Global annual results report 2019: Goal Area 1
Progress, results achieved and lessons from 2019 by Goal Area 1: ensuring that every child has the right to life, survival and development, and to grow up healthy and strong
Thirty years ago, a promise was made to the world’s children. That promise, crafted by global leaders and enshrined in the Convention on the Rights of the Child (CRC) articulates every child’s right to survive and thrive. This is the focus of Goal Area 1; ensuring that every child has the right to life, survival and development, and to grow up healthy and strong.
In UNICEF’s Strategic Plan (2018-2021), Goal Area 1 works across four interconnected sectors to address the structural challenges impeding children’s right to survive and thrive: health, nutrition, HIV/AIDS, and early childhood development. Goal Area 1, which contributes to Sustainable Development Goals (SDGs) 2, 3, 4, and 5 reported output level progress of over 90 per cent for all of its nine result areas. And while this strong performance is encouraging, the impact and outcome-level progress across the Goal Area is currently too slow to achieve the SDGs.
This report summarizes how UNICEF and its partners contributed to Goal Area 1 in 2019 and reviews the impact of these accomplishments on children and the communities where they live.
Every child survives and thrives
Both girls and boys have the ability to survive in their communities if a number of critical, quality services are available to them throughout their lives.
These same children have a chance to thrive in situations where they have access to nutritious foods; quality water, sanitation, and hygiene; are stimulated and cared for at home and in their community; and enjoy an early childhood education that gives them opportunities to learn and grow. This is particularly critical for girls and young women, for children who are the most vulnerable, marginalized or hard to reach, and during times of humanitarian crisis. UNICEF also engages with adolescents to ensure they are reached with services in the areas of health, nutrition, HIV and AIDS.
UNICEF is focused on improving child survival, growth and development by addressing the major challenges that have kept progress slow. To do this, UNICEF is leveraging community engagement and social data analytics – and working across sectors to address the social, cultural and financial barriers that stand in the way of results for children. In 2019, global programme expenses in Goal Area 1 across 152 countries totalled $2.15 billion.
Guided by the Convention on the Rights of the child (CRC), the most complete statement of child rights ever produced, UNICEF’s health programming is informed by human rights approaches and principles with a focus on those children who are the most deprived, disadvantaged or discriminated against. UNICEF strives to deliver results at-scale, through integrated and multisectoral programming using primary health care as a foundation. In 2019, health programmes were implemented in 119 countries with the help of 1,079 technical staff.
Maternal and new-born health
In 2019, UNICEF placed a special focus on improving the quality of care at the time of birth, accelerating global efforts for transforming care for small and sick newborns, moving from a survival-only approach to a more holistic early childhood development (ECD) approach encompassing survival, growth and development and linking facility-based care with follow-up care at the community level as the next frontiers for new-born survival.
27.4 million live births
delivered in health facilities through UNICEF-supported programmes
>6 million women
received two or more doses of tetanus toxoid-containing vaccine
received support from UNICEF to strengthen the quality of maternal and newborn care, in contexts of high neonatal and maternal mortality
3,008 health-care facilities
have improved access to WASH to strengthen the quality of maternal and newborn care in high-burden countries
Immunization is one of the most successful public health interventions, reaching 86 per cent of all children globally. As part of a strategic emphasis on equity, UNICEF advocates for the prioritization of children in the ‘zero-dose’ communities – such as those in urban slums, remote rural areas and conflict settings, and other minority and marginalized groups – for the delivery of immunization and other basic health services.
65.7 million children were vaccinated with three doses of the diphtheria, tetanus, and pertussis (DTP3) vaccine in 64 priority countries in 2018.
41.3 million children in humanitarian settings were vaccinated against measles.
A polio-free status was maintained by Nigeria for a third year, paving the way for the potential certification of Africa as polio-free in 2020.
UNICEF is supporting the Child to Child strategy where primary school children are enlisted as immunization mobilizers and defaulter tracers. As a result, more than 3,200 pupils were enlisted from 45 primary schools and were able to register and follow up on the vaccine completion of 6,867 children.
With UNICEF support, over 18,500 community-based vaccinators engaged with communities with the support of local influencers in polio high-risk areas, making significant gains in rebuilding community trust and reducing the number of children missing out on polio vaccination, in addition to promoting key health and hygiene practices beyond polio.
