Consultation on Child Injury Prevention in CEE/CIS Regional Office
Members of the Consultation on Child Injury Prevention in CEE/CIS
A consultation on child injury was organized in UNICEF Geneva on the 27/28 April 2006. Child injury and violence have been unrecognized as a major problem in several countries of the CEE/CIS region. Tackling violence and injury is vital to achieving the Millennium Declarations (MDG 1, 2 and 4), the WFFC Goals and is crucial to the achievement of all the rights of the Child (CRC). This is especially an issue in the CEE/CIS region as the IRC reported a threefold increase in the number of children with disabilities. Learning from the experience from other countries, where the prevention of injuries was addressed in a multi-sectoral approach and with partnerships, the Regional Office decided to bring together Colleagues from UNICEF Regional Offices of EAPRO and CEE/CIS, UNICEF HQ and country offices from Turkey, Armenia and Moldova and key potential partners - WHO-EURO and the European Child Safety Alliance.
This consultation aimed to assess the magnitude of the problem of Child injuries in the region and review what can be done in conjunction with regional partners. Experiences from within the region and other parts of the world were shared. Finally, this consultation discussed the implications of a potential involvement of UNICEF in the Region and the role of the Regional Office.
In two separate working groups number of questions were debated. The first group reviewed what had already been done to tackle injuries and violence, what information was available, what strategies had been successful and finally identified potential partners; The second group tried to assess how UNICEF could integrate injuries in its programmatic work, therefore, UNICEF’s role in addressing child injuries, the prevention mix and the level of intervention, the funding and other resources for child injury prevention. Consequently, the consultation defined the advocacy, the policy and the programming, the capacity development, the data analysis and monitoring and evaluation, and the funding needed to mainstream injury and violence prevention by a partnership between UNICEF, WHO-EURO, relevant NGOs and governments.
Evidence and risk factors
Injuries are a major unrecognized problem impairing the survival, development and welfare of children and adolescents in transition countries of Central and Eastern Europe and the Commonwealth of Independent States. The countries on top of the WHO EURO League Table on injuries are the Russian Federation, Turkmenistan, and Kazakhstan, followed by other CEE/CIS Countries. It was commonly agreed that there is enough evidence to tackle the problem in all countries of the region. All middle income/low mortality countries of the region should start programmatic and strategic work now, low income/high mortality countries should start assessing the magnitude of the problem, the root causes of violence and injury and addressing it along with other priority child survival interventions.
A lot of work has been done by UNICEF EAPRO related to child injury prevention. The experience available from these countries and the experience from high income countries in Europe will be very useful. Some of these strategies can be implemented in the CEE/CIS region and modified according to the local conditions.
Many common/standard risk factors were identified: alcohol and substances abuse, disruption of social norms, increased violence, risky and fatalistic behavior, migrations, poor governance, weak enforcement and regulatory mechanisms, unsafe environments, poverty and social inequality. The causes of injury follow a “life cycle” and are age as well as gender specific, and can vary from country to country. Enhanced surveillance at country level of age specific issues can help identify different causes to injury and violence.
Positioning injury is central to UNICEF programming and to the broader perspective of the MDGs as child injury is the leading cause of deaths and disability for children under five in the region.
UNICEF headquarters in conjunction with WHO and concerned NGOs should advocate for the Committee on the Rights of the Child to include the right of the child to safety, including child injury prevention in the regular reporting of countries. They should advocate with the UN for the appointment of a special rapporteur on child injury (and violence) prevention. The regional office should share with country offices global and regional strategies and commitments for their advocacy with government, civil society and the private sector. Country offices should appoint a focal point for violence and injury prevention within their offices, which would identify key partners and advocate for the mainstreaming of injury with all relevant sectors of the government and cross sectoral initiatives like PRSP and SWAP.
At all levels, evidence based advocacy should be strengthened, therefore strategic research should be put in place to address knowledge gaps, including evidence on cost-effective prevention strategies and best practices.
