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UNICEFAnnual Report

ContentsIntroduction by the Executive Director, James P. Grant 3

UNICEF 1983-84: a review 5Highlights of the year's pro/jramme co-operation, including trends andkey events, illustrated hy specific progmmiM profiles from different countries.

Child health and nutrition 7Primary health care 7

I*rvfile: "G" is tor "growth" (COLOMBIA) 8Towards a revolution in child survival 10

Profile: "Forward with the prevention of diseases" (ZIMBABWE) 11Profile: Breast and bottle (CONGO) 13Profile: They thought one shot was surely enough (PHILIPPINES) 15Piv/;fc:Tneklmidhushands"or*Bali (INDONESIA) 16

Child Nutrition 17Other basic services for children 19

Safe water supplies and sanitation 19Profile: Spreading the good news about water and sanitation (NIGERIA) . . 20Profile: "We need water, not gold" (BURMA) 22

Formal and non-formal education 23Profile: The clay-pot savings scheme (BANGLADESH) 24

Urban basic services 25Profile: A sense of comradeship (BRAZIL) 28

Women's activities 30Profile: Crocheting may not be the answer (COSTA RICA) 31

Childhood disabilities 32Appropriate technology 33

Profile: Sushila needs a new kitchen stove (NEPAL) 33Programme support activities 34Advocacy for children 36Emergency relief and rehabilitation 39

Profile: Seeing it coming just wasn't enough (ETHIOPIA) 40Map: UNICEF in action: programme commitments in the developing world . . . . 26

UNICEF's finances: income, commitments, andexpenditure 1983-84 43

Chan: UNICEF income 1979-84 43Map: 1983 governmental contributions 44Tabk: 1983 non-governmental contributions 46Chan: UNICEF income, by source 46Chart; UNICEF expenditures 1979-84 47Charts: UNICEF expenditures on programmes by .sector 1979-83 48

What UNICEF is and does 49An uvwieir of UNICEF's philosophy, policies, methods of programmeco-operation, mid supporting activities.

UNICEF's ExecutiveBoard1 August 1983 to 31 July 1984

Officers of the Board:Cbnninan (Kvivwrm- liotuii):

Dr. (Mrs.) Hmtce Mjrtinc/. dc Osorio(Venezuela)

Omitwati (Prtgpnmnic Commime):Mr. Amvan.il K.. Chowdhiiry (Bangladesh)

Clmhimni (Committee an Administrationami Finance):Mr. Jassim Bu-Allai (B.ihr.iin.i

First Vice-Chairman:H. H. Mr. Umhcno La ROUCJ (Italy)

Sccmui Vkc-Cbftinnan:Mr. Mihaly Siniii fHungan, 1 )

Third \ rke-Chainiinn:H. K. Mr. Arsu-Korti Amcga (Tdgo)

fourth Vkc-Chamium:Dr. Richard Manning (Aiisrrali.il

Members of theA IfHTUl

AustraliaAustriaBa&minHattfjiadwh(. 'anadnCiiitral Afi-ktw

ftya&UeChadChile(. 'IlinnC AihniihiaCubaFifilnnHFrance(imiHiti Democratic

Republic(u-nimm1. Federal

Rt-puf'lir ofI iituijfnyIndinItalyIwn Ctm.fi

BoardJapan

Lesotho

Alotifitin.tf.nr

MexicoNepalNfrhrrlaiuisI'ni'i-ftmiPfuiattuiSomaliaSwazilandSwedenSmtzwlawiThailandTiiijoUnion of'Soviet

Sontilitf RepubKcsI 'iiiicri Ami' EniimrfSUnited KhttidtnnLhiitfd Stares

of AmericaUpper VoltaVewzuefaI'luitxlnnn

Introductionby the Executive Director, James P. GrantThis pasr year has undoubtedly beenthe most exciting of the tour yearswhich I have served as UNICEFs Exe-cutive Director. That excitement hascome from a growing sense that,despite the terrible economic condi-tions that continue to afflict imnycountries and the lives of millions ofpeople, children still have, a chance.

That chance for children is not justto survive, but to grow in health asproductive, self-reliant human beings.

My belief that this possibility existshas gradually strengthened despitemany grounds tor pessimism. After all,these past tour years have brought anear complete reversal to the positivedevelopment trends which had charac-terized the previous three decides.Many of us will remember that 1979,the International Year of the Child,was celebrated in an atmosphere ofoptimism and renewed dedication tothe cause of children and childhoodeverywhere.

