UNICEF MADAGASCAR Newsletter on the Situation of Children and Families in Madagascar. No. 2: May 2010

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1 UNICEF MADAGASCAR Newsletter on the Situation of Children and Families in Madagascar No. 2: May 2010 PROTECTION Immense needs and no resources Based on data coming from the Police de Moeurs et Protection des Mineurs (PMPM) and the Syndicats des Professionels du Travail Social (SPDTS), the number of children being kidnapped or disappearing in Antananarivo continues to be high. The main reason for children disappearing is considered to be mistreatment and violence at home (often a sign of increasing family breakdown) combined with high poverty levels. In 2009 a total of 1,026 children have been reported as missing. Out of these, a total of 444 cases still require further investigation. The 2009 level has been particularly worrying as the political crisis precipitated the disappearance of children beyond previously known levels for the city of Antananarivo. Between January 1 and May , a total of 238 children have been reported missing out of which 138 were reunified with their families and 100 cases are still under investigation. The number of cases of sexual violence that have been received by the Befelatanana Maternity Hospital in Antananarivo alone is even more disturbing. In 2009, a total of 479 cases were registered of which only 27 were cases concerning persons over the age of 18, while 345 were cases concerning children aged years and 107 cases concerning children aged 10 years old and younger. Young girls appear to be particularly vulnerable. As of May 1, 2010, a total of 228 cases of sexual violence have been reported by the same institution. Table: Sexual Violence Cases received by the Befelatanana Maternity Hospital Antananarivo Age Under the age of Aged between 10 and Over the age of TOTAL Weak institutions, a failure of officials to adequately respond to reported crimes, and the lack of resources to address cases of disappearance, abuse, exploitation and sexual violence all result in many of children not receiving adequate response, treatment and protective measures. This situation is further compounded by the fact that government officials at the municipal (commune) levels have not been or only irregularly - receiving their salaries for several months and have reduced the amount of work they have carried out. This affects the child protection networks that UNICEF has facilitated in 761 municipalities as a means of local follow-up to cases of child abuse. The municipalities are receiving a lump sum amount of 8 million Ariary per year of government funding for the purpose of social protection interventions. In the absence of development resources being disbursed since the onset of the crisis, and given the delay in payments for local government staff, this amount is increasingly being used to fill the fiscal gaps for any other budgetary items, thus even further decreasing the little amount available for social protection measures including child protection. 1

2 Diego University students hospitalised in Diego Hospital following clashes with police Street clashes in Diego on April 26 and 28 between students protesting against the non-payment of scholarships since the beginning of 2010 and police forces led to violent use of force by the police resulting in one student being killed and six students being severely injured by gunshots.. Out of the injured, one has been confirmed by UNICEF to be 17 years old. As has been the case during the violent events at the beginning of 2009 in Antananarivo, children continue being drawn into violent public events thus are being exposed to and falling victim to physical violence. UNICEF is working on establishing, expanding and strengthening child protection networks throughout the country to prevent, and respond to, violence and abuse against children. These mechanisms/networks composed of child protection key actors are operating at district and community levels to facilitate interaction between law enforcement authorities, service providers and communities themselves to address identified cases of violation of child protection rules and to refer cases to appropriate services in a timely manner. Child protection networks are responsible for monitoring and reporting on child protection cases. To date there are networks operating in 761 communes with different degrees of efficiency. Besides this, UNICEF is advocating for 1) the recognition of the social workers role, 2) supporting the training of social workers to reinforce family structures and facilitate reintegration of children into their families and communities, and 3) training law enforcement officers to ensure that child rights are applied in the justice system. To date 80 per cent of judges have participated in awareness raising and orientation sessions on international standards to protect the rights of children in contact with the justice system, including in the context of the crisis and political unrest. More than 492 stakeholders benefited from training in the new child protection legislation, and 3,500 copies of the penal code have