1974 by the World Health Organi-zation (WHO). The goal of the EPI,adopted by the World HealthAssembly in 1977, is to immunizeever)' child by 1990 against six killerdiseases of childhood: measles,poliomyelitis, diphtheria, pertussis(whooping cough), tetanus and tuber-culosis.

When the EPI began, fewer than 4 percent of people in developing countrieswere protected against these diseases,which killed an estimated 5 millionchildren a year and disabled 5 millionmore. Today the proportion of one-year-olds vaccinated against measleshas risen to 20 per cent, and thenumbers vaccinated against the otherdiseases to nearly 40 per cent. Theannual death toll is now less than4 million.

But the diseases still have adevastating impact, especially onchildren weakened by malnutrition. Inmuch of Asia and Africa they accountfor a quarter and more of all infant andchild deaths. Overburdened health ser-vices cannot reach all families to informthem of the benefits of immunization,and particularly of the need for a fullcourse of vaccinations: a l though60 per cent of children now receive atleast one vaccination, only half of thesecomplete the three doses needed forfull protection against polio anddiphtheria, pertussis and tetanus (DPT) .

Clearly, if immunization is to beavailable to all children by 1990, EPIactivities need to be accelerated con-siderably. It is a formidable challenge.But the achievements of 1985 suggestthat the challenge can be met-pro-vided that new techniques of com-munication and social mobilization arebrought into alliance with the healthservices, in an all-out effort to spurgovernment and community interest.The year's EPI activities involvedministries of education, information,agriculture and defence as well as

health. The call to vaccination wentout from heads of state, nationalcelebrities, religious authorities, com-munity leaders and the mass media.Volunteer support came from school-teachers, priests, the armed forces,women's groups, political workers,private companies and voluntaryorganizations.

By year's end some 60 countries wereplanning accelerated EPI programmes(see box), and many have already putpromise into practice. Some examples:

• In El Salvador, government andanti-government forces stoppedfighting each other on three na-tional immunization days in 1985so thar over a quarter of a millionchildren under five could be im-munized.

• In the Dominican Republic, the20,000 volunteers who havegiven oral polio vaccine to 95 percent of the nation's children tookon the more demanding task ofmeasles and DIT injections.

• In Brazil, 80 per cent of childrenare now protected against measlesand 67 per cent against DIT, withthe help of the volunteers whosince 1980 have v i r t u a l l yeliminated polio {from 2,000cases a year to about 40).

• In Turkey, schoolteachers,rel igious leaders , privatecompanies and die mass mediajoined in the effort to immunize5 million children under five overthree 10-day periods (see profilepage 7).

• Nigeria's local governments arerapidly taking up an approach firstdeveloped in Owo, using coldboxes to carry vaccines to tem-porary vaccination sites in shops,market-places, schools and mos-ques. In some areas immuniza-tion rates have risen to ten timesthe 1984 figure.

• The Prime Minister of India hasestablished the goal of universalimmunization by 1990 as a 'livingmemorial' to his mother, rhc laceIndira Gandhi; strategies tested inpilot projects are gradually beingextended to the whole country.

• China, home to a quarter of theworld's children, is committed tobringing vaccination to 85 percent of its counties by 1990. A'rush and relay system has beendeveloped to speed vaccines fromthe manufacturing institutes tothe villages.

• In the cities of Hargeisa andMogadishu, Somalia, volunteersand mass media helped to protect

two-fifths of the country'schildren against five diseases. Andin Addis Ababa, Ethiopia, nearly70 per cent of children are nowprotected.

A number of countries are demon-strating that immunization can notonly be sustained over the years, itcan also provide the impetus for morecomprehensive child survival mea-sures. The 1985 launching of Brazil'snational Child First programme, Col-ombia's National Plan for Child Sur-vival, the Dominican Republic'sNational Programme for Mothers andChildren, the accelerated plans fornation-wide primary health care inBurkina Faso, Ethiopia and theSudan-all were sparked by successeswith immunization.

UNICEF'S expenditure on immuni-zation in 1985—some US$20 million-reflected the increased pace of the pro-gramme. UNICEF supplied aboutUS$13 million worth of vaccines, com-pared with US$9 million in 1984.Monitoring the experience gained, and

accelerating theirEPI programmes

Angola, Benin, Botswana,Burkina Faso, Burundi, CentralAfrican Republ ic , Congo,Dj ibou t i , Equatorial Guinea,Ethiopia, Gambia, Ghana, Guinea,Guinea-Bissau, Kenya, Mada-gascar, Malawi, Maur i t an i a ,Mozambique, Nigeria, Rwanda,Senegal, Sierra Leone, Somalia,Togo, Uganda, United Republic ofTanzania, Zaire

Brazil, Bolivia,Colombia, Dominican Republic,E! Salvador, Ecuador, Guatemala,Hait i , Honduras , Mexico,Nicaragua, Paraguay, Peru

Bangladesh, Bhutan, Burma,China, India, Indonesia, Maldives,Nepal, Pakistan, Sri Lanka,Thailand

Algeria,Democratic Yemen, Egypt, Iraq,Jordan, Oman, Sudan, Syrian ArabRepublic, Turkey, Yemen

sharing it with other countries, havebeen particular concerns: in 1985UNICEF conducted special appraisals offour immunizat ion campaigns(Burkina Faso, Colombia, El Salvadorand Nigeria) and funded visits to Col-ombia and Turkey by observers fromother countries. UNICEF and WHO alsoissued a joint statement on planningprinciples to guide acceleratedimmunization activities.

The support for immunization hasproved to be world-wide. The coun-tries of Africa, through their regionalWHO organization, named 1986 theirTear of Immunization', and the PanAmerican Health Organization an-nounced plans to eradicate polio in theAmericas by 1990. In an unprece-dented step, the Secretary -General ofthe United Nations wrote to thepresidents or prime ministers of all theUnited Nations' 159 Member States,inviting them to reaffirm their com-mitment to achieving universal childimmunization by 1990. The govern-ments' enthusiastic response at the

1985 General Assembly was matchedby that of 400 non-governmentalorganizations, which had gathered atthe same time to declare their supporttor the goal.

Governments and non-govern-mental bodies have also stepped uptheir practical support. Rotary Interna-tional, to cite one example, launched aUSS120 million 'Polio-plus1 cam-paign. The Government of Italypledged USS100 million towards im-munization and child survival in 28 de-veloping countries, and the Govern-ment of Canada allocated US$25 mil-lion for Commonwealth countries.

The drive for universal child im-munization has taken on the charac-teristics of a world trend. If themomentum can be kept up, ac-celerated EPI programmes show pro-mise of attaining a goal which hasalways lain at the heart of the primaryhealth care idea, but which has all tooseldom been achieved—the transform-ing of isolated health programmes intosustained social movements.

Oral rehydrationtherapyThe year saw a substantial increase ofthe momentum gathered in 1984 fororal rehydration therapy (ORT), themost cost-effective means of treatingand preventing diarrhoea! dehydrationin infants and young children.

In association with numerousgovernments, UNICEF developed socialmobilization programmes to ensurewidespread knowledge of the benefitsof home prepared solutions, usingavailable starchy foods or sugar and saltin the correct proportions to preventthe onset of dehydration in childrensuffering from acute diarrhoea.

During 1985, the global supply anduse of packaged oral rehydration salts(ORS) rose dramatically. Total produc-tion worldwide increased from173 million packets to 250 million,two-thirds of which were made insome 40 developing countries spreadout in Africa (9), the Middle East (4),Asia (15) and Latin America (12). Incollaboration with WHO, U N I C E Fassisted many of these countries withtechnical assistance, plant and machin-ery, raw materials and packaging.

UNICEF also procured and suppliedover 75 million packets directly to ORTprogrammes around the world. Earlyin 1985, a change was made in the ORSformula provided by U N I C E F ,substituting tri-sodium citrate forsodium bicarbonate, making for amore stable mixture, longer shelf-lifeand higher therapeutic value. Spon-sored by WHO, research continues atseveral centres.

Towards the end of 1985, UNICEFinitiated a field trial of a one litre plasticbag with every five packets of ORS. Thebag holds one litre of water, carriespktograms and diluting instructions inseveral languages, and thus overcomestwo constraints in the home-use ofORS: measure and dilution.

At another level, UNICEF and WHOsupport and assist comprehensive pro-

The support for immunizationhas proved to be world-wide.In Turkey, far example,fav million children under fivewere immunized overthree 10-day periods.

Leaving little to chance BANGLADESH

Oral rehydration worker KrishnaMondul was on her way to theculminating point of anothersuccessful household visit whenAfia Begum, the woman shethought she had convinced, ranout of the house and away intothe village of Shialora.

Mondul, 23, herself village bornand bred and a veteran of 10,000such visits, knew what the pro-blem was. Alone and without thereassurance of her menfolk, thewoman had lost her tenuousconfidence in the purpose ofKrishna's visit. In that moment ofcrisis, the simple mixing of apinch of salt with a hand scoop ofmolasses and a half litre of watersomehow was transmuted intosomething sinister, and she fled.

Not an everyday happening butone exemplifying the problemsfaced by one of the world'slargest and most sustainedefforts to put a medical advanceinto the hands of mothers. It Isnow five years since theBangladesh Rural AdvancementCommittee (BRAG) began to workhouse to house in Bangladesh, totransfer to village mothers theknowledge, skill and confidenceto prevent diarrhoeal dehydrationwhich could be, and often is, fatalto young children. By the end of

1985, their village teams hadvisited 5 million of the roughly16 million households in the coun-try and by the end of the decade,three-quarters of them.

The thousand and more BRACmen and women —who over thistime have endured accusationsthat they actually carried diar-rhoea with them (as an evil spiritconcealed in their standard-issueumbrellas) and that the verypaddy fields suddenly wilted andspoiled at their passing —havedoggedly pursued the goal ofhousehold visits, patientlyignoring superstition andmisunderstanding.

Meanwhile the shock troopscontinue to be the hard-workingyoung women whose job it is toteach a mother in 30 minutesenough to know why and how toprevent dehydration with salt,molasses and water. Tightmonitoring later tests mothers(and remunerates the oralrehydration workers accordingly)on what has been learned andhow accurately they can mix thesolution.

BRAC itself has learned as thevillage teams (some 800 men andwomen by late 1985) fed back thelessons from the accumulation ofindividual encounters, some150,000 a month.

Most important among theselessons was the realization thatgetting most people to actuallyuse the rehydration solutionwould take more than mothers

and more than one visit.To really work, the campaign

had to involve the whole com-munity, men as well as women,those with power as well as thosewithout, not just in demonstrationbut in treatment, not just visits toindividual households concen-trating on oral rehydration, butsix-month stays in a district by'concentrated reinforcement'teams dealing with public health,teaching the importance ofbreast-milk (colostrum) in the firstdays of life, proper weaning afterthe first four months and con-tinued feeding during diarrhoeaalongside oral rehydration as anutritional first aid; plus workingwith the health care 'establish-ment' from doctors to traditionalhealers and midwives, and thepermanent establishment ofwomen from the community ashealth educators, promoters andfrontline workers.

Beyond the several days ofmeetings undertaken with villagemen by an advance guard of maleprogramme organizers, specialreinforcement efforts follow up onthe household visits —conductingseminars, working with schoolchildren and teachers, andholding meetings in mosques andmarket-places.

LO

grammes tor control of diarrhoea]diseases (CDD) in more than 75 coun-tries, which aim not only at universalavailability of oar to treat or preventdehydration, but also on basic preven-tive measures like breast-feeding, im-mun iza t i on , part icular ly againstmeasles as part of EPI, safe drinkingwater, hygiene and sanitation, cleanpreparation and storage of food andhealth and nutrition education forparents.

Today about 95 per cent of all thechildren in the developing world live incountries that have national CDD pro-grammes.

Among numerous countries im-plementing national programmes ofdiarrhoea control is Nigeria, where thegovernment, through internationalagencies, seven universities, two pro-fessional organizations and medicaland paramedical staff from all twentystates is mobilizing an increasingly suc-cessful effort, in a context where some500 children die daily due to diar-rhoea. Egypt is another example wherediarrhoeal diseases account for 60 percent of the deaths in the 0-1 yearage group. A February 1985 surveyshowed that 95 per cent of the peoplewho responded knew about ORS and82 per cent had used it-thanks to theextensive use of television and othermedia, support of religious leaders andthe medical profession and wide avail-ability of ORS packets. Bangladesh, apioneer in ORT, also introduced itthrough schools, and in evaluatingsuch an information campaign foundthat some 2.6 million leaflets weredistributed through th~e primaryschool system, with co-ordinatedassistance from the departments ofeducation and public health; some87 per cent of the school children wereinvolved in follow-up, 78 per cent hadexplained the leaflet to adult familymembers and 73 per cent of the homesused home-prepared solutions duringdiarrhoea episodes. During the year,the national programme distributed17 million ORS packets. Meanwhile, theBangladesh Rural Advancement Com-mittee, a non-governrnental organiza-tion, has trained and fielded nearly1,000 ORT workers who have so farvisited over 5 million mothers and15,800 schools to give practicaldemonstrations (see profile, page 10).Similar programmes are successfullyprogressing in smaller countries, suchas Haiti and Honduras.

Breast-feeding,weaning and othernutritional prioritiesThe promotion of breast-feedingreceived sustained attention in Angola,Argent ina , Bangladesh, Benin,Bolivia, Botswana, Chile, Haiti, India,Indonesia, The Republic of Coted'lvoire, Republic of Korea, Mexico,Nepal, Pakistan, Papua New Guinea,Paraguay, the Philippines, Senegal, SriLanka, Syria, Thailand and Zim-babwe. Support was extended primar-ily through parents' education, train-ing of health workers, women'sgroups, social marketing and public in-formation, co-ordination between in-stitutions and agencies, preparationand distribution of manuals, informa-tion materials and television messages,postage stamp campaigns, extension ofmaternity leave, rooming-in and train-ing in clinical management of breast-feeding.

As of 1985, The International Codeof Marketing of Breastmilk Substitutesis the law or has the effect of law in26 countries. Distribution of breast-milk substitutes is controlled by thegovernment of 14 countries, and thecode is in effect as a voluntary measurein six countries and has been recom-mended by government committeeand is awaiting legislation in 26 coun-tries. Advocacy with the public andthe health profession for promotingbreast-feeding, and with governmentsfor adopting and monitoring the code,has continued through the year.

The promotion of sound weaningpractices, including the preparation ofappropriate foods, continued to be apriority. Among the innovative in-itiatives has been the production ofweaning foods by women with low in-comes from villages in India. Purchas-ing and distribution by the govern-ment serves as a means to increasewomen's income while ensuring pro-duct quality. Preparation of weaningfoods and sale through village co-operatives continues in Thailand, andin Nepal the propagation of locallyrelevant weaning food recipes by non-governmental organizations remainsan attractive means of nutrition educa-tion. Clearly, strong support is neededfor promoting appropriate and timelyfeeding during weaning.

Progress towards control and pre-vention of iodine deficiency disorders

A primary health care worker kelpsa young mother learn breast-feeditigin the Gambia.

CHILD NUTRITION:In 1985 UNICEF

co-operated in nutritionprogrammes in 100 countries:37 in Africa, 24 In theAmericas, 29 in Asia and 10 inthe Middle East and NorthAfrica regionhelped to expand appliednutrition programmes In35,700 villages, equippingnutrition centres anddemonstration areas,community and schoolorchards and gardens, fishand poultry hatcheriesprovided stipends to train164,600 village-level nutritionworkersdelivered some 13,470 metrictons of donated foods(including wheat flour, non-fatdry milk, special weaningfoods and nutritionsupplements) for distributionthrough nutrition andemergency feedingprogrammes

' i

was significant during the year. TheInter-Regional Project on Control ofIodine Deficiency Disease, establishedover the last three years, has triggeredsteadily expanding activity in Bhutan,Bolivia, China, India, Indonesia,Nepal, Pakistan and Peru. The yearalso saw the establishment, with theassistance of the government ofAustralia and UNICEF, of an Interna-tional Consultative Council on IodineDeficiency Disorders.

Recent investigations confirm thepossibility of deficiency in vitamin A inchildren leading to increased morbidityand mortality as well as to blindness.Nutritional anaemia in mothers andchildren continues to be a majorUNICEF concern, and prevention andcontrol of these deficiencies was sup-ported in several countries.

Supplementary feeding programmesfor young women and children inemergency situations and drought-stricken areas was a feature of the year.Nutrition education and trainingreceived support in 25 countries andstudies and surveys were supported as ameans to defining problems, shapingstrategies and designing programmesin some 20 countries.

WHO/UNICEFJoint NutritionSupport Programme(JNSP)

Nutrition projects in 18 countrieswere in different stages of progress dur-ing the year. They differ in speed andstrength, in the mix of programmeelements and levels and scope of par-ticipation, and in the modalities andenvironments of operation. Yet whatthey share is an approach towardsmalnutrition that sees the problem asan end result of inter-related factorsand processes and therefore a strategythat is multi-sectoral, preventive anddevelopmental.

The 'noted1 project was approved bythe Executive Board in 1982 andfinanced by the Italian Government.The projects in Tanzania, Mali andNiger have distinct elements of com-munity involvement. Voluntary orga-nizations are closely associated withthe project in the Sudan; farmers,women's and youth groups in Ethio-pia; and women's co-operatives inMozambique. In the Caribbean -Dominica, St. Vincent, and the

Grenadines-the projects have bene-fited from support from the health in-frastructure and the administrativesystem (see profile, page 13). In Bur-ma, JNSP is outgrowing the health sec-tor and moving into women's ac-tivities, in Haiti it is going beyond oralrehydration therapy into promotingbreast-feeding and better weaningpractices. In several countries likeAngola, Mozambique, and the Sudan,civil strife has been hampering pro-gress. The project is in full swing inNicaragua, ready to move ahead inNepal and preparing to start inAngola, Ecuador, Pakistan, Peru andSomalia.

Judged by the first key indicator ofgrowth performance, the Tanzanianproject has been notably successful,with health committees in 167 villages,community-based monitoring, localpreparation of weaning foods, childfeeding and nutrition rehabilitationand indigenous development of avariety of teaching materials. TheCaribbean experience centres ingrowth monitoring, home gardeningand income generation, and extends toprimary health care including controlof diarrhoea and anaemia, immuniza-tion, breast-feeding and weaning. The

A multi-sectoral, preventiveand developmental strategy is beginningto take shape in Somalia.

\1

Key to a healthier future DOMINICA

Standing in his spotless bakery,rolling the dough, ScottBeaupierre proudly enumeratesthe qualities that won him theBakery Cleanliness Award and theBest Vendors Award: 'Hygienicpremises, quality of bread, theway you treat people, selfconduct, handling the bread withtongs'. From behind the counterof his neat grocery store, HuletLloyd relates what earned him theBest Kept Shop Award: 'Howthings are laid out, maintainingclean premises, how food ishandled, keeping vegetables ona rack rather than the floor'.

Neither of these entrepreneursin the small town of Castle Bruce,situated on the east coast of thegreen mountainous CaribbeanIsland of Dominica, knew theywere participating in a competi-tion until their awards werepresented at a village functionduring National Food and Nutri-tion Month, held in September1985. But they both had put intopractice what they had learnedduring the previous year inlectures and discussions for foodhandlers which form part of aJoint Nutrition Support Projectbeing undertaken in Dominicawith UNiCEFand WHOassistance.

Other sessions too have beenheld in the community on nutri-tion and health related topics,and the same advice and informa-tion has been heard in CastleBruce over the radio, in a seriesof 15 minute radio programmeson subjects ranging from localrecipes using the foods producedin backyard gardens, to nutritiondealing with the six food groups,and from breast-feeding and wean-ing foods to gastro-enteritis. Thebroadcasts and communityeducational sessions reinforcethe messages being passed to thecommunity.

The 1,884 member community ofCastle Bruce is one where a 1978study showed anaemia to be aproblem among pregnant womenand children, and where malnutri-tion also posed a hazard tochildren's adequate development.Other nutrition-related problemsalso exist, such as obesity and

diabetes, and increased nutri-tional awareness and improvednutritional practices are the keyto prevention and cure.

One facet of the programmewas specifically targetedtowards an at-risk group ofchildren. About fifty such childrenliving in families of low socio-economic status and sufferingfrom malnutrition were identified.Their mothers have beenencouraged to attend the mother-craft sessions held at the localhealth centre every Thursday, andto bring their children regularlyfor growth monitoring. At thesesessions not only are theelements of good nutritiondiscussed, but demonstrations onhow to prepare appropriate andnutritious food are held with theactive participation of themothers. These families also haveraised backyard gardens withseeds and 'knowhow1 provided bythe project through the FarmersCentre and, to help them applythe sanitation and hygienemessages, they have receivedassistance to construct latrines.The local health team undertakeshome visits to each family everytwo weeks, and in addition theymight drop in at lunchtime toreassure themselves that the

lessons on how to prepare mealsare being applied at home.

One member of the healthteam, family nurse practitionerHyacinth Thomas, animatedlydescribes how the programmehas benefited the community.Born in Castle Bruce and trainedin the capital Roseau andoverseas, she has returned toher community where she isobviously well liked andrespected. She describes how, inthe short period the programmehas been underway, backyardgardens have become common-place in Castle Bruce, howhygiene has become standardamong food handlers, how inscreening children she is hardputto find one case of anaemia, andhow pregnant women now duti-fully take the iron supplement.She attributes these changes toeducation and better diet, and herimpression is that the programmehas already had a positive impacton the community. And forsomeone with as strong a senseof community as hers it is notsufficient that the programmereach and influence only the fiftytarget families. That is why thenutritional committee whicharranged activities duringNational Food and NutritionMonth embodies all communitygroups including the medicalofficer, teachers, the SocialLeague and all five religiousdenominations represented inCastle Bruce. And that is why thenutritional committee chose thebest backyard garden, bestbakery, and best kept shop out ofthe whole community.

Although Fiorina Bannis did notwin the Best Backyard GardenAward she nevertheless is right-fully proud of the plot where shecultivates pepper, aubergine,carrot, cabbage, chives, tania,okra and yam. These she hasgrown from seeds providedthrough the Farmers Centre,which co-ordinates the backyardgardening aspect of the project.For Mrs. Bannis the gardenprovides the ingredients for the'gravy* to accompany the staple ofeither dasheen or tania andassures her husband and six yearold daughter of nutritious meals.

],;

Andean countries have focused oncontrol of iodine deficiency, Boliviaconcluding the second year of its na-tional programme. A number of sec-tors are involved in the Sudan project;health, agriculture, water, educationand social welfare. Multi-sectoral ac-tivities are a feature of the communityprojects in Mali, ranging from foodproduction to soap manufacturing bywomen's groups.

The JNSP experience emphasizes theneed for strengthening communica-tion skills, training on a continuingbasis and inter-sectoral co-ordination.As it moves ahead, it could havepositive effect not only on nutritionalstatus but also on national develop-ment policies.

Monitoring children'sgrowthGrowth is a key indicator of childhealth. It is also a good index of howbalanced the social and economicdimensions of development are.

Almost one out of every two-to-three children suffers from somedegree of growth failure. Growth im-pairment during the first few years oflife is closely associated with diseaseand deaths in early childhood. It alsolargely explains stunting in childhood,small adult stature, high risk tomothers at childbirth and subduedproductivity of men and women-all ofwhich are common in developingcountries. Monitoring the growth ofinfants and young children followedby education for health and nutritionwill be effective in improving growthand development even in situations ofpoverty.

During 1985, growth monitoringcontinued to be used in conjunctionwith education and selective feeding,primary health care, communityorganization and women's self-helpprogrammes. A review of recentexperiences in different parts of theworld has shown that the state-of-the-art in this field is less advanced thanother child survival and developmentinterventions, and, therefore, growthmonitoring calls for greater strategicsupport. A consultation in April 1985suggested a step-up in global an dnational advocacy, snaring of informa-

14

don, strengthening and expanding theactivity in selected countries, study-and-action projects to enhance pro-gramme efficiency and impact, andinstitutional support at regional andcountry levels. These recommenda-tions are being followed up.

There has been an increase in manycountries in growth monitoring activ-ity. Although few countries havereached national scale, progress dur-ing the year has been impressive:Indonesia and Thailand continued toexpand and strengthen their pro-grammes and more than half thechildren are covered; Brazil has made abold beginning within the nationalscheme for primary health care, withsubstantial participation by non-governmental organizations, andexpects to reach universal coverage by1990; Colombia provided a growthchart to every child being immunized;and China is preparing for a nationalgrowth monitoring scheme. In India,some 30 million growth charts havebeen distributed, and over six millionchildren are under regular monitoring.Ninety or more per cent of children inBotswana, Maldives, Seychelles andGambia have their growth periodicallychecked.

Training support was extended to10 countries, while the effort to im-prove design and distribution was suc-cessfully assisted in 23 countries.Evaluation and feasibility studies wereconducted in Argentina, Bolivia, Chileand Mexico, In Mexico and Sri Lanka,psycho-social development aspectswere included in the programme.

