Survive and thrive

UNICEF helps to reduce child mortality in the region by working to reach the most vulnerable children.

A mother holding her baby


Help children survive and thrive in a region where still far too many do not see their fifth birthday.

While real progress has been made – the outlook on child survival in Eastern and Southern Africa has improved steadily since 1990, with under-five child mortality rates reducing at an average annual rate of 3.7 per cent – challenges remain.

Progress in reducing under-five mortality has been uneven throughout the region. There are significant differences across countries, and clear inequalities within countries. Maternal mortality continues to remain high and the region accounts for a quarter of all maternal deaths worldwide.

Overall, 31.5 per cent of under-five deaths are attributable to preventable causes such as malaria, pneumonia and diarrhoea. Newborn deaths account for more than 4 in 10 under-five deaths, and for every 10 newborn deaths, there are 9 ‘invisible’ stillbirths. About 30 per cent of neonatal deaths in the region are due to complications during delivery, prematurity, infections and pneumonia.

Despite progress made to eradicate polio in the region, some countries remain at risk and require significant and sustained efforts in the areas of surveillance, control, eradication and routine immunization – especially those in the Horn of Africa sub-region, as well as South Sudan and Madagascar.

Children are also at risk of not achieving their full developmental potential because of inadequate caregiving and early stimulation practices, particularly in the first 1,000 days of life.

A baby looks at the camera, his mother hands hold his.
In South Africa, A mother (partially visible) plays with her 1-year-old son, who is sitting in her lap.

Children’s experience during this period powerfully impacts their health, potential and productivity as adults, influencing individual incomes, household poverty and national economic growth. In addition, high levels of violence against younger children negatively impacts brain development, mental and physical health and the development of social skills.

In recent years, there has been remarkable progress in dual elimination of mother-to-child transmission of HIV and Syphilis (eMTCT). Greater efforts are required to ensure that all children reach the end of breastfeeding HIV-free, and that children who are living with HIV receive prompt and effective treatment and care.

Increased investment in transforming national civil registration and vital statistics systems has been demonstrated in Mozambique, Uganda, the United Republic of Tanzania, and Zambia. Despite these opportunities, national civil registration and vital statistics system reform plans are still underfunded.

Adequate water, sanitation and hygiene practices are critical to well-functioning health facilities, and can contribute to improved maternal and child health. Clearly there is much to do for the children of Eastern and Southern Africa. Happily, must is being done, with continued new solutions and co-creation with partners.


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Neonatal and maternal care

Every mother has a safe pregnancy and birth, and every newborn has a fair start in life.

UNICEF works to scale up quality health services for antenatal, delivery and postnatal care. Community health services that deliver a set of preventive and promotive measures, and basic curative care, with a focus on hard-to-reach areas, are equally vital to improving health outcomes. HIV prevention, diagnosis and treatment, especially for underserved mothers and children can be improved through the scale up of community-based care and differentiated strategies.

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Under-five child mortality reduction

Every child has adequate care and stimulation in the early years.

Good health facilities and staff who are trained in the integrated management of childhood illnesses means that more babies can be treated for pneumonia, malaria, diarrhoea, and paediatric HIV and TB. That is why UNICEF supports capacity strengthening of health facilities and staff, development of strong community platforms for delivering quality integrated community case management and monitoring of public spending in the health sector.

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Expanded Programme on Immunization and polio eradication

Every child immunized against childhood diseases.

UNICEF believes that no child should be left behind when it comes to vaccination. The Reach Every District approach targets deprived districts, communities and harder-to-reach children, in particular those children who have received zero doses of immunization. A good vaccination programme needs a fully functional cold chain, integrated supply management systems and efficient procurement processes. UNICEF is there every step of the way.

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Health emergencies

UNICEF works closely with partners to provide a humanitarian response for women and children. UNICEF works on the early detection and control of epidemics, while ensuring continuity of reproductive, maternal, neonatal and child health services.

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Early childhood development

Research has shown that nurturing approaches, stimulation and protection from violence, particularly in the first three years of life, are beneficial to a child’s overall development. UNICEF in Eastern and Southern Africa supports community-based parenting and care programmes.

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Birth registration

Every child has a legal identity.

UNICEF is leveraging resources for scaling up successful interventions for increasing birth registration. Although advances have been made in recent years, the goal is strengthened government leadership to manage and oversee civil registration and vital statistics systems reform at national and subnational level.

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Water, sanitation and hygiene in health facilities

Clean water and safe hygiene practices within health facilities can improve healthcare outcomes for babies, children and mothers. UNICEF works with partners to develop policies for institutionalizing Water, Sanitation and Hygiene in healthcare facilities, prioritizing those health facilities that provide maternal, neonatal and child health services.