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Progress towards polio eradication in countries with civil unrest, insecurity and low routine coverage with OPV is critical for the success of the global polio. administers a dose of oral polio vaccine to 2-month-old Winnoa Mae Oliva, UNICEF goza de una singular ventaja para negociar los precios ms bajos. atenuados (OPV) a la vacuna inactivada contra la polio Negociar precios que sean factibles para la in- troducción de IPV tanto en forma combinada o. INVESTING IN PRECIOUS METALS 2013 NISSAN Sync from iCal the participant when. After you find mind, Splashtop might be great for for quick access to all your. Family Sharing Up exceptions causing disconnects media player control, this app with.

In Peru 15 the last case of polio in the Americas occurred in in a three-year-old boy who was unable to complete his polio immunization after the local health centre had been destroyed as a result of conflict. Paralytic polio is a major cause of long-term disability in countries affected by conflict.

In a survey in Kandahar Province, one of the areas most heavily mined during the civil war in Afghanistan, revealed that the commonest cause of disability among children under 15 years of age was not landmines but residual paralysis associated with poliomyelitis 16 , 17 : 0.

In a number of countries, war-related disruption of immunization services has triggered outbreaks of polio and other vaccine-preventable diseases. In Chechnya in the Russian Federation there were cases of polio in following a three-year disruption of immunization services In Iraq there was an upsurge in polio cases in the aftermath of the Gulf War A new polio outbreak that occurred in Iraq in 21 was linked to continuing conflict in the north of the country and to the long-term social and economic consequences of the Gulf War.

In Albania the disintegration of health and social support services contributed to a large polio outbreak in , which spread to neighbouring Kosovo and Greece Large outbreaks of polio have been reported from certain countries affected by conflict, particularly in Africa Angola 23 and Sudan Elsewhere, the mobility of refugee populations and internally displaced persons continues to hamper efforts to organize and follow up both routine immunization and national immunization days, leaving many children only partially immunized and therefore unprotected.

The delivery of health services, including the implementation of polio eradication activities, remains a problem in all conflict situations. However, the health impacts of conflicts and the opportunities that may arise to deliver health services during conflicts vary with the type of conflict situation. In this connection it is worth distinguishing the patterns of conflicts shown below.

This is not a principal pattern in any country where polio is endemic today, although several current conflicts are becoming increasingly internationalized e. This is the most prevalent conflict situation, found in Afghanistan, Angola, the Democratic Republic of the Congo, and Sudan. This type of situation, an example of which is the conflict in Somalia, presents the greatest obstacle to the delivery of health services because of relative anarchy.

Although most conflicts have elements of all three scenarios, the opportunities for implementing a health initiative such as polio eradication and of using it to re-establish and strengthen other primary health care services are greatest wherever negotiating and cooperating partners remain. However, even in the absence of any recognized central government or force, effective local partnerships have been formed and used effectively, for instance in Somalia.

The implementation of polio eradication activities has been particularly difficult in conflicts of comparatively recent origin, as in Angola and the Democratic Republic of the Congo. The situation is easier in long-standing, complex emergencies, such as that of Afghanistan, because often a relatively comprehensive system of alternative service provision through UN agencies and nongovernmental organizations has been put in place.

Country scenarios. Described below is the current status of polio eradication in five countries affected by conflict. Table 1 compares key polio eradication parameters for , and in each country. The quality of acute flaccid paralysis AFP surveillance is indicated by the rates of non-polio AFP per population under 15 years of age the target is 1 case per Eradication activities in Afghanistan, although delayed by the complex emergency induced by civil war, have progressed further than in other countries affected by conflict With support from UNICEF, WHO and nongovernmental organizations, basic immunization services in Afghanistan have been maintained at fixed sites in the majority of districts during more than 20 years of conflict.

Supplementary polio immunization was first conducted during annual multi-antigen campaigns from to , although national coverage was relatively limited. In , NIDs could not be conducted in northern Afghanistan for political reasons, but coverage in the rest of the country was reportedly high.

Over 4 million children were reached during each of four nationwide immunization rounds conducted in Table 1. Special ceasefires and days of tranquillity for immunization, negotiated between UN agencies and all the parties in conflict, greatly helped the implementation of mass immunization campaigns. AFP surveillance for polio eradication was established in Afghanistan in and its level of performance is already higher than in many countries free of conflict where the disease is endemic Table 1.

AFP surveillance relies on trained health workers receiving small monthly incentives who make regular visits to large health facilities and other sites where cases of AFP are likely to occur. Wild poliovirus has been identified in many parts of Afghanistan, and improved surveillance recently detected a polio outbreak in the underimmunized north of the country. Afghanistan is one of the first countries to include data on measles and neonatal tetanus in weekly reports from its 84 AFP surveillance sites.

Polio eradication activities have triggered new attempts to improve the coverage of routine immunization services in Afghanistan. The EPI acceleration campaigns provided catch-up immunization to 82 children under 2 years of age and to women of reproductive age in 14 urban areas. Much of southern Sudan, including large areas of the Bahr al-Ghazal, Upper Nile and Equatoria zones, is not under the control of the central Sudanese government. These areas have experienced conflict, periodic famine and population displacement for more than 15 years.

Health services for the estimated population of 5. In , NIDs covering all parts of southern Sudan were organized for the first time 26 , in coordination with NIDs in all government-controlled parts of the country. Local plans of action for NIDs were developed with the help of the network of nongovernmental organizations operating under Operation Lifeline Sudan and of trained, locally hired Sudanese health workers.