That note of promise quickly faded.Before the decade began, the WorldBank predicted that the absolute num-ber of the world's poor would decline;two years into the decade, the UnitedNations forecast, that, instead, thenumbers of absolute poor would in-crease from 800 million to one billionby the decade's end. Infant mortalityrates had been on the decline. Bur allthe signs are that in certain areas morechildren died this past year than theyear before, and in some parts ofAfrica, the numbers appear to haveincreased substantially.

In these times of global economicrecession, when developing countriesarc earning less for what they have tosell, often paying more for what theyhave to buy, and when Hinds fordevelopment assistance arc scarcer, itwould be foolish to imagine that inthe next tew years there will be anydramatic increase in the resourcesavailable for social development. Thisis why I have felt it vital, in partner-

ship with our many developmentallies, to seek out by even' meansavailable ways of improving the ratiobetween inputs and results, to try todo more for the world's children withessentially the same limited resources.And just as, in times of hardship, peo-ple suddenly discover reserves ofen erg)' and imagination they neverknew they had, so they have done forchildren in these dark times.

In my introduction to the AnnualRejMtrt last year, I discussed the signst h a t offered grounds for hope.UNICEF, in the 1982-83 report onThe State of the World's Children, out-lined a series ot recent advances in bothbiological science and social organiza-tion which have the potential for pro-tecting the health and lives of millionsof children who would otherwise tallvictim to the ravages of malnutrition,infection, and ignorance; and whichwould, in due course, help to slowdown population growth.

We ibcussed attention in particularon accelerating the spread of four sim-ple, low-cost techniques, which areintegral elements of the primary healthcare and basic sen-ices activities whichUNICEF has been promoting for sometime. These are: growth monitoring ofinfants by regularly plotting theirweight on simple charts, so that moth-ers can "see" the otherwise invisibleonset of malnutrition; oral rehydrariontherapy, to treat the dehydration whichresults from diarrhoea, and which eachyear claims five million young lives; thepromotion of breast-feeding as thesafest, most nutritious infant food;and immunization to protect 10 mil-lion children a year from death ordisability from six major communica-ble diseases.

Wre also highlighted three other pro-gramme priorities - food supplements,family spacing, and female educa-tion - which can contribute signi-ficantly to improving children's healthand reducing child mortality. How-ever, in comparison with die four tech-niques outlined above, food supple-mentation is more expensive, family

UNIOT 354 H4 uuhb

4

spacing is more difficult, and extendingfemale education is both.

As I noted last year, none of thesetechniques is tally "new", althoughthe technology by which some arcapplied has been recently enhanced,or our appreciation of their value - asin the case of breast-feeding — recentlystrengthened. What is new is the in-crease in soeial organization whichmakes it possible to reach people withthem, This is exemplified by theexpansion of primary health care ser-vices, the increase in literacy, thegrowth in the number of women'sgroups, and the phenomenal spread ofcommunications media and transistorradios throughout the third world.Evolving social and administrative net-works, reaching right into villages andsquatter settlements, provide coun-tries wi th the oppor tun i ty ofspreading benefits to the poorest intheir societies. It is the combination ofthe child health techniques wi thmobilizing existing resources andcapacities which could save a highproportion of the children's lives nowbeing lost - if the \\wld wants to fin so.

We are now seeing the signs that theworld may, indeed, want to do so.

In December 1982, the Secretary-General of the United Nations appealedto "national leaders, to communica-tors, to health care workers and toconcerned institutions and individuals*1

to "take imaginative steps to heal someof the most tragic wounds of under-development and poverty". He citedthe opportunities outlined in The Stateof the World's Children report, andinvi ted the world to respond.Throughout 1983, the responseswhich we have heard in rhetoric andseen in action show that, even in timesof hardship, the world has shown signsthat it is willing to seize this oppor-tunity for a revolutionary break-through in children's prospects forsurvival and good health.

This December, die Secretary-Generalwas able to report: "Evidence accumu-lates that these and other such simplelow-cost interventions are being ex-tended both by governments andcommunity action groups, with theco-operation of the media and otherforms of mass communication. Gov-ernment leaders from a wide range ofdeveloping as well as industrializedcountries have pledged their support,reinforcing the United Nations1 call forurgent and sustained action for children.

