2000 IRQ: Joint Government of Iraq-UNICEF Programme Review 1990-2000
While routine evaluations were carried out as part of the regular assessment and planning process during the last ten years, UNICEF has not had the opportunity to conduct an overall review of programme interventions. In preparation for the next country programme for 2002-2004, it was felt that a comprehensive review of the past ten years was necessary for both UNICEF and the Government of Iraq to assess progress made, reflect on challenges, and use lessons from past experience to inform planning for the future. This report documents the process, findings and analysis that were derived from the review of existing documents covering the last ten years and participatory workshops held for all sectors. This programme review is unique, as it is the first ten-year country programme review exercise for UNICEF. Normally, the review exercises include the Annual Review, the Mid-Term Review, and the end of the five-year cycle review.
Purpose / Objective
The major objectives of the programme review were the following:
- Assess the relevance and effectiveness of UNICEF-assisted interventions in Iraq over the period 1990-2000
- Assess the appropriateness of key UNICEF programming strategies in Iraq with regards to the priority needs of women and children, particularly since 1996
- Distill lessons learned from the UNICEF-assisted programme experience
- Identify gaps in current programming practices, and recommend priorities and modifications for UNICEF's future role and programme intervention support
- Provide specific inputs to the upcoming situation analysis and new country programme of cooperation
To facilitate this major programme review exercise, the UNICEF country office put together a team of twelve resource persons. The team included three programme review consultants, two sectoral consultants, one advisor from UNICEF Khartoum, two senior advisors from UNICEF New York Headquarters, and three senior advisors and the planning officer from the regional office in Amman.
A review was made of the Master Plan of Operations (MPO) and Annual Reports (1990-2000), various study reports, as well as other secondary sources of information. Five sector reports were prepared in the areas of Health and Nutrition, Water and Environmental Sanitation, Education, Child Protection, and Communication.
Five sector-based workshops were conducted in Baghdad, which brought together more than 300 stakeholders in the UNICEF-supported programme. Participants included Programme Managers from the central and governorate levels, non-governmental organizations, UN agencies, sectoral specialists and programme review consultants.
UNICEF and the Government of Iraq are planning to undertake small survey-based studies around specific themes, which will provide additional information on both the status and effectiveness of interventions in different sectors. These will be undertaken early in 2001.
Key Findings and Conclusions
Due to the cumulative effects of two wars and new economic constraints associated with the imposition of far-reaching economic sanctions, there were rapidly-declining social service provisions in Iraq during this time period. This is reflected in the infant mortality rates, which rose from 47 deaths per 1000 live births between 1984-1998 to 79 between 1989-1994, and to 108 between 1994-1999. The nature of UNICEF's resource support to the Government also underwent a change from the provision of emergency support to children and women in distress, to using UNICEF resources to complement the rehabilitation process from resources generated by the Memorandum of Understanding (MOU). However, the thematic thrust of UNICEF-supported interventions has remained the same throughout the decade: to focus on the needs of children and women in the areas of health, nutrition, primary education, and drinking water supply.
In health, emphasis was placed on the rebuilding of the primary health care system through the training of traditional birth attendants, resumption and re-activation of the routine immunization programmes and launching of the control of diarrhoeal disease programme as well as a programme for the control of acute respiratory infections. Two key achievements have been the full resumption and re-activation of the Ministry of Health's Expanded Programme on Immunization (EPI) and the establishment of Oral Rehydration Therapy (ORT) corners in a number of hospitals and Primary Health Care centres, accompanied by substantial progress in the use of ORT. The UNICEF programme in support of immunization has been critical in a period of fluctuating and generally deteriorating health services, and has been the flagship programme supported by UNICEF.
For nutrition, the initiation of supplementary therapeutic feeding programmes through hospital-based nutrition rehabilitation centres was a key achievement. In addition, a new initiative of community-based and volunteer-run Community Child Care Units for the screening and monitoring of malnourished children was established and has expanded rapidly to more than 2,500 units in the country. UNICEF has also supported a programme incorporating Vitamin A supplementation with immunization activities. The Health Facility Study in 1997 showed that 80% of infants received Vitamin A together with the measles vaccine. This is a significant achievement.
The most important interventions supported by UNICEF in the education sector were school rehabilitation/reconstruction, rehabilitation of the chalk factory, and the ongoing rehabilitation of the textbook printing press. In addition, the distribution of educational kits to students and teachers during the period 1993-1996 was crucial because the country was facing serious shortages of education supplies, and this activity significantly contributed to ensuring access to basic educational services.
Regarding child protection, since 1997, UNICEF has emphasised a shift from supply-oriented approaches towards capacity building and human resource development in specific technical areas. This has been particularly important for the childhood disability project, which has benefited from an emphasis on the improvement of basic services and the identification of beneficiaries' needs. At the same time, an advocacy initiative was started for the introduction of new areas of concern, particularly working and abandoned children. Service delivery, through the provision of supplies and physical rehabilitation of buildings, served as an entry point to begin to address quality issues and other elements of the programme.