A review of the year's activity revealsareas needing attention. Advocacycampaigns and use of mass mediafocusing on child growth made pro-gress only in a few countries: Argen-tina, Indonesia and Sri Lanka. Lack ofpriority at policy level, a technical-bureaucratic approach to an activityneeding individual and personal atten-tion, lack of awareness of the public,inadequate motivation, knowledgeand skill among health workers,mothers' illiteracy and constraints onher time, irregular supply of growthcharts and weighing scales, insufficientflow of information, and delay infollow-up action when growthfaltered, were among the more com-mon problems. These call for correc-tive measures, along with the signifi-cant expansion in training and supplynow taking place.

Primary health careTwo major trends were seen duringthe year. The proportion of thenational budget devoted to health carehas been diminishing in many coun-tries, particularly in Africa. This isreflected in shortages of essentialdrugs, logistical problems, fewersupervisor)' visits, and a slowing downof the rate of service development andmanagerial process. However, nationalhealth systems are increasingly puttingthe PHC concept into practice, relyingon community-based health workers,services, and drawing on successfulexperiences in immunization and ORT.

Somalia and Morocco provideexamples of the current shift from con-ventional medical care to PHC.Pakistan, Papua New Guinea, thePhilippines and, to a lesser extent,Nepal, are decentralizing their healthprogrammes to make them commu-nity-based. Inter-sectoral approachesto PHC are making progress in Kenya,Malawi, Sierra Leone, Uganda andZambia. The successful organization

CHILD HEALTH:ln1985UNICEF

» co-operated in child healthprogrammes in 110 countries:42 in Africa, 23 in theAmericas, 32 in Asia and13 in the Middle East andNorth Atrica region

••• provided grants for training,orientation and refreshercourses for 154,000 healthworkers: doctors, nurses,public health workers,medical assistants, midwivesand traditional birthattendants

- provided technical suppliesand equipment for 201,100health centres of variouskinds-especially rural healthcentres and subcentres

• • supplied medicines andvaccines against tuberculosis,diphtheria, tetanus, typhoid,measles, polio and otherdiseases

National health systems are increasitgflyputting the me concept into practice.

of national immunization campaignsin Burkina Faso, Colombia, andTurkey (see profile page 7) has led togreater emphasis on allied PHCelements in support of child survivaland development and has revitalizedthe existing primary health care struc-tures or establishment of them. Aspart of th is t rend, governmentministries other than health, non-governmental organizations, andprofessional and religious groups

in a number of countries have becomeincreasingly involved in PHC devel-opment (see profile, page 16).

Community participation, a centralaspect of PHC, is expanding, throughcommittees in Cameroon, Gambia andZambia. Community volunteer move-ments are a significant element of thehealth sector in India, Indonesia, thePhilippines and Sri Lanka.

During the year UNICEF supportedthe training of traditional birth atten-dants and promoted the training ofcommunity-based health workers forPHC with paramedical and professionalpersonnel as trainers and supervisors;

UNICEF assisted in policy formulation,curriculum development, preparationof learning materials, evaluation andgeneral support.

The reach of maternal and childhealth (MCH) services remains limitedin most developing countries. Evenwhere services are free, as in Bahrain,neonatal mortality is high due to poorknowledge and utilization of services.UNICEF has continued to assist MCH pro-grammes, improve services, anddevelop and equip maternity units inmany countries, and in India the In-tegrated Child Development Services(ICDS) is a major channel of UNICEF sup-port for MCH/CSD concerns. A com-prehensive MCH strategy was initiatedin Bangladesh in 1985. The LatinAmerican and Caribbean countrieshave quickened the pace of their MCHprogrammes beyond immunization,following joint advocacy by UNICEF andthe Pan American Health Organiza-tion (PAHO).

UNICES has been active in pro-grammes of community health educa-tion, orientation of school teachers,and supply of educational materials toschools. In Benin and Sierra Leone,the school system is now involved inPHC/CSD activities, and in Egypt, Iraqand Morocco, national health educa-tion programmes are in progress. In-novative projects have been developedin the Sudan (nomadic drama grouppromoting immunization) and in TheRepublic of Cote dlvoire (PHC/CSDlearning materials for youth camps). Inschool health education, Colombia in-sists that all 400,000 9th gradestudents spend 100 hours in CSD train-ing; 20,000 children have been trainedso tar.

There are several major health prob-lems of relevance to CSD. AcuteRespiratory Infection (ARI) is next onlyto diarrhoea! disease as a cause of childdeath in developing countries. Argen-tina, -Brazil, Colombia, Gambia,Nepal, Paraguay and Viet Nam haveARI control programmes supported byUNICEF. Malaria has continued to be amajor public health problem in Africaand is showing resurgence in south andsoutheast Asia, with resistance tochloroquine spreading rapidly. Treat-ment of cases, prophylaxis duringpregnancy, and control of mosquitobreeding grounds are among thestrategies applied.

Cholera epidemics have flared up inAfrica south of the Sahara, and inmany cases UNICEF anticipated the out-

15

One for ten BURMA

The sound of bamboo clapperspunctuated the instrumentalmusic from loudspeakers, tied tothe top of a second World Warvintage bus —one of the manysedately chugging along thedusty track leading to animprovised hall of cane mattingthe size of an aircraft hangar. Infront of it stood lines of people,the young women dressed in theirbest longyis — the graceful wrap-around national dress —delicatelybringing embroidered handker-chiefs to their noses to keep outthe film of dust that particled themorning light.

The nearly 2,300 volunteers ofHlegu township —some 35 milesfrom Burma's capital,Rangoon-were gathering tomark the successful completionof their training as Ten-householdworkers'.

Burma is developing a primaryhealth care system built aroundindigenous mechanisms ofcommunity co-operation. Selectedby their local units of the BurmaSocialist Programme Party, thevolunteers are responsible forhealth promotion activities foragroup of ten households. They areofficially slated to become theeyes and ears of the healthservice.

The primary health care wing ofthe Ministry of Health recognizesthat, for empowering low-incomefamilies with health-givingknowledge on preventing illness,there is no substitute for person-to-person communication. In thisperception, it began the Ten-household worker1 pilot project inHlegu and Ayadaw, two of thecountry's 314 townships.

The Hlegu township hasalready benefited from the activepresence of these trainedvolunteers —in a recent rodent-control exercise run by them.Under the township medicalofficer's supervision, they weretrained in the principles and prac-tice of primary health care by theBasic Health Services staff, overa six-day course. The duties ofthe volunteer include first aid,control of communicablediseases, locating pregnantwomen and nursing mothers,nutrition promotion, environ-mental sanitation and healtheducation.

The volunteers are taught torecognize the symptoms of thecommon diseases and reportcases to the health staff. InHlegu, they are especially alert todetection of leprosy and malaria,

UNICEF 1347/85/l?N7CEF Rangoon

which are endemic to the country,alongside trachoma, iodine defi-ciency disorders and protein-energy malnutrition.

The prevention and manage-ment of diarrhoea is an importantpart of the training. This involvesenvironmental sanitation and per-sonal hygiene on the one handand oral rehydration andcontinued feeding during diar-rhoea, on the other. A smallrandom group of volunteers —consisting of a constructionworker, a house-wife, studentsand a shopkeeper —seemed toknow the proportions of thehome-made salt-and-sugarrehydration mixture.

While their palpableenthusiasm was encouraging, thetown health officer was quick tostate that the real work was onlybeginning, and stressed theimportance of re-training andsupervision.

The volunteers are notexpected by the government orthe community to offer curativeservices. Indeed, they have beenwarned against playing the 'mini'physician. Their function is todeliver health knowledge to thepeople, which is often moreprecious than treatment. In thisthey are helped by two factors:first, their selection has ensuredthat they already have the respectand confidence of their com-munities and the innovations theysuggest are likely to be seen ascommunity initiatives, rather thanas administrative instructions.Second, to take the case ofHlegu, the 20,000 Ten-householdworkers' have the backing of some175 trained community healthworkers, 160 trained traditionalmldwives, 50 auxiliary rnidwivesand 170 basic health workerslinked to 12 rural health centres,sub-centres and station hospitalsthat serve as referral points.

Burma's health services areexpanding despite resourceconstraints and underdevelop-ment. More importantly, andperhaps because of the negativefactors, the orientation of theseservices is shifting from conven-tional medical care accessible tothe few to primary health carereaching out to all.

16

breaks with advance provision of ORSand other supplies. Cholera was easierto contain where there was a commu-nity-based health system as in Somaliaand Gambia.

Other areas of UNICEF healthassistance included control of intestinalparasites in collaboration with JOICFP ofJapan (Nepal, Sri Lanka, Viet Nam),guinea worm control (India) and im-munization against Japanese encepha-litis in many Asian countries.

Essential DrugsIn 1985, UNICEF supplied essentialdrugs and vaccines to developingcountries, as part of UNiCEF-assistedprogrammes and on behalf of govern-ments on a reimbursable procurementbasis, to a value of about US$35 mil-lion, almost double that supplied in1983.

UNICEF assisted in the containment ofprocurement costs by lowering itsprices through international com-petitive bidding with bulk purchasecombining the orders of both thegovernments' procurement needs andUNICEF supply needs. Another measureof potential benefit to underservedpopulations was the approval to seekfinancing for a fund which wouldenable developing country govern-ments to pay for reimbursable pur-chases on delivery rather than with anorder.

During the year, Angola was assistedin procuring kits of essential drugs;Bangladesh was helped in producingORS packets and obtaining vitamin Acapsules, in providing other essentialdrugs and in training; Burkina Faso,Ethiopia, Guinea-Bissau, Mozam-bique and Somalia were supportedthrough programmes tailored to theirspecific needs, including long-termdevelopment of training, production,storage and distribution.

The problems lie not only in short-ages, but also in the way drugs are usedby health workers and patients. UNICEFsupported training courses to changeattitudes and understanding from thehigh technology curative approach toprimary health care. Together withWHO, UNICEF assisted a number ofcountries to develop essential drugpolicies, and to date at least 80 coun-tries have initiated or adopted nationalessential drugs programmes. D

Formal and non-formal educationThe past year, in Africa and elsewhere,again exposed the link between ill-health and lack of basic education,poor nutrition, low incomes andpreventable deaths. While there hasbeen considerable educational expan-sion and literacy growth in the pasttwo to three decades, important needsremain to be met.

As of the mid-1980's, illiteracyremains heavy in south Asia, and sub-Saharan Africa. In west Asia and northAfrica, primary education is expand-ing, but adults, particularly women,remain mostly illiterate. In east Asia,where primary enrolment is close touniversal, not all children complete thecycle. Large pockets in Latin Americaare denied educational opportunities.

In another perspective, disparitiescould be seen between: enrolment andretention; boys' and girls' enrolment;child and adult learning; resourcesavailable and needed; educational con-tent and its relevance to life; institu-tional structures and social reality; andlevels of literacy among and withincountries.

Several concurrent lines of actionhave been supported, often in co-

Whik primary education is expanding,adults-particularly women—often remainilliterate.

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operation with UNESCO, the WorldBank, bilateral aid agencies and non-governmental organizations, with thenational government playing the keyrole in planning and implementation.

These included strengthening thelinks between educational pro-grammes and health, nutrition andsanitation, in order to help futureparents ensure the survival anddevelopment of children. The year sawhealth education programmes forprimary schools, teachers' guidebooksand training materials on child healthin Africa and Asia. In Guinea andNiger, schools serve as communityhealth posts where students learnabout health in a practical setting; inBangladesh and Nicaragua, primaryschool children teach rural womendiarrhoea management by ORT;students and teachers in Burkina Faso,Colombia, Nigeria and Turkey informpeople on immunization and en-courage parents to bring children backfor the second dose; CHiLD-to-childhealth education, by which children inprimary schools become active in pro-tecting the health of the younger onesat home, has made a beginning insome 35 other countries.

Non-formal learning for children,youth and adults, especially girls andwomen, continues as a strong compo-nent of basic education. Possibilitiesexist for breaking away from the rigid-ity and social cost of the conventionalsystem not only to make learning morerelevant for life, but also to reach outto unserved poor. National-level ac-tion is beginning to recognize theseoptions. For the nationwide networkof adult education programmes inIndia, learning materials for motherand child health have been adapted foruse in local languages. A satellite televi-sion series is aimed at rural women incommunity centres. In Sri Lanka,non-formal programmes for schooldrop-outs have been strengthenedwith new learning materials, teachertraining, research and evaluation.Similar support was extended to In-donesia's community-education pro-gramme with some 200,000 learninggroups nationwide. In several coun-tries, national literacy programmes arefocusing on family well-being andmaternal and child health.

The year saw efforts to devise pro-grammes for the young child, withpriority attention in the first two yearsof child development, including thepsycho-social. Given the risk of the

pre-school movement becoming anappendage to the formal school systemcatering to the few, UNICEF'S concernhas been to foster community-basedearly childhood development.

&£"iEDUCATION:In 1985 UNICEF

co-operated in primary andnon-formal education in112 countries: 42 in Africa,28 in the Americas, 29 in Asiaand 13 in the Middle East andNorth Africa regionprovided stipends forrefresher training of some97,400 teachers including68,100 primary-schoolteachershelped to equip more than55,800 primary schools andteacher-training institutionsand 155,100 vocationaltraining centres with teachingaids, including maps, globes,science kits, blackboards,desks, reference books andaudio-visual materialsassisted many countries toprepare textbooks locally byfunding printing units,bookbinding and paper

The accent on comprehensive earlychildhood development can be sus-tained in poor communities only as theeducational core of a strategicallydesigned cluster of community-basedservices. Early childhood services aspart of area-specific programmes forthe rural and urban poor are expandingin coverage and improving in effec-tiveness in several countries. India'sIntegrated Child Development Ser-vices reach several million youngchildren and women with health care,nutritional supplements and learningopportunities. Adult education andchild care are woven into Nepal's smallfarmers1 programme which servedsome 40,000 families in some 162 loca-tions. The Mahaweli project in SriLanka, urban services in Brazil, India,Mozambique and Peru, the villagecredit project in Bangladesh, in-tegrated basic services in Ethiopia,

community education programmes ofIndonesia, Thailand and Zimbabwe allillustrate the potential of this strategy.

The child development/ health/nutrition synergism in adult learning isincreasingly evident in broad spectrumprogrammes into which child care andpre-school development have been in-corporated. Examples include thehealth care and nutrition programmeof northeast Brazil; national literacyprogrammes; and health, nutrition,and income-generating programmes.In all of these, child developmenttraining and activity are an integralpart.

Programmes to educate parents us-ing home-based learning methods andmaterials are being tried out amongsome disadvantaged groups, and in thePhilippines, an innovative non-formalproject for pre-schools among the Bad-jao community has been started in theisolated southwesterly islands. Ap-propriate curricula and content forrural community-based programmesin Kenya, Tanzania and Mexico areunder preparation. Projects serving thespecial needs of refugee children areexpanding in Lebanon, Mexico,Mozambique, Pakistan, the Sudanand Thailand.

Pre-school centres are beginning toserve as a location for contact, inter-change and delivery of services like im-munization, growth monitoring, earlydetection of disability, women'sliteracy, economic activity, small scalefood production, sanitation activityand community education.

Meanwhile, innovations in childdevelopment and basic education offerpossibilities: for example, a commoncentre for work, learning and child carewhere a woman can be engaged ineconomic activity, her school-agedaughter can attend classes and heryoung child can be cared for. Anotheridea is to demonstrate the feasibility ofuniversal basic education by pressinginto service all channels of learning andliteracy, government and private, for-mal and non-formal, fixed rime or flex-ible hours, direct teaching or distancelearning.

The Universal Primary Educationand Literacy project (UPEL), funded byspecific donations and initiated in 1983jointly by UNESCO and UNICEF operatesin six countries-Bangladesh, Bolivia,Ethiopia, Nepal, Nicaragua and Peru.Such ventures need to be encouragedas even proven ideas do not alwaysreceive the support they need. D

i s

Safe water and basic sanitationUNICES in 1985 co-operated with some95 countries in water and sanitationprojects with inputs significantlyhigher than in the previous two years.Halfway through the InternationalDrinking Water Supply and SanitationDecade, there is enhanced awarenessof needs, constraints and possibilities.This has helped to stimulate public,private and government initiatives inboth industrialized and developingcountries. On balance, the progresstowards the goals set for the decaderemains hopeful.

UNICEF became the first recipient ofthe International Water ResourcesAssociation's award for "excellence inbringing water resources to good useby human populations". In mostUNiCEF-assisted countries the link be-tween water supply and sanitation andhealth education is well established,first in south and southeast Asia, andlater in Africa, notably Nigeria,Mozambique and Angola.

Water and sanitation are part ofhealth programming in several coun-tries; in Botswana, Burundi and the

Philippines, it is coupled with childsurvival and development activities; inBangladesh, Gambia, India, TheRepublic of Core d'lvoire, Thailand,Tunisia and Zimbabwe it is closelylinked to diarrhoea management; inIndia it joins forces with the guineaworm eradication; in Bangladesh, In-donesia and Zimbabwe it is linked tonutrition through small-scale hor-ticulture; in Nigeria it helped open thedoor to immunization and diarrhoeamanagement; in the Yemen ArabRepublic it is part of primary healthcare; and in Mexico it belongs tocommunity-based services.

A few water and sanitation pro-grammes are now specifying behav-ioural objectives related to the extentand nature of better use. In severalcountries, socio-cultural studies weremade preparatory to programming.Training of community-based workersis growing. Even whole movementsand associations are sometimesbrought into the training-for-deliveryprogramme. India, Indonesia, and SriLanka use youth movements, especial-

ly the Boy Scouts and Girl Guides, tofurther programme aims.

Community participation is now anestablished aspect of water and sanita-tion projects in several countries. Theinvolvement of women is becomingthe centre-piece of this approach, andin many villages water and sanitationcommittees of women and men formthe administrative unit. Women proj-ect staff working as health educatorsare now a regular feature in countriessuch as Belize, Central AfricanRepublic, Indonesia, Nepal, Pakistanand Uganda. The involvement ofwomen at all project levels results inmore appropriate plans and designs,hygienic use of water and sanitationschemes, reduced burdens, improvedhealth and increased production.

In Pakistan, 70 per cent of thehouseholds in the Baldia slum areahave built latrines, due mainly to thework of women sanitation promoterswho mobilized women and othercommunity sell-help groups. Angola,Bolivia, India, Lesotho, Malawi, andSri Lanka have reported a considerabledecline in vandalism and breakdown of

The magic of water appearing ina village in Nyjer.

('-•

Good things come free INDONESIA

Pak Torijo never let go a windfallwhen he sensed one. He said 'yes'when the village head asked himif he would like to try out a raincollection tank. He did so evenbefore he took a close look atthe cylindrical object beingconstructed by several men fromthe health service, just outsidethe community hall. It was oneof the five sample tanks beingintroduced in the village.

A dryland farmer in Koting Cvillage, some eight kilometressouth of Maumere, capital of theIndonesian district of Sikka,57 year old Pak Torijo explained:"At that time, near the end of thedry season, water was verydifficult to find —unless we wentdownhill about 4 km to Batikwaer,a small stream to the south". Thehardest part of it was the four-hour climb back to the house,through hilly rock-strewn terrain,carrying about 10 litres of wateron a long bamboo pole.

Over four days, seven men builta nine cubic metre ferro-cementtank next to Pak Torijo's brickand bamboo house. The iron rods,cement, sand and assorted pipeswere provided by the healthservice. Pak Torijo supplied thelabour. For him, it was a net gainat no risk and no cost. He notonly got the tank free, he alsoacquired the expertise to buildone. In fact, he was designated akader (advisor) to help buildmore tanks, and that meant extraearnings.

In Sikka, in the whale-shapedisland of Flores, rainfall is 168 cma year, but much of this is highintensity rain that comes inDecember and January. Thus thedry season lengthens to eight tonine months at a stretch. Wateris thus a major, if not themajor problem in many ruralcommunities.

Surface and underground watersources are either inadequate orimpossible. Water wells needboring 20 to 70 metres deep. Therivers are flooded in the wetseason and then run dry formonths. So people have no optionbut to walk to wherever is thenearest brook. The life-timemileage logged by some would bea record by any standard.

Rain collection tanks are thus anatural option. And as bamboo isavailable locally and cheaper,ferro-cement construction hasbeen replaced by bamboo-cement.Commensurate with its lowerstrength, the size of bamboo-cement tanks is moderated toabout six cubic metres. Amongsources of funding to promotethem are Oxfam, the UK-basedprivate aid agency and UNICEF.On an average, a 6 1/2 cubicmetre tank can collect enoughrainwater for one family to last160 days, if the water is usedfrugally for drinking and cookingonly, say, at the rate of 40 litresa day.

If the water level in the tankruns low for any reason —andthere must be a minimum amountinside the tank to keep it fromcracking —the Torijos have threealternatives; the creek, a publictap 1 1/2 km to the north with itsusually long queue, or buyinga supply from a mobile watertank, a thousand litres for4,000 rupiahs.

Life has changed for Pak Torijo,since the coming of the rain col-lection tank. For the first time,water is not too difficult to get.Time is saved in the morningpreparing for work and in theevening for continuing the work,as he does not have to comehome early to fetch water. Hishealth has improved; before thetank arrived, he constantly hadfever, diarrhoea or coughingspells; now he has only an occa-sional temperature. His incomehas improved partly because hehas more time to spend on hisfarm, and partly from extra moneyhelping others to build tanks, upto Rp 12,000 a tank, and as astonemason in Maumere, thedistrict capital.

There is no end to improve-ment. The village has gone in forgroup construction: twelvefamilies will build twelve tankstogether with their own resources,the other six with funding fromUNICEF and Dian Desa, aYogyakarta-based appropriatetechnology group that haddesigned the tank.

UNICEF 1343.'85/UNiaiF Jakarta

20

water systems following training ofwomen caretakers. In Ngusur ia(Kenya) and Surigao city (Philippines),women have been relieved of thearduous daily climb to water sources inthe mountain after helping to plan andconstruct gravity-fed water schemes.

In partnership with other interna-tional organizations, including theWorld Bank and WHO, technologistsand manufacturers, UNICEF has helpedevolve and apply simple, low-cost andsocially acceptable technologies todevelop and sustain village-level opera-tion, maintenance and management ofwater supply and sanitation. Wells orboreholes with handpumps and simpleon-site excreta disposal facilities are thebasic hardware. The World Bankhand-pump testing programme, work-ing with UNiCEF-assisted water projectsin several countries, is now movingtowards promoting, and possiblyaiding, local manufacture of certaintypes. Meanwhile, some types ofhand-pumps arc already being locallymanufactured - the India Mark II inMali, a shallow well hand pump inMozambique and the tubewell devel-oped and produced in Bangladesh.Local production can help reduce unitcosts (1985 Mark Us cost USS123each, compared with US$180 in 1984and US$230 in 1983) and makeavailable badly needed spare parts. Insanitation, the Ventilated ImprovedPit Latrine with its vent pipe and flyscreen, together with the Water SealPour Flush Latrine, have revolution-ized on-site excreta disposal. Theirstructured simplicity and effectivenessin controlling flies and preventingsmell have begun to popularize theiruse in rural and urban areas. At thesame time, UNICEF continues its co-operation with the World Bank (TAGGroup) on low-cost sanitation.

Low-cost, light-weight and simpledrilling rigs costing from US$5,000 toUS$100,000 now are taking over fromthe US$300,000 heavy duty rigs muchof the shallow (50-60 metre) boreholedrilling in Costa Rica, Indonesia, Laos,Pakistan, Thailand and Viet Nam. Inseveral countries, such as India andIndonesia, local manufacture of suchrigs is slowly becoming a reality.

Other appropriate technologiesmake use of surface water, either withsimple, low-cost rain-water catchmentsystems or by piped, gravity-fedsystems.

At the beginning of the waterdecade, the capital cost of water pro-

jects was considered to be aboutUS$50 per beneficiary. Appropriatetechnology and community participa-tion have significantly reduced thatfigure.

Use of power derived from wind andsun is gaining acceptability. Thoughwind and sun pumps have a highercapital cost, they are cost-effectivecompared with fuel-powered pump-ing. Cape Verde, Somalia, Sudan, andTanzania presently use wind energy forpumping. Several West African coun-tries and some Asian countries havesolar pumps on trial.

The emphasis on low-cost solutionsthrough appropriate technology andinvolving the community is con-tributing to confidence in an increasingnumber of countries that water andsanitation can be made available na-tionwide. Peri-urban water and sanita-tion programmes have proved feasible,but the growing size of the problemraises the question of resources. Whilethe growing link with health educationand community involvement is ahopeful sign, continued effort is re-quired to achieve sanitation and healtheducation and to build a versatile cadreof community workers. D

IWATER ANDSANITATION:In 1985 UNICEF

» co-operated in programmesto supply safe water andimproved sanitation in 93countries: 36 in Africa, 21 inthe Americas, 25 in Asia and11 in the Middle East andNorth Africa region

» completed approximately92,562 water supply systems,including 79,548 open/dugwells with handpumps,779 piped systems, with594 motor-driven pumpsand 11,641 other systems suchas spring protection, rainwater collection and watertreatment plants

» benefited some 16.6 millionpersons from Its rural watersupply systems

» completed 307,199 excretadisposal installationsbenefiting some 6,023,300people

Women at workThe UN Decade for Women ended dur-ing 1985 and was reviewed at themajor international conference inNairobi. iMeanwhile, UNICEFcontinued, and in some respectsenhanced, its support for women hitheir role in the social and economiclife of low-income communities,within new guidelines approved by theUNICEF Executive Board in April 1985.Within the strategy of community-based services, the aim has been to in-crease their access to: nutrition ade-quate to the needs of work load,childbearing and child-rearing; educa-tion and training related to self-helpgroup activity and the needs of dailylife beyond conventional domesticroles; health care responding to thespecial needs of women, infants andchildren; income through economicactivity helped by training, financingand marketing arrangements; tech-noloffy which can increase productivity,reduce drudgery and save time,

money, energy and anxiety; and, orga-nization for productive effort as well asto strengthen their capacity toinfluence decision-making in the com-munity. Constraints notwithstanding,these multi-sectoral components areincreasingly coming together withinthe overall programme framework.