They have been joined by non-govern-mental groups such as the League ofRed Cross Societies and authoritativeprofessional bodies . . , parliamentar-ians in Asia, Africa, and the Americas,and religious leaders at world level aswell as at national and communitylevels."

UNICEFs 1984 State of the. World'sChildren report documents thatevidence from around the world, andchronicles the commitments whichhave been made in the past year byleaders. Organizations and institutions.

These signs are still scattered. Manyof the pledges are yet to be rumed intoaction. Many of the actions will bevaliant attempts but will fall short.And, of course, more campaigns willneed to be launched, and more pro-grammes implemented, before a per-ceptible impact is made in the dailydeath toll of 40,000 small children.But what has happened is cause forexcitement and hope.

That sense of excitement and hope-can be sensed within UNICEF. Aswell as increasing the effectiveness ofour programmes and advocacy onbehalf of children, we have alsoresponded to the challenge of thesedifficult t imes wi th in our ownorganizational framework. The waysin which we have done so — by refin-ing our criteria for programmingassistance, by relocating our personneland technical resources, by increasingthe cost-effectiveness of our opera-tions — are documented in the mainRci'it-ir, chapter of this 1984 AnnualReport.

As I look back as this year of intenseUNICEF endeavour draws to a close,I feel a profound sense of satisfaction.It stems not merely from the fact thatthe entire UNICEF family - Execu-tive Board, secretariat. National Com-mittees for L'NICEF, donor countriesand recipient countries alike - haveresponded so promisingly to the chal-lenge for child survival. It stems fromthe growing signs that this oppor-tunity • • which we have called a"Child Survival Revolution" hasrapidly grown so much larger thanUNICEF. It is becoming an integralpart of the priorities of manymultilateral and bilateral developmentassistance agencies; of the programmesof non-governmental organizations; ofthe coverage of information servicesand communications media; of theministries of churches and religious or-

ganizations; and it is gradually takingits rightful place in the commitmentsgovernments make to their people,and in the demands people make oftheir governments.

The "Child Survival Revolution" Isnot a UNICEF programme. We canarticulate its potential to those whowill listen, and we can help translateideas into action with the very limitedresources which governments and con-cerned individuals entrust to ouradministration. But in the last analysis,we can only claim to be but one of themany forces which must join togetherto make this "revolution" real, andgive children the chance which theywould otherwise nor have. Our great-est hope is that these forces willtogether constitute such a vast multi-tude that the UNICEF contingent intheir midst will be indistinguishable.

This Ann-Hal Report reviews the workwhich UNICEF has been doing tohelp transform that revolution onbehalf of children from a dream into areality.

fl*M toG.n**James P. Grant

Executnv Director

UNICEF1983-84: a review

Over the past few years, globaleconomic recession has cast a darkshadow over the prospects for thepoorest in the developing world.Modest recovery- in the industrializedcountries during 1983 was not mir-rored in the developing countries,some of which are struggling hard toreturn to income levels of pre-reccssion years.

In the words of UN Secretary-General Javier Perez de Cucllar, theseare times of "acute financial strain forsocial services and tor international co-operation"-a situation which chal-lenges UNICEF from several direc-tions simultaneously- At a momentwhen women and children in poorcommunities lace even more profounddeprivation than usual, social sectorexpenditure is declining in almosteven- country; at the same time, thereis considerable pressure on the shrink-ing resources available for internationalassistance, whose investment level inthe social sector is parsimonious at thebest of times. UNICEF itself has beenhard-pressed to maintain, let aloneexpand, its own capacity to helpwomen and children in need.

During 1983, a special study entitledThe Impact of World Recession onChildren was prepared by UNICEFst.iff and field offices, assisted by apanel of distinguished economists.The moment had come, in UNICEF'sview, to assess as specifically as possiblethe actual impact of world economicrecession on the well-being of childrenin different parts ot the world.

The task of measuring changes in thewell-being of children is difficult. It iseasier in most countries to establishhow many dishwashers have been soldin the past year than to find out howmany children have been immunizedagainst disease. In fact, one of thestudy's main recommendations wasthat a "Child Monitoring System" beset up in every country to provide earlywarning of deterioration in children'swelfare.

In spite of data deficiencies, theevidence Forthcoming confirmed ingeneral the assumption on whichUNICEF has been working in recentyears, namely that children in poorsocieties arc measurably suffering therecession's effects. In the northern

provinces of Zambia, for example,there arc indications that children'sheight-for-oge is falling; in Sao Paolo,the proportion of low-birth-weightbabies is rising; in one area of CostaRica, the number of children beingtreated for severe malnutrition doubledbetween 1981 and 1982.