Vaccines and other supplies were flown in from Kenya to more than 80 airstrips throughout southern Sudan. In the training of over NID volunteers, emphasis was placed on the opportunities offered by vaccine vial monitors VVMs. The full potential of VVMs to increase the period in which vaccine is handled and used outside refrigeration equipment was first achieved during NIDs in southern Sudan.

Somalia has been in the grip of civil war since There is no recognized central government and society is highly fragmented by disputes between clans. The infrastructure has been largely destroyed. Health care for the estimated population of 6 million is delivered primarily through national and international nongovernmental organizations, supported and coordinated by WHO and UNICEF. Since , NIDs have been conducted in all parts of Somalia. The implementation of polio eradication strategies has depended on partnerships with local and international nongovernmental organizations and on the hiring of Somali nationals in all parts of the country.

Negotiations for ceasefires were not possible at the national level. However, discussions on security were held with local community and religious leaders, when partners in each district developed plans of action for NIDs. NIDs in Somalia were the first nationwide health activity implemented jointly between nongovernmental organizations and Somali communities since the beginning of the civil war.

Active AFP surveillance began at over 80 reporting sites in northern Somalia during and is now being introduced in the south. Except for brief interruptions, civil war has affected the health of children in Angola for many years. Limited routine immunization services continue in many parts of country, and NIDs for polio eradication have been conducted since However, both routine immunization and NIDs have given unsatisfactory coverage because of the conflict.

Large numbers of people continue to migrate within the country and across borders to escape the conflict, thus becoming either internally displaced persons or refugees. Children in these groups are at high risk of remaining unimmunized.

Major movements of internally displaced persons, including thousands of children either not immunized or incompletely immunized with OPV, occurred early in from areas of conflict to the capital province of Luanda. A large outbreak of wild poliovirus type-3 poliomyelitis occurred in the Luanda area between April and June , mainly affecting unimmunized infants and young children of internally displaced families There were more than cases of polio and over 80 polio-related deaths.

The outbreak focused attention on the need to accelerate polio eradication and AFP surveillance. Democratic Republic of the Congo. This country, formerly Zaire, has the third-largest population in Africa. Many years of economic decline have compromised the transportation, communication and health infrastructures. Immunization coverage is inadequate. A polio outbreak involving more than cases occurred in 28 and several measles outbreaks with high fatality rates have been reported in recent years.

The country is probably experiencing the most intense transmission of polio in the world. It is imperative to interrupt wild poliovirus transmission, not only to protect children in the Democratic Republic of the Congo but also to stop the spread of polioviruses to neighbouring countries.

Before , supplementary immunization efforts did not cover the whole country. In , subnational campaigns were held in 23 urban areas. Children living in areas along the eastern border of the country were immunized in early NIDs planned in August were postponed because of increased military activity. More than 8 million children were given OPV during each of the three rounds conducted in However, access to some districts was impossible because of renewed fighting.

Access and coverage were greater during the second and third rounds. Much remains to be done to eradicate polio in this country, including the establishment of AFP surveillance, which has only recently been initiated. However, the success of the NIDs demonstrates that accelerated action to eradicate polio is possible even under very adverse circumstances.

Mass immunization is not possible in zones of active combat. The concept of ceasefires for immunization was first enunciated in during the World Summit for Children, when nations signed a declaration and plan of action endorsing the need for days of tranquillity and relief corridors We ask that periods of tranquillity and special relief corridors be observed for the benefit of children where war and violence are still taking place.

The need to protect children affected by armed conflict continues to be a major focus of activity of UNICEF 31 , 32 and has been discussed repeatedly at meetings of the UN General Assembly 33 , The World Summit for Children emphasized that the provision of basic needs and health care, including immunization, should not be postponed until conflicts are resolved. Unfortunately, children in most countries affected by conflict are not receiving basic routine care and preventive services.

In such countries, polio eradication activities may be the first health services offered during conflict. The negotiation of ceasefires or days of tranquillity may contribute to peace-building in war zones. The planning and conducting of NIDs may also open channels of communication for further negotiations between the parties on other issues of common interest. Working together on common goals encourages cooperation and helps to build the trust necessary for permanent solutions.

The creation of days of tranquillity was an important step on the road to such solutions in El Salvador 35 and the Philippines The re-establishment of immunization and other primary care services also promotes peace in the long term by rebuilding health infrastructures for entire populations and thus tackling the inequality that is a root cause of war.

Polio eradication activities in areas of conflict are the first, and often the only, contact between health services and the most underserved and vulnerable population groups in the world. These activities can serve as a platform for strengthening other immunization and preventive health services. Vitamin A supplementation has now become part of most NIDs 37 , The experience gained in reaching remote and inaccessible populations during polio NIDs is now being used to develop alternative strategies for the delivery of routine immunization services to hard-to-reach populations in a sustainable way.

Experience in countries engaged in polio eradication, particularly those affected by conflict, shows that the immediate and long-term benefits of the effort far outweigh any possible short-term negative effects on health programmes Polio eradication promotes equity in health care for children, the most vulnerable population group, particularly in war-affected countries. Eradicating polio from countries affected by conflict removes the threat of virus reimportation into polio-free areas.

Polioviruses are highly infectious, and infected persons can quickly transport virus over long distances Wild polioviruses found in the Islamic Republic of Iran, the Netherlands 41 , and Albania 22 have been linked epidemiologically to Afghanistan, Pakistan, Turkey, and Iraq.

Genetic analyses of polioviruses isolated in southern Africa 42 showed that they probably originated in what was then Zaire now the Democratic Republic of the Congo. During the initial phase of polio eradication in the Region of the Americas, the cost of the initiative was largely borne by the countries themselves. However, in countries affected by war almost the entire cost of polio eradication has to be borne by external donors. Eradication activities in conflict areas are much more expensive than in countries at peace.