been printed and distributed since January At community level volunteers were identified by the community and mobilized to address child protection issues and to reduce exposure of children to violence and abuse. They contribute to identification and referral of child protection cases to appropriate services. They played a significant role in mobilizing the research of missing children. In the Analamanga region there are 471 volunteers /FIANTSO engaged in 127 Fokontanys (out of 192). To improve services provided to victims of sexual violence reported by the Befelatananana Maternity Hospital in Antananarivo, an integrated unit is in the process of being set up in the building to facilitate access to psycho-social and legal counseling and medical assistance for victims. UNICEF and its partners from the Child Protection Networks initiated a series of consultations with youths on the problematic of violence. Regional discussions were realized in Antananarivo, Toliara (Tulear) and Fianarantsoa involving youths from different districts on their perception on violence, juvenile delinquency and criminal responsibility. At the end of each consultation a set of interventions were identified on how to prevent and respond to violence at the local level. 2

3 EDUCATION a halt to Madagascar s primary school enrolment success An assessment carried out by UNICEF of the situation in 65 public primary and lower secondary schools across twelve regions 1 provides a mixed picture and some worrying trends in performance during the 2009/10 school year compared to 2007/2008 and 2008/2009. The study, carried out in rural and urban schools along three axes (central/ east, north and south), confirms results from the McRAM : Parents in Madagascar are increasingly stretched to ensure the education of their children. This has become more difficult as government A fifth grade student in Morondava Public Primary School contributions designed to help decrease direct education expenses for families through school kits and school capitation grants has so far not been provided for the 2009/2010 school year. At the same time, household budgets, particularly in urban areas, are increasingly distressed. While primary school enrolment rates in the 65 assessed schools (using a non-representative but indicative sample) increased by 6.5 per cent in urban areas between the 2007/08 and 2008/09 school years, it decreased by 4.6 per cent between 2008/9 and 2009/10. 3 For rural areas, on the other hand, there was a minimal increase for the same period (0.1 per cent), but the previous level of increase in enrolment (3.3 per cent between 2007/08 and 2008/09) was not maintained. According to parents and teachers, the reasons for this negative development are primarily economic: the inability of parents to cover the education expenses for their children combined with the increase in fees requested by schools. According to information from 175 parents interviewed, direct primary school expenses to families increased on average by about 21,400 Ariary (about 11 USD) per student from the school year 2008/09 to 2009/2010 an increase of 30 per cent: The total cost to families per student was on average 67,400 Ariary (USD 34) in 2008/2009; in 2009/2010 it has increased to 87,500 (USD 44). This cost is difficult to bear for many families. For the first time in many years the exceptionally strong upward trend in Madagascar s primary school enrolment has been arrested and reversed. Madagascar s net enrolment rate increased with breathtaking speed between 2001 and 2007 with rates jumping from 65 per cent to 87 per cent. The drop in enrolment in urban areas in 2009 is even more worrying when taking into account results from the McRAM study, indicating that there is a shift from private to public schools in urban areas. Since the study did not take into account private school enrolment, it can be inferred that the overall enrolment has decreased even more than revealed by the study data, since some of the enrolment registered can be presumed to result from children previously enrolled in private schools. Of serious concern is also the significant reduction in inscription rates for the end of primary school exams, which enable students to proceed to the secondary level. The study shows a 17.7 per cent decrease in registration for the CEPE in 2009/2010 compared to 2008/2009. Inscription rates for the secondary level examinations (BEPC) required for proceeding to upper secondary school have decreased by 4.6 per cent. These reductions in exam inscriptions risk translating into reduced transition rates between primary and lower secondary, and between lower and upper secondary schools, in turn threatening the progress towards universal basic education and a general lift in the level of education of the population a lift which is deemed essential for economic growth and poverty reduction. 1 Evaluation de la situation des écoles primaires et collèges en période de crise, 2009/10. UNICEF, May McRAM III. Evolution de la situation socio-economique des ménages de la ville d Antananarivo durant la crise sociopolitique. United Nations Madagascar, November Data based on local school registers 3