The impact of recession, however,differs considerably in different parts ofthe world. In some countries, welfareprogrammes were less drastically cutthan had been feared. In the Republicof Korea, allocations tor mother andchild health care actually increased andin Chile, food supplementation pro-grammes for pregnant and lactating

mothers and the under-fives wereexpanded.

In general however the conse-quences for children and mothers weregrave. The situation in Sub-SaharanAfrica is very serious. Economicgrowth in the region has lagged farbehind that of other parts of thedeveloping world. In man}' countries,per capita income was lower in 1980than ten years earlier, and since thenhas dropped still farther. Disastrousterms of trade, drought and armedconflict have devastated many eco-nomies. In 1983, 22 African countrieswere on FACTs "Food Alert" list, giv-ing rise to great concern about their

The situation inSulf-SaharanAfrica isparticularly serious,A mother and hertwo children,victims oftirofyjbt,fit a feeding centrein Nouakchott,Mauritania.

I ' M C I-.!- 247/83/Murrtv-Lee

Within the poorest communities, it is often the most vulnerable - the women and children- who hear the brunt when times arc hard.

children's nutritional status.It is clear that Sub-Saharan Africa

needs to be singled out as a special case.Among basic services for children,education has been hard hit, and inothers primary health eare programmesarc crippled by persistent shortages oisupplies, including fuel for transport,spare parts tor vehicles and refrig-erators, medical equipment and essen-tial drugs.

Among other finding?, the studydoeuments the multiplier effect whichreinforces the impact of global eco-nomic cut-hack on those least able towithstand it-on those so poor thatthey have little or nothing to fall backon when times are hard. The studyestimated that a one per cent fall in thegrowth rate in the industrialized coun-tries produced a one-and-a-half percent fall in that of the developingcountries. Within the developingcountries, an echo of the same processpasses the effect onto the poorer sec-tions of society: a two per cent na-tional decline, for example, can resultin a 10 or 15 per cent decline in theincomes of the poorest communities.

Although there are signs in theindustrialized countries of someeconomic upturn, in many developingcountries the picture is of deterioratingwell-being among children, with worsestill to come. And by the same token,the level of resources available to meet

their needs both from within theirsocieties, and from external assistancechannels, is unlikely to grow over therest of the 1980s.

During the past year, UNTCEF hasdevoted much of its energy to develop-ing a strategy specifically designed tomeet this set of challenges. The firstchallenge is: how best to reverse themultiplier process, to respond to themounting effect of economic hardshipon those least able to stand the strain,with policies whose potential bene-fits-as opposed to disadvantages—aremutually reinforcing. In this context,as spelled out in the Executive Direc-tor's introduction to this AnnualReport, UNICEF has redoubled itscampaign to persuade opinion leadersand policy makers everywhere of thepotential for a "revolution'1 in childsurvival and development prospects, inspite of the setbacks of recession.

Such a potential rests on the provenefficacy of the package of low-costchild health interventions firstelaborated in the 1983 State of theWorld's Children report. The forcefulpromotion of these actions, throughprimary health care sen-ices using para-medical workers, reinforced by vol-untary organizations, and backed upbv media and educational campaigns,would constitute a great step forward.Until and unless countries assess the

impact of their existing policies ontheir children's well-being, and recon-sider how to use the resources availablein ways that ameliorate the recession'seffects, the world's poorest womenand children will continue to be itsprincipal victims.

The second challenge is: where toapply UNICEFs own scarce resourcesto achieve the maximum impact forthose in need. At the May 1983 ses-sion of the Executive Board, UNICEFdecided to make an addition to thecriteria used to allocate its financial andtechnical support between countries.A new emphasis is now being placedon the Infant Mortality Bate (IMR), asa guide both to the levels of UNICEF'sassistance to countries and regionswithin countries, and to the ftx-us andcontent of UNICEF's co-operation.The Executive Board deckled that:"The IMR should be used in conjunc-tion with other indicators (includingnotably GNP per capita an'd childpopulation) and applied as a guidingprinciple, not as a rigid formula."

The third challenge is to UNICEFitself. Not only within UNICEF's pro-gramme of co-operation, and in itsdiscussions with governmental andnon-governmental partners, withsister organizations in the UN systemand outside it, but within UNICEFsown structure and operations, thechallenge of adjusting to the effects ofthe recession has had to be addressed.