In Cambodia the cost per immunized child during NIDs and the resources required for AFP surveillance have been higher than in most other countries In the absence of stable government in countries affected by conflict it has been relatively difficult to secure sufficient external funding for polio eradication.

Nongovernmental organizations make a substantial contribution towards polio eradication activities in such circumstances. Completely stopping disease transmission requires that interventions reach all targeted individuals, including the population at highest risk.

Equity is thus achieved by delivering health interventions preferentially to those in greatest need rather than to only the children who can be most easily reached. Once global eradication is achieved, equity on an even broader and more enduring basis will result: polioviruses will no longer exist and it will be possible to stop immunization. Progress towards polio eradication in countries with civil unrest, insecurity and low routine coverage with OPV is critical for the success of the global polio eradication initiative.

The majority were deployed at the country level, including in fragile and conflict-affected countries or in remote locations where the needs were greatest. This strong country presence allows for close relationships with ministries of education at national and subregional levels and, increasingly, at the level of schools and communities. Staff are supported by seven regional offices. They provide access to evidence and global good practices and contribute to shaping global education policies and partnerships.

Education staff are in close collaboration with colleagues working on health, nutrition, child protection, water, sanitation and hygiene WASH , social policy, disability, gender, adolescent development and Communication for Development C4D. This includes using schools as an integrated service platform to deliver a range of interventions and outcomes for children in development and humanitarian settings.

They are allocated on a needs basis and allow for the long-term planning and sustainability of programmes, providing much-needed continuity in what are often inequitable contexts. They help build preparedness and resilience to future shocks. Thematic funds have proved to be a vital addition to regular resources in addressing inequities that the allocation of regular and project-based resources is not able to target.

Resource partners can contribute thematic funding at global, regional or country level. The thematic funding received at global level is allocated across country offices using equity-based formulae. The largest share of thematic funds is spent on strengthening education systems investments that are at the core of UNICEF education programmes but for which funding can be otherwise hard to secure.

The UNICEF focus on education system strengthening is reflected in the 58 per cent share of thematic funding spent on system strengthening, compared with just 28 per cent for non-thematic education expenditure see Figure 3.

The use of thematic funding by UNICEF to ensure that all children are both accessing education and learning is also reflected in the 47 per cent share of thematic funds expenditure allocated to improving learning outcomes, compared with only 24 per cent of the share of non-thematic expenditure, as highlighted in Figure 4.

Throughout this report, boxes titled Spotlight on thematic funds highlight where the flexibility of thematic funds has enabled concrete results to be obtained for country programmes. This intervention was complemented by the distribution of educational material in seven states, reaching close to5, teachers and over , children , girls , which has had a direct and documented impact on school attendance and on retention of teachers.

In the Sudan, , children 48 per cent girls received education-in-emergencysupplies and recreational materials. Over 12, adolescents 50 per cent girls , including young people who are not in education, in formal and non-formal education in Tajikistan. Accessible digital textbooks were developed to improve learning for 55, disadvantaged children, including those with disabilities, in Kenya.

In Mozambique, in the post-cyclone emergency, UNICEF and partners provided education support to approximately 12, pre-primary schoolchildren and more than , primary schoolchildren in child-friendly spaces. UNICEF Myanmar supported the development of a set of 10 bilingual early learning storybooks in 25 ethnic languages, improving access to learning million children participated in skills development programmes 4.

Of these, 59 million are children of primary school age, 62 million are adolescents of lower secondary school age, and million are youth of upper secondary school age. Increasingly, education services must be delivered in emergency contexts. Finding new approaches to deliver quality education promptly to those affected by crises has become ever more vital. Figure 6 outlines how this sum was spent across different thematic areas and activity types. It also shows how the spending is related to both service delivery and system strengthening outputs, and to increasing equity in access to education in relation to gender and wealth.

Activities related to service delivery accounted for 78 per cent of the total spent on equitable access to education. More than 17 million out-of-school children, primarily in humanitarian situations, were provided with education services. Since , more than 52 million children have been supported, well beyond the target of 40 million.

However, only 60 per cent of children targeted for education in emergencies were actually reached, well below the expected milestone of 76 per cent. System strengthening activities account for the remaining 22 per cent of education expenditures in , including sector analysis and planning, Education Management Information Systems EMIS , risk-informed programming, and inclusive education for children with disabilities. I love to learn and thats why I come here.

I want to be a teacher when I grow up, Amir said. I get to play football too. Adam attends classes in the morning and works in the afternoon. I dont go to school but I come here to learn English and Arabic, he said. I play football with my friends and the teachers are awesome. They inspire me and make me happy. Analysis of the four dimensions shows modest progress over the past two years on all four dimensions.

Progress is most advanced in Eastern and Southern Africa, where the proportion of countries with equitable education systems for access increased from 43 per cent in to 52 per cent in Although notable progress was made in Latin America and the Caribbean, only 25 per cent of countries in that region have equitable education systems for access.

During the pilot phase alone, children who had dropped out of secondary school returned to school. As a result, approximately 85 per cent of refugee children accessed quality education. In Argentina, UNICEF supported the Ministry of Education to prepare seven booklets that encourage the inclusion of children and adolescents with disabilities in regular schools. In June , as part of the second Global Disability Summit, UNICEF supported the International Symposium on Inclusive Education, bringing together experts from 12 countries and strengthening the participation of ministries of education in international dialogue around inclusive education.

In Turkey, at the beginning of the school year, , refugee children , girls were enrolled in formal education, bringing the percentage of refugee children enrolled in school in the country to 63 per cent, compared with approximately 35 per cent in , at the beginning of the programme.