In most countries training of healthworkers and traditional birth atten-dants at the community level, andhealth education, form a major part ofUNICEF assistance. Primary health care,incorporating functional literacy forwomen, nutrition, water supply andenvironmental sanitation, has becomean umbrella for an integrated approachin Bangladesh, Ethiopia, Indonesiaand Nigeria. A women's health pro-gramme in Rocinha (Brazil) is moving,through group organization, to reachever)' pregnant woman in the com-munity (sec profile page 22). The par-ticipation of village women in a healthmovement in Anambra (Nigeria) has

:i

Women on the way

Beyond slogans and resolutions,women are fighting for their ownspace in societies around theworld. And the effort starts withan understanding of the facts of agiven situation they findthemselves in. Strengthening theirinterpersonal relationships todevelop an effective social andpolitical network is the next stageof the struggle. The slums of Riode Janeiro present a typical battlefront. "We are no longer seekingfavours", says Maria-Helena daSilva, who heads a neighbourhoodorganization in Rocinha, ''we areasking for our rights".

Some 63 per cent of Brazil's133 million people live in urbanareas, most of them huddled inlow-income favelas. About 70 percent of the total are materiallypoor. And more than half theadult population are women. Theirwages are 40 to 60 per cent thoseof men. Following the dictates oftradition, women occupy many ofthe socially most important butfinancially least remunerativepositions, such as teachers,nurses, social workers andmothers. They also occupy someof the dreariest - such assecretaries and domestic

workers. They form the majorityof minimum wage earners ina society where large numbers ofthem do not have a paying job atall.

The promise held out by thehigh aggregrate growth rate of theBrazilian economy in the early1970s has soured. The countryhas the largest external debt, ataround US$120 billion, for anydeveloping nation. The inflationrate of well over 200 per cent haseroded real wages, the worstconsequences, includingextensive unemployment, beingreserved for the poorest.

Families are breaking up undereconomic pressure and more andmore women are left alone withchildren to raise. They have thegreatest responsibilities, butlimited education, often noliteracy, relative inexperience inthe job market and skills usuallyconfined to the routines of thehome.

A survey of a group ofhouseholds in Rocinha, con-ducted with UNICEF support,revealed a situation even worsethan commonly expected. Morethan half of the women surveyeddo not work outside their homesfor money. Close to three quartersof those who do, list their occupa-

tion as domestic worker. Amongthe reasons for not working out-side their homes, 65 per centstated the need to stay at hometo watch over the children. Of thewomen surveyed who do havejobs, a fifth reported leavingchildren under 12 years of age athome with no adult to take careof them. In the case of the firstchild, over half were born tomothers under 20; and nearly halfthe women in the 17-50 years oldrange had not completed primaryschool.

As a result of the survey'shouse-to-house visits, many of thewomen are obliged to think aboutproblems they had not consideredpreviously, problems of sexualrelations, child care, educationand their own health. "They havecome to know about their bodies,their children, in fact about thewhole woman", says Maria-Helena da Silva.

Another community leader inRocinha, Eliza Plrozzi, analysesthe reality behind the statistics ofthe survey. A variety of familysituations occur in slum life andoften the best intentioned effortsto improve them appear to beswimming against the tide.

Development programmes haveusually bypassed women.Women, such as those inRocinha, have begun to recognize,discuss and deal with theirproblems —learning the hard wayby force of circumstance. Brazil isstill a very machismo society,says one of them. "The 'old boysclub' that has run the develop-ment business has shown ageneral lack of familiarity in deal-ing with women", observes aformer project evaluator. "Often ithas taken a woman on the evalua-tion committee to raise the properquestions at all."

Some of the women involved Inthe Rocinha survey have startedto assert more control over theirlives. They work as healthworkers, teaching other womenhow to administer oral rehydra-tion to prevent diarrhoea!dehydration common amongyoung children and spend a dayworking at the local clinic. Othersare involved in starting a conv

22

BRAZIL

munity school. But these effortsneed to be helped along and builtupon by other women if the socialsituation is to change.

Policies are still run by men.And the challenge for women is toovercome their isolation —ashousewives isolated from com-munity affairs, as workers withouteconomic power, as constituentswithout effective representation.There is healthy self-criticismamong leaders of the women'smovements in Brazil. According toone, the earlier efforts to promotewomen's issues often resulted inmore talk than action. Today, anumber of them work withestablished agencies like govern-ment welfare departments, thechurch and national and interna-tional development organizations.With women in the forefront thereis organized effort among thepoor to raise consciousness anddeliver tangible necessities likejobs, education and health care.

With the return of civilian rulein Brazil, several women havedecided consciously to go intopolitics, assume a role in policyformulation and use the existingstructure to initiate action fromwithin. The state council forwomen's affairs in Sao Paulooffers one such possibility: thecouncil is linked to unions,neighbourhood associations andpolitical parties. It guides womenworkers in how to start day-carecentres, change labour laws, getmaternity leave increased fromthree to five months, get theirissues on the union agenda, dealwith family violence, enddiscrimination on the job andhave women's wages increased.

There is change in the air. Allthe same, according to one coun-cil member, "the justice systemhas so far not solved any of theproblems of women". Indeed thereis no particular reason to expectthe established social andpolitical structures to supportsubstantial change forwomen —unless women see to itthemselves. "The political leaderswill not give anything" says awomen's leader. "We will have totake it. They are giving us aspace, nothing more."

become a model for other states in thecountry.

Among the more significant nutri-tion-related activities supported byUNICEF are: production of low-costnutritious food for weaning as well asfamily consumption (Haiti); sup-plementary feeding for vulnerablegroups (Zimbabwe and Botswana);organizing women around appropriatefeeding and weaning practices (SriLanka); community gardens, fishponds and livestock raising(Indonesia). Some of these projects, asin Mauritius, need to be refined tofocus on poorer segments and youngerchildren.

Self-sufficiency in food consumptioncontinues to be a UNICEF priority. Prac-tical examples are support for homegardens (Bangladesh, Bolivia,Dominican Republic, Gambia, Ghana,Paraguay and Sri Lanka), sometimeswith extension training in farmingmethods (Ethiopia, Indonesia); dryseason gardening for maternal andchild nutrition, solar crop dryers forfarming and fishing communities andfish smoking technology (Ghana);food production plus child carethrough women's co-operatives(Mozambique) and women's gardengroups (Senegal). Across this range ofactivity, significant impact on outputand income have been reported as wellas weaknesses related to farmingmethods and access to transport andmarkets.

Income generation and child healthcare are the two pillars supportingwomen's activities in several countries.While conventional choices-pottery,weaving, handicrafts—still dominateincome-earning projects, increasingemphasis is placed on mainstreameconomic activities and also onupgrading the quality of training andskills, the training of better trainers,exploring potential markets and accessto technical expertise and managementskills (Ethiopia, Indonesia, Morocco,Pakistan, Paraguay, Thailand, Zim-babwe). Easier channels and terms ofcredit for productive activities bydisadvantaged women is gaining wideracceptance (Bangladesh, Ethiopia, In-donesia, Nepal, Pakistan, Sri Lanka).

Income generation and child health careare the two pillars supporting women's

activities in several countries,such fts Nepal.

23

In India, several programmes couplerural women's economic activities withchild health measures and pre-schoolfood supplementation projects. In-come generation and funct ionalliteracy are linked in Djibouti,Ethiopia and the Yemen ArabRepublic. The linkage with ap-propriate technology is seen inParaguay and Thailand, among othercountries.

U N I C E F support to women'seconomic activities is being con-tinuously refined by experience withdifferent approaches through exchangewith government partners, voluntaryagencies and local institutions.

To give mothers more time for bet-ter child care requires sound and affor-dable technologies. Health 'techno-logies' such as oral rehydration therapyor other preventive measures free timefor more attention to child develop-ment, household economy and thewoman's own well-being. Easy accessto water and a variety of labour-savingdevices help in the same way as docommunity-based day-care centres, ator near women's work places. UNICEFcontinues to support new day care cen-tres (Botswana, Burkina Faso, Egypt,Ethiopia, The Republic of Coted'lvoire, Mozambique, Nepal, and SriLanka), upgrading existing ones andtraining child care staff (Ethiopia,Mozambique, Nepal, Nigeria, SriLanka).

The most positive aspect of the year'sexperience was the strengthening ofthe linkage, conceptually and opera-tionally, between health, nutrition,literacy, training, credit and economicactivity in programmes for women.However, a common range of prob-lems still limits effectiveness in thefield: scarcity of resources and manage-ment capacity; traditional attitudestowards women; inadequate admin-istrative infrastructure; shortage ofrural women development agents;high turn-over of village-levelvolunteers due to poor incentives; andthe lack of defini t ion and co-ordination of responsibility amongvarious government ministries dealingwith women's concerns. D

Urban basic servicesThe relevance of the participatory andintegrated approach to community-based services for the urban poor wasreaffirmed by the experience of the pastyear. UNICEF advocacy, mainly bydemonstrating feasibility, has had avisible effect on national policies andtherefore on the steady expansion ofurban basic services, which have pro-vided an effective channel for promot-ing child survival and developmentpriorities.

While UNICEF involvement in urbanbasic services has been growing, it hasnot yet spurred national effort to keeppace with the staggering rate of urbangrowth. All the same, starting in thecommunity with clearly definedstrategy and aims, such services havebecome ready vehicles for key elementsof primary health care and child sur-vival and development. The past yearoffers a variety of practical examples.

Outstanding among them are theprimary health care programmes inAddis Ababa, Bangkok, Metro Manilaand Davao City (Philippines), Popayanand Bucaramanga (Colombia) andGuayaquil (Equador). There aresimilar projects in Brazil, Jamaica, Jor-dan, Kenya, South Korea, Pakistan,Somalia, Sri Lanka and Swaziland,while new primary health care com-ponents are being introduced in CostaRica, Jordan and Viet Nam. Theseefforts have a direct bearing on nationalgoals such as universal immunization.In some countries, they cover the fullrange of primary health care elementsto include supplementary food, safewater, sanitation, monitoring ofweight during pregnancy, pre- andpost-natal care, and special attentionto children at risk.

The gradual orientation of service in-frastructure by governments towardsthe basic needs of the urban poor hasgreatly helped this past year in extend-ing immunization. From modest be-ginnings, the quick expansion and pro-per maintenance of immunization hasbeen possible in several cities. A highproportion of eligible children havebeen covered in Kabul, 75-80 per centin Colombo and over 80 per cent inBangkok. More than 80 per cent ofchildren below five years have been im-munized in Mogadiscio and Hargcisain Somalia, compared to about 10 percent earlier in the year. The accelera-

tion in Addis Ababa has reached 41 percent of expectant mothers. In Demi,the programme for immunization ofslum children continued, doubling thecoverage to 65,000. In Kisumu(Kenya), a campaign against measles isprogressing towards the aim of halvingthe infant mortality rate of 190 in fouryears. There is a slow but steady in-crease in immunization coverage inKotulu (Benin). Plans for immuniza-tion in urban areas are under way inJordan, Mozambique, the Sudan, thePeople's Democratic Republic ofYemen and Zambia.

Low-cost water supply and sanita-tion are strongly expressed needs of theurban poor. Many urban projects inIndia and Pakistan began with thisfocus before broadening to meet otherneeds. In Ecuador, the process wasreversed, beginning with primary

M SOCIAL SERVICESFOR CHILDREN:In 1985 UNICEF

- co-operated in social servicesfor children in 104 countries:41 in Africa, 28 in theAmericas, 22 in Asia and 13 inthe Middle East and NorthAfrica region

» supplied equipment to morethan 37,500 child welfare andday-care centres, 4,200 youthcentres and clubs and28,600 women's centres

» provided stipends to morethan 79,700 women and girlsfor, training in child care,homecrafts, food preservationand income-earning skills

» provided stipends to trainsome 88,400 local leaders tohelp organize activities intheir own villages andcommunities

» provided equipment andsupplies to 800 traininginstitutions for social workers,and training stipends for51,500 child welfare workers

24

health care and now adding water andsanitation as crucial components.Together with oral rehydrationtherapy, safe water and basic sanitationare the major means of controllingdiarrhoea in congested urban set-tlements. Niger, Swaziland and VietNam are preparing to introduce sanita-tion as a major health support to theirurban projects.

Childhood malnutrition remains aserious and difficult urban problem,usually more intractable than in therural areas due to: low income in a casheconomy, early discontinuation ofbreast-feeding by working mothers,diarrhoea resulting from poor healthand insanitary conditions, and thedirect consequences of economicrecession bearing even more heavily on

Urban basic services-cm effective channelfar mepngpwnmes sitch as those inBwaramanga (Colombia).

the urban than the rural poor. Thereare no shortcuts to improved nutritionin this challenging situation; action isrequired across a broad front, as for ex-ample: backyard gardens in whateversmall space is available, community kit-chens for children (Panama City andPuno, Peru), immunization againstmeasles, control of malaria, contin-uance of breast-feeding, birth-spacingto reduce the incidence of low birth-weight, supplementary food for preg-nant mothers and for timely weaning,routine deworming, safe water, im-proved sanitation, health educationand income-generating activities forwomen. These are being promotedthrough urban basic services, with at-tempts to monitor impact on thenutritional status of children andmothers.

The increasing presence of streetchildren and working children is now aworld-wide concomitant of poverty,natural and man-made disasters andthe urbanizing process.

In relation to working and streetchildren, the principal experience hasbeen in Brazil where contact is main-tained with some 300 communitygroups working directly with thesechildren. This Brazilian experience hasbeen the basis too for new projects car-ried out in four departments of Co-lombia, five states of Mexico, and thetwo principal cities of Ecuador. Aswell, local projects have taken firmroot in Argentina and the DominicanRtpublic. Beyond the Americas, thelessons of these countries have beenshared with Mozambique (see profilepage 34), Kenya, Ethiopia, Somalia,the Philippines and Thailand, resultingin new situation analyses of thesechildren's needs as well as several newnoted projects to be presented to the1986 Executive Board. A global ap-proach to this increasing social prob-lem, within the framework of urbanpreventive basic services, is currentlybeing pursued.

UNICEF also learned that the effortto establish community-based servicesfor the urban poor has to be com-plemented by assisting the rural poorthrough agriculture and agro-based in-dustry, so that they have fewer reasonsto migrate to larger cities. D

£5

Preventing childhood disabilityThe major causes of childhood disabil-ity are the same as those of falteringgrowth, illness or death of infants andchildren-nutritional deficiency, infec-tious diseases, neo-natal problems andaccidents. Since 1980, UNICEF hasexpanded its programme strategy,stepped up global advocacy and en-larged country-level co-operation inorder to reduce the widespread in-cidence and varied consequences ofdisabilities affecting children. In 1985,specific prevention and rehabilitationactivities at the community level werepart of programmes of co-operation in34 countries spread over Africa, Asia,the Middle East, the Pacific and Cen-tral and South America.

Because the same problems whichkill also disable, chUd survival anddisability intervention programmes in-termesh and naturally evolve, onefrom the other. Immunization, for ex-ample, may avert as many disabilities asdeaths. Programmes against iodine andvitamin A deficiency protect as muchagainst stunting and faltering growthas against disability. Breast-feeding andbetter childbirthing practices con-tribute to healthy growth and develop-ment as much as to outright survival.The strategic focus is on policydevelopment, training at community-level of those concerned through pro-moting and monitoring preventivemeasures, early detection andintervention,

Interest and resource commitmentby national governments have been

growing, and the technical infrastruc-ture of trained professionals andrehabilitation facilities is beingstrengthened gradually. UNICEF is giv-ing priority to projects which: benefitchildren in the 0-6 years age group; useavailable local resources of personneland materials, leading increasingly tocommunity self-reliance; benefit low-income and low-access groups; providefor family and community participa-tion; incorporate cost-effective ap-proaches; and integrate the disabledchild in the community.

Disability prevention has seized theinterest of Asian and Pacific nations.Many of them have launched commu-nity-based low-cost programmesstrongly linked to community educa-tion and to the elimination of micro-nutrient deficiencies. In Sri Lanka, thesuccessful project in Anuradhapura hasprompted preparations for nationalcoverage. China is organizing a nation-wide survey. Pakistan has includeddisability prevention and rehabilitationin its national development plan. In-dia's programme seeks convergencewith area-based programmes and co-operation with a number of voluntaryagencies in the field (see profilepage 27). Other Asian countries activein programmes against childhood di-sability include Bangladesh, Brunei,Hong Kong, Indonesia, Kampuchea,Nepal, the Philippines, Thailand andViet Nam.

In Africa, the policy-level interest inpreventing childhood disability has

been recent, although 15 countrieshave disability-related projects, UNICEFhas supported advocacy and training,establishing in the process strong con-nections with child survival anddevelopment activities. Several coun-tries have begun organizing surveys; insome, the school system is involved inpreventive and rehabilitation activities.

In the Middle East, countries havealso begun analyses of the childhooddisability situation. In Bahrain, pre-survey estimates of disability preva-lence are approximately 10 per cent.In camps in Lebanon, special pro-grammes for the rehabilitation andeducation of disabled children as wellas training for social workers in earlydetection and intervention, have beenintroduced.

In Latin America, an infrastructureof rehabilitation services already existsand child survival and development ac-tivities are gaining momentum. Theneed for disability prevention pro-grammes has so far been explicitlyrecognized in three countries: Brazil,Guatemala and Haiti, and through thespecial sub-regional programme onchildhood disability in CentralAmerica.

UNICEF seeks to improve family andcommunity capacities to help disabledchildren become active members oftheir societies and to prevent needlessdisabling. The challenge now is toreduce the needless burden of disabil-ity; like the infant mortality rate, theprevalence of childhood disability is anindex of social development, D

The challenge now is to reduce theneedless burden of disability.

26

Sound of learning INDIAU

For three years, 'co-operativecorporation for the disabled1 inthe state of Andhra Pradesh,based at the Gandhi Hospital InSecunderabad, has been givingfree or subsidized hearing aids todeaf persons who were unable toobtain them on their own. Lookingback, it came as something of asurprise that about 60 per cent ofthese hearing aids went tochildren below six years of age.But there was a bigger surprise.

Those young children who werelucky to have received hearingaids could not make use of them.There were no schools teachingspeech and language to deafchildren of pre-school age. Thefew existing schools for deafchildren in the state admit onlythose over six years and theyteach only sign language. Everyparent was faced with these ques-tions; how to use the aid, how tomake the child wear it, whatsounds should be taught first andhow, what words can be taught. Itwas plainly not enough to give ahearing aid to a deaf child.

A good home managementprogramme for the mothersseemed to be the answer. Of themothers who had come to receivehearing aids for their children,10 were selected for training. Theonly criteria were a minimumeducation up to the seventhstandard and willingness to comeand be trained. To help theirtravel, a monthly stipend of Rs25(US$2) was offered over a three-month training course.

The first month was devoted todiscussions — concerningdeafness, hearing identification ofdeafness, hearing aids, fitting theaids, counselling parents,language acquisition, phonetics,auditory training, language train-ing, speech training, lip reading,reading and writing.

This basic understanding wasfollowed up the next month topractise and learn how eachsound in the alphabet was madeand how it could be taught tochildren. Various auditory traininggames were practised withchildren who came over from thenearby play centre. Thereaftertrainee mothers had to take

classes in language training, lipreading, reading and writing —fordifferent levels of training. Forexample, two and a half year oldchildren for the auditory games,three year olds for the languagegames, six year olds for readingand writing and ten year olds forstory-telling.

The third and final month wasdevoted to preparing teachingaids for the deaf children fromlocally available materials. Eachmother had to prepare a set ofaids of each type which, later on,she could either use for her ownchild or donate to the play centrewhere she would eventually beworking. The training closed withguidance to each mother onestablishing and managing a playcentre for deaf children, onmaterials and equipment requiredfor it, on writing reports and casehistories and testing a child'sprogress. The usefulness of linkswith local social service organiza-tions was also illustrated, topersuade the more promisingamong the mothers to organizeand run play centres in variousparts of the city and nearby areas.

So far some 20 mothers ofchildren with hearing problemshave received training, their ageranging from 18 to 35, theireducational level from theseventh standard to a degree inarts, their economic status frompoor to middle class. The age of

their children ranged from threeto 14 years old.

The transformation in theability of the children attendingthe pre-school centres has beeneven more remarkable. Thosearound the age of 14, previouslyattending the 'school for the deafhave moved from the 'word' levelto the 'story' level. Those agedbetween three and eight, whohave had no previous exposure toscientific training, are progres-sing at different levels of prepara-tion for Integration at theappropriate grade of regularschools.

Children who had no speech atall have learned around 200 wordswith understanding; they alsoread, write and take downdictation. Mothers too havepleasantly discovered their pointsof strength. Thus, one who hadsome difficulty teaching the olderdeaf children, has proved to beexcellent with the nurserygroup —the toughest of the lot!

True, the more educated themother, the faster her grasp, thegreater her contribution and thehigher her readiness to assumeresponsibility. But this is onlypart of the work which requires anenormous fund of patience,perseverance and endurance.Most women are endowed withthese resources to a degree thatoften surprises them.

27

UNICEF in action: programme con

'̂ -oThe programme commitments shown on this map arc for multiyear ^£periods, and are exclusively those from UNICEF'S general resources.Those commitments being proposed to the April 1986 Executive Boardsession arc indicated in colour, and should be regarded as tentative.

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

Higher-income countries, where UNICEF does not have aspecific commitment from general resources over a givenperiod, but co-operates in the provision of technical oradvisory services, are shown without programmeamounts or durations.

Altogether, UNICEF currentlyin 118 countries: 42 in Africa; 3

13 in the Middle Eaa

GUATEMALA1983-86: 52,518,000HONDURAS1984-86: S616.000EL SALVADOR1985-87: 3852,000

NICARAGUA19SA-W. $1.160,000COSTA RICA1985-89: $248,000PANAMA1985-87: $147,000COLOMBIA1984-87: $5,790,000

ECUADOR1986-89: SI,754,000GUYANAW«<WT. 1,230,OWSURINAME1975-79: $130,000

PERUIWtf t -mul l*J,S~- SI . 142.000PARAGUAY1985-89: 5989,000CHILE1985-87: S206.000

CUBA1983-86: S178.000JAMAICA19H6-X8: S138,000HAITI1982-86: $5.114,000DOMINICAN REPUBLIC1984-87: $1,405,000

EASTERNCARIBBEANISLANDS'1984-88: $1,500,000

ANTIGUA ANDBARBUDA1983-85; $70,000DOMINICA1982-85: $83.000ST. LUCIA1983-85: $75,000

TRINIDAD &TOBAGOBARBADOS

' Includes Saint Vincent and the Lircnadmci, Saint Christopher andNevis, Grenada, British Virgin Islands, Moritscrrat and Turks andCaicos Islands.

2 In addition 1984-1987: 51.950,000 for Palestinian*.

•' Dotted line represents approximately the Line of Control in Jimniuand Kashmir agreed upon by India and Pakistan. The final status oflarnmu .ind Ka-shmir has not yet been agreed upon by the parriev

* Includes Cook Islands, Fiji, Kiribati, Nine, Samoa, Solomon Islands,Tokelau, Tonga, Tuvalu, Vanuatu, and Federated Stales ot MicronesiaMarshall Islands and Palau,

The bouiidams nnd names im ibis nuip do nor imply official endorsement oratceptfttiee by the United Nations.

0,

TUNISIA1983-86: 51,507.000MOROCCO1981-85: $7,612,000

7

MAURITANIA1982-86: $1,995,000

CAPE VERDEI9S090 $330.000

SENEGAL1987-91: SrGAMBIA1984-86: 5389,000GUINEA-BISSAU1984-88: $600,000GUINEA1985-86: $1SIERRA LEONE1986-90: $4LIBERIA

«: $2BURKINA FASO1985-87: $3

COTE D'lVOIRE1986-90: $1,998,000GHANA1985-90: $8,574,000TOGO1984-88: $3,533,000,BENIN1985-88: 53,154,000

J8

imitments in the developing world:o-operates in programmes> in Asia; 30 in Latin America;and North Africa.