The emphasis on IMR has ledUNICEF to expand its level of co-operation and the allocation of its per-sonnel and support services to coun-tries with high IMRs, particularlythose in Sub-Saharan Africa. Effortshave also been made to streamline thedelivery of supply assistance to fieldprogrammes by the consolidation ofmost of UNICEF's procurement andsupply operations in a new centre inCopenhagen. Special funds have beenallocated tor country or regional pro-grammes specifically directed at reduc-ing the IMR,

Within UNICEF's existing pro-grammes of co-operation, a specialeffort has been made to reinforce thetraditional areas of UNICEFs principalconcern: the expansion of primaryhealth care services, and their utiliza-tion for the four major thrusts whichUNICEF has identified as having thepotential for a revolution in child sur-vival and devlopment over the courseof the coming decade. D

Child health and nutrition

The "child survival revolution" target: toItnrer infant mortality rates.

Co-operation in health and relatednutrition activities continued to beUNICEFs largest lield of activity in1983. Resources were mobilized for anintensified campaign to reduce dramat-ically infant and child mortality andmorbidity over the next five years.

Despite improvements in healthcare, the infant mortality rate (IMR)has remained extremely high in manycountries, particularly in Africa, wheredrought-related food shortages exacer-bated the deadly effects of malnutri-tion, combined with diarrhoeal, respi-rator)' and other infectious diseases.The global economic recession led toshortages of drugs, vaccines, and trans-port in countries with severe foreignexchange problems. Even countrieswith well-developed services wereforced to make some retrenchments.

Under these circumstances, the chiefhope tor what UNICEF has termedthe "child survival revolution'1 lay inthe extension of such measures as themonitoring of infant and child growth,oral rehydration for the treatment ofdiarrhoea, the promotion of breast*feeding, and universal childhood im-munization, within the context of pivm.irv health care (PHC) sen-ices. The

energetic promotion of this "package"ot child health and nutrition measuresmay in itself provide a boost to theextension of primary health serviceinfrastructures.

The strategy' for the child survivalrevolution was fully communicated toUNICEFs field offices. Many of themsubsequently presented the strategy1

and argued its case in their country'programme consultations with gov-ernments. At the same time there wasa constant exchange of informationyvith field offices on child survivaland development issues. The widesupport received from internationaland national leaders and developingamong non-governmental organiza-

tions (NGOs) yvas also communicatedthroughout the UNICEF field officenetwork. In many countries, NGOshave king been close partners inUNICEF country' co-operation, and inthese countries UNICEF sought theiractive support in accelerated pro-grammes to reduce infant and childmortality and morbidity.

UNICEFs natural allies on the inter-national front included WHO, theleading specialized internationalorganization, as well as the Interna-tional Fund for Agricultural Develop-ment (IFAD), FAO, UNDP, WFP,the World Bank, and many of the prin-cipal bilateral aid agencies.

Primary health careDiarrhoea, acute respiratory infec-tions, and malnutrition were, asalways, the major contributory causesof death in children during 1983.Many countries also reported a resur-gence of malaria in areas where it used

to be controlled. High perinatal mor-tality and high maternal mortality werecited as special problems in some coun-tries. UNICEFs continued emphasison primary health care recognized thatthese and other health problems can

The PHC approachrelief on conmmmticfto take pan inmnniiiq pmxnfivfami simple curativeiCTTttw, throitffhnomhuitiji.fi members

fm- trainituj, andcoHtritmtiiyf jw'medicines and advice.A "clink" in Chad.

[CEFWJ3 Mun-av-l,a-

"G" is for "growth» COLOMBIA

In Colombia's mountainous CaueaDepartment in the southwest, aspecial campaign has beenlaunched to focus on four life-saving aspects of primary healthcare for the young child: growthmonitoring, oral rehydrationtherapy, breast-feeding, andimmunization.

In its present pilot stage, theproject is being carried out in twoadjacent districts, Piendamo andMorales. While far from being thepoorest in Cauca, these have beenselected because they have a fairlygood primary health care infra-structure, so as to give the projecta fair trial. For the past eightyears, 21 health promotoras havebeen visiting the families in theirneighbourhoods, introducingthem to sound health and hygienepractices. Now these promotarashave been given special training ingrowth monitoring and the otherproject components.