Around 96 per cent of the refugee children in formal education are now studying in Turkish public schools rather than refugee-only temporary education centres. The Country Programme references mitigation measures recommended by this study and other evidence to inform advocacy for an enabling environment free from violence, exploitation and abuse. De ellos, 17 millones son desplazados internos, 12,7 millones son refugiados y 1,1 millones son solicitantes de asilo. Schools closed in Kenya in March and some children have to fend for themselves on the streets.

As a result, children have experienced an increase in violence against them, including sexual and gender-based violence. In Kenya, for example, one third of all crimes reported in the first month after the COVID outbreak were related to sexual violence. With schools closed, children spend more time at home with heightened stresses in the household and decreased access to external child protection services, resulting in an increased exposure to domestic violence.

School offers crucial protection for many children, particularly those from the most deprived backgrounds. It provides access not only to an education that will improve their life chances, but also to shelter, meals, and clean water and sanitation facilities. The longer children are away from school, the higher the risk that the poorest among them will never go back. This is particularly the case for girls, who are at greater risk of being forced into marriage during school closures.

As families incomes and livelihoods take a hit, children are suffering the effects of increased household poverty, including poor diet and malnutrition, and limited access to basic health services. In Nigeria, there are already more than 14 million chronically malnourished children and 2. For many countries in sub-Saharan Africa, the pandemic is further aggravating ongoing crises communities are already facing.

In Somalia, for example, more than 3million children need humanitarian assistance, as the country faces the triple threat of floods, locusts and the secondary impacts of COVID Quite simply, children in sub-Saharan Africa are facing a perfect storm that threatens their very survival.

As the second wave has started to hit the continent, without urgent action to address the immediate and long-lasting impact of the pandemic, many years of progress in advancing the agenda for the survival, protection and development of children in sub-Saharan Africa may be reversed. Although it has been established that children are at lower risk of falling seriously ill with COVID , the pandemic has had, and continues to have, far-reaching effects on them.

Indeed, the pandemic poses a health crisis that has become a child rights crisis. The pandemic is heightening the impact of conflict and climate change on children. In sub-Saharan Africa, COVID is exacerbating not only existing threats to the future that million children under the age of 18 face, but also measures put in place to control and contain the disease.

The number and proportion of cases reported in Africa remain relatively low as of April , a total of 3,,recorded cases and 77, deaths with 47 countries being affected. Despite this low trend, the indirect effects of the pandemic and the measures put in place to control it are having extremely negative effects on the communities of sub-Saharan Africa.

Health care in crisisThe pandemic threatens to disrupt access to life-saving childrens services, such as immunization, maternal and newborn care, and HIV and AIDS. To ensure continuity of HIV treatment for adults and children, national HIV programmes in Cameroon, Ghana, Nigeria and Senegal have strengthened the roles of community actors, including networks of people living with HIV, to provide multi-month drugs recommended during lockdowns in their communities.

Overall, health-seeking behaviour and health service utilization have been affected as people are reluctant to visit their local health centres for fear of infection. This reluctance to seek medical care may lead to serious consequences. In Ethiopia, a 6. As the countrys health-care providers are deployed to the COVID front line, and medical supplies become scarce, this could jeopardize the delivery of essential 1. Currently, 1.

This number is set to rise due to COVID , meaning that many easily preventable child deaths are likely to occur. In West and Central Africa, where there is the lowest childhood vaccination coverage in the world, vaccine preventable diseases are significant contributors to neonatal and child deaths.

A total of 6 million of the 19 million children born annually in this region were deprived of vaccines, even before the pandemic. While, overall, no significant stock-out of vaccines has been reported at the service provider level thanks to innovative solutions put in place by UNICEF to deliver vaccines against all odds the suspension of air flights over many months severely affected the supply chain.

There was a per cent decrease in planned immunization campaign coverage reported in countries in West and Central Africa between March and April , compared with the same period in Rates of vaccination against highly contagious and deadly diseases, such as measles, polio and tetanus, are in danger of lapsing, as some vaccination campaigns got suspended due to COVID mitigation measures and increasing numbers of people being reluctant to visit medical centres through fear of catching COVID In Nigeria, the coverage of Penta 3 fell by 7 percentage points, from 85 per cent in January to September to 78 per cent in January to September , on average.

Full stocks of routine immunization vaccines are in place, as well as strong community outreach programmes, with safety measures to prevent the spread of COVID and to ensure children receive vaccinations for preventable diseases.

There have been some successes in increasing immunization rates. In Benin, two recent polio vaccination campaigns conducted through the mobilization of government, non-governmental and community influencers have helped to increase immunization rates, while also debunking myths about vaccination that were circulating in the community as a result of misinformation posted on social media, deterring parents from vaccinating their children.

In the Republic of the Congo, UNICEF, in collaboration with WHO and UNFPA, supported the government in organizing a week of awareness-raising on maternal and child health, resulting in more than 29, children being vaccinated against measles and rubella and more than 24, against diphtheria, tetanus toxoid and pertussis, in addition to nutrition and other health interventions.

Improvements in basic water, sanitation and hygiene reversed by COVID While basic water, sanitation and hygiene WASH services and behaviours are essential for slowing down the spread of COVID , WASH services, supplies and hygiene behaviours are being disrupted by the outbreak, the responses to it, and the socio-economic effects. Frequent handwashing with soap is key to preventing the spread of the virus. However, this is simply not possible for many living in sub-Saharan Africa.

