Global Annual Results Report 2020: Goal Area 1
Ensuring that every child has the right to life, survival and development, and to grow up healthy and strong
Every child survives and thrives
COVID-19 interrupted progress against every aspect of child survival, growth and development in 2020. Severe service disruptions reduced access to maternal, newborn and child health, nutrition and HIV services and immunization. In addition, the schools of over 168 million children were closed, many for an entire year. Restricted movement increased the risk of abuse and neglect, as well as gender-based violence which in turn increased the risk of HIV transmission to women and children. Access to services and protection has become a challenge for many refugee, migrant, and internally displaced children. While the initial impact of the pandemic has been immediate and severe, the consequences for children will be felt long into the future.
4,725 health-care facilities
in 52 high-burden countries supported with water, sanitation and hygiene (WASH) services
was certified as free of wild polio virus, in turn affording Africa the same status
17 million children
in humanitarian situations vaccinated against measles
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. Using primary health care as a foundation, UNICEF aims to deliver results at-scale, through integrated and multisectoral programming.
The COVID-19 pandemic overwhelmed some of the world’s most robust healthcare systems. UNICEF is redoubling efforts to address this new emergency. UNICEF supported the continuity of lifesaving maternal and newborn health, by adapting its programme delivery to respond to the impacts of the COVID-19 crisis, focusing on community-based and digital solutions, and by seizing opportunities to make primary health care systems more resilient.
Maternal and newborn health
UNICEF continued to focus on high-impact survival programmes, that includes special emphasis on improving the quality of care at the time of birth, the acceleration of global efforts to transform care for small and sick newborns and linking facility-based care with follow-up care in the community as the next step for newborn survival.
The COVID-19 pandemic severely disrupted the delivery and utilization of essential maternal and newborn health services in 2020. The disruption of life-saving interventions threatens to erode the significant gains made over the last decade in newborn health and survival and in maternal health and exacerbate pre-existing coverage gaps and inequities.
30.5 million live births
were delivered in health facilities through UNICEF-supported programmes in 2020
By the end of 2020, UNICEF supported 38 countries
to strengthen the quality of maternal and newborn care, and strengthen Sick Newborn Care Units, critical to ensure newborns’ survival, health, growth and development
8 million women
of reproductive age received tetanus toxoid-containing vaccines
Special Newborn Care Units: Saving precious young lives
Sick Newborn Care Units are special newborn units in large hospitals, generally at district level. These units aim to reduce the case fatality among sick newborns, either born within hospitals or outside including home delivery. They also act as teaching and training hubs for imparting the skills of newborn care.
Immunization remains one of the most cost-effective public health interventions. UNICEF advocates for the prioritization of children in the ‘zero-dose’ communities such as those in remote rural areas, urban slums and conflict-affected settings, for the delivery of immunization and other basic health services.
Disruptions to health services led to reduced delivery and uptake of immunizations in many countries during 2020. Amidst the adverse consequences of the pandemic lies an opportunity, to reimagine immunization, to bring better results for children especially the most disadvantaged. To build back better, routine immunization services must be restored, revitalized and firmly integrated within primary health care. UNICEF’s large-scale delivery of COVID-19 vaccines also provides an opportunity to strengthen systems.
66.3 million children
were vaccinated with three doses of the diphtheria, tetanus and pertussis (DTP3) vaccine in 64 priority countries in 2019
2.9 million girls
in target countries received their final dose of HPV vaccine to help protect against cervical cancer
UNICEF procured 1.9 billion doses of vaccines for 102 countries
– enough vaccines to reach 45 per cent of the world’s children under 5 years of age
Eradication of polio in Africa
Polio, a virus that is transmitted through contaminated water and food, or contact with an infected person, was once the leading cause of paralysis among children worldwide. UNICEF worked with volunteers in Nigeria to pioneer new models of community infrastructure: the influence and trust that volunteers possess had a critical impact in the polio eradication programme. After three consecutive years without any cases of wild poliovirus, in August 2020, Nigeria was certified as wild poliovirus free, in turn affording Africa the same status.
To address the leading causes of under-five deaths, UNICEF interventions aim to accelerate progress and change the current trajectory, access to and utilization of high-impact interventions to reduce child deaths from pneumonia, diarrhoea and malaria. UNICEF continued to implement its thrive agenda, including through the strengthening of multi-sector nurturing care for ECD and disability interventions through health platforms, as well as injuries, prevention of non-communicable diseases (NCDs), management of chronic conditions and addressing environmental pollution and climate change.