Policy and programming
There is a need to mainstream injury and violence prevention into policies, programmes and practices. UNICEF HQ in partnership with WHO and relevant NGOs should prepare a guide on global good practices and disseminate a Program guidance. At the Regional level it is important to include injuries for discussion in the RMT and issue a guidance note for country offices. The regional office should also, in partnership with WHO and EURO SAFE contribute to the preparation and the dissemination of the European Child Injury Report. The country office in partnership with the MOH focal point should review existing interventions, data, research, policies, resources and tools available in the country for violence and injury prevention. Also, they should also mainstream injury prevention within their existing programs (education, child protection, child survival and social policy). Next year’s MTR in eleven CEE/CIS countries will be an opportunity for this process. The issue of programming child injury prevention will be discussed at the Regional Child Survival Cluster Meeting in May/June.
The guiding principle for capacity development should be mainstreaming and integration, vertically and horizontally. The Regional Office should collect and disseminate tools and resource packages to country offices. In that regard experiences from EAPRO and industrialized countries will be very useful. It has to identify key institutions that should be linked to country offices and facilitate the exchange of information, experiences and joint capacity building activities to country offices as well as all other partners (The CDC course on injury surveillance and the WHO Teach VIP training package). The regional office therefore should ensure adequate human and other resources at the regional and CO level.
Data analysis and M&E
There is a need to add new indicators and process indicator for injury and violence prevention. At present, the indicators used by UNICEF have been defined by WHO. Indicators have to be included in the annual report guidelines by headquarters and other key documents such as the State of the World’s Children. A Progress for Children Report Card on Child Injuries and violence should be considered.
HQ should coordinate with the Division of Policy and Planning to include the indicators on injury and violence into the MICS, DHS and other household surveys. HQ should coordinate with the WB on developing monitoring systems and analysis of cost saving to economies by preventing injuries.
At the three levels (HQ, RO, CO) in partnerships with WHO and concerned NGOs, analysis of data per age groups and gender, country per country should be conducted.
UNICEF HQ should develop multi country project proposals in consultation with country offices. Headquarters from UNICEF and WHO should discuss the feasibility of securing funds for child injury and violence prevention. The Regional Office should prepare in conjunction with WHO and EURO SAFE, a fund raising strategy. They should discuss with the EU and other donors, the feasibility of submitting a joint project proposal with WHO and EURO SAFE. The country office should lobby with the governments and large donors on adequate allocation of funding to child injury prevention.
Partnership is a major component of the strategy to tackle injury and violence (abuse and neglect). Without partnership none of the focus areas outlined above can be efficiently addressed. Different partners and agents of change have to be identified, for different levels of programming that will create opportunities for funding and joint programs, for mentoring and study exchange, and to leverage opportunities. UNICEF experience from South Asia suggests the huge importance of “champions” for injury and violence prevention.
How can we build on the momentum created by the Global Study on Violence and by the Global Report/Strategy on Child Injury Prevention? How can we capitalize on policy change in the context of EU accession to make sure that injury prevention is adequately addressed? Can we use injuries to enter public and policy dialogue on more sensitive issues such as violence, abuse, use of small arms etc.? It will be also very important for UNICEF to be prepared to link child injury with coming events such as European Conference in June 2006.
This consultation was extremely fruitful and helped clarifying the key areas on child injury prevention and helped strengthen partnerships between organizations. The participation of different sectors in UNICEF, like Child Protection, Social Policy and Planning was crucial for understanding the multi-sectoral nature of the burden of injury and key prevention strategies. UNICEF Regional Office will work on the development of the regional guidance note, including fund-raising strategy to address the issue of injury prevention, which will be presented to the RMT by the end of this year. The strategy will be developed in partnership with WHO-EURO and the European Child Safety Alliance.
If all the CEE/CIS Countries had Sweden’s rate of injury related mortality, then 75% of childhood deaths could be saved in the 1-14 year age group. Sweden's achievement is not an accident, but took years of work.