4 A positive development highlighted in the study is the increased achievement in final examinations at the end of the 2008/09 school year compared to the previous year. Primary school examinations (CEPE) were successfully mastered by 75.6 per cent of students at the end of school year 2008/09 compared to only 62.7 per cent of students at the end of school year 2007/08. This could at least in part be due to a change in the examination, since a new competency based examination (supported by UNICEF) was in place for the first time in 2008/09 4. Also on the positive side, the study indicates that repetition rates in primary schools dropped slightly in the transition between 2008/09 and 2009/10 (21.2 per cent) compared to the previous transition 2007/08 and 2008/09 where the repetition rate was 24.2 per cent. The above positive trends could be interpreted as the results of efforts to improve the quality of education over the past years. However, the overall implications of the study are that there is significantly high risk of losing these achievements unless urgent action is taken to reverse current trends in enrolment and costs to parents. At the policy level, the local education partners have taken the initiative to organize an external study of the state of implementation of the endorsed education sector plan covering primary and lower secondary education. It is hoped that the results will be a good basis for dialogue to re-establish progress and the inflow of resources to the sector. Access to safe WATER AND SANITATION: a deteriorating trend The recently released Joint Monitoring Progress (JMP) report of March 2010 documents a recent downward trend in access to water and sanitation. In 2008, 47 per cent of households had access to improved water facilities whereby in 2010 it is only 41 per cent. Access to improved sanitation decreased from 12 to 11 per cent over the same period. In an attempt to address the shortage of urban water capacity, UNICEF negotiated with JIRAMA to have NGOs involved in the construction and management of water points in urban areas. Over the past two years a total of 174 urban water connections were put in place still short of the target of 450 per year required to achieve the MDGs. A significant regression in the access to safe water has been diagnosed in urban areas where no investment is being made in the expansion of respective infrastructure, yet urban populations are growing by an estimated 2.5 per cent annually. UNICEF, together with the World Bank, is currently engaged in a study on the situation of urban water and sanitation that is expected to shed more light on critical issues to be addressed and how. NUTRITION a situation mitigated in the South but grave deficiencies for treatment of severely malnourished children elsewhere In April 2009 the acute malnutrition situation in the South reached alarming levels due to a failure of the 2009 harvest, due to inappropriate rainfall and also compounded by poor access to clean water, inadequate sanitation and inadequate care seeking behaviour. In response, the national and international communities launched a multi-sectoral emergency intervention with the local communities and health structures. The successful intervention resulted in a halving of acute malnutrition rates between April 2009 and November The latest survey carried out in Androy and Anosy in April 2010 showed a slight increase due to the lean season with, global malnutrition rates were 7.2 per cent in Androy and 8.7 per cent in Anosy, 4 A separate evaluation of the 2009 CEPE examination results is being conducted by the Ministry of Education with support from UNICEF 4

5 significantly lower than the levels seen in April For severe acute malnutrition the levels were 1 per cent in Anosy and 1.7 per cent in Androy resulting in 3,593 children still in-treatment at the end of April in the 145 UNICEF-supported Centres de Récupération Nutritionnelle Ambulatoire pour Sévères (CRENAS) and roughly 1,500 new admissions are seen every month. In order to effectively identify all children with severe acute malnutrition, active mass screening of acute Malnutrition screening in the Beloha Basic Health malnutrition was integrated in the April 2010 Mother and Centre, Beloha District, Androy region Child Health week. This successfully integration resulted in a total of 208,427 children under 5 screened equating to 97% coverage. A recent assessment exercise by UNICEF with partners of the Centres de Récuperation et Education Nutritionel le Intensifs (CRENIs) in Antananarivo and elsewhere has found a serious deterioration in their capacity to adequately treat severe acute malnutrition. The CRENI provides intensive in-patient treatment of severe acute malnutrition and are located within the public hospital structures. In 2003 the Malagasy Government declared fee-free the package of treatment for severe acute malnutrition (SAM) within the CRENI. The free package of treatment includes; therapeutic food (F100 milk), first and second line systematic drugs, hospital consultation fees as well as the nutritional meals for the child and their carer. This