S Y R I A N ARAB REPUBLIC 1986-9IJ- i l . N 1

— LEBANON 1980-82: $630,0002

- JORDAN 1986-90: $920.000-

1SLAMICREPUBLICOF IRAN

LIBYANARAB VS SAUDI

1AMAH1KJYA ABASHEGYPT, '1985-89 * ! BAHRA3,371,000? '

' '" """"̂ r \

iER5-89'8.000 SUDAN

CHAD | 1^1-85mss-yii «2,T50.ouo

ie.2iD.oni)

.Ml PAKISTANI » K | - K 6

SH7,l(^.nuii

NEPAL1'182-So

Si:."]!),

UNITEDINDIA198A-S9

$140,437.00(1EM!AW/OMAN

J 1985-1990: $300,000

/YEMENf—/ 1985-86: $1,590,000

DEM. YEMEN1985-90:53.550,000,DJIBOUTI1986-90: $206,1)00SOMALIA1984-87: $5,035,000

'/

w

UGANDA1987-90: $10,305,000

KENYA1987-89: $6,366,000

RWANDAl9Sh-S"- $2,220,000

'•$$.1 LANKA\J 1985-88

S3.313.00ll

MALDIVESW82-87

5159,000

MADAGASCAR',1985190

.SS.08J.HOU

SEYCHELLES1984-86: $124,000

COMOROS1985-87: $178,000

MALAWI1984-87: $5,724,000MAURITIUS

U S'AH.'HMt

ZIMBABWE19S4-86: $4,260,000

MOZAMBIQUE1985-90: $13,370,000

SWAZILAND1985-88: $594,000LESOTHO1982-85: $1,203,000BOTSWANA1984-86: $486.000

*=*.'

INDONESIA }1985-89: 54440 ,̂01)0

*t>c£>f=f'J(7'^ ^East Timor

*0

DEM. PEOPLE'SREP, OF KOREA

JSfS-SH: SI,050.()0{t

REPUBLIC OF KOREA1982-86: $2,716,000

BURMA1982-86: $27,000,000BANGLADESH1982-85: $50,000,000

LAO PEOPLE'SDEMOCRATIC REPUBLIC1982-86: $4,256,000THAILAND1982-86. $14,74(^000PHILIPPINES1984-87: S10,827,0(H)KAMPUCHEA.dyri" S2.M)0,IMH) L

VIETNAM1983-86: 527,142,000MALAYSIA1983-84: SL.062,000PAPUA NEW GUINEA1983-85: $591.000

PACIFICREGION*

L98fiSI,300.Oi Mi

V

ZAMBIA 1984-86: $1,477,000

CONGO I 1 ' "i.OOO

SAO TOME AND PRINCIPE 19Kh-VO: S2S'

CAMEROON 1985-90: §2,747,000EQUATORIAL GUINEA 1984-87: $374,165CENTRAL AFRICAN REPUBLIC 1984-88: S2,294,00(i

UNICEF'S programme expenditure in ijiftcrcnt countries is allocated according torlircc criteria: inline mortality rate (1MR: annual number of deaths of infantsunder one year of age per 1,000 live births); income level (GNP per capita); andthe size of the child population.

A new index, the Under 5 Mortality Rate (USMR), has been developed by the UNPopulation Division with support from UNICES (USMH: annual number of deathsof children under 5 years of age per 1,000 live births). This year, the U^MR (1984figures) is shown, as follows:

• U5MR 250 and above (10 countries) U5MR 100-145 (22 countries)U5MR 150-245 (36 countries) U5MR under 95 (42 countries)

Developed countries arc not shaded but most have a U$MA under 20.

19

Life begins anew MAM

The Kel Taborak used to roamfree. They lived in tents whereverthere was water and pastures fortheir cattle, their only asset. Theymoved up to the north during therains and southward along theNiger river In the dry season.

By 1983, a decade-long droughthad destroyed thousands of theircattle, yet the Kel Taborak heldon to some 50 camels, 40 cowsand a hundred goats, and to theirway of living —true to their namewhich means 'the independentones'.

Twelve months later, everythinghad changed. The Saheliandrought left neither water norpasture anywhere. Most of thelivestock died. Along withuprooted others, the Kel Taborakheaded for the regional capital ofGao in south-eastern Mali. Now,some 40,000 self-reliant peoplewere on relief aid. It meant theend of their culture. But it alsomarked the beginning of a newapproach to life. The village nearGao where they decided to settletook the name of Kel Taborak.

"Yesterday we planted sorghumhere", says Mohammed Aliad, 35."We did that right after the watercame from the sky." The sorghumseeds came from UNICEF. Thefields look sandy but once therains come, they turn fertile. TheKel Taborak hope that the oralagreement by which the regionaladministration handed overpossession of the land will soonbe followed by a written one. Withmore people turning from cattle-rearing to farming, fertile soil hasbecome an issue for sometimesbloody disputes —as in nearbyForgho.

The Kel Taborak still feeloneness as a tribe. Theywork with and for each other,Mohammed Aliad explains: "FirstI find rice and meat and tea for allthe people that are to help me.Then we will go all together andwork in my field and the next daywe will do the same in mybrother's field". He points toanother field, planted five daysago, where the seedlings arealready inching up. "If there isenough water, we will be able toharvest in 80 days", he adds. "If

we can get enough seeds, we willplant and plant until we havea thousand fields."

For the first time since 1969,the N'Shawague, a tributary of theNiger, is again a true river. "Welike to work. All we need is somehelp to get us started. We want tobuild a dam in the river. We wantto cultivate rice and millet andsorghum." Yes, the Kel Taborakneed seed to plant, and food untilthe crops ripen. They need help tolearn how to cultivate, to buildwells, to irrigate fields, to planttrees, to build houses. The Euro-pean Economic Community (EEC)and UNICEF have been providingsuch assistance for about a yearnow.

Indeed, the first new construc-tion has started in the centre ofthe village. It is a mosque, animpressive structure with some15 domes designed by an Italianarchitect. Some 50 men are atwork with bricks of clay-like earthcalled banco. Soon family homesare to be built in the samemanner. Already a 100-foot wellsurrounded with garden plots tobe irrigated through earthencanals has been dug. South of thevillage, work has started ona catchment basin, 300 feet by60 feet and 10 feet deep, tocollect rain. By October, the rivermay have vanished!

"Since we want to stay here, weare now planting trees. We haveasked our children to plant treesand to guard their growth", saysMohammed Aliad. All the youngboys in Kel Taborak are responsi-ble for the trees. They are givenacacia seeds, taught how to growseedlings in a nursery andwhen to plant them. Each tree isprotected by a circle of bancobricks and prickly bushes.

The people working on the damand in the gardens receive weeklyrations of sorghum from a 120-tonstore supplied by UNICEF andthe EEC. In addition, a feedingprogramme run by the Red Crossprovides two daily meals forabout 450 young children.

A year ago, the Kel Taborakwere in dire peril. Today, they arecautiously optimistic that therains will continue and will

harvest what they have planted.And they have plans. Already,they have asked for help to buildtwo more wells, a health centreand an Irrigation system fittedwith a motor pump.

The 5,000 Kel Taborak seem tohave determined their title infact as well as in name: theindependent ones.

L'NiCEP L34W8S/Sdwffiasfct

30

Responding to emergency

The Situation in AfricaDuring 1985 UNICEF greatly expandedits capability to deal with the Africandrought emergency. Programmeexpenditures rose to USS102 million,a 30 per cent increase over 1984.Among some 35 million people be-lieved to be at risk at the beginning ofthe year, the majority were childrenand mothers. Together with govern-ments and other partners UNICEF wasable to save millions of lives, workingprincipally in the fields of health,water, relief items and supplementaryfeeding.

The response to the emergency, inwhich UNICEF is proud to have played apart, was one of the major interna-tional achievements of recent years. Ina world in which emphasis is so oftenplaced upon division and confronta-tion, the crisis brought the commu-nity of nations and peoples together ina massive co-operative effort.

The African emergency led to thelargest intervention ever mounted byNon-Governmental Organizations. Inaddition to the thousands of groupsactive in fund-raising and advocacy,several hundred organizations wereoperating in Africa. Along with the UNOffice for Emergency Operations inAfrica (OEOA), UNICEF provided aframework for many NCOS, facilitatingtheir access to governments, givingthem logistical backing, assisting theirco-ordination and often providingthem with the medicines, supplemen-tary food and other supplies and ser-vices with which to undertake theiractivities.

UNICEF worked very closely withWHO, WFP and other members of the UNfamily. Through this co-operation, itwas possible to organize pledging con-ferences together and make appealswith the OEOA, as well as to co-ordinateoperations.

UNICEF'S regular programmes wereexpanded and re-focused to deal withthe emergency. For example, a majorpart of the water programme inEthiopia was devoted to the creationof water points and the improvementof environmental sanitation at reliefshelters. At the same time, emergencyprogrammes have gradually been

Relief operations continued for themore than eight million affected peoplein the Sudan.

M

modified, to shift the emphasis torehabilitation and longer-termdevelopment goals.

Tightly packed communities incamps and around cities had facedserious sanitation problems and short-ages of safe water. UNICEF responded tothe diarrhoea epidemic in Ethiopia bya swift and massive airlift of ORS packetsand intravenous fluid, distributedthrough governmental and non-governmental channels, includingseveral international relief agencies.Basic drugs and relief supplies wererushed to the cholera stricken camps inSomalia, hardly recovered fromdrought. Similar responses wereorganized in the tacc of cholera inNiger and diarrhoea in camps inDjibouti. To meet Lesotho's healthemergency in October 1985, caused byepidemics of tuberculosis, typhoid andgastro-enteritis among malnourishedchildren, essential drugs were providedon a priority basis.

Belief operations continued in theSudan as part of a special UN assistanceeffort for the affected population ofmore than eight million, but by mid-year rains disrupted the road and raildistribution network; and UNICEFfinanced internal transport of reliefcommodities, particularly food. InEthiopia also, UNICEF assisted transportof water, supplementary foods,blankets and needed supplies, besidesfrilly using trucks from various donors,inc lud ing Belgium, the FederalRepublic of Germany, and Japan.Some 33 trucks donated by Francewere used to reduce logisticsdifficulties in Angola, Burkina Faso,Chad, Mozambique, and Niger.UNICEF assisted Mozambique with fuelsupplies, supported by Italy, Norwayand Canada,

Relief and survival supplies includedplastic sheeting, blankets, clothes andcooking utensils. As a result of a peo-ple to people campaign launched bythe Executive Director in December1984, some 1.5 million blankets weredistributed from the National Com-mittees of Belgium, Canada, the Ger-man Democratic Republic, Italy,Japan, the Netherlands, Spain, theUnited Kingdom, and the USA, andfrom the governments of Finland andJapan, as well as from the EuropeanEconomic Community.

Nutrition support is high amongUNICEF priorities. In Mali, schoolfeeding, involving 185 schools, wassupported with help from the Euro-

pean Development Fund. Increasedfood production tor family consump-tion and/or income was encouraged byUNICEF support to small-scale farmers,often women, in off-season crop pro-grammes, as in Niger. In Mali, seedswere distributed on loan to be re-turned after harvest. Along the RiverNiger, UNICEF is assisting small irriga-tion projects which need limited in-vestment and simple technology.Training for rational management ofcrops, as well as herds, feed and grazingacres, is an important component ofUNICEF co-operation.

The breakdown of the family struc-ture as a result of war, famine andeconomic recession has led to a rapidincrease in orphaned or abandonedchildren. UNICEF has helped familyreunification or family assistance inMozambique (see profile page 34) anda similar initiative is under way in theSudan.

The emergency situation hasenhanced the relevance of programmesassisted by UNiCEF-such as immuniza-tion, oral rehydration therapy, watersupply and sanitation. Accordingly,UNICEF support for these has in-creased—speeding up vaccines, cold-chain equipment, water equipment,pipes, handpumps and constructionmaterials. The supply of clean waterprevented the health situation fromworsening in parts of the CentralAfrican Republic, Chad, Mali, Nigerand the Sudan.

Needs for 1986Donor assistance met just over half ofthe USS120 million appeal for theAfrican emergency launched by UNICEFin 1985. The shorttall in non-food aidseriously undermined the benefits offood aid. Such requirements, par-ticularly those geared to deal with thedesperate situation of children andmothers, must be given priority in thecurrent year. In Ethiopia alone, asmany as eight million people may stillbe at risk. UNICEF will need an addi-tional USS16 to US$20 million to dealwith emergency needs in that onecountry.

It is true that the rains did come tomost African countries during 1985but the crisis continues in at least adozen of them. Many people are stilldirectly affected in Angola, Botswana,Burkina Faso, Cape Verde, Chad,

Ethiopia, Lesotho, Mali, Mauritania,Mozambique, Niger and Sudan. In ad-dition to longstanding, internationalrefugees, as many as four million peo-ple are still displaced from their homes.

UNICEF will need continuingemergency support in 1986 for essen-tial drugs, vaccines and equipment forprimary health care, especially in ruralareas. It will need to back the efforts ofgovernments and of NGOS withlogistical, supply and administrativeservices. Supplementary feeding, im-munization and the supply of ORS fordisplaced and drought-affected familiesremain key components of theresponse to the emergency.

From crisisto development

As the emphasis moves from relief torehabilitation and development, thenew and enhanced capabilities of

A EMERGENCIES:In 1985 UNICEF

» assisted 30 countries hit bydisasters, 21 in Africa, 3 inAsia, 3 in the Middle East andNorth Africa, and 3 in theAmericas

» expended US$1.9 million fromthe Executive Director'sEmergency Relief Fund andchannelled specialcontributions amounting toUS$46 million for shelter,medicaments, water supply,equipment, food supplements,and other essentials

» supported the initiative of theUN Secretary-General inmobilizing extra resources forvictims of drought, famine,and conflict In Sub-SaharanAfrica; and continued tooperate a relief and rehabilita-tion programme in Lebanon

» provided relief for earthquakevictims in Mexico and Chile;landslide victims in Colombia;nutritional and food securityprogramme in the Philippines

32

OSS packets and water purification tabletsare beirig distributed after the earthqtwikein Mexico.

UNICEF'S regional and country officeswill increasingly focus on the humandimension of the recover)' process.This will mean concentrating on childimmuniza t ion and other GOBIelements, as well as on expanding basiceducation. It will involve the en-couragement of social mobilization toachieve these goals.

In facing the 'loud' emergency,UNICEF increased its African budget by25 per cent and this enhanced level ofactivity will have to be sustained.Food-for-work projects and other pro-grammes designed to enable people tobecome productive and self-sufficientwill be expanded.

Many interventions undertaken inthe emergency will have long-termbenefits. New water supplies will helpto improve the quality of life in thefuture; displaced families educated inthe use of ORS will carry that knowledgeback home with them; children im-munized because of epidemics willhave lifelong protection; above all,those saved from disease and death inthe emergency will go forward withbetter health and strength to thefuture.

There is nevertheless a need to en-sure that relief in 1986 is provided informs which will best underpinrecovery and long-term development.

Special attention will be paid to pro-grammes which provide people withthe means and the incentives to pro-duce. The capabilities of governmentsto maintain early warning systems anddevelop preparedness plans to dealwith emergencies and disaster must beenhanced. The collaborative systemsbuilt up in response to the droughtemergency will need to be extendedinto the recovery phase. Means mustbe found to reduce the impact of inter-nal conflicts, which have so often ex-acerbated the effects of naturalcalamities.

Africa faces daunting long-termchallenges. A sustained effort by theinternational community and byAfricans themselves will be requiredbefore problems of low productivity,declining export prices, populationgrowth, environmental degradationand debt-servicing are solved. AsUNICEF moves to fulfill its mandate forchildren everywhere, droughts andother crises will be less threatening tothis most vulnerable segment of soci-ety. After all, it is the poor and theunderprivileged, the weak and themalnourished, who die and sufferwhen famine strikes. Droughts anddisasters may always be with us. Never-theless, economic and social develop-ment, especially when aimed at better-ing the condition of children, willrender disasters less alarming and lessdevastating.

Other emergenciesOutside Africa a number of emergen-cies occurred during the year, imperil-ling children: two severe earthquakesin Mexico City, landslides andflash-floods in Colombia, an earth-quake in Chile, an epidemic of denguehaemorrhagic fever in Laos, floods inViet Nam, a crisis caused by economicdepression and severe malnourishmentof children in a sugar producing pro-vince of the Philippines, and thedisplacement of families in Lebanondue to repeated hostilities. Actions in-itiated for those emergencies were, inmost of the cases, linking immediateanswers to longer-term programmesfor children.

This UNICEF support, with the help ofUNIPAC and, in certain cases, expe-ditious approval of local procurement,consisted of ORS packets, waterpurification tablets, sanitation guide-

33

Restoring broken ties MOZAMBIQUE

"The number of abandonedchildren always rises whenfoodstuffs and production arelow", explains Joanna Mangueira,Director of the Department ofSocial Action in Mozambique'sMinistry of Health. And stocks runout when cyclical drought is anannual feature. Despite the strongAfrican tradition of the close-knitfamily and community support,people's coping capacity isfurther eroded by a prolongedinsurgency which, besides disrup-ting transport and communica-tions, attacks schools, healthposts and shops, indiscriminatelykilling or displacing largenumbers of rural peasants."These days, when a child's fatherand mother die, the relatives donot want to keep the child, theysimply do not have the resources,so they abandon it", observesAntonio de Sousa, a nurse at adistrict hospital in Gaza province.

New vulnerable groups arecreated by the day and hundredsof children have been identifiedas orphaned, abandoned ormaladjusted. Officially, Maputohas 500 such wandering children.The actual number could be fiveor more times as high. And thesituation in this capital city isrelatively less harsh in com-parison with the regional capitals.

Orphanages in the towns areopen to the abandoned childrenbut even if that were a solution,they cannot cope with the sharpincrease in numbers. And theproblem is not confined to theurban centres. Often, the armypicks up children In the bush oralong the road, and brings themto the nearest village.

Whatever the longer-termanswer, the children needimmediate help and guidance. So,relief centres are extending toregions from which most of thesechildren come, such as the prov-inces of Tete, Inhambane, Gazaand Nyassaland. The centre atMacuacua in Manjacaze istypical. Forty-eight children wereliving there, some recent arrivals,some residents for a year or more.The arrangement is rudimentary.One woman-an orphan herselfafter her mother, father, husbandand three children were killed in a

raid by insurgents on her villagein 1982 —is responsible for thechildren. She cooks for them overa three-stone fire, using rationsfrom the World Food Programmethrough the Mozambican RedCross. The children themselvespound the maize by hand to make

UNICEF mS/as.Rulfci

it into flour. Two local men havedug a latrine. There is only onesleeping hut and that createsproblems when infectiousdiseases occur.

However necessary in theinterim, these centres are not theanswer. Sometimes, parents sendtheir children to the centresbecause they cannot supportthem themselves.

Prodded by UNICEF, variousorganizations are seeking durablesolutions to child abandonment.For example, child-care centres,being set up in villages andtowns, have a role in preventinga further increase in the numberof wandering children. Parentsforced to go in search of food farfrom their homes can leave theirchildren in the temporary care ofa child-care centre.

More important, localauthorities are encouraged toreintegrate orphans and aban-doned children within thestructure of extended familiesand village communities, withgovernment support for his or herfood and clothing. To avoid plac-ing the chifd in a privilegedsituation, the assistance isadapted to the standard of livingof the village. It is not alwayseasy to establish exactly where achild comes from and who theparents or relatives are. So, localvolunteers and health staff oftenspend time researching eachchild's background to trace afamily member.

To encourage families to takechildren back, or foster or adoptan orphan, first priority is given toresponding families in channelingmaterial assistance like food,seeds, farming tools and clothes.At least 68 children from theMacuacua centre have beenreintegrated into their families orfostered.

Many of the wandering childrenof Mozambique are already show-ing the signs of alienation anddistrust of adults that have beenobserved among the streetchildren of Latin America. It hasbeen shown that this can beprevented, as it must be, withoutwaiting for solutions to the socialtensions afflicting the country.

34

lines, training for childcare workers inpsychological skills to handle trauma inchildren and a two-phase communitybased, self-help, rehabilitation pro-gramme in rural and urban slum areasin Mexico; water purification tablets,ORS tablets, surgical pins for bone frac-ture, X-ray supplies, pumps, water-testing sets, chemical disinfectants,water tanks, spraying pumps, hospitaland medical supplies, portable latrinesand other relief items for Colombia;essential drugs, medical supplies andminor repair materials for flood ravag-ed schools in Laos; medical equip-ment, vaccines and essential drugs forChile; weaning foods, vitamins, essen-tial dru££, chlorine powder, doth forchildren's clothes, and roofingmaterials for ravaged schools, hospitalsand day-care centres in Viet Nam;emergency feeding, vitamins, localfood production and basic health andsocial services in the Philippines; andrelief supplies and restoration of waterand sanitation works in Lebanon.

These needs were met from theExecutive Director's EmergencyReserve Fund as well as by relief andrehabilitation assistance from regularcountry programmes and special con-tributions. D

Inter-agency collaborationThe working partnership of UNICEFwith sister agencies in the UnitedNations system strengthened in 1985.

Close relationship with UNDP con-tinued in the field. UNICEF participatedin activities of the International Drink-ing Water Supply and SanitationDecade (IDWSSD) chaired by UNDP andin the IDWSSD Steering Committee andtask forces.

The Joint Consultative Group onPolicy (ICGP), comprising UNDP, UNTPA,WFP and UNICEF continued to meetregularly, respecting each agency'smandate and working procedureswhile moving forward with practicalactions. UNICEF also participated fullyin the work of the African emergencyunder the rubric of the UN Office forEmergency Operations in Africa andhelped establish a l ink betweenemergency work and developmentactivity.

UNICEF continued its dialogue in1985 with the World Bank and the In-ternational Monetary Fund and otherconcerned organizations on the

human dimension of adjustmentwork.

The long-standing collaboration be-tween UNICEF and WHO was reinforcedduring 1985. The executive heads ofthe two organizations had continuousextensive consultations during the yearto ensure complementary interactionbetween UNICEF advocacy of child sur-vival and development in the broadercontext of primary health care and theWHO objective of Health for All by theyear 2000. Comprehensive workingagreements were reached between theregional directors of the two organiza-tions for Africa and the MiddleEast/Eastern Mediterranean regions.Using Indonesia and DemocraticYemen as case histories, the twoorganizations are conducting a jointstudy of complementary inputs in sup-port of country activities. Successfulcollaboration was sustained throughthe year in a number of programmeareas: immunizat ion, diarrhoealdisease control, maternal and childheal th, nutrition, environmentalsanitation, essential drugs, tropicaldiseases, and primary health care. WHOand UNICEF also issued joint statementsduring 1985 on acute respiratory infec-tions, malaria, maternal care and plan-ning principles for accelerated pro-grammes of immunization.

During 1985, UNICEF and the UnitedNations Educational, Scientific andCultural 'Organization (UNESCO) con-tinued their fruitful co-operation onthe broad range of concerns in formaland non-formal education, healtheducation, nutrition, education forchild survival, appropriate technology,water and sanitation, etc. with specialemphasis on female education, im-proving external and internal efficien-cy, and education for child survival anddevelopment.

UNICEF collaborated with ILO during1985 in analysing the situation ofworking children, and continued workwith ILO in all other mechanisms affect-ing the well-being of children andwomen. D

Successful collaboration is sustained inprogramme arms such as environmentalsanitation and nutrition.

35

Breaking out of a shell THAILAND

A small village of 150 people inthe Dej-Udom district, Ban SaoLao is like thousands of others inThailand's dry northeast: fewroads, no electricity, hardly anyproper water supply, poor sanita-tion and inadequate healthservices. The contrast to themodern capital city of Bangkokis striking.

A closer look reveals that thevillage, though slow to start onthe road to development, is nowmoving ahead. For instance,Nukon Tongtai, a 56 year oldwoman who has lived through theneeds and the changes, illus-trated the improvement: "I wasmarried at 17 and had sevenchildren, two of whom died ininfancy. But my children, now intheir thirties, have only twochildren each; and none of themgot married before the age of 20."

Nukon Tongtai is an eman-cipated woman: a promoter offamily planning in her village, shedistributed contraceptives atprices two to three times belowthe commercial rate, andencourages men and women tobe sterilized. If Thailand's popula-tion growth continues to declinefrom a rather high rate of 3.3 percent in 1974 to 1.6 per cent in1984, the trend is the result ofconvinced action by many likeNukon Tongtai.

Other changes are happening inthe village, involving NukonTongtai herself. She presides overthe women's farming group, all ofwhose 30 members have under-gone an eight-day training coursein nutrition, vegetable growing,food preparation and child care.This is symptomatic of a transfor-mation process in the village forsome years, especially since 1982when the fifth national develop-ment plan, supported amongothers by UNICEF, came intooperation. Villagers wereencouraged to plant threehectares of land, used previouslyonly to grow one rice crop a year,with vegetables for the rest of thetime, thus improving the nutritionand income level of the wholecommunity. With seeds suppliedby UNICEF, they now grow Chinesecabbage, mung beans, corn,spinach, onions and pumpkins.