In the water and environmental sanitation programme, the focus of UNICEF-supported interventions prior to the MOU was on the supply of chemicals for water purification; supply of equipment, spares and other parts for repair and replacement; and training of personnel on the maintenance of the system. With the MOU in operation, the emphasis has shifted to supporting the transport and installation of equipment and spares, training of operation and maintenance personnel and improving water quality monitoring. An important initiative has been to build up a management information system for tracking operation and maintenance requirements, water supply quantity and quality, and management of the system.
In the early 1990s, intensive lobbying and advocacy was undertaken to ensure the iodization of salt in Iraq. In 1993, a national coordinating committee was established and a plan of action for salt iodization was outlined. Legislation was adopted in 1996 and the action plan reviewed in 1998. Currently, only iodized salt is distributed in food rations and household use of iodized salt is over 90%.
UNICEF/WHO-supported polio campaigns are well-known and very successful campaigns. The media campaigns have been accredited to having played a critical role in achieving almost universal coverage during Polio National Immunization Days (PNIDs).
Communication strategies for social mobilization not only enhance programme service usage by increasing demand, but are also most effective when used as a complementary input to services. Social mobilization and communication strategies towards social advocacy have been successful where they have been focussed on creating a demand for specific programme outputs, such as promoting the use of Oral Rehydration Therapy (ORT), immunization of children, and promoting growth monitoring of children. However, campaigns have not been successful where basic behaviour practices have to be changed, such as breastfeeding of babies and hygiene practices.
It is clear that an enabling policy environment is absolutely necessary for the success of social mobilization and communication campaigns. For example, the campaigns for Polio National Immunization Days (PNIDs) have been highly effective because of the full support from policy makers and local authorities. In addition, the campaign to increase the use of iodized salt has been successful because not only has the Government supported a policy of supplying only iodized salt in food rations but also the availability of non-iodized salt has been restricted. On the other hand, the successful promotion of breastfeeding has been limited by the lack of a policy to control the widespread availability of infant formula in the market.
Achievements throughout the past decade have been significant, especially given the multi-layered constraints to long-term planning and programme implementation, as a result of the emergency situation and the short six-month cycles of the MOU/Oil for Food Programme. However, there is room for improvement in terms of building upon current strategies as well as exploring new initiatives to address issues and the special needs of vulnerable groups that are not receiving adequate attention.
The programme review has revealed a weakness in internal monitoring and evaluation. Collecting complete and accurate data for this ten-year period was an enormous task, made all the more difficult given the emergency situation that the country programme was operating under for most of the decade. However, even taking these factors into consideration, it is clear that internal monitoring and evaluation of UNICEF-supported interventions have been weak and, as a result, a complete picture of activities undertaken and especially results achieved have not been possible.
UNICEF's comparative advantage throughout the past ten years has been its country-level presence and ability to generate reliable information and analysis. Virtually all individuals and agencies concerned with the situation of Iraqi children have used UNICEF statistics on mortality and malnutrition in advocating for Iraq's vulnerable groups. The successful conduct of surveys has also opened up avenues for further analysis of the situation of children, such as a second multi-indicator cluster survey being conducted in 2000, which is a follow-up to the first survey in 1996.
There are areas where there have been inadequate emphasis. There are areas that require new programmes, strengthening of existing programmes, or expanding the range and quality of services provided. These areas include prenatal and postnatal care, early childhood care and development, girls' education, and adolescence:
Prenatal and Postnatal Care - Safe Motherhood Programme -- The rehabilitation of the health services system as well as the supply of micronutrients has only indirectly addressed women's health. Direct attention has not been given to the nutrition needs of women, obstetric care for pregnant women, safe delivery practices both in hospitals and homes, and neonatal care after childbirth.
Early Childhood Care and Development -- The thrust of UNICEF support, particularly in health and nutrition, has been focussed only on the physical well-being of a child's growth and development. Little attention has been given to the early learning needs of children.
Girls' Education -- The focus of UNICEF support between 1990-2000 has been on the rehabilitation of the primary school system. Even though enrolment and dropout rates have steadied compared to the earlier years of the decade, direct attention to promoting girls' education and reducing girls' drop-out rates has been missing.
Adolescence -- Adolescence is a critical phase of a child's life. However, given the other priority needs in the context of Iraq, there has been no programme support to this group. Within this age group are the majority of abandoned and working children.
Current interventions are now well-established within the country and it is now time to refine the impact of interventions through focusing on improving the quality of services as well as addressing access and coverage issues to ensure inclusion of the most vulnerable groups. In addition, given the importance of capacity building and training on both programme delivery and portion of funding allocation, it is necessary to strengthen and expand current training methodologies to a more comprehensive, inter-sectoral approach. Similarly, an inter-sectoral approach is required to address some gaps in programming, such as early childhood care and development, girls' education, and safe motherhood. Finally, monitoring and promotion of the Convention on the Rights of the Child need to continue in a more targeted manner.
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