commendable policy resulted in a reduction in case fatalities in CRENIs to less than 10% across Madagascar and was supposed to be financed by the Office Nationale de Nutrition (ONN), via its decentralized structures Office Regional de nutrition (ORN), in all 45 CRENI of Madagascar. The Befelatanana CRENI in Antananarivo, where the families of patients with severe acute malnutrition with complications are now obliged to pay certain costs as part of their treatment However, reports from the field suggested that ONN is no longer in a position to continue financing the 45 CRENI leaving the families to bear the cost of treating SAM children. Surveillance teams found these reports to be true particularly in the CRENIs of Antananarivo where out of 33 admissions, 9 children died, equating to 27% case fatalities. Of the 9 children that died, 8 died within the first 48 hours following admission due to the inability of the families to pay for the drugs necessary for SAM children with complications. In addition, the supervision team found a 40% default rates as families are unable to pay for the complete treatment of the SAM child. In 2009, 4,143 children were admitted in 40 CRENIs (data from 5 CRENI remains unavailable). If inappropriate treatment to SAM children continues, case fatality is likely to reach 50-60% resulting in 2,000-2,500 SAM children across Madagascar at risk of dying due to inappropriate care. To provide some initial relief to the situation, UNICEF has provided 100,000 USD for the basic functioning of 15 CRENIs in the most vulnerable areas. The amount is sufficient to provide basic services until October 2010 only. Additional funds are urgently needed to extend the services in the 15 CRENIs until at least May 2011 and to ensure adequate services also in the additional 30 CRENIs 5

6 which are also facing challenges in providing basic essential services to severely malnourished children. HEALTH malaria outbreak, deteriorating maternal health care and shortage of basic drugs An outbreak of malaria affected Tolagnaro district in the southern Madagascar. A total of 3,391 cases were confirmed between January and March 2010 of which 64 per cent were of children under the age of five years. Thirty children have been reported dead due to malaria infections. The peak of the epidemic was in April, and no mortality cases were so far reported for May. The national impregnated bed net distribution campaign originally planned for later this year was advanced and 22,000 bed nets distributed at the beginning of May - complemented by indoor spraying. Between February and March, community health agents were trained to provide community based advice, mobile clinics for malaria testing and management were activated and sensitisation campaigns carried out. UNICEF and partners such as CARE, ASOS and Santenet 2 assisted the government in its response. UNICEF started preparation activities to address a wave of increased malnutrition among children that is likely to occur following malaria epidemics. Currently there are no more than 22 out of 194 required emergency obstetric and newborn care centres operating in the country. Out of these, only 19 are able to provide caesarean sections as opposed to 39 that should provide this service. This does not bode well for maternal health in cases of birth complications (on average 10 per cent of all deliveries encounter some form of complication). Mother and Child Health Week completed: The Mother and Child Health weeks (MCHW) are a free-of cost out-reach activity providing high impact interventions through immunisation (for children under the age of one year and pregnant women), de-worming of children under the age of five years and pregnant and postpartum women and vitamin A supplementation. According to 2009 data from the The latest campaign started as planned on April 26 in all government s drug monitoring 111 districts of Madagascar targeting 3,967,300 children system there have been and 56,000 pregnant and postpartum women. Despite a shortages of medical stocks in 2 strike announced by paramedical staff during the per cent of basic health centres planned period, the campaign received full support from (on average lasting between one the Ministry of Health at regional and district levels. A and 2 ½ months depending on total of 6,430 health workers, 16,100 health volunteers the kind of drugs). Drugs for and 600 supervisors were involved. At the community sexually transmitted diseases level, 58,000 mobilisers including 13,000 scouts have not been available in 8-30 encouraged women and children s caretakers to per cent of health facilities participate in the campaign. The campaign was depending on the type of drugs budgeted at 954,000 USD, and was financed by for an average period of 3 UNICEF, GAVI, WHO and UNFPA. months. A total of 20 per cent of health facilities are not receiving the ordered amount of drugs due to blockages/shortages at the level of SALAMA or the district drug distribution system. CONTACTS Bruno Maes Valérie TATON Representative Deputy Representative Tel: ( ) /93/94 Tel: ( ) /93/94 bmaes@unicef.org vtaton@unicef.org UNICEF Madagascar UNICEF Madagascar 6