8.6 million children
with suspected pneumonia received antibiotics through UNICEF-supported programmes
36,816 community health workers
enhanced their skills to improve equitable health care for children that need it the most
17.5 million people
in 22 countries received insecticide-treated nets
16,795 oxygen concentrators
delivered to 94 countries, to address COVID-19 needs and provide services for children with severe pneumonia
Prevent mosquito-borne diseases like malaria
Bancé Fatoumata, 37 years old and her children are happy to receive a mosquito net, in Grand Lahou, in the South of Côte d’Ivoire. The use of mosquito nets help to prevent mosquito-borne diseases like malaria.
Despite the significant challenges posed by the COVID-19 pandemic, 2020 has also been a year of opportunity to mobilize political will and resources for promoting the health and well-being of adolescents globally.
By the end of 2020
75 countries had an inclusive, multisectoral and gender-responsive national plan to achieve targets for adolescent health and wellbeing
8 additional countries
were supported in the introduction of HPV vaccine to protect young girls against cervical cancer, making the total number of countries 16
actively supported by UNICEF with school health programmes
Teen advocates for clean air in Mongolia
Ulaanbaatar, home to half of Mongolia’s three million people, is one of the most polluted capitals in the world. UNICEF has been working with the Government of Mongolia and other partners to reduce air pollution, as well as to protect the health of children and pregnant women from its impact. The Youth for Climate and Clean Air Network initiative champions young people as agents of change to mitigate and alleviate the harmful effects of air pollution by working with communities and decision makers.
244 million children under 5
were reached with services to prevent stunting and other forms of malnutrition in early childhood
35 million adolescents
were reached with services to prevent anaemia and other forms of malnutrition
About 5 million children
were reached with services for the early detection and treatment of severe wasting, in both humanitarian and development contexts
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 child wasting is critical to save lives and return children to healthy growth and development.
After years of steady improvements, the COVID-19 pandemic threatened to unravel hard-won progress in realizing the right to nutrition for every child. The pandemic dramatically affected families’ lives and livelihoods, disrupting access to nutritious, affordable diets; upending the delivery of essential nutrition services; and negatively impacting child feeding practices.
UNICEF’s response to COVID-19 focused on maintaining services through programming adaptations and by leveraging innovations to respond to delivery challenges. Despite the setbacks of 2020, UNICEF is on track to meet most of its Strategic Plan nutrition targets.
Prevention of stunting and other forms of malnutrition
Prevention of malnutrition is the primary objective of all UNICEF nutrition programmes. To prevent malnutrition in children and their mothers, UNICEF works with governments to improve access to nutritious, safe and affordable diets; support quality nutrition, health, water and sanitation services; and promote optimal feeding, hygiene and care practices. This foundation of good nutrition fuels children’s growth, development and learning in childhood and keeps them healthy and resilient throughout their lives.
In 2020, UNICEF supported programmes to improve the diversity of children’s diets in 58 countries, an increase from 47 in 2019. As part of these efforts, UNICEF is testing innovative tools and strategies to support caregivers in feeding their young children.
Complementary feeding bowl and spoon
UNICEF and partners are developing a complementary feeding bowl and spoon as a practical innovation to ensure good feeding practices in the home. Once scaled, this tool has the potential to reach 23 million caregivers in more than 40 countries.
An innovative solution to child malnutrition
In Kano State, Nigeria, UNICEF provided mothers with livestock and seeds to grow vegetables with support and training as a strategy for improving dietary diversity in young children. The success of the project has ignited social change in many communities.
Middle childhood and adolescence are a second window of opportunity to reap the benefits of good nutrition. Yet even before the COVID-19 pandemic, far too many school-age children and adolescents were not consuming the nutritious foods they needed for healthy growth and development.
In 2020, school closures – affecting 1.6 billion school-age children – disrupted the delivery of school meals and other nutrition services in schools. UNICEF adapted its programmes in response to ensure that critical services continued to reach children in need.
The number of countries implementing UNICEF-supported programmes on the prevention of anaemia in adolescents increased from 29 in 2019 to 43 in 2020. UNICEF also made significant strides in scaling up programmes to prevent overweight and obesity: 9.6 million adolescents were reached with services to prevent overweight and obesity in 2020, a significant jump from 5.7 million in 2019.