Food availability is one thing,proper and balanced use isanother. "You see", NukonTongtai says, "in the beginningwhen I taught my neighbours toprepare nutritious foods to sup-plement their diets, we had to getthe ingredients from outside. Nowwe grow them ourselves. Informer times, people weresuspicious of chicken and othermeats. They believed thesetransmitted parasites and so theywere reluctant to give them totheir children. But that is allchanging now."

The six chickens or duckswhich UNICEF has provided foreach family with a malnourishedchild, have grown into impressivelittle poultry farms, every family inthe village owning no less thanten chickens and five ducks. And,the village boasts of a hundredfish ponds, the first of which wasstarted by Nukon Tongtai, withhelp from the government.

How do the children fare? Thevillage health volunteer, KaesornIntana, weighs the children everymonth and plots their height andweight on growth charts designedto show early signs of malnu-

trition. She also delivers sup-plementary food for childrenprovided by the villagers, ata price of 3 baht (22.96 baht =US$1) per family per month. Allthe children in this village havereceived their first vaccinationagainst diphtheria, pertussis,tetanus and tuberculosis — a vastimprovement on the nationalaverage —ranging from about halfto three-fourths.

One of the more strikingchanges in Ban Sao Lao is thatabout 70 per cent of allhouseholds now have latrineswhich, partly subsidized byUNICEF, cost 80 baht each.According to the villagers, thenext step is to encourage the useof the large traditional jars forstoring rain water to provide theentire village with clean water.The first two already built are 'onshow'. The villagers have alsoconstructed a road. You cansense the women's pride as theywalk its length to their vegetableplots. Nukon Tongtai articulatesthe change: "Yes, people havenow started to understand whatdevelopment means" —to themand to their children.

36

Monitoring and evaluationMany country offices have developed,as part of their programme manage-ment systems, monitoring tools tomeasure the progress of UNICEF inputsin physical and financial terms, againstestablished workplans. These effortshave expanded during the year, as alearning process for course correctionand reshaping strategy and content forthe next stage of programming. Intheir basic form these are periodicreports in prescribed formats. Severaloffices, like Nepal, are adapting it forcomputer use allowing for regularfeedback to the project site. Indonesiais using standardized description andcomputer coding to link up supply andnon-supply assistance, unit costestimates and observed evaluations ofspecific activities. In India, the internalmonitoring system has helped,through systematic appraisal of activityat component level, to establish morebalanced achievement between pro-gramme components in terms ofphysical output and actual expen-diture. In Tanzania, a co-ordinatingmechanism dovetails village levelmonitoring of nutrition and healthwith higher management proceduresto serve operations at all levels fromthe village to the centre.

The increasing emphasis on projectand programme monitoring is leadingto improved efficiency in the use ofUNICEF resources, increased adoptionof similar practices by governmentpartners and better assessment of thecoverage and effectiveness of UNICEF-assisted programmes.

During 1985, more evaluations andstudies were conducted than in anyprevious year-421 of them coveringprojects and programme activities in87 countries. The number of evalua-tions doubled since 1980, with thehealth sector leading, followed bywater and sanitation, education andnutrition. A good number of evalua-tions covered multi-sectoral pro-grammes.

Some examples of the many insightsemerging from these evaluations are:the need to improve training in the useand maintenance of equipment sup-plied by UNICEF; the overall adequacyof supply does not automatically leadto equitable distribution; the shortage,in particular pockets, of items like ORSpackets could be traced to low de-

mand, and to low acceptance by thehealth workers promoting ORS. As aresult, the health centres hesitated toincrease supply.

A number of evaluations focused onthe effectiveness of communication forpromoting programmes like water sup-ply, immunization and oral rehydra-rion, with widely varying results; thedifference in impact seems to be relatedto problems of quality, of programmedesigned implementation and themeasurement or interpretation of in-formation used in the evaluation.Thus not only the strengthening of thecommunication component of pro-grammes, but also their evaluation hasbecome a priority.

Important findings have emergedfrom the monitoring and evaluation ofimmunization programmes, par-ticularly on the importance of politicalwill, social mobilization, mass com-munication, planning, cold chainmaintenance, participation by thecommunity, staff training, manage-ment information, supervision, fund-ing, follow-up, and the evaluation pro-cess itself.

In certain cases, recommendationsfrom the evaluative exercise were usedto readjust programme strategy. Forexample, as a result of a study onknowledge, attitude, and practice ofmothers towards management of diar-rhoea using OR.S in West Java (In-donesia), programme emphasis wasshifted from home-made ORS to stressprovision of any safe liquid in thehome and a move to promote moreuse of ORS packets.

An interesting development duringthe year was the greater use of lrapidassessments1, particularly of child sur-vival and development interventions-to capture, share and apply informa-tion and insights, especially about theprocess. The methods include open-ended and non-directed interviews,document analysis and field observa-tion and combine the perspectives ofseveral disciplines, e.g., the technicalexpert, the adminis t rat ion, theeconomist and the social scientist.While less rigorous and quantitativethan conventional evaluations, theyhave proved to be practical, flexible,timely and useful for decision-making.Five such assessments, each using adifferent approach, were made of the

Important fitidityjs have emerged frontmonitoring and evaluation ofimmunization fmgjrammes.

immunization experiences in BurkinaFaso, Colombia, El Salvador, Nigeriaand Turkey. As a result specific prob-lems have been tackled, the immuniza-tion programme has strengthened, andthe lessons learnt applied to allied pro-grammes. These lessons were shared atthe 'Bellagio II' international meetingin Cartagena, Colombia.

U N I C E F headquarters developedoperational guidelines for field officeson child monitoring, project and pro-gramme monitoring and evaluation,and rapid assessments. To strengthenthe programming process, a workshopon Situation Analysis for 37 UNICEFoffices coming up to the 1987Executive Board, was held in Sri Lankain Mav 1985. D

37

Programme communication andsocial mobilizationThe year saw a heightened awarenessof the importance and increased appli-cation of communication and mobi-lization for social development, as abasic component of programmes of co-operation between governments andUNICEF. As a result, improvements tothe whole programming process, in-cluding situation analyses, planningand evaluation, are under way.

By reaching out to involve institu-tions beyond traditional partners,whole societies have been motivated tosupport immunization campaigns andother elements of the child survivaland development revolution. InBrazil, not only the Ministry of Healthand the Association of Paediatricians,but also many other governmentministries, the Catholic Church, the

Church groups and cultural bodies fire among the supporters of oral rehydmtion therapyand immunization.

mass media and the Brazilian Assist-ance League are promoting immuniza-tion.

Messages in support of oral rehydra-tion therapy have gone out from mos-ques, churches and temples aroundthe world; unprecedented supporthas come from the mass media to re-mind families of immuniza t ion ;political parties on all sides insert childsurvival and development messages intheir campaigns; in El Salvador govern-ment and opposition forces observed aceasefire in order to facilitate and par-ticipate in nationwide immunization.

Elsewhere professional institutionsand trade unions, service organiza-tions and youth groups, sporting,social and cultural bodies, have helpedto rally nations in support of pro-grammes on behalf of children.

These multi-sectoral initiatives havedemonstrated that dramatic changes insocial dynamics can be achieved whenthe political leadership and wholesocieties participate.

Through seminars, such as one heldin Bogota in 1985, and by sponsoringobserver missions between countries,UNICEF hopes to extend awareness ofsocial mobilization as a tool for foster-ing the child survival and developmentrevolution.

Effective working relationships havedeveloped with a growing understand-ing of the concepts of social mobiliza-tion, social communication and social(or no-profit) marketing. Respondingto the emerging need for increased in-stitutional capacity in these directions,UNICEF Staff Development and Train-ing Section has joined in to meet thechallenge. Programme communica-tion as a function has moved closer toprogramme planning and develop-ment. To sustain effective child sur-vival and development actions, socialcommunication and health educationinfrastructures need to be strength-ened through organization and humanresources.

Examples of the new priority are:planning and application of surveys;studies on knowledge, attitudes andpractices of target audiences, includingmothers; concern for anthropologicaland social factors in the design, testingand evaluation of communication andtraining messages and materials. Theuse of such materials is increasing bothwithin and between countries. Co-production of printed materials and ofradio and television series representsanother innovation. D

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dvocacytindfundraising Global mobilization for children

Throughout the year, advocacy hasbeen an integral and essential part ofthe work of UNICEH. In promotingcost-effective interventions for the sur-vival and development of childrenwithin the framework of the commu-nity-based, integrated approach, effec-tive and pragmatic communicationprocesses have been used to bringabout the dialogue necessary amongnational and local governments, thecommunity and the professionalsbefore such programmes could be in-itiated. Through communication andadvocacy UNICEF has been at worktowards two broad aims: first, toinfluence public policy and enlargeglobal resources on behalf of children;and second, to expand the horizons ofeducation and training in support ofthe initial but decisive phase of whatmay be called 'social preparation' dur-ing which communities organizethemselves, resources are mobilized,workers are trained and activitiesbegun.

During 1985, the aims of UNICEFadvocacy were significantly enhancedworldwide in a variety of ways:publications, audio-visual produc-tions, exhibitions, extensive coverageof child-related concerns in die elec-tronic and print media and a goodbeginning in establishing the facility ofelectronic exchange of messages.Speaking engagements, personal con-tacts at political and other levels by theExecutive Director, Deputy ExecutiveDirectors and other officers ofUNICEF continued to be a majormeans of global and national advocacy.

All these channels of exchange weremultiplied through an enlarging net-work of allies in the cause of children,namely UNICEF Goodwill Ambas-sadors, National Committees, govern-ment communication systems andnon-governmental organizations in in-

creasing numbers and categories:women's associations and youthorganizations, religious and culturalgroups, professional and businessforums, school systems, sen-ice clubsand voluntary agencies. Setting astrategic goal-orientation to this many-sided activity is the function of 'pro-gramme communication"1 which wasrevamped during die year with theprincipal aim of facilitating socialmobilization.

In preparation for the 40th Anniver-sary of UNICEF in 1986, the HistoryProject worked on a publications pro-gramme which included a history ofthe Children 's Fund , a pictorialhistory, an almanac of the world'sc h i l d r e n , and about a dozenmonographs on specific subjects.Work also continued on the archivalrecord of UNICEF experience. D

The aims of advocacy were significantlyenhanced worldwide.

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PublicationsThe 1986 Stau of the World's Childrenreport, released on 11 December1985, was the major publishing eventof the year. The report carried theevidence and clarified the process ofthe first round of success for child sur-vival and development activities inmany countries, particularly on theimmunization front, closely followedby other priority interventions such asoral rehydration therapy. Translatedinto more than 40 languages, thereport has become the main focus forcorporate action as well as a tool formobilizing social resources.

Reports from all parts of the worldshowed in-depth media interactionwith the 1986 State of the World'sChildren report, with well-timeddiscussions of child-related concerns innational and global contexts, pointingmostly to the hopeful message thattime-bound targets for child health areachievable-despite the burden ofpoverty.

Simultaneously, another UNICEFreport focusing on Africa's childrenwas published under the title Withinhuman reach. Documenting the recenttrends of decline in Africa's already lowlevels of nutrition, health and educa-tion, the report analyses the basicreasons behind them, and argues thatthe most productive part of the invest-ment required by African economieswill be in people, in children par-ticularly. The report has encouragedserious debate on fundamental devel-opment issues beyond the immediateneeds of survival.

Radio, televisionand filmDuring 1985 there was a marked in-crease in the distribution of videotapesto field offices and National Commit-tees in support of child survival and inparticular Universal Child Immuniza-tion by 1990. Some 1,300 of themwere duplicated for the purpose, in ad-dition to 450 titles from the filmlibrary.

The radio coverage of child-relatedissues expanded during the year. Co-

productions, eight in all, were under-taken with broadcasting agencies, in-cluding the BBC, Finnish Radio,Australian Radio, Canadian Broad-casting Corporation and the NationalPublic Radio (NTR) in the USA. TheNPR scries on Chad won the 1985World Hunger Media Award. Amongthe many interviews arranged was theExecutive Director's appearance on theBBC programme 'It's your World', alive call-in talk programme duringwhich he received questions fromaround the world.

Television co-productions also rosein number, including those on theAfrican emergency. Themes of UNICEF

concern were seen on prime-time pro-grammes in over 12 industrializedcountries. NOVA, the premier sciencescries of the us, produced a one-hourdocumentary: 'Child Survival-theSilent Emergency*.

Among a number of video pro-grammes produced during the yearwere: 'Within human reach1

highlighting some of the positivedevelopments in Africa in a year ofsuffering; 'uNicEF-the First FortyYears1 outlining policy and programmedevelopment over these decades; andthe immunizat ion campaigns inTurkey and in Addis Ababa. D

Media relationsThe response of the media to the con-cerns of UNICEF is central to a coalitionof effort on behalf of children. By farthe most sensitive example of thisemerging relationship was seen in thecontext of the continuing emergencyin much of Africa. The world's press,radio and television came, saw andcovered, more than the events, theprocesses that led to them. UNICEFfacilitated many of these visits andgained from the insights brought backby the journalists. They came not onlyfrom Western countries, but also fromJapan and developing countries.

The media coverage of Africa morethan chronicled the drama. It dimin-ished the false distinction between theemergency of food shortage anddevelopment issues like water supply,education, health and sanitation. Itspurred artists in Europe and Americato raise large funds. It bridged the gapbetween countries; of this the 'Irelandfor Sudan' response is but one ofseveral examples. Even a small countrylike Trinidad and Tobago was movedto collect a quarter of a million dollarsfor Africa. As the UNICEF ExecutiveDirector noted, the words of the BBCcorrespondent against the filmbackdrop of thousands of Ethiopianshuddled on a cold barren plateau,"triggered one of the most massiveworldwide mobilizations of resourcesfor a non-war purpose in history'1. Ineastern Sudan, what were death campsin January had been transformed intomassive centres of relief, drawing upon

every mode of transportation: camel,donkey, truck, train and aeroplane.The next stage of painful process hadin fact begun-to wards a viable con-cept of development true to the localcultural and physical context, addingwater to the land, drought resistantand quick-yielding crops, livestockmanagement, health education andeducation for life, including the life ofthe mind.

Even as the media was helping theslow transformation by influencingworld public opinion, governmentpolicies and people's capacity to share,it was re-learning the meaning ofdevelopment journalism, as educationfor themselves and the audience. Therelevance of UNICEF'S reliance on themedia was captured in the words of ajournalist visitor to Africa: "In ourtruest role we should warn of the ap-proach of crises, not cover theirarrival".

UNICEF'S' media relations dur ingthe year were many-sided. Mediaworkshops were held in the MiddleEast on the situation of girls and in In-dia on the bias against the female child.In January, thirty-five journalists fromaround the world met in Oxford,England, where the subject was 'Mediaand the World's Children'. A globalmeeting of Journalists for Childrenmet in Venice with some 120 par-ticipants from 64 countries to reviewthe progress of immunization andallied concerns. Three regional projectsto educate, motivate and train com-

40

municators in child survival anddevelopment strategies were initiatedduring the year, one of them in

association with development-oriented communication organiza-tions, n

Electronic information networkA significant srep forward in UNICEFcommunications facilities during theyear was the establishment of elec-tronic transmission of messages andother materials. This involves threebasic capabilities: electronic mail, elec-tronic bulletin board and full-textdata-base.

U N I C E F New York and Genevanow exchange mail electronically withNational Committees in the USA andseveral west European countries. Inthe next phase field offices in Africa,

followed by those on two other con-tinents, will be similarly linked, toachieve quicker, cheaper transmissionthan by telephone.

The bulletin board presents con-tinuously updated information in avariety of categories including currentmaterials, news flashes, staff changes,travel plans, meetings schedule andsen-ices available. The full text database provides access to entire articlesand other materials of selected origin.

a

Special events and fdndraising activitiesThe plight of children in Africa andelsewhere was the leading concern ofmost special events in 1985, many ofthem organized by or with the help ofthe National Committees and non-governmental allies of UNICEF.

During the year popular artists ex-pressed their concern, raising millionsof dollars for international reliefefforts. Top singers from LatinAmerica and Spain, calling themselves'HERMANOS' (Brothers) produced aspecial recording pr imar i ly forUNICEF work in that continent. Atelevision special on this recording andU N I C E F activities in Bolivia wasshown in all of the Americas.

UNICEF'S Puerto Rican youthambassadors Mcnudo visited Brazil,the Philippines and Japan. Americanartist Sammy Davis Jr. gave a benefitconcert for UNICEF in Paris, whichwas televised in the Federal Republic ofGermany.

In December, the World Philhar-monic Orchestra (including 92 soloistsfrom 55 countries) performed inhomage to Alfred Nobel, underUNICEF auspices, to an audience inStockholm including the King andQueen of Sweden, and Nobel Prizewinners. The UNICEF message in the

Executive Director's address to thegathering was on peace and universalimmunization. Over 55 television andradio stations worldwide broadcast theevent.

Tetsuko Kuroyanagi, UNICEF'SGoodwill Ambassador from Japan,spent several days in Niger, accom-panied by journalists from Japan andthe BBC, and met with the President,government officials and project per-sonnel. The TV, radio and pressreports resulted in significant fundrais-ing for Africa.

Liv Ullmann gave several media in-terne ws and participated in UNICEFadvocacy events in Europe and theUSA. Her daughter Linn spoke onbehalf of UNICEF in the USA, Nor-way and Finland and visited projects inEthiopia.

American actress Cicely Tysonvisited Chad and Burkina Paso andsupported information fundraisingactivities in many us cities. AnotherAmerican personality. MamaMcBroom Landess, started an educa-tional programme in the USA aftervisiting B u r k i n a Faso and TheRepublic of Core dlvoire.

In Canada, Peter Ustinov paid ahighly successful media-related visit

Goodwill ambassadors TetsukoKwoyanqgi from japan (top), and PeterUstinov (bottom) as well as Americanactress Cicely Tyson (centre) together withmany others, advocate on behalf ofchildren.

41

timed for the launch of the 1986 Stateof the World's Children report andDavid Frost was the guest speaker at arundraising dinner organized by theNational Committee in Vancouverand gave several media interviews.

UNICEF benefited from a 24-hourradio programme 'Hungcrthon 85';broadcast live from the UN andorganized jointly with WNEW-FM,New York, it succeeded in raising overUSS60,000.

A number of exhibits were preparedduring 1985 on the themes of childsurvival and development, Africanemergency, paper production inNepal, 'Water for All', youth and childactivities, oral rehydration therapy andUniversal Child Immunization by1990. An interesting collaboration wasinitiated with the Smithsonian In-stitute tor production of educationalmaterials in conjunction with thecultural exhibition on India. D

National CommitteesThe Na t iona l Commit tees forUNICEF gave valuable support duringthe year in fundraising, public infor-mation, advocacy and developmenteducation. The challenge of generatingsupport in industrialized countries forchild survival and development ac-tivities in developing countries metwith considerable success, in renewedalliance with non-governmentalorganizations, religious groups, pro-fessional associations, trade unions andthe media.

A major part of the fundraising effortwas devoted to the African emergency.A joint review early in 1985 by 25 Na-tional Committees agreed on severallines of action and approach: workingwith parliamentarians, closer associa-tion with the media, focusing on newaudiences of young people, morefunds of general resources, includingchi ld survival and developmentpriorities in all fandraising activities,and rundraising plans aimed at annualtargets.

In September, representatives ofNational Committees met with UNICEFstaff in a colloquium in Warsaw,hosted by the Polish Committee torUNICEF. The main objective was theestablishment of stronger links be-tween child survival and developmentissues and national level action in in-dustrialized countries. The Conven-tion on the Rights of the Child, nowunder discussion by a United NationsCommittee, was seen as being of par-ticular relevance in areas of children'sneeds largely untouched by govern-ments and NCOS. In the context ofUNICEF'S 40th anniversary, the work ofits founders, among them Dr. LudwikRajehman of Poland, the first Chair-

man of the UNICEF Executive Board,was highlighted.

The National Committees con-tinued to encourage journalists andtelevision teams to visit UNiCKF-assistedprojects in Africa and elsewhere. Co-productions, supported by UNICEF,were arranged with national televisioncompanies in Austria, Finland, France,Greece, and the United Kingdom. Amajor information campaign by theNational Committees was the dissemi-nation of the 1986 State of the World'sChildren report. Many committeesused the child survival and develop-ment theme in promoting UNICEFgreeting cards. The National Commit-tee in the United Kingdom promotedthe use of growth charts, oral rehydra-tion therapy and immunization atplanned intervals. The AustralianCommittee linked Universal Child Im-munization 1990 to a national com-mitment to eradicate measles by 1988.The us Committee launched an appealtor child survival and development in-terventions, a forerunner to a full-scalefive-city campaign in 1986 in col-laboration with NCOS.

Several National Committees tookinteresting initiatives. In Greece theCommittee encouraged the head ofthe Greek Orthodox Church to inviteUNICEF to participate in a consultationwhich included heads of Christianchurches from 23 countries. One con-clusion of the consultation was thatchildren be identified as a priority,with immunization as a possible actionto be taken by the churches. The UKCommittee brought together opinionleaders, among them the Secretary-General of the Trades Union Con-gress, the Chairman of the Head-

masters Conference and the BritishCouncil of Churches.

Development education has been aUNICEF concern in response to thegrowing need of teachers, youth groupleaders and other NGOS for educationalmaterials. Its importance was under-scored at the First Global Develop-ment Education Workshop held nearGeneva in June. National Committeepresentations reflected a rich diversityof approaches and work in progresscovering study visits to developingcountries, school-linking, adult educa-tion, street children and Youth inService to Children. The workshoprecommended that the impact andvalue of development education beevaluated and that a funding formulabe adopted so that developmenteducation be defined as a 'UNICEFProgramme1. Q

"Youth in Service to Children"—!* themefor collaboration by National Committeesand NG'df,

42

Non-governmental organizationsUNICEF collaboration with non-governmental organizations strength-ened and expanded during 1985, as acentral concern of the advocacy func-tion towards specified time-boundchild-related goals.

UNICEF facilitated the promotion andplanning of the five-year 'Polio-Plus"projects of Rotary International inAfrica, Asia and the Middle East. TheInternational Council of Nursesdeclared immunization as the themefor the International Nurses Day1986, and UNICES is preparing an infor-mation and action kit for use by na-tional affiliates of the Council. UNICEScollaboration with the League of RedCross Societies has continued throughthe "Child Alive1 programme focusingon diarrhoea management using oralrehydration therapy, breast-feeding,proper weaning and sanitary practices.

The International Planned Parent-hood Federation is incorporating childsurvival measures into its family plan-ning service strategy and training offamily planning workers, while theAssociation of Non-Government Or-ganizations in Chile has implemented a'Youth-ro-Child' programme in thatcountry, training young people tobecome health educators and ad-vocates for child survival and involvingthem in service deliver)- in associationwith UMCF.F.

UNICEF has worked closely withthe World Organization of ScoutMovements and the World Associa-tion of Girl Guides and Girl Scouts toplan a joint 'Child Health1 programmein Bangladesh, Burkina Faso, Egypt,India, Nepal, Peru, Senegal, Togo andUganda. The programme will trainscouts and guides to promote childsurvival measures, provide basic healthand nutrition education and carry outsimple health surveillance activitiesamong vulnerable groups.

UNICEF assisted the Global Com-mittee of Parliamentarians on Popula-tion and Development in planning theAll-African Conference on Populationand Development (Zimbabwe, May1986). Also, UNICEF supported apreparatory workshop for English-speaking parliamentarians in Nairobiand participated in a meeting of Carib-bean parliamentarians on population,employment and adolescent fertility.

UNICEF participated fully in theXGO Forum held in conjunction withthe UN Conference on Women inNairobi. Following up on this,UNICEF supported a regional con-ference in Indonesia sponsored by theInternational Council of Women,focusing on women's role in primary

health care with particular reference tochild survival interventions.

UNICEF continued its co-operationwith specialized NCOS on the issues of'Children in Especially Difficult Situa-tions' and the draft Convention on theRights of the Child.

In collaboration with the NGOCommittee on UNICEF, a meeting ofthe NGO Forum was held in conjunc-tion with the UNICEF Executive Boardsession in April 1985.

A major event of the year was thePeoples' Forum on Universal ChildImmunization 1990 in celebration ofthe 40th anniversary of the UnitedNations. Organized by the NGOCommittee on UNICEF, this broughttogether a number of heads of state,prime ministers, foreign ministers,celebrities and over 800 NGOrepresentatives who signed a Declara-tion of Commitment of uci 1990.This declaration is being circulatedaround the world for more signaturesin support of a decisive global com-mitment.

To mark the 40th anniversary ofUNICEF in 1986, work has started inclose collaboration with NCOS ona number of events and continuingactivities.

Preparations for publishing amonthly bulletin, Action fa- Children*on behalf of the NGO Committee onUNJCEF, have been completed. D

International Youth YearUNICEF took an active part in theInternational Youth Year, 1985 withthe thematic thrust: Youth in Service toChildren. The year provided an occa-sion to review ongoing programmesinvolving youth and to stimulate newefforts in support of children. It alsoproved to be another channel for co-operation with government partners,non-government allies and theNational Committees for UNJCEF.

A few examples illustrate the IYY ac-tivity. Among the fields of interest toyouth were literacy and non-formallearning situations, promotion ofhealth and nutrition, population con-trol and environmental protectionand, not the least, child care.