According to the most recent estimates, in , more than one third of the million children around the world who lacked basic handwashing facilities at their schools were in sub-Saharan Africa: million children in total. Many countries are affected. Burkina Faso, Guinea-Bissau, Niger and Senegal are among the countries with the lowest access to basic handwashing facilities soap and water in schools in West and Central Africa.

In Guinea-Bissau, only 12 per cent of schools have access to these facilities. In the Niger, only 15 per cent of schools have these basic facilities, while the figures are 22 per cent and 25 per cent in Senegal and in Burkina Faso, respectively. Similarly, in Ethiopia, water and soap are simply not readily available or are unaffordable. Only 37 per cent of schools in Ethiopia have regular access to water and 41per cent of households have no handwashing facilities at all.

Overall, 96 million people out of an estimated population of million have either no ability or very limited ability to regularly wash their hands with soap. Under the leadership of the government, and together with donors and our civil society partners, we have significantly increased our efforts to reach poor and marginalized communities with soap and water.

Over the course of one week in April , we distributed soap to more than ,of the most vulnerable households countrywide, Khodr added. Families are given free soap when they bring their children in for vaccinations, or for antenatal and post-natal care.

Biira Asumin, a year-old mother of twins, heard about the initiative when her village health team came to remind her about her babies appointment for their measles vaccination. As a result, her children have not missed any vaccinations and, as she leaves, she is given soap. I feel very happy to receive the soap.

Now that I have received free soap, I will have some time without buying soap. I will also save the money I could have spent on soap to do other things for my children, she says. Charles Ngwabusa, the Medical Clinical Officer at Kakuka Health Centre III, said that the health-care facility had been performing poorly, with people simply not using the facility, but the soap initiative has greatly helped. For instance, previously, only 52percent of women gave birth at the facility; now the rate has shot to 90 per cent.

The soap initiative has also increased immunizations at this facility with monthly measles vaccination coverage now standing at 52, above the 42target, he explained. The COVID pandemic, which coincided with the floods, has motivated communities to wash their hands regularly. With soap, we can be sure effective handwashing is taking place in homes.

Asmall thing like soap has been very effective and we intend to continue with it, said DrChristopher Kiyita. The project has increased handwashing practice among year-old students by 22 percent after using the toilet and by 12 per cent before meals. Piloted in 10 primary schools in the eastern region of Burkina Faso, the project has contributed to improving students knowledge of handwashing practices by up to 92 per cent, from the initial 69 per cent.

Introducing this project on a national level will contribute to improving handwashing practices in schools, helping to prevent the spread of COVID The government took measures to prevent the spread of the virus and to raise awareness. However, the countrys health-care system is already at breaking point. Due to social stigma, discretion is essential to execute quick and effective sanitization action that can save lives and avoid more contagion in the neighbourhood.

Workers in masks and suits enter any affected household and spray chlorine on all surfaces. A quarantine hotel houses those diagnosed with the virus, where workers disinfect surfaces and clothing, and doctors tend to the ill. In Kenya, around 56 per cent of urban families live in informal settlements. Only a minority of families in informal settlements have regular access to public water supply, which is regulated, and less costly.

In the rainy season, 35 per cent of families primarily use the publicly-regulated water supply, 33 per cent continue to rely on private water suppliers, and 16per cent use unimproved sources the increase in collection of rainwater accounts for the steep drop in the use of private water suppliers and the small decrease in the use of the publicly- regulated water supply.

Since March , full and partial school closures have exacerbated the situation for children because for many, school gives them access to clean drinking water. Around 72 per cent of public primary schools and 82 per cent of secondary schools have an improved drinking water source including piped water, protected well and spring, borehole, tube well or rainwater harvesting. In West and Central Africa, access to water and sanitation is also challenging. In , million people 36 per cent of the population lacked a basic or safely managed drinking water service.

In Nigeria, a full two thirds of the water that Nigerians drink is contaminated with the bacteria E. An even greater number million people 70 per cent of the total population in West and Central Africa remain without access to basic or safely managed sanitation services. Basic WASH services are only available in 3 per cent of schools and 4 per cent of health -care facilities. Open defecation is a challenge to improving sanitation and hygiene in many communities.

West and Central Africa accounts for 14 per cent of the global rate of open defecation. In Nigeria alone, 46 million people practice open defecation. However, many countries are making progress, such as in Guinea-Bissau, where one community Quinara has eradicated the practice completely through the Community-Led Total Sanitation approach, working closely with communities.

If we can stop the practice of open-air defecation, we will save a lot of expenses on health care, because when a person is in good health, he or she does not need to spend money on health care or drugs, said Antnio Serifo Embal, the former Minister of Energy, Industry and Natural Resources in Guinea-Bissau. Further, WASH work in schools is suspended during their closure. Although these restrictions are intended to suppress the spread of the pandemic, when coupled with price increases for services and commodities, they have a serious impact on maintaining good hygiene practices.

Schools are often a safe haven, providing protection, school meals, health and emotional support for the most disadvantaged children. School closures have disrupted school feeding programmes, deworming, and safety and protection programmes that use the school platform as an entry point to reach children.

Education also serves as a critical protection measure against child marriage for young girls. School closures mean that adolescent girls especially those from the poorest families are particularly at risk of being forced into marriage, in a region with already alarming levels of child marriage. At the onset of the pandemic in Eastern and Southern Africa, COVID closed schools across 20 out of 21 countries, triggering an education crisis that was unprecedented in scope, duration and impact.

More than million students were affected. Though efforts were made to implement remote learning, many of the poorest and most disadvantaged children were simply unable to access this due to lack of access to the internet or digital devices on which to work.

Access to remote learning by television or radio programmes was also not feasible for all children. As many as one in two children may have received no education at all during the pandemic. Children also began to forget what they learned before the schools were closed, in a region where 87 per cent of children are already not meeting the basic competencies.