Even it" these arc not theworst-off areas of the Cauca, starkpoverty is common enough tocomplicate implementation ofwhat would seem to be straight-forward child health measures.The introduction of the growthchart, tor example, has beenfraught with special difficulties.

Why it is important to fill inthe chart, and how it will help thechild, is not easily understood bymothers whose first concern issatisfying their children's hunger.In the previous growth monitor-ing programme, they were givenfood radons.

They have also been told thatthe child's first weighing musttake place at one of the area's fourhealth centres. Some mothers,especially those with many smallchildren, simply cannot make thelong trek. Others say, "What goodis it to weigh my child if 1 havenothing for him to cat?".

Dr. Angel Erazo, the residentdoctor at Piendamo health centre,recalls one woman who tore upher child's growth chart in his

face. "What could I say? She hada boy who was dying of under-nourishment. We can't practisepreventive medicine here until wehave real solutions for our prob-lems," Dr. Erazo says.

In spite of this and other dif-ficulties, the project has succeededin getting off the ground "inparts", according to Nurse Am-paro, one of the staff at the Pien-damo health centre, who helpssupervise ^tfrwwtoras. The newbaby scales have an unfortunatetendency to slip and land theirsquealing burdens on the ground,and modifications in die designhad to be urgently requested. Butthe rest of the equipment—growthcharts, oral rehydration salts, andthermos flask vaccine carriers-have all arrived and been put togood effect.

The oral rehydration salts havebeen generally well received andacceptance is high. As NurseAmparo notes, "They don't/nnvnt diarrhoea. Diarrhoea isprevented by potahle drinking

water, latrines, hygienic livingconditions-things we have towork at over the long term. Butthey are preventing many deaths,and that is important."

Breast-feeding is almost universalin this region, and in itself is noproblem. Emphasis is thereforebeing placed on its duration, toconvince mothers to continuebreast-feed ing beyond four or fivemonths, with, of course, the pro-per supplementary foods. "Weexplain why it is better to nursefor at least a year. We talk aboutthe baby's health and child spac-ing," says Nurse Butica. "But torsome mothers it is hard. Theymay have to go to the fields towork, and for economic reasonswill find it difficult to nurse aslong as they should."

The Cauca programme has beenat its most innovative in the im-munization strategy. This is basedon "mini-concentrations" of peo-ple in rural areas. Each of thepmmotmns first takes a survey of allthe children in her coverage areawho need to be immunized. Com-munity leaders are then askedto let the people know when theimmunizations will be given, andwhere. The sessions arc usuallyheld at a local school or home,and communi ty leaders come andhelp out.

Among the more encouragingaspects of the whole primaryhealth care programme is the for-mation of local health committees.One of the most outstanding isthat in the small town of Car-pin tero, whose president is JorgeAlzate, the police inspector. Eventhough all the members of thecommittee are men, they are norinhibited about giving spirited lec-tures on breast-feeding and fami-ly planning. As Maria CeciliaLopez, the director of the projectputs it, this is a definite step tor-ward. "When men begin to ulkabout health problems that onlywomen discussed in the past, it is.1 sign of deep transformation in acommunity's attitudes".

only he tackJcd by providing bettersen-ices at the community level.

In general, there was progress andexpansion in primary health care sen--ices in 1983, with an increased accept-ance of the PHC approach, and greaterunderstanding at the national level.UNICEF played an important advo-cacy role in several countries and sup-ported national seminars on PHC aminational reviews of PHC strategy. InColombia, Nepal, Oman, Philippines,Sudan, Swaziland and Thailand, re-views and workshops focussed on theretraining of community health work-ers, specifically to emphasize childhealth measures.

Community involvement is perceivedas being at the heart of the PHC ap-proach, but the health establishment isoften reluctant to accede to commun-ity participation in PHC management.This problem is being dealt with in thePhilippines by including organizationand communication skills in the train-ing of government health workers.

In some countries it has been dif-ficult to obtain support tor local com-munity health workers. Kenya andMalawi are training district teams tomobilize community leaders for plan-ning and managing PHC. Swazilandhas set up community health councilsand carried out leadership courses fortheir members.

Economic constraints have encour-aged more countries to promote com-munity financing. In Thailand, wean-ing food co-operatives, run bywomen's organizations, have been suc-cessful. Village pharmacies are beingdeveloped in Cameroon. Ethiopia isusing revolving funds for the purchaseof drugs.