Improving the food environment in Indonesian schools
UNICEF supported an increasing number of countries to improve children’s school food and nutrition environments in 2020, such as in Indonesia, where UNICEF and the Ministry of Health conducted a study to learn more about food safety and nutrition standards in school canteens
Treatment and care of children with severe wasting
When efforts to prevent malnutrition fall short, children with wasting need early detection, feeding, treatment and care to save their lives and put them back on the path to healthy development.
The COVID-19 pandemic triggered an even greater urgency to maintain services for children with wasting, who were particularly vulnerable. This urgency sparked unexpected policy and programme opportunities and catalysed a radical shift in approaches to expedite and sustain treatment. For example, UNICEF supported more than 70 countries to shift to simplified approaches for detecting and treating children with wasting. As a result, UNICEF and partners were able to sustain treatment services for nearly 5 million children in 2020 – the same number as the previous year.
Detecting malnutrition at home during the COVID-19 period
One of these simplified approaches is training mothers and caregivers to screen their children for malnutrition at home using a mid-upper arm circumference tape. This approach empowers caregivers to make informed decisions about when to seek appropriate care for their children.
HIV and AIDS
34 per cent drop
in the number of new infections among adolescents aged 10–19 years in 2019 compared to 2010
52 per cent drop
in annual new HIV transmissions from mothers to their children between 2010 and 2019 and 2 million HIV infections among children averted between 2000 and 2019
More than 48 countries
received some form of technical and financial support from UNICEF to address COVID-related challenges
Despite many successes, the fast-track targets set for 2020 were missed and the world is now off track to ending AIDS as a public health threat in children and adolescents by 2030. Access to treatment for both pregnant and breast-feeding women and children living with HIV had stalled even before the COVID 19 pandemic.
Almost 1 million children and adolescents are living with HIV who are not receiving treatment. Children with HIV who are receiving treatment face poor outcomes with rates of viral suppression at 37 per cent compared with 60 per cent in adults. The number of adolescent girls and young women who acquired HIV in 2019 (280 000) was nearly three times the Fast-Track target for 2020 (100,000). High rates of HIV acquisition persist among adolescent girls and young women, mainly driven by harmful social norms, pernicious gender inequalities, sexual violence, poverty and age-disparate sex. Each day, 880 children became infected with HIV and 310 children die of AIDS-related causes. These are not small tragedies for families and societies.
Commemorating World AIDS Day on 1 December 2020
UNICEF’s ongoing work to accelerate the HIV response for pregnant women, mothers, children and adolescents aims to address major gaps that highlight their heightened vulnerability and identify where improvements must be made. It also emphasizes building and increasing resilience among these populations in all parts of their lives and seeks to remove barriers to their health, safety and well-being. With partners, UNICEF leverages strengthening and integrating health and HIV services, enhancing data collection and use, reducing stigma and discrimination, safeguarding human rights, and promoting innovation and efficiency through data-informed targeted programming.
HIV information for young people in Guatemala through radio spots
In Guatemala, UNICEF is implementing a pilot project in collaboration with UNAIDS to produce radio spots in an effort to reach some of the most vulnerable adolescents and young people with HIV and prevention information. By January 2020, it was estimated that the campaign had reached over 1.6 million adolescents and young people, representing different ages, genders, sexual orientations and cultural identities.
The impact of interrupted health services from COVID 19 will challenge our goals but provide important opportunities to harness as we regain momentum towards achieving the 2030 Sustainable Development Goals (SDGs). In 2020, UNICEF adapted and reimagined its programme delivery to help minimize impacts on HIV responses in countries where it works. These efforts, which included multi-month prescribing, digital communications and empowering communities in self-care, contributed to surprising results. In most countries, there was much less disruption in HIV service coverage than expected based on early modelling. This lesson will serve as a blueprint for further resilience-building approaches for UNICEF to take going forward.
Early Childhood Development
Only 71 per cent of children
globally 36–59 months of age are developmentally on track
have established a national ECD policy or action plan
have government-owned multisectoral ECD programmes
The COVID-19 pandemic has underscored a crisis of care and learning. It has also highlighted the significance of parents and caregivers as first responders for children’s learning and development, especially when childcare and early learning services are disrupted. Despite the challenges this year, multisectoral ECD programmes progressed during the pandemic. In addition to providing adaptable and flexible support to children and families, UNICEF has been working to strengthen enabling systems. UNICEF collaborated with partners to explicitly elevate the needs of parents/caregivers – and to further amplify the importance of creative and alternative play-based learning and responsive care opportunities, including in humanitarian settings.