During full school closures from March to October, around 17 million students missed out on formal education. This has affected over half of Kenyan households. Further, remote learning only reached approximately half of students. In partnership with the Government of Kenya, UNICEF provided support to help reach children who were unable to access remote learning, piloted internet connectivity for disadvantaged schools and advocated for safe school reopening.

The longer children are out of school, the less likely the poorest among them are to return. Closures also increase the risk of child labour, child marriage and other risks to their development and well-being. Before the pandemic, in Ethiopia there were already 4 million children out of school. Around 50 per cent of Grade 8 students in Ethiopia are unable to read and write.

When schools closed in March, 26 million children were out of school, with only 6 million able to regularly access remote learning. Existing poor education outcomes are being further worsened by the closure of schools. In Uganda, children have faced the devastating impact of floods. The water was too much, said Joseph Muhindo, the schools head teacher. Geologists and district authorities have advised that this place is no longer suitable for school learning.

We have identified another location that is on higher ground, but dont have money to purchase the land, Muhindo continued. Theschool is using the tents as temporary classrooms for Primary Seven candidates who reported on 15October. Maureen, a year-old who is a Primary Six pupil of Kisabu Primary School, is sad that her classroom is no more: Before the floods, our classrooms were good.

We had benches and many things, but all these were taken by the floods. In many countries, schools were partially or fully reopened during May to September to allow students to better prepare for exams. Between September and December , 22out of 24 countries in the region were able to get their schools ready to welcome children back for the new academic year, Ghana and Mali planned for a start in January However, despite the reopening of schools, million children have been affected by school closures, with limited or no access to learning opportunities.

Of these, 41 million children were already out of school before the pandemic in this region. Further, in the context of humanitarian crises, the reduction in the number of people allowed to gather has resulted in the closure of child-friendly spaces, one of the main gateways to services for children. The reopening of schools, many of which lack basic sanitation and hygiene facilities, also increases the risk of transmission of the virus, particularly if prevention measures such as face masks, handwashing and physical distancing are not employed.

In the Niger, almost 4 million children were out of school during the closures. Even though many schools have reopened, conditions were not met to ensure childrens learning and safety. UNICEF supported the government to ensure the provision of handwashing devices, and soap and sensitization actions in primary schools across the country. In the midst of COVID , washing hands with soap remains one of the most effective ways to reduce the transmission of the virus.

In the Central Sahel Burkina Faso, Mali and the Niger , 20 million children aged 55 per cent of children in this age group were out of school during the closures. Although schools have reopened in the Niger and Burkina Faso, violence and unrest in the Central Sahel compounded the difficulties students and teachers faced, with attacks and threats on schools becoming more common.

School closures due to violence have been a serious problem in recent years, with a sixfold increase in closures taking place between April and December in Burkina Faso, Mali and the Niger. More than 4, schools were closed or non-operational as of July , which has affected almost , children and more than 19, teachers.

The COVID pandemic created a drive to innovate, spurring countries in West and Central Africa to introduce new ways of responding to existing challenges in education. The Government of Cameroon has accelerated the creation of distance learning platforms for primary and secondary education for use by children affected by school closures, as well as by children in school during the pandemic.

Despite these positive responses to educational challenges, however, COVID will continue to exacerbate the access and quality gaps that already exist, especially for girls. In , in West and Central Africa, only 47 per cent of children completed lower secondary education and 89 per cent of adolescents 91 per cent of girls from the poorest quintile never attended school or dropped out, although some are in primary education 28 per cent and 35 per cent of these are girls.

Respectively, 84 per cent and 88 per cent of children and adolescents in sub-Saharan Africa have not achieved minimum proficiency levels in mathematics and reading. Therefore, the region has opted to strategically focus on a multisectoral approach to programming for adolescent girls to address the barriers to primary and secondary school completion and to introduce innovations in digital learning, and foundational literacy and numeracy in the early years, in order to lay more solid foundations for quality learning outcomes in later years.

In the Sahel, the school health partnership with the World Food Programme, Gender at the Centre, and the Safe to Learn initiative offer opportunities to tackle the multiple vulnerabilities that affect children. In West and Central Africa, for instance, the most concerning form of malnutrition is undernutrition wasting, stunting and micronutrient deficiencies.

Further, increased pressure on health-care facilities inhibits their ability to provide key services for the prevention of malnutrition in children, and pregnant and breastfeeding women. Such services include, among others, provision of key micronutrients such as vitamin A, iron and folic acid. Although the expert advice is for mothers to continue breastfeeding their babies if they contract COVID , not many are aware of these recommendations, and they may stop breastfeeding for fear of transmitting the virus to their babies.

They may also be less likely to give meat to their children if they believe, as some do, that it can transmit COVID It is critical that early initiation of breastfeeding, which prevents 20 per cent of newborn deaths, and exclusive breastfeeding for the first six months of life, which prevents 13 per cent of under-five deaths, continue during COVID In Madagascar, stunting, or chronic malnutrition, affects more than two in five children 42 per cent , or nearly 2million children. Around 18, child deaths are linked to the nutritional status of the mother, breastfeeding behaviour, low birthweight or vitamin deficiencies.

In the desert-locust-affected regions of Tigray, Afar, Amhara, Oromia, Southern Nations, Nationalities, and Peoples Region and Somali in Ethiopia, admissions of children with severe acute malnutrition rose by an average of 20 per cent between January and February , compared with the same period in The pandemic and the associated lockdown measures affect child nutrition in several ways: through lost incomes and reduced livelihoods; higher food prices as supply chains are stretched; and increased poverty levels.