With the recognition that behav-ioural change is a fundamental prere-quisite for achieving health goals,health education is receiving more em-phasis. There was major stress pur oncommunication programmes forhealth in 1983 in the Arab Gulf coun-tries. Central America, Liberia ,Mauritius, Syria and Tanzania.

In many countries the maternal andchild health (MCH) content of PHC isrelatively weak, and UNICEF advo-cacy for child survival has underlinedthe need to strengthen MCH activi-ties. This has taken the form ofexpanding and strengthening thetraining of traditional birth attendants(TBAs), who still cany out the major-ity of deliveries in many countries. InSudan, a new programme has started to

Child health:four key elements

train traditional birth attendants, sincetrained village midwives only cover alimited part of the population. Nepal,Pakistan, Malawi, Djibouti, Papua NewGuinea, and North Yemen arc also ex-panding their TEA training; and inmany countries TBAs are being trainedin the use of oral rchydration therapyfor diarrhoea.

Most of UNICEFs financial supportto PHC has gone into training andequipment. A critical area thatUNICEF, in co-operation withWHO, has been addressing in recentyears is the supply of essential drugs.Nothing undermines the credibility ofhealth services more than shortages ofdrugs to treat common diseases such aspneumonia, malaria, and parasitic in-festations. Foreign exchange shortagesin many countries have exacerbatedthe problem. In Tanzania, lor exam-ple, a study comparing health servicesin 1978 and 1983 showed an increasein staffing, training, and constructionof health centres, but a reduction ofalmost 50 per cent in items requiringforeign exchange, including drugs.

UNICEF has been a partner withWHO in a joint action programme onessential drugs for several years.UNICEF has supplied drugs to thevalue of about LTSS15 million a yearthrough regular country programmes,and has also helped countries to iden-tify their requirements of essentialdrugs, and to train health workers intheir proper use. In 1983 UNICEF in-creased the level of its co-operation inthis joint programme, giving special at-tention to a number of African coun-tries, including Ethiopia, Somalia,Tanzania, Guinea Bissau, Upper Voltaand Mozambique. Tanzania launcheda five-year programme to ensure a bet-ter supply of essential drugs, withUS$30 million in support fromDANIDA.

UNICEF normally provides healthcentres with only an initial supply ofessential drugs. In Thailand, as part ofthe PHC programme, a network ofnearly 10,000 village drug banks hasbeen established to ensure the replen-ishment of the health services1 phar-maceutical supplies. D

Zimbabwe: a child health card inwidespread use far numitmiwg growth.

Liberia: tin illustrated booklet <m ORT.Jamaica: a leaflet to promote breast-feediiyj.Nigeria: a poster exhorts mothers to haw

their children immunized.

Towards a revolution in child survivalWithin the context of the expansion ofprimary health care services, four speci-fic interventions have been singled outby UNICEF as having the potential, incombination with each other, forbringing about a dramatic drop in in-fant morbidity and mortality. It is this"package11 ot low-cost interventionsthat UNICEF has termed the key in-gredients of a "child survival revolu-tion", and which arc to be given aspecial emphasis within ongoingprimary health care programmes.

Monitoring children'sgrowth

The systematic use of simple charts toshow mothers whether or not theirchildren are growing and gaining weightcorrectly can be an effective aid to betterchild health and nutrition. Unless achild is seriously underweight, or hasthe tell-tale signs of advanced prorcin-calurie ma lnu t r i t i on (listlessness,discoloured hair and a distendedstomach), a condition of under-iHitrition may not be visible to amother. A health card, which chartsthe child's monthly progress up the"road to health", can help the motherto "see" her child's nutritional status.UNICEF is supporting the use ofgrowth charts as an aid to better nutri-tion, and the training of health workersand mothers in how to use the charts tomonitor children's growth and recordother h e a l t h data (see profi leinset from Zimbabwe).

In some countries charts are beingwidely used in mother and child healthclinics, and in others educational drivesare being conducted to promote theiruse. There arc, however, a number ofproblems. Community-based growthmonitoring requires properly calibratedbaby scales, which may not be available.Some health service professionals arereluctant to let the mothers keep thecharts between weighing sessions,because they are viewed more as clinicalrecords than educational tools. Conrli-sion has arisen in some countriesbecause different types of cards are in-troduced by different organizations.