Globally, pneumonia, diarrhoea and malaria remain the leading causes of death for children under age five. In addition, over half a million children under five years died from air pollution related causes in 2016. An estimated 300 million children globally, including 17 million babies, currently live in areas where the air is toxic – exceeding international limits by at least six times.
9.5 million children
with suspected pneumonia received antibiotics through UNICEF-supported programmes
24.83 million people
in 21 countries received insecticide-treated nets
35,840 community health workers
enhanced their skills to manage and treat childhood illnesses
UNICEF is on-track and achieved all planned milestones in 2019 for adolescent health and wellbeing. Mobilizing political will and resources for implementation, using technology and strong youth engagement across all aspects will be a priority in the coming years.
have an inclusive, multisectoral and gender-responsive national plan to achieve targets for adolescent health and wellbeing
(exceeding 2021 target of 45 countries)
were supported to introduce HPV vaccine to protect young girls against cervical cancer
were implementing school health programmes in at least two intervention areas, with UNICEF actively supporting 33 countries.
Good nutrition is the right of every child. Well-nourished children are more likely to survive and thrive. They are better placed to lead healthy lives, access equal opportunities, and participate fully in their communities and nations.
UNICEF prioritizes interventions to prevent all forms of malnutrition – including stunting, wasting, micronutrient deficiencies, overweight and diet-related non-communicable diseases. Where prevention falls short, the early detection and treatment of children with life-threatening wasting is critical to saving lives and returning children to healthy growth and development.
307 million children
were reached with services to prevent stunting and other forms of malnutrition
60 million adolescents
were reached with services to prevent anaemia and other forms of malnutrition
5 million children
benefitted from services for the early detection and treatment of severe wasting and other forms of severe acute malnutrition
Prevention of stunting and other forms of malnutrition
Understanding the barriers to and drivers of good diets is essential to preventing malnutrition in children under 5 and their mothers – particularly during the critical developmental period from pregnancy to the child’s second birthday.
Before and during pregnancy, nutrition counselling and supplementation with essential nutrients (e.g., iron and folic acid) can improve women’s nutrition and children’s growth and development, and help ensure a healthy pregnancy and delivery for mothers and babies. In early childhood, UNICEF programmes aim to increase and sustain breastfeeding, improve the quality of young children’s diets, and support supplementation and food fortification to prevent nutrient deficiencies in settings where nutritious diets are out of reach.
‘Banana bags’ for better complementary feeding in Myanmar
UNICEF, in partnership with Save the Children International and 17 Triggers, piloted an innovation in Northern Chin and peri-urban Yangon, Myanmar, to improve complementary feeding practices. The ‘banana bag’ contains tools and materials to promote dietary diversity, while doubling as a play mat for children. The bags were promoted by midwives and front-line health workers, along with interactive digital content that caregivers can access using their mobile phones.
Adolescent nutrition and health
Good nutrition during middle childhood and adolescence improves school attendance, educational achievement, and cognition, and offers a chance to break the cycle of intergenerational malnutrition and ill health.
UNICEF supports the delivery of nutrition services for school-age children and adolescents that aim to improve nutrition knowledge and skills, support nutritious diets, and provide vitamin and nutrient supplementation where needed. UNICEF has made significant strides in scaling-up programmes to prevent overweight and obesity: the number of adolescents reached with such programmes increased from less than 118,000 in 2018 to more than 5.7 million in 2019.
Food labelling to combat the marketing of unhealthy foods
UNICEF supports countries to adopt front-of-package labelling to help consumers identify whether foods are healthy at the point of purchase. In Mexico, for example, UNICEF and partners generated evidence and advocated for the government to advance legislation on front-of-pack labelling in 2019. Once this legislation is adopted, food labels will be required to warn consumers about excess calories, sugar, sodium, saturated fats, trans-fats, and the presence of caffeine and artificial sweeteners. The legislation will also regulate the use of popular characters and cartoons on food products with one warning label or more.
Treatment and care of children with severe acute malnutrition
UNICEF prioritizes the early detection and treatment of children with SAM as an essential intervention to help severely undernourished children survive and thrive, in both development and humanitarian contexts.
The number of children being treated for severe acute malnutrition (SAM) has continued to rise in recent years: however, globally, only one in four children with SAM is currently being reached.
According to the latest estimates;
- About 5 million children with SAM were reached with treatment and care in 2019, compared with 4.1 million in 2018.