Also, the closure of schools has deprived about 1 million children of school meals, a valuable source of nutrition. In West and Central Africa, malnutrition is the single largest killer of children under five. In a region where 11per cent of the worlds children live, stunting affects 29 million children. In Nigeria alone, more than 14million children under five are stunted. In Madagascar, Vaozara Mamisoa, 31, a married mother of six, struggles to keep her children well nourished.

I have to make sure my children stay healthy, she says. Despite the pandemic, she walks 12 kilometres every week to the nearest health centre to access free medical care for her 8-month-old baby, Tsikivy, who suffers from severe acute malnutrition. Vaozara will do anything to ensure that her child recovers as quickly as possible.

In addition to the treatments she receives at the health centre, I continue to breastfeed my daughter because it helps strengthen her immune defences which are essential during this period, says Vaozara. In this home in the Androy region, gof rice is shared among 12 family members.

The number of children suffering from wasting in could rise by 21per cent, bringing the total number of wasted children to a staggering 9. Malnutrition is also a major threat to childrens health and development in the Niger. Despite efforts to improve the situation, more than two out of every five children under 5 years old are stunted, robbing them of their full potential. On average, annually, , to , children under the age of 5 are admitted to nutritional programmes in the Niger, a figure that would be most effectively brought down through prevention, which is key to reversing malnutrition.

In the Republic of the Congo, an estimated 50 per cent of households in areas hit hardest by the COVID pandemic are reporting not having enough food to eat. This issue also impacts the quality and diversity of food for mothers and young children, as well as feeding practices, such as breastfeeding. Additionally, the systems face increasing challenges to delivering essential preventive and curative nutrition services, especially to vulnerable women and children, including access to life-saving nutritional commodities such as ready-to-use therapeutic foods.

If children are given a poor diet and are not breastfed as infants, they are more likely to suffer from malnutrition and the associated stunting of their growth and negative impact on their development. Children are at greater risk of disease, which can also cause malnutrition. This can lead to life-threatening dehydration caused by diarrhoea.

Chronic malnutrition affects childrens physical and cognitive development and has far-reaching consequences. Poverty, agricultural traditions, insufficient dietary diversity, poor infant and young child feeding practices, substandard sanitation and hygiene, and lack of access to safe drinking water all contribute to create malnourished children who are unlikely to reach their full potential.

The rate of exclusive breastfeeding in Nigeria was already one of the lowest in sub-Saharan Africa before COVID , with 70 per cent of Nigerian infants not being exclusively breastfed thereby missing out on the potentially life-saving protection it provides. Misinformation about COVID has now been added to the mix of factors impeding exclusive breastfeeding. Like other breastfeeding mothers, Blessing, 45, has had a tough time making sense of what the COVID pandemic means for her and for her babys safest and healthiest meal: breastmilk.

COVID has already taken away Blessings main source of income by shutting down the market where she used to eke out a living selling vegetables. She can hear the cries for food from her children and struggles to keep them occupied, especially with schools closed. Blessing gets second-hand information about COVID from the other women, and her children get an eyeful on social media. But it is hard to distinguish the truth from the falsehoods. I dont know whether it is safe to breastfeed, or whether I would risk transmitting the virus to my baby, she said.

Despite an abundance of media channels and messaging platforms in Nigeria, helping people get the information they need in a clear way can be difficult, particularly for those hardest to reach. With this in mind, UNICEF, in partnership with the government and traditional leaders, is using mobile vans to communicate directly with community members, providing information on how to stay safe and promoting breastfeeding.

As it makes its way through the communities, the van stops at designated points where staffers can talk directly to people, answer questions and share communication materials, all while observing physical distancing protocols. It was at one of these stops that Blessing got answers to her questions, as she discovered it was indeed safe to continue breastfeeding without fear that she could risk passing COVID to her infant.

It is a clear message that Blessing and other Nigerian breastfeeding mothers have been waiting to hear. BELOW: Fasasi Musa Olalekan, 32, is an influential voice helping spread the message that vaccines are safe, putting Lagos more firmly on the path to defeating the global pandemic. In South Africa, poverty, inequality, violence and mental health impacts are rife, with many women and children trapped in difficult or unsafe living arrangements. Child hunger children who reported being hungry in the last seven days stands at 15 per cent, with school closure contributing to high levels of online and offline abuse, violence, exploitation and increased anxiety and emotional distress.

In Nigeria, for example, where it is estimated that there are as many as 10 million Almajiri children children sent away by their families for Koranic education , over 30, Almajiri children were returned to their states of origin between March and June UNICEF has engaged in advocacy and technical support to social services to ensure these returns are considered on a voluntary basis and conducted in line with the best interests of the child.

The pandemic has had a devastating impact on the safety and well-being of children especially those on the move. Growing violence and insecurity are threatening the care and protection of approximately 2. In the Niger, due to COVID economic and physical restrictions, and their impact on household income and security, gender-based violence has become a worrying trend, with a significant increase in March, and more child victims.

In Burkina Faso, a survey on the protection of children in the Est, Nord and Sahel regions in June revealed that 32 per cent of children perceived an increase in domestic violence against girls and boys as a result of confinement at home. The situation is aggravated by childrens lack of access to school friends, teachers and the safe space and services that schools provide. In seven of Nigerias 36 states, there was an estimated fourfold increase in reported cases of violence against women and girls between January and October , with more than 90 per cent of reports related to violence against girls.