The preferred approach of mostNational Committees for UNICEF is to

focus on development education andNorth-South interchange, often in co-operation with national NCOS.

UNICEF has encouraged activities ofthis kind in Bangladesh, Burkina Faso,Ghana, Lesotho, Nepal, Nicaraguaand the Sudan. At another level,UNICEF has facilitated active linksbetween different countries, such asyouth of West Germany and Colombiaco-operating in communication forcommunity work, the Scouts of theUK and Sri Lanka promoting ruralwater supply, and the school-to-schoolprogramme between Norway andUganda.

UNICEF has found it productive tohave direct contact with youththrough NCOS (See NCOS above). D

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Greeting Card Operation AGFUNDThe UNICEF Greeting Card Opera-tion (tico) serves the twin functionsof advocacy and resource generationfor the development of children. Sinceits beginning in 1950, a total of overtwo billion UNICEF cards have beenmailed in 145 countries and more thanUS$203 m i l l i o n con t r ibu ted toUNICEF'S general resources. Otherproducts such as calendars, stationeryand paper products have been a signifi-cant source of revenue. In 1984, a sumof US$10.1 million was realized fromsales through the global voluntary salesnetwork of National Committees,UNICEF field offices and non-governmental organizations, This uni-que capacity to generate public sup-port-ranging from contributions byartists and museums of reproductionrights for card designs to the sale ofUNICEF products by volunteers inboth industrialized and developingcountries—resulted in Gt:o being oneof the largest individual sources ofUNICEF general resources.

GCO, like any commercial enter-prise, is affected by changing marketconditions and requires operationalautonomy to respond promptly tothese changes. To strengthen thecapacity of the operation, a c-coBoard of Directors, chaired byUNICEF'S Executive Director, wasestablished in 1985 to review majortrends and establish policies. ThisBoard also reviews budgets, financialreports, sales performance, productionplans and other major managementissues. Gco-managed offices havebeen established in Brazil, Colombia,India, Japan, Mexico and Singapore,which serve as sales and distributioncentres for important markets that donot yet have strong voluntary supportnetworks.

Concurrently, an inter-regional salesdevelopment programme approved bythe U N I C E F Executive Board in1984, was initiated in 1985 to developand strengthen field sales organizationsand volunteer networks in the USAand Latin America, as well as toexpand sales activities in Asia. One ofthe marketing strategies in the USA for1985 has resulted in the voluntary par-ticipation of major supermarket andreta i l store chains to sell UNICEFcards on a no-commission basis in over2,800 stores nationwide. In support of

this programme two television spotsfilmed on location in Africa aimed toincrease public awareness of theU N I C E F work for children wereshown widely in the United States ofAmerica.

For the first time, a global workshopwith participants from National Com-mittees and other sales partners washeld in Denmark, to discuss salesstrategies witii emphasis on increasingrevenues.

As a contribution to the preparationof the 40th anniversary of UNICEF, GCOcollaborated with the award-winningCzechoslovakian animator, BretislavPojar, to produce a 12-minute featurefilm on UNICEF'S history.

As in previous years, the success ofGCO in pursuing its mandate to raisefunds and create awareness for thedevelopment of children has been dueto the productive relationship with theNational Committees and UNICEF'Sother partners. D

The Arab Gulf Programme for theUnited Nations Development Organi-zations (AGFUND) continued tor thefifth year its world-wide support to theactivities of the United NationsDevelopment Agencies. On the basisof specific project allocations, a total ofUS$5,282,500 was recorded by UNICEFas income from AGFUND in 1985.

A G F U N D has added the UnitedNations Relief and Works Agency(UNRWA) and the United NationsUniversity (LINU) to the list of UnitedNations agencies to benefit from itsfinancial assistance, bringing theirnumber to ten: FAO, ILO, UNDP, UNEP,UNESCO, UNICEF, UNRWA, UN TfUStFund of the International Year ofDisabled Persons, UNU and WHO.

UNICEF continued co-ordinatinginter-agency information support toAGFUND. A third inter-agency meeting,hosted by FAO and attended by all tenagencies, was held in Rome on27 September 1985. A decision wastaken on joint action focusing mediacoverage on AGFUND-assisred projectsin Africa.

AGFUND was established in April 1981by Bahrain, Iraq, Kuwait, Oman,Qatar, Saudi Arabia and the UnitedArab Emirates, on the initiative ofHRH Prince Talal Bin Abdul Aziz, itspresident. D

Italian Aid FundIn lune 1985, the government of Italyand IJNICEF agreed to be partners injointly developing a programme toaccelerate child survival and develop-ment, with emphasis on immuniza-tion and related activities in countriesto be chosen from a group of 26 inAfrica and 3 in Asia. Accordingly,programmes are being launched tostart early in 1986. They will be fi-nanced up to 200 billion Italian lire(some US$110 million), from thenewly established Fund for ItalianEmergency Aid (FAI) . D

Since 1950, over ttvo billion UNICEF cardshave beeti mailed..

44

esources

Finances: income, commitmentsand expenditures 1985-1986

Income

UNICEF'S income is comprised of volun-tary contributions from both govern-mental and non-governmentalsources.

Total income in 1985 was US$362million. This includes US$48 millionof contributions for emergencies,

mostly in response to the AfricaEmergency Appeal. Income growth in1985 over 1984 came mainly from themore favourable exchange rates and in-creases in contributions for the AfricaEmergency.

In 1985, income from governmentsand inter-governmental organizationsaccounted for 76 per cent of UNICEF'Stotal income; non-governmental in-

UNICEF Income 1985Total income$362 mil lion100%

76%-$2?6

Generalresources

{ } Supplementaryfunds

Emergencies

+,

OSOVERNI*^

INCOME•?4%.$86«l

*F

45

come accounted for 24 per cent. Thepie chart on page 45 shows the divisionbetween governmental and non-governmental income for 1985. Themap on pages 48 to 49 shows in-dividual governmental contributionsby country for 1985; a list of non-governmental contributions by coun-try appears on this page.

UNICES income is divided betweencontributions for general resources andcontributions for supplementary fundsand emergencies. General resources arethe funds available to fulfill com-mitments for co-operation in countryprogrammes approved by the Ex-ecutive Board, and to meet pro-gramme support and administrativeexpenditures.

General resources include contribu-tions from more than 120 govern-ments; the net income from theGreeting Cards Operation; Hinds con-tributed by the public, mainly throughNational Committees; and otherincome.

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

As illustrated on the chart on thispage, about 23 per cent of UNKT.F'Stotal income over the period1984-1985 was contributed as sup-plementary funds for long-term pro-jects and 12 per cent for emergencies.

Projects funded by supplementaryfunds contributions for long-term pro-jects are normally prepared in the sameway as those funded from generalresources. Most are in countriesclassified by the United Nations as"least developed" or "most seriouslyaffected".

As a result of pledges at the UnitedNations Pledging Conference for De-velopment Activities in November1985, and pledges made subsequently,uxiCHi-ns income for general resourcesin 1986 is expected to total US$274million. Some of the larger increasespledged in national currency so far arefrom Belgium, Canada, Denmark,Federal Republic oi Germany, Finland,India, Italy, Norway, Sweden andSwitzerland. Certain governmentshave yet to pledge.

46

1985 non-governmental contributions

Countries where non-governmental contributions exceeded $10,000

778.8405.6

14.3189.4

1,843,0640.5

83.326.0

1,671.917.9

614.71,454.5

Canada 12,171.4Chile 69.0Colombia 187.7Costa Rica 17.3C&te d'lvoire,

Republic < > f 20.8Cuba 53.0Cyprus 110.7Czechoslovakia 385.8Denmark 730-7Dominican Republic 30.3

AlgeriaAngolaArab Gulf FundArgentinaAustraliaAustriaBahrainBangladesh....BelgiumBoliviaBrazilBulgaria

Ecuador . . ,EgyptEl SalvadorEthiopia . .Finland .

39.650.330.916.8

2,1H.6France 13,217.7German Democratic

Republic 71.6Germany, Federal

Republic of 11,726.0Ghana 13.2Greece 541.2Guatemala 41.0Honduras 13.2Hungary 243.0India 692.1Indonesia 165.1Iraq 817.5Ireland 521.5Italy 1,622.6Jamaica 18.7Japan 8,278.1Jordan 16.3

UNICEF Income 1984-86

(In millions of US dollars) $399

OEmergencies

OSupplementary

Funds

Generalresources

Note: General resources figures arc net of staff assessment

(in thousands of US dollars)

(figures include proceeds from greeting card sales)

KenyaKorea, Republic ofKuwaitLebanonLuxembourgMexicoMonacoMoroccoMozambiqueNetherlandsNew ZealandNigeriaNorwayOmanPakistanPanamaParaguayPeruPhilippinesPolandPortugalQatarRomania

23.462.330.510.888.0

104.313-341.5

150.45,543.5

137.3«0.2

597.220.4

121.813.426.799.470.2

239.6116.718.461.7

Saudi ArabiaSenegalSomaliaSpainSri LankaSudanSwedenSwitzerlandSyrian Arab RepTanzania, United

Republic ofThailandTrinidad 8t TobagoTunisiaTurkeyUnited Arab Emirates . .United Kingdom of

Great Britain andNorthern Ireland

United States ofAmerica

UruguayVenezuela

203.123 011.8

1 ,972.323.214.6

1,113.14,553.8

43.1

112.456.0

275.031.6

113.8148.4

2,212.6

, 16,013.151.536.8

Viet NamYugoslaviaZambiaContributions from

UN StaffContributions under

$10,000

TOTAL

Less costs of GreetingCard Operations*

Net available forUNICEF assistance .

•Costs of producing cards.

17.0573.4

31.1

154.1

183. 8

. . 97,407.7

(27,590.7)

69,817.0

brochures;freight, overhead, adjustments.

UNICEF Expenditures 1984-86 Expenditures

(In millions of US dollars)$393

OAdministrative

Programmesupport

Cashassistance

Supplyassistance

The Executive Director authorizesexpenditures to fulfill commitmentsapproved by the Board for programmeassistance and for the budget. The paceof expenditure on a country pro-gramme depends on the speed ofimplementation in the country con-cerned.

In 1985, UNICEF'S total expendituresamounted to US$377 million. Of thistotal, expenditures for programmescame to US$279 million: US$117 mil-lion in cash assistance for project per-sonnel, training costs and other localexpenses and US$162 million for sup-ply assistance. The net cost of pro-gramme support services was US$59million and US$39 million for admi-nistrative services.

The chart on this page shows expen-ditures on programme assistance for1984 and 1985. The bar and pie chartson page 50 show programme expen-ditures by sector in 1981 and 1985, byamount and proportion respectively.

Note: Figures arc net of staff assessment

r

1985 governmental contributions

Contributions to UNICEF'S genera] resources arc shown at right;additional contributions tor supplementary funds and emergenciesare shown in colour, at left.

in thousands of US dollars)

OCEANIAAustralia4 MMU. . . . .1,838.0Fiji 2.0

New Zealand400.3 370.4

Tonga 0.9

NORTH AMERICACanada5.579.5 9,725.1

United States of America53,500.0

Tilt World on the Azimuthal Equidistant Projectioncentered at New York Cttv.

48

A1TAAcH-A

Afghanistan30.0

Bangladesh8.3

Bhutan4.2

Burma181.7

"RTTROPF

Austria351.3 819.0

B.S.S.R.69.5

Belgium1,068.4

Bulgaria60.9

Czechoslovakia82 6

Denmark2,575.4 . . . .5,146.4

MIJLJJU L/ 1/ li.

Arab Gulf Fund2,600.1) 2,682.5

Algeria

Bahrain12.5

Al-luCAAngola

5 0

Benin7.5

Botswana2.5

Burkina Faso1.2

T,ATTTO A1W

Antigua0.3

Argentina38.5

Bahamas3.0

Barbados. .3-0

China400 0

Hong Kong14.6

India. . . 1 ,797 2

Indonesia300 0

EuropeanEconomicCommunity14,114.0

Finland1,586.5 5,797.1

France4 4 3 684 2

GermanDemocraticRepublic

4129

ASTDemocraticYemen

7.0

Egypt82.2

Iran50.0

Cameroon,UnitedRepublic of

74.1

Congo14.6

Cote d'lvoire,Republic of

64.4

ERICABrazil44 6

British VirginIslands

0 2

Chile..70.0

Japan4,738.6. . .14,200.0

Korea, Republic of147 0

Lao People'sDemocraticRepublic

5.0

Germany, FederalRepublic of1,370.7 ....4,716.5

Greece52.2 135.0

Holy See1.0

Hungary

Icelandft 0

Ireland380 0

Israel50.0

Jordan26.8

Kuwait200.0

Lebanon59 9

Djibouti1.0

Kenya

Lesotho2.5

Madagascar5.6

Malawi5.9

Colombia456.8

Costa Rica30.0

Cuba116.5

Ecuador..25.4

Malaysia.102.2

Maldives3.0

Mongolia3.6

Nepal6.8

Italyl6,5K4.r . .17,492.7

Liechtenstein2.0

Luxembourg16.7

Malta4.1

Monaco3.4

Netherlandsl,58ft.7 ....6,731.2

Oman50.0

Opec Fund, The250 MQatar

200.0

Saudi Arabia1,000.0

Mali, . , 1 0

Mauritius. . .3.1

Nigeria308.3

Rwanda4.3

El Salvador19.9

Guatemala19.9

Guyana...3.3

Honduras. .21.1

Pakistan

Philippines

Sri Lanka

Thailand

164.5

262.3

.13.4

154-7

Norway4,989.3 ...16,415.7

Poland61.6

Romania

San Marino

Spain

Sweden4,912.6. , .22

Syrian ArabRepublic

Tunisia

Turkey

Senegal

Sierra Leone

Sudan

Swaziland

Jamaica

Mexico

Panama

Peru

. . 13.0

. . .3.1

435.7

,500.0

..64.1

. 36.3

. 68.8

...6.0

10.2

..25.0

2.5

. . .3.1

102.4

. .25.0

.120.0

Viet Nam60

Switzerland4,488.7.. ..5,012.5

Ukrainian S.S.R.

U.S.S.R.. . . 750 9

UnitedKingdom1,522.8.. . .8,302.3

Yugoslavia306 0

United ArabEmirates

984 9Yemen

12.9

Tanzania,United Republic of

21.1

Uganda3.4

Zambia

Zimbabwe186

Saint Vincent andthe Grenadines

0.8

Suriname25

Venezuela. 114.7

49

Expenditure on Programmes by Sector

51 dm S2(Jm S30m M < n n >-l >m SdOrn S70m S80m

BitMC /Ml \Health" fi ' !

WaterSupply

Nutrition ,*f"^"'

82.3

SocialService)- forChildren

Planning PS*! •& Project I^I'ASupport ™

EmergencyRelief

"Family planning component is included iu basic health.

Financial planand prospectsUNICEFIS striving to maintain the levelof its resources in real terms at a timewhen support to multilateral agenciesis tailing below previous modest expec-tations. In this situation, UNICES isendeavouring to persuade donor gov-ernments to maintain their social de-velopment assistance, and to increasethe level of their contributions toUNICF.F in real terms. UNICES is alsoencouraging the non-governmentalsector, through the National Commit-tees and NCOS, to further expandtheir important contributions.

At the April 1986 session of theExecutive Board, proposals tor new orextended multi-year programme com-mitments in 23 countries will be sub-mitted. L'NicEF currently co-operates inprogrammes in 118 countries. Theproposed new commitments totalUS$83 million from LKICKF'S generalresources and US$286 million tor pro-jects deemed worthy of support if sup-plementary funds are forthcoming.

1981

m+ **

1985

A% "B~~rMS§̂ *&

Programme commitments from gen-eral resources for all the countrieswhere I'NICEF co-operates are shownon the map on pages 28-29. It also in-dicates countries for which com-mitments from general resources arebeing proposed at the 1986 ExecutiveBoard session.

A Medium Term Plan covering theyears 1985-1989 will be submitted tothe Executive Board at its April 1986session.

The biennial budget1986-1987UNICEF is committed to rinding cost-effective solutions to programme plan-ning and delivery. Similarly, theorganization continues to be commit-ted to finding the most effective andefficient means for using budgetaryresources to meet increasing andchanging work requirements.

Accordingly, the 1986-1987 budgetfor programme support sen-ices and

50

administrative services at Headquartersin New York and Geneva, as well as inCopenhagen, Sydney and Tokyo, andin UNK:F,F'S 87 field offices around theworld, reflected a policy of consolida-tion, integration, and redeployment ofbudgetary resources to meet increasingand changing work requirements andto strengthen UNICEF capacity in theAfrican regions. Planned net expen-ditures against the two-year budgetamount to US$221 million: US$108million tor 1986 and USS113 millionfor 1987.

A policy of budgetary restraint andof no overall growth in professionalstaffing levels has been applied.Strengthening L'NICEF capacity inAfrica reflects the practical applicationforming UNICFF'S response to the crisisin Africa. UNICEF has two establishedregional offices serving the sub-Saharancountries: the Central and West AfricaRegional Office and the Eastern andSouthern Africa Regional Office. Thenew strategy for improving capacity inAfrica therefore was also characterizedby increasing interregional and inter-country collaboration, thus con-siderably enhancing efforts throughoutthe continent.

The process of reallocating bud-getary resources to countries with highinfant mortality rates and weak UNICEFrepresentation is to be continued.These priorities will be reflected in the1988/89 budget, within the context ofa continuing policy of budgetaryrestraint, designed to ensure that therate of growth in budget costs does notexceed that of planned expenditure onprogrammes.

The last few years have beencharacterized by a declining expecta-tion of general resources income.I N K I-F'S attempts to maintain the levelof programme assistance in real termshas led to a fall in liquidity. Although

the liquidity provision has been ade-quate up to now the latest MediumTerm Plan allows for its build up overdie next few years so that programmeassistance can be protected againstfuture income uncertainties.

Human resource management

During 1985 the development of acomprehensive human resource plan-ning process was begun, concrete stepswere taken to improve the status ofwomen within UNICEF, the first GlobalRotation Exercise was implementedand the personnel management infor-mation system was improved.

The development of overall humanresource planning, designed to matchrequirements of jobs with theknowledge and skills of staff", wasunder taken in order to l i nk thedevelopment and allocation of humanresources more closely with corporateobjectives and programme priorities.

In April 1985, the Women's TaskForce presented its recommendationsfor enhancing the status of women inUNICEF and facilitating the corporatecommitment to having a third of theinternational core posts of the orga-nization occupied by women. TheExecutive Director endorsed the

recommendations or accepted them inprinciple. Since March 1985 the pro-portion of women in internationalcore posts has increased from 24.8 percent to 27.5 per cent. Among nationalprofessional officers the proportion ofwomen increased over the same periodfrom 26 to 30 per cent.

In May 1985,118 staff members wereinvolved in a Global Rotation Exercise.This was the first time that all rotatablcstaff and all available posts were con-sidered at the same time.

In 1985, UNICEF maintained 87 fieldoffices serving more than 110 coun-tries, with 433 professional posts (in-ternational and national), and 1075clerical and other general service staffposts. During the year, 220 profes-sional and 345 general service staffposts were maintained in die head-quarters locations of New York,Geneva, Copenhagen, Tokyo andSydney.

LiquidityprovisionUNiCEFworks with countries to prepareprogrammes so that commitments canbe approved by the Executive Board inadvance of major expenditures onthese programmes. UNICEF does nothold resources to cover the cost ofthese commitments, but depends onfuture income from general resourcesto cover expenditures. The organiza-tion docs, however, maintain a liquid-ity provision to cover temporary im-balances between income received andspent, as well as to absorb differencesbetu'een income and expenditureestimates.

Information resourcemanagementDuring 1985 a UXICEF task force on in-formation resource management map-ped out the organization's actual andideal information flows and maderecommendations, most of whichwere accepted by the Executive Direc-tor.

A new plan for Informat ionResources Management (IRM) has beenproposed, based on an analysis of theexisting processes relating to policies,planning, programmes, supply,finance, accounts, personnel, opera-tions support, advocacy and the

Greeting Cards Operation. It clarifiesprocesses with categories of data andrelates them productively to oneanother, so that usable information isgenerated.

All five headquarters offices andsome 49 field offices have now beenequipped with computers, with a goodnumber of staff already trained in theiruse. Thus, a foundation for moderniz-ing information management, usingelectronic data processing systems, hasbeen established- D

I

Strengthening UNICEF's deliverycapacityBy ensuring the swift distribution ofsupplies and equipment to developingcountries, the Supply Division in NewYork (including the UNICEF Procure-ment and Assembly Centre (UNIPAC),which was recently consolidated inCopenhagen) assists UNICEF field officesin implementing programmes.

In 1985, deliveries to UNICEF pro-grammes, governments, other UnitedNations agencies and NGOS amountedto USS172 million, a 14 per cent in-crease over 1984. More than US$55million worth was shipped from theUSIPAC warehouse and US$34 million

worth purchased locally in developingcountries. Included in these figures isUS$38 million for deliver)' of essentialdrugs and vaccines, a 57 per centincrease over 1984.

The composition of the UNIPAC in-ventor)- has been overhauled, in prepa-ration for Universal Child Immuni-zation by 1990 and in light of expectedincreased demand for items on theWHO Essential Drugs List.

These results have been achieved inspite of a reduction of 23 staffmembers, D

Swift distribution of supplies and equipment is ensured from the UNICEF Procurementand Assembly Centre (VNIPAC) in Copenhagen, Denmark,

52

UNICEFis and does

MandateThe UNiCEi- mandate is, in essence, thesame as when it was originally given: tohelp protect the lives of children andpromote their development. Thegreater their vulnerability the higherthe priority -

At the very first session of the UnitedNations General Assembly a unani-mous decision, on 11 December I946ncreated UNTCEF-then called the UnitedNations I n t e r n a t i o n a l Children's

Emergency Fund. In the early years,the resources of the Fund weredevoted main ly to meeting theemergency needs of children in post-war Europe and China for food,medicines and clothing. In December1950, the General Assembly reformedthe UNICEF mandate to respond to thesilent yet desperate needs of countlessnumbers of children in developingcountries. In October 1953, theGeneral Assembly decided that UNICEKshould continue die work as a perma-nent arm of the United Nations

Children: thejfreaKr their vulnerability the higher the priority to protect their lives and pro-mote their development.

53

system. It would be called the 'UnitedNations Children's Fund1, but retainthe well-known UNICEF acronym.

Outgrowing the distinction betweenhumanitarian and development objec-tives, UNICEF began to reach out tounder-developed countries in projectsprimarily concerned, in an inter-related manner, with protective nutri-tion, primary health care and basiceducation of mothers and children, in-volving as much as possible people atthe community level.

U N i t K F co-operation evolved sys-tematically to become part of nationaldevelopment efforts in keeping withthe spirit of the General Assembly's1959 Declaration of the Rights of theChild, which recognizes the intrinsicvalue of childhood as well as its poten-tial to contribute to national progress.The Declaration emphasizes the child'sright to maternal protection, health,adequate food, shelter and education,in a family and community environ-ment conducive to the child's Rilldevelopment.

By the sixties, a global partnershipfor children of a kind and on a scalenever before achieved was takingshape. The awarding of the NobelPeace Prize to UNICEF in 1965 wasrecognition that the well-being oftoday's children is inseparable from thepeace of tomorrow's world. At thesame t ime, despite in t e rna t iona lassistance to child-related projects, thestatistics of need were not diminishing.The UNICEF mandate called tor pro-gramming to shift beyond sectoralprojects, to engage the process of socialand human development. UNICEFresponded to this strategic need firstwith country programming and thenwith the community-based servicesapproach.

The principles of the community-based services strategy find expressionin UNICEF programmes of co-operation, and rather vividly in theconcept of primary health care, jointlypromoted by WHO and UNICEFthrough the international conferencein Alma Altan 1978. Relying on thecapacity of local communities to beresponsible for their own health care,with help from auxiliaries trained fromamong them, the concept of primaryhealth care, in its essence, goes beyondthe immediate concern of conven-tional health systems. It has receivedenthusiastic and increasing support,nationally and from the international

54

community and remains a centralplank of the UNICEF approach to"basic services' for ch i ld ren andmothers.

The General Assembly proclaimed1979 as the International Year of theChild (IYC) and made UNICEF thelead agency within die United Nationssystem co-ordinating support to TYCactivities, most of which were under-taken at the national level. At the endof the year, the General Assembly gaveUNICEF the primary responsibilitywithin the United Nations system fornv follow-up. UNICEF thus becameresponsible tor drawing attention toneeds and problems common tochildren in both the industrialized andthe developing worlds. Wliile extend-ing UNTCF.F areas of concern, the newfunction did not diminish the Fund'soverriding preoccupation with theproblems of children in developingcountries.