- Of the children admitted for treatment, 88 per cent fully recovered in 2019 compared with 82 per cent in 2018.
Delivering urgent treatment to wasted children is central to humanitarian response. Countries in humanitarian crisis account for 89 per cent of children accessing SAM treatment globally. Yet despite the perception of wasting as the result of acute emergencies, two thirds of all children affected by SAM live in non-emergency settings, where poverty is widespread and where basic services, clean drinking-water and nutritious, safe and affordable diets are out of reach.
HIV and AIDS
The global coverage nearly doubled for antiretroviral treatment among pregnant women living with HIV, rising from 44 per cent in 2010 to 82 per cent in 2018 resulting in an estimated 650,000 infant HIV infections averted, but progress has stalled
This translates to 150,000 new infections in children in 2019, far short of the end 2020 target of <20,000 per year.
We have the tools to win the HIV battle for pregnant women, children and adolescents. Lessons learned show us that when there are technical and financial resources, political will, engagement of these populations and strong underlying health systems, great achievements are possible.
Treatment and care of children and adolescents living with HIV
Treatment is life-saving for the 1.8 million children living with HIV, and just over half have access to treatment (54%). But treatment coverage has stalled in the last four years and far from the global target of 95%. Mortality has declined due to prevention of mother to child transmission efforts, but we are still far from ending AIDS in children.
UNICEF is improving ART coverage for children by leading the way in technologic innovation to reach infants with an HIV diagnosis. In 2019, UNICEF committed to expand access to point-of-care (POC) diagnostics in 10 countries in West and Central Africa to improve HIV testing coverage in HIV-exposed infants and HIV viral load monitoring in people on antiretroviral treatment.
"We need to test infants as early as possible, give them the correct ARVs and then, that makes it better for their survival and general health. With this approach, we have seen the time between test and initiation of ART decrease from 90 days to almost 1 day."
Adolescent HIV Prevention
An estimated 1.6 million adolescents (10–19 years) were living with HIV in 2018, an increase of 4 per cent since 2010. And despite a 25 per cent decline since 2010, new HIV infections among adolescent girls and young women (15–24) are still more than three times higher than the global target set for 2020.
UNICEF continues to engage the leadership of young people in this response and transferring that knowledge to the Global Fund Catalytic Initiative on prevention of new infections in adolescent girls and young women in 13 African countries.
"The sustainability of HIV response highly depends on our capacity to reach the most marginalized, including, young people to address their specific needs.”
Early Childhood Development
2019 witnessed a significant increase in the recognition and renewed commitments to enhancing collaboration and investment in Early Childhood Development (ECD) across sectors, including governments, UN agencies, CSOs, and businesses.
The foundation for sustainable scale up of ECD services has been progressing
have multisectoral ECD packages on track for scaleup with established government ownership and costed action plan
have established enabling policy environment for ECD with national policy or action plan in place
affected by humanitarian contexts had play, stimulation and early learning opportunities through ECD in Emergency programme
The UNICEF ECD Kit for Emergencies and kits made with a locally procured materials continued to play a pivotal role in delivering ECD programmes for children affected by humanitarian situations, including refugee children and internally displaced children. The kits also support caregivers and their ability to create safe environments to afford play, stimulation and early learning for young children.
ECD kits provided 158,706 children in the Rohingya refugee camps under 5 years, including 645 children with disabilities, with ECD opportunities.
Community-based ECD centres in 11 refugee-hosting districts served as platforms for multi-sectoral services to drive healthy stimulation for more than 110,000 children.
UNICEF supported the integrated centre and home-based ECD services for 6,660 children Mahama refugee Camp.
The world is currently not on track to meet the SDGs. Failing to achieve goals and targets translates to needless loss of life despite the existence of known, low-cost and proven solutions to preventable and treatable causes. This reality compels UNICEF to take bold steps, working collaboratively with its trusted partners, to create a world that helps children survive and get the best start in life.
In responding to the COVID-19 pandemic, UNICEF will aim to ensure that children’s right to survive and thrive services are protected, including through efforts to mitigate the impact of disrupted food systems, strained health systems, lost livelihoods and children out of school, while employing the ethic of doing no harm and minimizing new risks. UNICEF will look for opportunities to harness new technology and innovations and scale up linkages between health, nutrition, HIV, ECD and social protection to reach children and families most at risk during the ensuing economic downturn.