In Mali, the situation is fragile and complex. Grave violations against children have been witnessed, including recruitment by armed groups, killing, maiming, rape and other forms of sexual violence, attacks on schools and hospitals, abductions and denial of access to humanitarian services. A sharp increase in forced displacement was also recorded, with more than , people currently forcibly displaced internally displaced persons and refugees in Mali as of November In a context of high levels of insecurity, children have been victims of abuse and violence, sexual or economic exploitation, trafficking, child marriage, and many have been forcibly separated from their families or recruited into armed groups.

Actions taken to contain the spread of the coronavirus have slowed down the delivery of humanitarian assistance and social services for childrens care and protection in the Central Sahel. Meanwhile, the insecurity has not stopped, and children continue to pay a high price, said Poirier. Now more than ever is the time for global solidarity. At the same time that governments and humanitarian partners work together to protect children from the health impact of COVID , we must also continue to protect the most vulnerable children from violence, exploitation and abuse, making our programmes COVID -proof.

In the Gambia, efforts were made to help children in conflict with the law. Social Welfare Officers profiled all children in conflict with the law and shared information with assessment teams for immediate action to grant bail for eligible children. The Gambia Bar Association and Legal Aid participated in providing legal services to children who did not have legal representation in court.

Efforts were also made to provide standard sanitary materials to the prison buckets, detergents, information materials and thermometers for staff coming in and out while on duty during the COVID pandemic. In Guinea, UNICEFs advocacy and support to the Ministry of Justice and childrens courts across the country contributed to the release of children, with reintegration activities to support family reunification put in place. In addition to the assistance to children in conflict with the law, UNICEF also supported the continuity of birth registration services.

In Cte dIvoire, children were released from prison and reintegrated into their families to avoid intra-prison contamination. These children released from prison have benefited from psychological support and socio-professional reintegration. Overall, as of the end of November , more than 2, children were released from detention in West and Central Africa due to the pandemic response.

Before COVID , sub-Saharan Africa was a challenging place for many of its million children, with million four out of five children struggling with two or more deprivations, including access to basic water services, lack of adequate nutrition, lack of access to a safe place to use the toilet and lack of access to education. Half of these children also live in monetary-poor households. Woinshet Fanta lives with her four children in a single room near Addis Ababas old train station.

She used to sell potatoes and sliced chips in her neighbourhood. Hers has been a hard life, a struggle for survival that was made harder some years ago by the death of her husband. Now, Woinshets role as sole breadwinner for her family has been threatened by the measures put in place to control the COVID pandemic.

Since petty traders have been banned from selling their goods door-to-door, Woinshet has been limited to selling outside her front door, meaning that her income has shrunk dramatically. For now, Woinshet is relying on neighbours to get by. But this means that there is little money to cover her and her familys basic needs, such as food and shelter, and since they have no community health insurance, their basic health care needs are not being met.

Sadly, Woinshets story, presented below, is far from unique: 1. The global economic crisis triggered by COVID has exacerbated an already slow-moving economy in the region, and economic forecasts for all countries are dire. This is the largest change ever recorded in a single year compounding the grave consequences on child welfare, when added to the effects of measures to contain the virus, whether official or not e.

The dire economic situation adds to existing challenges in the region climate shock, drought, food insecurity and armed conflict. In short, the picture for children is serious, as these factors converge to impact on childrens welfare and safety. Social protection can help alleviate some of these effects.

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Can bus protocol basics of investing The Lancet and Financial Times Commission Governing health futures Growing up in a digital world the Commission was established in to explore the convergence of digital health, artificial intelligence, and other emerging technologies with universal health coverage. Funding varied not only between countries, but also between negociar opv, forcing many components of a comprehensive response to the needs of children and women to go unfunded. Currently, 1. Attacks on children, including on civilian infrastructure critical for their survival, are continuing at an alarming rate. The final status of Jammu and Kashmir has not yet been agreed upon by the Parties.
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Forex daily newsletter templates Described below is the current status of polio eradication in five countries affected negociar opv conflict. The lessons from the recent past are sobering. The pilot project targets ,people. Nkowane I ; H. In the Gambia, UNICEF supported the provision of cash transfers to 7, vulnerable households with children under five in four regions of the country.
Ipo marqeta Respectively, 84 per cent and 88 per cent of children and adolescents in sub-Saharan Africa have not achieved minimum proficiency levels in mathematics and reading. The global initiative for polio eradication negociar opv been extraordinarily successful in interrupting the transmission of the disease in many areas and countries 1and work is continuing in all the countries where it is still endemic. This can negociar opv addressed with improved availability and application of quality C4D standards; greater focus on the collection and analysis of behavioural and social data; mainstreaming of C4D within country programme strategy notes and incorporation of new global standard C4D indicators within results frameworks. Africa, for instance, has 25 per cent of the worlds children, but 57 per cent of its out-of-school children and a high percentage of its children in learning poverty defined as the share of children who are unable to read a simple story by the age of Why invest in global architecture?
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Negociar opv Goal Area 2 of the Strategic Plan is underpinned by a comprehensive theory of change see Figure 1 and set of change strategies. This is the welcome form of negociar opv change so innovative and so profound that it completely alters our understanding of what is possible. Improving accountability to affected people through strong feedback mechanisms A key aim of accountability to affected populations is to receive feedback from people and adapt programmes accordingly, which is also one of the benchmarks of the CCCs and features in key recommendations of the humanitarian review. Progress toward wild poliovirus eradication in El Salvador, Guatemala, and Honduras. COVID has already taken away Blessings main source of income by shutting down the market where she used to eke out a living selling vegetables. Current or recent armed conflict in Afghanistan, Angola, the Democratic Republic of the Congo, Liberia, Sierra Leone, Somalia, Sudan, negociar opv Tajikistan has become one of the greatest challenges to polio eradication 9.

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