An equity focused approach getting results for disadvantaged children

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1 An equity focused approach getting results for disadvantaged children Right in principle. Right in practice. Richard Morgan Director, Policy and Practice UNICEF December 7, 2010

2 Outline PART I: Situation Analysis PART II: UNICEF s Equity Focus PART III: Equity Focus Process so far and next steps 2

3 Under-five mortality declined between 1990 and 2009 Trends in the under-five mortality rate (per 1,000 live births), by region

4 Progress in Child Survival is unequal in 2/3 of countries 2/3 countries that have made progress in reducing U5MR have shown worsening inequalities (i.e. gaps between better off and worse off have increased) Indicates : delivery and financing of health and nutrition services as well as demand / use of these favor the better off UNICEF Progress for Children 2010

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6 Poor children are lagging behind in reduction of stunting Proportion of children 0 59 months old who are stunted, by household wealth quintile in India Note: Prevalence trend estimates are calculated according to the NCHS reference population, as there were insufficient data to calculate trend estimates according to WHO Child Growth Standards. Estimates are age-adjusted to represent children 0 59 months old in each survey. Information on household wealth quintiles was not originally published in the and National Family Health Surveys (NFHS). Data sets with household wealth quintile information for these surveys were later released by MeasureDHS. For the analysis here, the NFHS and data sets were reanalysed in order to estimate child stunting prevalence by household wealth quintile. Estimates from these two earlier rounds of surveys were age-adjusted so that they would all refer to children 0 59 months old and would thus be comparable with estimates from the NFHS. Source: National Family Health Survey, , and

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8 Education marginalization inequalities within countries (The case of Nigeria) 14 Ukraine 12 Average number of years of schooling Nigeria 6.7 years Cuba Education poverty Bolivia Indonesia Honduras Cameroon Bangladesh Chad Extreme education poverty 9.7 years Richest 20% Poorest 20% 3.5 years 10 years Rural Urban Urban 6.4 years Rural 3.3 years 10.3 years Rich, rural boys Rich, urban boys Rich, rural girls Poor, urban boys Poor, rural girls 2.6 years Boys Girls 0 C. A. R. Rural Hausa 0.5 years Poor, rural Hausa girls 0.3 years 8

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11 What does equity mean for UNICEF? Universality the over-riding principle Freedom from discrimination, bias or favoritism Focus on the most disadvantaged children poorest, excluded, discriminated Interrupting the perpetuating inter-generational cycles of deprivations 11

12 Disadvantaged because... Poverty Gender Area of residence Race Ethnic group Disability Cultural and social norms Other factors. 12

13 What are these children facing? Different manifestations: high mortality, morbidity, malnutrition, illiteracy, exploitation etc WHY? Services are not reaching them Information is not reaching them Multiple deprivations compounding one another e.g nutrition/education They are vulnerable to exploitation, abuse They do not have a voice Limited opportunities And so on 13

14 An equity-focussed approach examines... (a) societal factors i.e. which social norms, behaviours, practices are impeding access to services or fuelling discrimination and deprivations (b) services and systems i.e. why are services not reaching those who are most in need? What are the barriers to access and what systems constraints are there? (c) political and ideological issues i.e. what are the governance, accountability, policy, legislative etc issues that are not favouring equal opportunities for the disadvantaged children and communities. 14

15 Focusing and doing more for the disadvantaged children Strengthening a human rights based approach underpins the equity agenda 1. What, who, where and why? Identify the most deprived children and communities 2. Invest in proven, cost-effective interventions/services (including cash transfers) 3. Why are services/interventions/opportunities not reaching them? Analyze barriers and bottlenecks 4. Support context-specific strategies aimed at removing policy, systems, societal barriers 5. Think innovation, scale-up strategy 6. Ensure timely monitoring of progress; robust evaluation 15

16 An even stronger argument - right in practice too Child Survival & Devt modeling study Conventional wisdom has been that it is too costly and too difficult to go into poor, hard to reach communities; reaching better off, easier to reach children has been considered more cost effective. UNICEF s Idea : Because the needs are greatest amongst the unreached, and new, innovative, efficient strategies and tools exist to reach them, the benefits of concentrating on them through an equity focused strategy could outweigh the additional costs of reaching them. This would mean a greater equity focus would : a) be more cost effective and b) accelerate progress towards MDG s 16

17 Conclusions of Narrowing the Gaps An equity-focused approach improves returns on investment, averting many more child and maternal deaths and episodes of stunting than the current path. With an equity-focussed approach US $1 million investment in reducing under-five deaths in a low-income, high-mortality country would avert an estimated 60% more deaths than the current approach. Because national burdens of disease, ill health and malnutrition are concentrated in the most excluded and deprived child populations, providing these children with essential services can accelerate progress towards the health related MDGs and reduce disparities within nations 17

18 Implications for country level programming Data, evidence, monitoring and evaluation Improve generation, presentation and use of disaggregated data to better target programmes and policy-related work Increase understanding of the drivers/causes of exclusion and inequities Policy and programming Understand the national policy environment and developments on equity issues Ensure alignment between programme focus/strategies with equity profile and national / local context Re-assess existing programme strategies using the equity lens Promote integrated strategies e.g technical sector strategies with social protection, community empowerment; coherence between programmes and operations 18

19 Implications for country level programming Partnerships Creativity in partnerships to reach the disadvantaged Leverage national partnerships to focus on equity engage them in the evidence-based analysis, defining barriers/bottlenecks, solutions and resource allocation, accountability systems Regional think-tanks, academia sourcing external partners Monitoring and Evaluation Innovations and adaptations in monitoring, measuring results and evaluations; sensitivity to determine outcomes for disadvantaged children General Determine priority capacity / resource gaps Mobilize around equity on a few key issues that will yield a high impact 19

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