UNICEF is unique among the orga-nizations of the United Nations in thatits mandate is concerned with a par-ticular age group-the holistic concernfor the child—rather than with a sec-toral involvement such as in health andeducation. UNICEF is distinctive inthat, in the pursuit of its mandate, itdepends on voluntary financing.UNICEF not only seeks governmentand public support tor programmes ofco-operation but also tries to stimulatepublic awareness of children's needsand the means to meet them by ad-vocacy—wi th governments, civicleaders, educators and other profes-sional and cultural groups, the mediaand local communities. For thisreason, UNICEF greatly values itspartnership with National Committeesfor UNICEF and its working relation-ship with non-governmental organiza-tions in industrialized as well asdeveloping countries.

OrganizationAn integral part of the UnitedNations system, UNTCEF is semi-autonomous with its own governingbody, the Executive Board, anda secretariat.

The Board is comprised of 41 mem-bers, elected on the basis of annualrotation tor three-year terms by theEconomic and Social Council with""due regard to geographical distribu-

tion and to the representation of themajor contributing and recipientcountries". The membership includes:nine African members, nine Asian, sixLatin American, four East European,twelve West European and others.The 41st seat rotates among theregional groups.

The Board establishes UNICEFpolicies, reviews programmes and ap-proves expenditures for UNICEF co-operation in the developing countriesand for operational costs. Except forextraordinary sessions, the Boardmeets for two weeks each year; itconstitutes itself as a Programme Com-mittee to consider programme recom-mendations and as a Committee onAdministration and Finance for opera-t ional matters. Executive Boardreports are reviewed by the Economicand Social Council and the GeneralAssembly.

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

UNICEF field offices are the key opera-tional units for advocacy, advisory ser-vices, programming and logistics.Under the overall responsibility of theUNICEF Representative for the country,programme officers help relevant min-istries and institutions to prepare, im-plement and evaluate programmes inwhich UNICEF is co-operating. Regionaloffices in Abidjan, Amman, Bangkok,Bogota, Nairobi and New Delhi pro-vide and co-ordinate specialized sup-port for these programmes.

The functions of Headquartersoffices in New York, Geneva,Copenhagen, Tokyo and Sydney areto: service the Executive Board;develop and direct policy; manageresources-financial, personnel andinformation; audit operations; dis-seminate information; and maintainrelations with donor governments,non-governmental organizations andNational Committees for UNICEF.

Although directed from NewYork, most of UNICFF'S supply opera-tions are located in Copenhagen at theUNICEF Procurement and AssemblyCentre (UNIPAC).

The Greeting Card Operation,managed from New York, raises fundsthrough the sale of UNICEF greetingcards, calendars and stationery, which

are also a channel for advocacy onbehalf of children.

StrategyThe parent, particularly the mother, isthe child's first and most dependableline of defense. The next is the localcommunity . UNICEF advocacy aswell as co-operation seeks to focus par-ticularly on services based in the com-munity itself, planned and supportedby-and responsible to-the people ofthat community.

The villagers, or residents of theurban neighbourhood, choose fromamong themselves, people who couldbe 'community workers1. After briefpractical training, the workers returnto their communities to organize basicservices and to help their neighbourslearn new ways of doing things. Thecommunity supports them and partici-pates in the activities.

To be effective over time, commu-nity workers must become part of a'system', linked to and supported bythe network of government services.These services need to be reoriented toenable, support and extend their reachto unserved and underservcd com-munities. Linking with the commu-nity workers, for example, needs to bestrengthened to support those effortswith direction, refresher t ra ining,technical supervision, technical andlogistical assistance and referralservices.

From the outset community in-volvement in identifying needs,deciding priorities, p lanning thesequence of activities and choosingcommunity workers for initial andrefresher training as well as in monitor-ing progress, is the key to organizingand sustain ing essential services in p(x>rrural or urban communities.

The strategy has worked and is work-ing in numerous communities, evenamong large populations. Extending

the effort to the national scale requiresthe full commitment of the nationalgovernment.

The strategic focus on community-based sen-ices has particular relevancefor the most cost-effective and prac-ticable means of saving children's livesand protecting their health anddevelopment . UNICEF believes itpossible to reduce the rate of infantand young child death, disability anddisease by at least half within a decade-through the growth of community-based services and the spread of com-munity workers, paid or voluntary,who make these services work.

While there is no single model fordeveloping community-based services,which must address local needs and fitlocal circumstances, several commonpriorities and possibilities have beenidentified worldwide: reversing declin-ing trends in breast-feeding, improvingweaning practices, monitoring growthto detect malnutrition and to in-tervene before it becomes serious,universal use of oral rchydration toreplace body fluids lost during diar-rhoea, and universal immunization ofchildren against six major diseases. Suc-cess in each of these possibilitiesdepends absolutely on the involve-ment of parents and communities—noless than for organizing basic educa-tional services, primary health care,safe water supply and sanitation, tarni-ly planning services or simple tech-nologies to lighten the daily tasks ofwomen and girls. Mutually support-ive, the community-based serviceswork far more effectively together thanpiecemeal.

Under this community self-helpapproach, the role of government andnon-governmental organizations, aswell as of external co-operation, is toencourage community initiatives tohelp meet children^ needs, tostrengthen technical and administra-tive support for family and communityefforts, and to match community in-itiative and effort by funding ap-propriate technical help, supplies andtraining.

The strategy derives its logic fromdeveloping country experience. Theconventional pattern for expanding

The parents and the local communityare the child's most dependabkline of defence.

55

services which benefit and protectchildren is a gradual spreading out-wards of the social development pro-cess from the centres of economicgrowth to the periphery., in keepingwith-and paid for by—economicgrowth. In most developing countries,that model is unlikely to work for themajority of the population in theforeseeable future. And the needs ofchildren do not brook delay. The alter-native is to centre the developmentprocess on the community and thefamily, through sen-ices maintained bythe communitv.

Partners

Developing CountriesVNICKF co-operation is worked ourwith the government of the countrywhich administers and is responsiblefor the programme, either directly orthrough designated organizations.Relatively greater support is given toprogrammes benefiting children in theleast developed countries. In appor-tioning limited UNICEF resourcesamong countries, the infant mortalityrate (IMR) is one of the principalde t e rminan t s of the extent ofassistance.

UNICES endeavours to suit its co-operation to the cultural, social,geographic and administrative struc-ture of the country or area as well as toits development goals. Typical ex-amples of programme co-operation arecommunity-level services benefitingchildren and the family, includingeducation, health, nutrition, watersupply, sanitation and improvement inthe situation of women. Co-operationextends to development of policythrough advisory services or inter-country exchange of experience, sup-port for training and communication,orientation of national personnel forcommunity-level work and procure-ment and delivery of supplies andequipment.

The channels of co-operation cover arange of sectoral ministries. Inter-ministerial co-ordination and a cross-disciplinary approach are essential forsuccessful co-operation, because at thecommunity level the problems to beaddressed are often a combination otfactors spanning the technical com-petence of several ministries. Efforts in

one sector may tail without corre-sponding efforts in others. Narrow sec-toral perspectives, moreover, mayobscure the need at community levelto match the technical strength of pro-gramming with social support.

National CommitteesThe 'National Committees forUNICES1, organized mostly in in-dustrialized countries, play a crucialrole in generating a deeper understand-ing of the needs of children in develop-ing countries and of the work ofUNICEF. The committees, of whichthere are presently 33, are concernedwith increasing support for UNICEF,financially - through hind-raising activ-ities and the sale of greeting cards, forwhich the committees are the mainsales agents-and otherwise throughadvocacy, education and information.The committees have proved them-selves an effective organizationalmechanism for mobilizing moral andpolitical as well as financial support forchild-related development issuesthrough their networks ot committeevolunteers, study tours of developing

countries by groups of committeemembers, and collaboration with the'Goodwill Ambassadors1 of UNTCEF.

Non-go vernmentalorganizationsUNICES has always worked closely withthe voluntary sector. Many of the in-ternational non-governmental organi-zations: professional, developmentassistance, service, religious, businessand labour among others, havebecome working partners of UNICEF, byproviding channels for targeted ad-vocacy, by raising funds anci by engag-ing directly in programmes. Relationsat the global level promote, and are inturn helped by, interaction in the fieldin pursuit of shared aims.

At the national and local levels, therole of non-governmental organiza-tions in programmes benefi t ingchildren has been increasing throughtheir emphasis on community-basedservices and people's participation inthem. Many of them are free and flex-ible enough to respond to commu-nity-level needs and are active in placeswhere services are either inadequate or

UXUCEF is one of the largest sources of co-operation in national services and pmppnmmes benefit-ing the developing world's children

S6

non-existent. They work directly withlocal communities and provide a two-way channel between the communityand the government for communica-tion and resource transfer.

In certain si tuations, non-governmental organizations aredesignated by governments to carryout part of the programmes in whichUNICEF is co-operating. Because oftheir access and flexibility, they can testinnovative projects which often pro-side a springboard for expansion oradap ta t ion , They also provideUNICEF with information, opinionsand recommendations in fields wherethey have special competence. For ex-ample, a special study on childhooddisability undertaken by RehabilitationInternational has resulted in a con-tinuing partnership between the twoorganizations reinforcing the effortsof both.

United NationsAgenciesUNICEF is part of the pattern of co-operative relationships l inking thevarious development organizations ofthe United Nations system, as well asbilateral aid agencies and non-governmental organizations. Financedfrom several sources and drawing on avariety of technical and operating skillsto strengthen the effectiveness of aprogramme, the linkages also help tomake the most of the funds at thedisposal of UNICEF, While the finan-cial contribution may be modest, itseffect is frequently catalytic, stimulat-ing effort on a larger scale by testingand proving an approach, thereby trig-gering substantial new investmentfrom other sources.

The inter-disciplinary nature ofUNICEF programming calls for closecollaboration within the UnitedNations system in much the same wayas it demands close inter-ministerialco-ordination within a government.This collaboration ranges fromcountry-level sharing of expertise tosystematic exchanges on policies andexperience. These exchanges occurthrough the machinery of theAdministrative Committee on Coor-dination (ACC), as well as throughperiodic inter-secretariat consulta-tions.

Such meetings regularly take place,tor example, with the World HealthOrganization (WHO), United Nations

Development Programme (UNDP),Food and Agriculture Organization(FAO), World Food Programme(WFP), and the United NationsEducational, Scientific and CulturalOrganization (UNESCO). Agenciesalso discuss common concerns inthe Consultative Committee on Pro-grammes and Policies for Children.

UNICEF does not duplicate servicesavailable from the specialized agenciesof the United Nations, but benefitsfrom their technical advice-mostnotably from WHO but also FAO, UNESCOand the International Labour Organi-sation (ILO). Institutional mechanismsfor such collaboration exist: for exam-ple, the joint UNICEF/WHO Committeeon Health Policy which meets annu-ally to advise on policies of co-operation in health programmes andundertakes periodic reviews.

UNICEF co-operates in count ryprogrammes with other funding agen-cies of die United Nations system,such as the World Bank, the UnitedNations Fund for Population Ac-tivities (UNFPA) and the World FoodProgramme (WFP). The Fund alsoworks with regional developmentbanks and regional economic andsocial commissions on policies andprogrammes benefiting children.

When disasters strike, U N I C E Fworks with the office of the UnitedNations Disaster Relief Coordinator(UNDRO), WFP, UNDP, the UnitedNations High Commissioner forRefugees (UNHCR) and other agen-cies of the United Nations system, aswell as with the Red Cross and RedCrescent Societies at the internationaland national levels.

UNTCF.F Representatives in the fieldwork with the UNDP Resident Repre-sentatives, most of whom aredesignated by the Secretary-General asresident co-ordinator of developmentactivities.

FundingAll UNICEI-income comes from volun-tary contr ibut ions —from govern-ments, inter-government agencies,non-governmental organizations andindividuals. Most contributions are forUNICEF general resources. Others maybe earmarked for supplementary pro-jects approved, or 'noted* by the

Board, or for emergency relief andrehabilitation.

The Executive Director authorizesexpenditures to fulfill commitmentsapproved by the Board for programmeassistance and for the administrativebudget. For a country programme, theapproved expenditure is reflected inperiodic agreements between thegovernment and UNICEF.

While most of the funding is con-tributed by governments, UNICEF isnot a "membership' organization withan 'assessed1 budget. Nevertheless,almost all countries, industrialized anddeveloping, make annual contribu-tions, which together account forsome three-quarters of the UNICEFincome.

Individuals and organizationsaround the world are also an importantsource of funding, and they representfor UNICEF a value far greater thanthe sum of their contributions. As the'people to people' arm of the UnitedNations, UNICEF enjoys a uniquerelationship with private organizationsand the general public worldwide.Material support from the publiccomes through the buying of greetingcards, individual contributions, theproceeds from benefit events (rangingfrom concerts to football matches),grants from organizations and institu-tions, and collections by schoolchildren. Such fund-raising effortsoften are sponsored by the NationalCommittees. U N I C E F is continu-ously seeking to increase funding bothfrom traditional donors and otherpotential sources.

Its modest financial resources not-withstanding, UNICEF is one of thelargest sources of co-operation in na-tional services and programmes bene-fiting the developing world's children.Direct fund-raising, however, is onlyparr of the larger objective of en-couraging a greater share of nationaland international resources to bedirected to services for children inthese countries. In this sense, thelong-standing and well-establishedfund of public goodwill and support inthe industrialized world constitutes aresource for advocacy and policy devel-opment more valuable than any finan-cial importance it has or may attain. D

Further information aboutUNICEF and its work maybe obtained from:

EF Headquarter!Unm-d Nations, New York 10017. U.S.A.

KF Regional Offif ; -indSonthi-rii Africa

Box 44145. Nairobi. Kenya

UNICEF Regional Ot!kv t in (.Vnrraland West Atrka

B.r. 44.1. Abidjan U4 Cote d'hoirc

UN1(.» Hi.1;, tor die AmericasApartai! • unhia

UNICFF Rrgioiwl Office ibr East -,and Pakistan

P.O. Box 2-154, Bangkok 10200. I i

UNICEF Cicncva Headquarters• :LA Natmns. t_ H 1 2 1 1 , CJcncv.i 10.

• !.ind

L'NK Hh Rtgmiul Office for the Middle Eastand North Africa

P.O Box SI 1721Amman- [nrdaji

I ' N K 1-1- Ki-i nth UmralASIJ

7,1 Ludi EM.IU-, Now Delhi 110003. India

UNICKF Office tbr Australia andNew /A-ahnd

G.P.O I 'H. \ 4045,::IH)1. AiMraliJ

UNICEF Office Tor Japani. n L ' l i i u d N.itmiis tnformationOnrre, 22nJ l l imrJihiti Acv^m.i Buiki ing Nishikan1-1, Min.iiiWinato-Ku,Tokyo in"Japan

Information may also be obtainedfrom the following Committeesfor UNICEF

UNIt E - h (..ommirtcc i>f AustraliaI nf * (;.isrlcrragh StreetAUS-Svdney N.S \V 2000

Austrian Committee for UNICF.F\ricnn.i IntcnutiiMial CcnircI UNO '22 Wagramcr Stns.w 9A-1400 Vienna

Belgian (..oninmuv liir UKi1 .I , rut- Inscph II-[ii>irc 9B-1040Brusscl5

Bulgarian National CiommittccforUNUIi

L 'n M i M i - . t i \ - nt Public Health5 Lenin PlateBG-Sofia

( ' .uuJian UNICEF Gannii'.443. Mount Pleasant KmdCDN-Tnmnt.>, Ontanu M4S 2L8

i > k G'trnmincc. w i i h UN!'

; j»n \liun.I.. irctAiiskc nam. 5CS-llOOOOPngy

Danish Committee for UNBilled-, •FnhaiDK-2lOOCo

Stcintcldcr Gassc 9D-5000 Cologne 1

Finnish Committee for UNICEF[Vm Rin thcn ink j sn 1 ISF-00130 Helsinki 13

French Gtmmirree Sin U N I <35, rue Fclicicn-David

y-\ Pans Ode* 16

National Committee for UN!of the German Democratic RtpiiblK-

Warachaucr Str:i»c 8DDR-1034 Berlin

Hcllcnit N.niunal (.ommirtecMICEF

Xcnijs Srrct! 1\ thcns

Hung.inan NationalrNICEF

lUkpan, 6H-1054 Budapest S

1 , National Committeefur UNICEF

4. St, iViulrt-w Sia-eiIRL-Dublin 2

Israel National Committeefor U N K .

P,O &jx80090^93105 Jcrusalen)

Italian Comrmtttr thr L.'NIO.^. ni 25

1-00144 Rome

MII Committee ibr UNICEF. Inc.A/ahuiHai 3-Chomc Minato-Ku,

o 106

Luxembouig Ctjmminccfor UNICEF

99, Route d'ArlonI.-1140 Luxembourg

^̂ ^̂ ^̂ 5 Mctfaerianda Commitrcet i n i

Bankasrraat, 128

NL-250R CNVGravcnhagc

New Zealand N.;iCommictec fur UNICEF, Inc.

|- n li, > x M7. 5 Willcsmn StieetNZ-WcUmgton I

Norwegian Committee t in I ' N K . K HOfal" Ryes Phss 8N-0552CW<

Polish ( . 'c i i t imit tce ( i l ' t ' impr ;

with LINKul. Mukotuwslu, 39PL-00551 Wanuw

Portuguese IJ immir to IPrata Dr Fernando Am..

"3, 1 And-i!P-1900Lwbon

Romanun Nacioiwl Cximnt-

tneniR-701X1 Bucharest 1

N.itU'mal <in Manno

c/o Segrctar\: ; git Affari iIkgni

SM-47031 San Mannn

'021E-28080 Mjdnd

SwcdLsh Committee for UN!Skalgriind, 2, Box 151 15$-104; 65 Stockholm

SwhsCcmmmec for UN!1.: dstrassc 36

CM-81)21 Zm-Kh 1

Tutmun Commmec lur UN :

llscalierB- Bureau 158TN-Tunis

Turkish NUN!.

AWuIlah CevjT Vk 2.TR—Ca

United Kingdomi 'NILhi-

55 Uncolns Inn I:ieldsGB-I^ndnn WC2A 3NB

United Stares-uminee for UNK

331 FJSI 38th StreetUSA--N,u York. N Y 10016

Yns -inmirtcc

• n n a 2Pal.;!.1 inn KriluYTJ-11070 N n v i ReotErad

irine Asw>*Av. Bclgrano 254AR-1092 Buenos .Aarus

United NCyp: -mmittee (or U N ' S -

14 Ma&irios III A\t. . 2nd fli.mrMusis U!dg., No. 2, office No. 5P.O BwISOSCY-Nicosia

U N K ' F F i n Keland:;crdi, .HII

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J986

unicef &United Nations Children's Fund

nnualReport1986

SupplementTHE APRIL 1986

EXECUTIVE BOARD SESSION

UNICEF's Executive Board2 August 1985 to 31 July 1986

Officers of the Board:Chairman (Executive Board);

Mr. Anwarul Karim Chowdhiiry (Bangladeshi

Chairman (Prwmwtmf (ImntHttur):Mr. Gabriel Restrepo (Colombia)

Chairman (Cmntnittfc on Admatistnffsmarid Finance):

Mrs. A. P. Mam ping (Lesotho)

Pint Vii'e-Chairtnan:Mr. Gaetano Zucconi (Italy)

Second Vice-Chairman:Ms. Poliana Cristescu (Romania)

Third Vice-Chairman:H. E. Mr. Bcrhanu Dinka (Ethiopia)

Fourth Vice-Chairman:Mr. Hector Terry Molincrr (Cuba)

Members of the BoardArgentinaAustraliaBitqgkukslsBelgium

RtftitiBhutanBrazilBulgariaCanadaChileChinaColombia

OnyjoCubaDcmnarkDjibouti

EthiopiaFinlandFranceGabonGermany,

Federallit-puhlic of

India

IndonesiaItalyJo/miLesothoMaliMexicoNetherlands

NuterOmanPakistanlijjtHaniaSnntzertanti

ThailandTunisiaUnion tifStn'ift

Socialist RepublicsUnited Kingdom

of Great Britainand NorthcniIreland

United Staffsof America

VenezuelaYtMOslffpia

Further information about UNICEF and Its workmay be obtained from:UNICEF HeadquartersUnited Nations, New York 10017, U.S.A.

UNICEF Geneva HeadquartersPalais dcs Nations, CH 1211, Geneva 10, Switzerland

UNICEF Regional Office for Eastern and Southern AfricaP.O. Box 44145, Nairobi, Kenya

UNICEF Regional Office for Central and West AfricaB.P. 443, Abidjan 04, Cote d'lvoire

UNICEF Regional Office for the AmericasApamdo Aereo 7555, Bogota, Colombia

UNICEF Regional Office for East Asia and PakistanP.O. Box 2-154, Bangkok 10200, Thailand

UNICEF Regional Office for the Middle East and North AfricaP. O. Box 811721, Amman, Jordan

UNICEF Regional Office tor South Central Asia73 Lodi Estate, New Delhi 110003, India

UNICEF Office for Australia and New ZealandG.P.O. Box 4045, Sydney, N.S.W. 2001, Australia

UNICEF Office for Japanc/o United Nations Information Centre,22nd floor. Shin Aoyama Building Nishikan1-1, Minami-Aoyama 1-Chomt Minato-Ku, Tokyo 107, Japan

Enter the ChildrThe 1986 Executive Board, under thechairmanship of Mr. Anwarul K.Chowdhury of Bangladesh, openedwith a performance by primary schoolchildren of the UNICEF fortieth an-niversary song, which is in the form ofa message from children to childreneverywhere.

Later, at the non-governmentalorganization (NGO) exhibition in theUnited Nations public lobby, the Ex-ecutive Director, Mr. James P. Grant,received, a sack containing US$237 incents. The money had been raised, acent at a rime, by New York children,many of them from deprived back-grounds themselves. The collectionhad been organized by Tapori, thechildren's branch of the NKW/FourtbWorld Movement, an internationalorgani/ation which exists to build con-cern for the plight of others even lessfortunate.

In his report to the Board (E/ICEF/1986/2), the Executive Director statedthat the most disturbing feature of theworld economy in 1984 and 1985 wasthe precarious economic situation ofmost countries in Africa. In thedeveloping countries as a whole, 1985was the sixth straight year of negativeor negligible growth of income percapita.

Not only health, but also water sup-ply, education and concerns of womenarc salient elements of most UNICEScountry programmes. Immunizationand oral rehydration therapy (our)programmes are designed as entrypoints tor other primary health care(PHCI actions. Experience to datedemonstrates that immunization cov-erage can be increased rapidly by ac-celerated programmes. Moreover,special immunization efforts can leadto the development of a positive pro-gramme momentum that encouragescountries to invest significant resourcesin the further development of basichealth services. The world-wide effortto achieve universal child immuniza-tion by 1990 (UC1/1990) nor onlysaves millions of young lives, but alsocontributes to forging a new globalconsensus that recognizes that mostcurrent infant and young child deathsare preventable.

There was some alleviation of the"loud" emergcncv in Africa in 1985.

*en.This was due to improved rainfall insonic countries, surplus crops inseveral localities, massive internationalaid and critical actions by Govern-ments and local communities. Never-theless, an estimated 19 million peo-ple, mostly women and children, con-tin Lie to suffer rrom widespreadmalnutrition, a slow-down in infantand child mortality rcducrion, foodshortages, rising unemployment, theuprooting of Families by large-scalepopulation displacements and a seriousdecline in the most critically-affectedcountries.

In response, UNICES has staked outa course for "adjustment with a humanface", involving the protection of childnutrition and the restructuring ofsocial sectors to make the best use ofresources. It also means the cost-

the past three years. As these interven-tions emerge as the "twin engines" ofchild survival and development (CSD),they open up opportunities for abroader acceleration of PHC.

Even as attention focuses on GOBI(growth monitoring, ORT, breast-feeding and immunization) initiatives,UNICEF is maintaining and extendingthe thrust of its broad, ongoing pro-grammes, with 21 per cent stilldevoted to water supply.

UNICEF has continued its efforts toaccelerate implementation of CSD in-terventions, with particular emphasison the twin goals of UC1/1990 and ac-cess and use of ORT in the treatment ofdiarrhoea! dehydration. They arc-short-term foci of attention whichtend to "open the door" for morecomprehensive and sustained im-provement and do not obscureITNICEF'S long-term commitment toand support for the broad range of

We began with children. That is, afterally where UNICEF begins. And, in this case,these children also represent where we hopeto end: with children—bright, happy,alert, vibrant and joyful. We haveno other goal.

James P. Grant, at Opening Ceremony.

effective encouragement of family foodproduction, income-generating activi-ties for women and low-cost com-munity action. The Deputy ExecutiveDirector (External Relations), Mr. V.Tarzie Vittachi, told the meeting thatwhile maintaining and developing itsworking relations with Governments,UNICEF had been making alliances withan increasing number of private citi-zens and their institutions. He men-tioned the goodwill ambassadors,NGOS, religious bodies, people's actiongroups, parliamentarians, professionalassociations, women's organizations,business corporations, journalists,popular artists and trade unions.

More than one million child deathswere avoided in 1985, through ex-panded immunization and ORT over

basic sen-ices. Indeed, in terms ofexpenditure, water supply and sanita-tion remains the largest field of UNICEFactivity. Support for education wasalso significant and UNICEF has takennew steps to strengthen support forwomen, especial ly i n income-generating activities and agriculture.