Improving services and community demand
UNICEF has been strengthening multisectoral packages of interventions. In 2020, UNICEF continued to focus on stimulation and responsive care in the early years. Existing programme platforms, such as community health centres, home-visiting programmes, parenting networks and preschools are being increasingly used as entry-points to integrate stimulation and responsive care with maternal health, child health, nutrition and early learning services. The number of countries with government-owned multisectoral ECD programmes has been increasing since the beginning of UNICEF’s current strategic plan. By the end of 2020, 117 countries, up from 105 in 2019, have government-owned multi-sectoral ECD programmes, which focused on promoting stimulation and nurturing care for young children.
Building stronger institutions
UNICEF has continued to strengthen enabling policy environments to promote multisectoral ECD interventions at scale – critical to institutionalizing ECD practices. This year, 87 countries, four more than in 2019, confirmed that they have a national ECD policy or action plan. UNICEF is also working with 46 countries to advance family-friendly policies (FFPs) to promote paid parental/caregiver leave, breastfeeding support in the workplace, affordable childcare and child benefits. As of the end of 2020, 18 countries reported moving to address at least one of these policy asks.
Playful parenting in Zambia
In Zambia, UNICEF conducted a multimedia communication campaign to highlight the positive role of playful parenting and nurturing care in a child’s development, reaching an estimated 3 million people with messages over social media, billboards, print media, television and radio.
Renewed focus on ECD in emergencies – Action in humanitarian settings
In the face the COVID-19 crisis, more UNICEF country offices prepared to support ECD and/or early learning programmes in humanitarian settings, growing from 46 in 2019 to 74 in 2020. UNICEF reached nearly 2.8 million children under 5 who were living in humanitarian and fragile contexts, including the COVID-19 pandemic. UNICEF supported ECD stakeholders to innovate so that young children’s development could continue to be supported. Countries in most regions sought to adapt ECD programmes to rely on distance modalities already in use, while other countries introduced online parental support and early learning programmes for the first time.
Adapting a humanitarian programme to the COVID-19 situation in Jordan
In Jordan, lockdowns closed face-to-face ECD services in Makani centres. In response, UNICEF helped partners set up WhatsApp groups to provide direct support and guidance on nurturing care to parents and caregivers. UNICEF adapted the Better Parenting Programme, sending regular automated messages to families with information, tips and fun activity ideas for early learning. Refugee families received internet data cards so that they could join. So far, more than 70 videos have been developed and shared with approximately 7,000 parents.
UNICEF will continue to save lives by bolstering the delivery of integrated front-line services through communities, schools and health-care facility platforms. Nutrition programming will focus on the roll-out of both the Nutrition Strategy 2020–2030 and the Global Action Plan on Child Wasting. Strengthening and integration of comprehensive HIV responses will be prioritized toward sustainable health systems for Universal Health Coverage and work to reduce HIV-related stigma will move forward by addressing the social, cultural and legal contexts that perpetuate it. Support for parents will be elevated and UNICEF will continue investing in advocacy and technical support for the adoption, scale-up and sustainability of ECD programmes.
As the COVID-19 pandemic enters its second year, UNICEF remains firmly committed to working with partners to provide a future where children thrive as well as survive. UNICEF is focused on responding to the COVID-19 pandemic by saving lives, maintaining services and strengthening systems.
This report highlights the achievements made possible by the generous contributions of softly earmarked thematic funding received from various partners. UNICEF would like to express it's sincere appreciation for these contributions.
The COVID-19 pandemic has had a huge impact on vulnerable children. While young people are not among those most at-risk of contracting the virus, the social and economic ramifications of the pandemic have been particularly acute for the most vulnerable and marginalized. Shocks to the global economy, to networks and services, to social systems and to parents and caregivers have slowed progress against every measure of child survival, growth and development. Throughout the year, UNICEF redoubled efforts to save lives, maintain critical services and continue strengthening the systems that support children’s ability to survive and thrive. This was accomplished in part through UNICEF’s Goal Area 1, which brings together four interconnected sectors – health, nutrition, HIV/AIDS and early childhood development (ECD) – in support of Sustainable Development Goals (SDGs) 2, 3, 4 and 5.
This report summarizes how UNICEF and its partners contributed to Goal Area 1 in 2020 and reviews the impact of these accomplishments on children and the communities in which they live.