The delegate from Mali noted that allAfrican States had dedicated them-selves to UCI/L990 and had demon-strated a desire to accelerate theseefforts. Other delegates, includingthose from Bangladesh and. China,hoped to achieve uci by 1988, withChina observing a "Child VaccinationDay" in 1986, with a goal of 85 percent child immunization. India is seek-ing to achieve UCI/1990 as a "livingmemorial" to former Prime MinisterIndira Gandhi.

A number of the largest donorsdescribed their increased support foraccelerated immunization and otherprogrammes. Some other delegatesw a r n e d aga ins t the danger of"spearhead programmes", such as im-munization, detracting from UNICEF'Straditional basic services, such as watersupply and sanitation, education,nutrition, women's projects and theneed to establish strong national PHCsystems in developing countries.

At the close of the general debate,Mr. Grant responded to the issue ofwhether recent attention to im-munization represented a narrowing ofUNICEF'S focus.

He noted that this proper concernhad been addressed fully in themedium-term work plan and that con-cern for this matter at the ExecutiveBoard had not come from the develop-ing countries who were virtually all ac-celerating child survival measures whilecontinuing other activities. Interna-tiona] support to countries to helpthem achieve the 1990 goals for uciand ORT also helped the broad agendaof child and maternal health and basicservices to improve the developmentalenvironment for children.

The Executive Director added: "1have also taken note of related issuesraised regarding sustamability, in-frastructure establishment and the im-portance of the PHC approach. Theseissues are critical points for our plan-ning with governments in support ofuci and expanded awareness ofORT."

He noted that with the advent of theChild Survival and DevelopmentRevolution children's concerns wereagain receiving support in many coun-tries from the highest leaders of Statesand from different walks of life. Theywere being transformed into socialmovements. Such national commit-ment and political will were the bestinsurance that programmes would besustained.

The relationship between UNICEFand the World Health Organization(WHO) had been especially close fromthe outset, almost 40 years ago, theSenior Medical Liaison Officer ofWHO, Dr. Karin Edstrom, told theBoard.

WHO appreciated the innovativeuse by UNICEF of communicationtechniques for social mobilization butsuggested that this has to be put intocontext. Once awakened to awareness

about the possibilities of doingsomething about their problems, com-munities had to be supported, notonly in sustaining the immunizationservice but also in tackling otherpriorities.

Reference was made to joint effortssuch as the continuing Joint Commit-tee on Health Policy (JCHP) and therecent Parliamentarian's meeting inThe Hague, sponsored by the twoagencies together with the United Na-tions Fund for Population Activities(UNFPA).

In 1987, UNICEF and WHO, boththrough JCHP and at the regionallevel, will focus on an in-depth analysisof how their collaboration for PHCbetter takes into account the com-plimentarity of their mandates andactivities.

JCHP meets every two years, andinter-secretariat meetings are heldtwice a year. Recently, contacts in rela-tion to specific programmes and atregional and country level have grownconsiderably. Current collaborationbetween the two organizations focuseson the expanded programme on im-munization (EPI), control of diar-rhoeal dehydration (CDD), acuterespirator)1 infections (ARI), maternaland neonatal care, malaria, nutrition,essential drugs, sanitation, and PHCinformation, education and com-munication. At the regional levels,memoranda of understanding weresigned last year in the Africa, LatinAmerica and Middle East regions.

Co-operation with the United Na-tions Educational, Scientific andCultural Organization (UNESCO) hascontinued in the midst of severebudgetary constraints. UNESCO hasmaintained its level of resourcesdevoted to areas of common concernwith UNICEF such as early childhoodeducation, basic education, adultliteracy and health and nutritioneducation. "Indeed, when it comes tothe education of women and girls,UNESCO'S severely eroded budgetcontains a net increase in resources",the organization's speaker told theUNICEF Board.

The Chief of the UNESCO unit forco-operation with UNICEF and theWorld Food Programme (WFP), Mr.Dieter Ber Stecher, said that co-operation had been forced to confrontnew challenges which were linked tothe course of educational develop-ment, to a better understanding of the

role of education in the welfare ofmothers and children and to the wayeduca t ion in terac ts w i t h o therdevelopmental factors. Formal andnon-formal education can be effective-ly combined to meet the learningneeds of underserved and difficult toreach population groups, such asnomads, The need for interaction andmutual reinforcement between theeducation of children and their parentsresulted in a project launched byUNICEF and UNESCO in six devel-oping countries to attack the problemof universal primary education ofchildren and adult literacy.

Several delegations had underscoredthe importance of female education,and expressed concern over deeply en-trenched disparities in educational op-portunity between women and men.Mr. Ber Stecher informed the meetingthat UNESCO was paying a great dealof attention to the problem in its cur-r e n t programmes, and i n v i t e dUNICEF to join hands in a commoneffort.

The Deputy Executive Director (Ex-ternal Relations) told the meeting thatmore and more involvement with theprivate sector was becoming a priorityfor UNICEF, He cited recent col-laboration with the League of RedCross and Red Crescent Societies intheir "Child Alive" programme, withRotary International in its polioeradication efforts and with the WorldOrganization of Scout Movements inhealth and nutrition education. Col-laboration policy was being pursued inthe media as well, notably with the

"•While political will at thetop is essential to successfuloutcomes, unless it isbalanced by communitywill at the bottom, it cantoo easily turn into a seriesof authoritarian orders,which people merelyfollow, rather than anenabling, developmentalthrust in which peopleinitiate and lead."

Mary Racelis:Regional Director, Eastern

and Southern Africa

British Broadcasting Corporation(BBC) and with "Nova", a majorscience series in the United States.Both focused on the UNICEF childsurvival programme.

Mr. Gilbert Jaeger, Chairman of theStanding Group of National Commit-tees for UNICEF, expressed satisfac-tion with the immunization and ORTprogrammes and the child survivalfocus adopted by UNICEF.

He was gratified by the attentionpaid to children in urban areas, sincethe rapid pace of urbanization indeveloping countries would require anincreasing proportion of means and ac-tion. Children facing especially difficultcircumstances were frequently in ur-ban areas.

President Betancurof Colombia Honoured

A special award was made to President Belisario Betancur ofthe Republic of Colombia for his outstanding efforts in the

area of child survival.

Under his leadership, Colombia became in 1984 the first countryever to move, in only a brief, specific period of months, from havingjust a minority of its children protected against killing diseases, tocoverage of a substantial majority. The achievement demonstrated,for the first time, the extraordinarily powerful capacity of socialmobilization in immunization campaigns.

The same mobilization techniques had been used in Colombia forliteracy campaigns and for basic sen-ices programmes, including health,child development and income-generating activities for women.

He deplored the tact that the draftconvention on children's rights hadbeen lagging behind in its elaboration,and appreciated UNICEF'S increasingfocus on that matter. The NationalCommittees proposed to devote atten-tion to the draft convention at theirJune 1986 meeting in Paris.

The fundraising efforts of the Na-tional Committees during the Africancrisis had enabled Committees to con-siderably increase their income,thereby increasing their contributionsto general resources by US$22 millionin 1985.

During the period of the Board, theExecutive Director paid tribute toDr. Gabricle Wiilker, who retired asChairperson of the National Commit-tee tor UNICEF of the Federal Re-public of Germany (FRG) at the end of1985 after 15 years of" sen-ice.

He noted that Dr. Wiilker had beena staunch supporter of UNICEF, whowas dedicated and demanding in herinsistence on the efficacity of pro-grammes, the accuracy and relevanceof information and the effectiveness ofpolicies.

Mr. Grant said that he was happythat the FRG Committee had hon-oured her contribution by making heran honorary member, on permanentattachment, adding, "We look forwardto benefiting from her continuing ad-vice and counsel in the vears to come"".i

During the Programme Committee,a total of 65 programme proposals,both regional and interregional, werereviewed, as summarized in the 1986programme submission and estimatesof future programme expenditures(E/ICEF/1986/P/L.l).

The Commi t t ee c o m m e n d e dUNICEF for increased priority andsupport to Africa as manifested byhigher expenditure levels, improvedp r o g r a m m i n g and strengthenedcapacity. Support was expressed forsocial mobilization, women's incomegeneration and food production.However, the Committee questionedthe insufficient Involvement/supportto education and social sen-ices, in-cluding birth spacing, the necessity forintegration of EPI and uci into abroader approach to PHC; and thefeasibility of uci by 1990 in someAfrican countries, especially its sus-tainability.

With regard to Latin America andthe Caribbean, the Programme Com*mitree noted the grave social impact of

adjustment measures on the quality oflife of the poorest and the most vulner-able.

For Asia, improved presentation ofprogramme documents was noted,although suggestions were made fortheir standardization. Noting thatmany countries in the region exhibitedhigh population growth rates, it wasurged that birth spacing should forman e lement in the country pro-grammes.

With regard to the Middle East andNorth Africa, the Programme Com-mittee noted the commendable effortsbeing made to accelerate child im-munization and improve data basesand situation analyses.

Throughout the genera! debate andalso in its own proceedings, the Pro-gramme Committee again expressed astrong consensus for the integration ofwomen in development activities andwas of the view that the issue shouldbe a subject for discussion at future ses-sions of the Executive Board.

The Board authorized new com-mitments from general resources forcountry programmes in the amount ofUS$84.5 mill ion. These covered23 country programmes: 10 in theAfrica region; four in the Americas andCaribbean region; four in the MiddleEast and North Africa region; and fivein the Asia region. This year, the twolargest programmes are for Nigeria(US$31 million) and for the UnitedRepublic of Tanzania (US$24 million).

During the Committee on Adminis-tration and Finance, it was reconfirm-ed that general resources should re-main the core of UNICEF income andthat supplementary funds should bereceived from governments only ifthese governments already contributedgenerously to general resources.

The Committee also reviewed thereport on "Staffing and h u m a nresource management in UNICEF"(E/ICFF/1986/AB/L.8). In responseto points raised by various delegationsabout recruitment, it was pointed outthat, wherever possible, vacant postswere tilled by internal candidates, in-cluding project staff, junior profes-sional officers and national officers.The secretariat reconfirmed the com-mitment to having 33 percent of inter-national professional posts tilled bywomen by 1990.

Several delegations noted with satis-faction the increased efficiency andthroughput of the supply operation in

"A major lesson of theUNICEF experience of40 years is that the focusfor the spectrum of servicesfor children must be on thelocal community. The mainmeans for effective servicedelivery is to mobilize thelocal community, empowerthem with knowledge to beself-reliant and to demandof the public service what isexpected of it."

David P. Haxton:Regional Director,

South Central Asin

the first years following consolidation(E/ICEF/1986/AB/L.9).

In response to interventions bydelegates, the secretariat noted thatlocal procurement was supportedwherever appropr ia te , i n c l u d i n gdelivery from one developing countryto another. Deliveries from theUNICEF Procurement and AssemblyCentre (UNTPAC) are limited to thoseitems that are required for kits and set-packing. ,

The Director of the Greeting CardOperation (GCO) told the Committeethat the sales growth rate of 17 percent projected for the period 1986/90would come from extra activities to beinitiated by National Committees andfield offices (E/ICEF/1986/AB/L.5).

During the session, the Boardadopted various recommendations andresolutions. These included a recom-mendation to allow for adequate in-depth discussions during Committeemeetings by limiting delegates1 in-terventions to 10 minutes and secre-tariat presentations to 15 minutes. Afurther expenditure of US$1,281,500was authorized for the one-tune in-stallation costs at UNICEF House, inaddition to the US$2 million approvedin 1985.

A special resolution was passedmarking UNICEF'S 40th anniversaryin which the Board called upongovernments, organizations, institu-tions and individuals throughout theworld to mobilize all necessary effortsto achieve a significant acceleration incsn (E/ICEF/1986/AB/L. 15). D

Policy reviews Medium-term P

Children in especially difficultcircumstancesThere was broad and strong consensuson the timeliness ol the policy reviewundertaken on the subject of childrenin especially difficult circumstances.Concern was expressed at the growingnumbers of such children, notablythose in areas of armed conflict, thoseaffected by natural disasters, childrenin exploitative work situations, stiverchildren and children subject to abusea n d neg lec t (E / ICEF/1986 /L .3 ,E/ICEF/Ji986/L.6, E/ICEF/19«fi /CRT.2, E/ICEF/ W86/CRT.3, E/1CEF/1986/CRP.4).

The Deputy Executive Director(Programmes), Mr. Richard Jol ly , toldthe Board that, according to roughestimates, as many as 20 per cent ofchildren in developing countries are in-volved and the numbers are growing.

In addition to suffering the directeffect of armed conflicts children alsosuffered indirectly, and since 1945,civilian casualties in armed conflictshad escalated and affected mostlywomen and chi ldren. Fighting dis-rupted normal access to basic servicesand made it d i f f i cu l t for humanitarianassistance to get through.

Natural disasters had been exacer-bated by environmental degradation.Disaster relief was part of .1 con t i nuum,stretching from early warning toprevention and preparedness, to relief,to rehabili tation, to development.While it was felt that UNICKF shouldnot get too involved in disaster relief,certain aspects concerned children veryc lo se ly ; i n t h e s e , U N I C E F co -operation was appropriate.

The numbers of working childrenand street children are increasing aspart of the process of urbanization thatis an inevitable accompaniment todevelopment. Children have to work,and this is not necessarily bad. Tradi-tionally, it has been an important partof their growth and socialization.What is bad is exploitation, includingdeprivation of time for schooling andfor play, and types of work that do notprepare them for a d u l t l i f e . Ex-perience, much of it by voluntaryagencies, is alreadv showing that it is

possible to make improvements m thesituation ot these children.

The ques t i on of abused andneglected chi ldren was only jus temerging into professional discussion.The N a t i o n a l Commit tees fo rUNICEK which had declared their in-terest in problems of children thats p a n n e d the i n d u s t r i a l i z e d anddeveloping countries, were taking aninterest in the matter.

The Board agreed that feasibleprevent ive and rehabilitative measureswere available at both the country andi n t e r n a t i o n a l lev els to s u p p o r tphysical, mental and social develop-ment of these children. Some of themeasu re s i n c l u d e d suppo r t t < >UNJCEF-assisted programmes, socialmobilization and collaboration withinternational agencies and concernedagencies w i t h i n the United Nationssystem. The Board urged all countriesto consider increasing resources con-tributed TO UNictF in order to ex-pand programme activities for childrenin especially di f f icul t circumstances.

The Executive Board requested thatU M C K F s h o u l d deve lop a n i m -plementation strategy with special at-tention to improved staff training andappropriate allocation of resources andstaff time w i t h i n the framework of itsmandate to u n d e r t a k e a c t i v i t i e srelating to c h i l d r e n in especiallydifficult circumstances. It was felt thatthis should be undertaken raking intoaccount UNICKF'S priorities and overallresource situation, and the need forL T N K i-:i- to concentrate m a i n l y on ad-vocacy and to rely p r i m a r i l y onGovernments and voluntary agenciestor implementat ion.

The Executive Board requested t h a tactivities undertaken by UNICHF inthis area should be reported annua l lythrough t h e Executive Director'sreport.

Uncertain financial prospects continueto be a central issue for UNICEF in1986 and 1987. The need for stringen-cy comes at a time when increasedresources are needed because ofeconomic difficulties and emergenciesaffecting c h i l d r e n and mothers .UNICEF has been reducing its projec-tions for income growth while increas-ing its focus on child survival anddevelopment actions which otter verybeneficial returns from re la t ive lymodest investments and seeking newforms of financial support such asthrough Sport Aid.

The medium-term plan for theperiod 1985-1989 (E/ICEF/1986/3)envisages an average annual growth inincome of about five per cent innominal terms and about one per centin real terms. Real expenditure is plan-ned to remain stable throughout theplan period. Income for 1986 isestimated at USS399 mil l ion and ex-penditure at US$393 million. For1987, the projections are US$416 mil-lion for income and US$4.10 millionlor expenditure. This will bnnggeneralresources income and expenditure intobetter balance and improve l iquidi ty.

The plan forecasts that by 1989nominal annual income will rise toUS$461 million and expenditure toUS$454 million.

As approved by the Board, it pro-vides the following four basic goals,which should guide UNICEF workand country programmes over the longterm: to accelerate the reduction of in-fant and child mortality; to protectand, wherever possible, improve thesituation and well-being of childrenthrough support for a broader range ofchild development actions; to help im-prove the situation, well-being andstatus of mothers and women; and tocontribute to the slowing of popula-tion growth as port of the support torthe above three goals.

As far as programme thrust is con-cerned, the plan notes that the coun-try programme approach is fundamen-tal to UNICEF development co-operation.

Priority will be given to those pro-grammes which offer the prospect ofachieving the most for children andmothers in need tor modest costthrough such means for social mobili-zation as increased use of radio and

fan Africa: Responding to Crisistelevision. The reduction of infant .indchild mortality is expected to remainthe priority' concern. This will involvedie acceleration of' child immuniza-tion, with rhegoal of achieving uci by1990 and the acceleration of the use or"ORT in the treatment of diarrhoea)diseases. Other programme thrusts in-clude the promotion of breast-feedingand sound weaning practices and thecontrol of malaria.

Further concerns are control ofiodine deficiency disorders, the allevia-tion of micro-nutrient deficiencies,such as vitamin A and iron, and thecontrol of parasitic infections. Prioritywill also be given to the following ac-tivities: basic education; householdwater supply; household food secur-ity; improvement of the situation, roleand status of women; strengtheningmonitoring and evaluation capacity;the promotion of adjustment policies"with a human face"; local-leveldevelopment; protection of childrenin especially difficult circumstances;communication; and social mobiliza-tion.

As for regional strategies, Africa willremain a focus for die rest of the cen-tury. Country concern in the Americasand Caribbean region and in the Mid-dle East and North Africa region willfollow mainly global priorities. In Asia,UN ICEF will concentrate on sustain-ing CSD activities and on strengthen-ing PUT. Special attention will be paidto combatting iodine, vitamin A andiron deficiencies.

Total 1985 UNICKF programme ex-penditures in Africa increased by about35 per cent over 1984, rising fromUS$78 million to US$106 million.From 1980 to 1985, UNICHF expend-iture in Africa doubled (comparedwith a 37 per cent increase in globalprogramme expenditures, excludingmajor rehabilitation), in 1985, Africaabsorbed 38 per cent of UNICES totalglobal programme expenditures(K/ICEF/19S6/L.5).

The urgent need to respond-rapidlyand cffect ivcly- to the Africanemergency and to implement expand-ed programmes necessitated ,1 majorincrease in staff". UNICKF professionalpersonnel in Africa in January 1986 in-creased bv 136 over January 1984drom 213 to 349); many were rede-ployed from uNir^F offices else-where in the world.

The primary csn objec t ivethroughout Africa is the reduction ofhigh infant and child mortality rates.This js being pursued through anumber of projects, including m, toright six childhood diseases, andthrough ORT efforts.

Africa is the only region in the worldwhere the absolute number of infantand child deaths has risen over die lasttwo decades. Total infant deaths inAfrica rose from 2.1 million in 1955 to2.7 million in 1982. For 1983, thetotal number of deaths among chil-dren under five years of age was3.75 million. The drought has exaeer-

Prince Talal of Saudi ArabiaReceives Award

Prince TaloJ Bin Abdul Aziz Al -Saud received a special awardfor his sen-ices to children, as .Special Envoy of UNICKF

from 1980 to 1984 and as President of the Arab Gulf Programme forthe United Nations Development Organizations (ACiKUNn).

UNict> Executive Hoard Chairman, Mr. An warn I K. Chowdhuty,said Prince Talal had established himself as one of the staunchestdefenders of the interests of children everywhere and as one ofUNK F>\ most articulate advocates. Thanks to his support, ITNIOKF hadbeen a major recipient of contributions from AC;FU\D.

The award followed the honouring of Prince Talal in 1985, whenhe was appointed as an honorary delegate to the uNlct'F Executive Board.

"The fundamental problemin Africa is not drought oreven food scarcity, butpoverty. It is the absence ofpurchasing power whichexplains why malnutritionis gaining ground in mostcountries of the region.Nevertheless, untildevelopment can resume,malnutrition of childrenand mothers remains amajor problem to betackled. . . Necessary effortsat restoring economichealth run the risk ofaffecting social and humandevelopment. This is whythe notion of ^adjustmentwith a human face* becomesso important."

Bertram A. Collins:Regional Director, West

and Central Africa

bated this toll; it is estimated thatabout five million African childrenunder five years of age may have perish-ed in each of the past two years.

In addition, man-made and naturaldisasters, particularly the drought,have forced more than four millionAfricans to become refugees, with anadditional 10 million displaced withintheir own countries;

The general underdevelopment ofAfrica has been aggravated byeconomic decline, civil strife, un-balanced agricultural development andrampant population gnm th (at 2.7percent, the highest in the developingworld). At the same time, food pro-duction per capita in comparison withthe I974-19"6 figures dropped in theearly 1980s by about sc\en per cent.Consequently, food imports haverisen.

Not only does Africa have the louestgross nat ional product K ; N P ) percapita among the world's developingregions (USS320), but the rate uf

growth has actually dropped by about2.1 per cent annually between 1980and 1983. Of the 40 African countriesfor w h i c h data exists, 35 haveregistered a decline in per capita in-come.

U N I C E F strategy i n emergencycountries has focused on the restruc-turing of regular programmes to takeinto account the emergency situation.Wherever possible, emergency reliefprogrammes have been broadened toform the basis of medium- and long-term development, Relief activities arenow limited to countries where

drought, accompanied by populationdisplacement, continues and to coun-tries affected by civil strife,

U N I C E F requested policy-makers tobear in mind the impact of economicpolicies on the food, nutrition andhealth of the more vulnerable groupsin African society. The request came ina Board resolution at the special ses-sion of the United Nations Genera!Assembly on the critical situation inAfrica, It stressed that measures aimedat ensuring a better future for childrenwere an integral part of the develop-ment of human resources. D

Women's Development

During 1985, major programme im-plementation strategies were devel-oped in response to women's con-cerns. One method was to incorporatethese priorities into mainstream ac-tivities. A major approach was to ex-amine how UNICEF could better meetthese concerns through "hookinginto" large-scale national projects toensure a wider impact.

Another strategy involved women'srole in production, especially in thecontext of household food security.This and income generation are strate-gies which are being successfully pur-sued in Africa.

Female education and literacy pro-grammes are given prominence in alleducation projects where female il-

literacy is high or where female enrol-ment in schools is low.

The enhancement of child healththrough csn is of special significancefor mothers since such improvementwill contribute to reducing an alreadyexcessive workload and freeing them toparticipate more actively in develop-ment for themselves and their com-munity . In focusing on adjustmentpolicies "with a human face", UNICEFpays special attention to the health,nutritional status and development ofwomen.

Following calls from a number ofdelegations for greater focus onwomen's concerns, the topic will bethe subject of a major paper and debateat the 1987 Board session.

Maurice Pate Memorial AwardThis year the award, which commemorates UNICFJ'S first ExecutiveDirector, was made to the League of Bid Cross and, Red Crescent Soci-eties for its "outstanding contribution to the health and survival ofchildren".

In making the presentation to Mr. Hans Hoegh, the League'sSecretary-General, the UNICEF Executive Board Chairman, Mr, AnwarulK. Chowdhury, praised the "Child Alive" programme of the League ofRed Cross and Red Crescent Societies. Through its national societies, theLeague has developed programmes for diarrhoea! disease prevention andcontrol, and for child immunization.

Mr. Chowdhury concluded, "UNICEF has been co-operating with theLeague in many programmes for a long time and looks forward to a con-tinued, fruitful partnership between our two organizations'".

NGO Forum

For t he f i r s t t ime, the Non-Governmental Organization Forummet in joint session with the ExecutiveBoard.

The Forum, "Action for children:unfinished business", was divided intofour working groups to consider thefollowing topics:

(i) Healthy children: common goals,different approaches;

f i i ) All work and no play;(iit) Street children;(iv) Children in armed conflicts and

naUiral disasters.The first group urged UNICEF to

draw upon the experience of NCOSworking for the empowerment of poorfamilies. It suggested that programmeslimited to preventive health care couldnot address the problems of the wholechild. Greater male participation andsupport needed to be mobilized forprogrammes affecting maternal andchild care.

The group dealing with child labourasked UNICEF to take a strong posi-tion on the elimination of all forms ofextreme exploitation, such as bon-dage, labour, slavery, sexual exploita-tion and other illegal activities involv-ing children. Research should be sup-ported which could form the basis ofpreventive measures towards theelimination of the exploitation of childlabour,

The third working group called forprogrammes that emphasize familyreunification or the reintegration ofstreet children into the community.The need for alternative educationalmodels for street children, buildingupon their creativity, strength andvalues, .was stressed.

The, idea of "'children as a zone ofpeace11 was supported by the group ex-amining the plight of children inemergencies . I t suggested tha tUNICEF should have a role in the im-plementation of the Convention of theEights of the Child, which is currentlybeing drafted. The critical needs ofchildren in armed conflict should beconsidered by UNICEF.

In his concluding remarks to thejoint session, the Executive Directorsaid that the Forum was a welcome in-troduction to the Board's policydiscussions. D