The tnajority ofdeliveries are stillcanned out in nuuivcountries by tradi-tional birth attend-ants, A new babycomes into the nwA/,in Egypt,

Evaluations of the use of charts byvillage health workers, and of mothers1

understanding of their purpose, haveshown mixed results. In Indonesia,95 per cent of volunteers were foundto use the chart properly, and themothers understood it. Studies inSudan, on the other hand, showed thatneither community health workers normothers were convinced of its value.

There is a need tor more in-servicetraining of health staff and communityvolunteers in the growth chart's use. InZimbabwe, 55 district seminars forhealth staff are to be held in 1984, andspecial training of health staff and com-munity health workers in growth sur-veillance is also being carried out inNicaragua, Belize, and Niger. In In-donesia and Liberia, traditional birth at-tendants are being trained in the use ofthe growth charts.

An important function of growthcharts is to alert mothers to signs ofmal- or under-nutrition they haveoverlooked, so that they can make aspecial effort to provide the child withmore food. In cases where sheer pov-erty makes it impossible to do this,other solutions will have to be found;subsidized rood for the poorest fami-lies, for example.

ICEF 8246/Wolff

CHILD HEALTH:In 1983 UNICEF

co-operated in child healthprogrammes in 102 countries:43 in Africa, 21 in theAmericas, 27 in Asia and 11 inthe Middle East and NorthAfrica region

provided grants for training,orientation and refreshercourses tor 68,900 healthworkers: doctors, nurses,public health workers, medicalassistants, midwives and tradi-tional birth attendants

provided technical supplies andequipment for 53,700 healthcentres of various kinds -especially rural health centresand subcenrressupplied medicines and vac-cines against tuberculosis, diph-theria, tetanus, typhoid,measles, polio and otherdiseases

! ( )

"Forward with theprevention of diseases!^ ZIMBABWE

In the grounds behind ChinyikaClinic in Mashonaland, Zimbabwe,a group of mothers is seated be-neath a tree, their small children intheir laps and older ones gatheredaround them. A mobile immuniza-tion team is holding a clinic."Pamberi mkutiziririra zmnwrcrshouts Sister Nhliziyo, die sister incharge of community health: "For-ward with the prevention ofdiseases!"

The mothers respond:"'Pamberir - "Forward!"

Sister Nhliziyo holds up a childhealth card. "What is this?" she asks.

"It is for preventing diseases,"says one mother.

"How does it prevent diseases?""The card shows the diseases

your child is supposed to be vacci-nated against," answers anothermother, and another - withprompting - manages to recite thenames for all six immunizablediseases.

A mother puts up her hand."The card also shows if your childis growing well. When you bringyour child, the nurse puts him ona scale and tells you if you arcfeeding him properly."

This kind of question and answersession is bringing home to Zim-babwean mothers the need to beon the look-out for their children'sgrowth, and how to use the healthcard as a child-care aid.

Most health cards in Zimbabweup to now have been supplied by amajor baby food company. Alarger, more attractive card with apicture of a mother breast-feedingher child has now been issued bythe Ministry of Health. This cardis to be the standard one used:mothers can take their children toa clinic anywhere in the countryand the same information will berecorded. Haifa million of the newcarets have been printed withUNICEF financial assistance.

On the card, a single line showsthe child growth curve, the normalweight at a given age. The previouscards had a "green road to health11

which the mothers found hard to

understand. The new cards cany alot of additional information aswell: a record of the child's illnes-ses; when solid foods were intro-duced; if there are more than fivechildren in the tamily; and thename of the health worker whoinitially explained the uses of thecard to the mother,

To help ensure widest use of thehealth cards, hospitals and clinicsask every mother who bring? a sickchild for treatment for the child'shealth card. Mothers who haveforgotten the cards go to the endof the line. This may seem severe,but the Ministry of Health attachesgreat importance to health cards a>an aid in promoting child nutri-tion, and in reaching the country'starget of universal child immunisa-tion by 1990.

Mothers arc coming to see asymbolic link between die cardsand their children's health. But thecard only works if all levels of staffdealing with mothers and childrenunderstand just how the cards canhelp. For this reason, introductionof the new cards ILLS been accom-panied by an intensive training pro-gramme for all levels of healthworkers.

Where effectively used, growthcharts can serve as a useful entry pointto primary health care- in the commun-ity, motivating mothers to participatein community-based health and nutri-tion activity. Many growth charts con-tain information about a child's im-munization record, and other keyhealth data. In many countries thecharts have proved valuable in the con-text of immunization programmes.

Oral rehy dration

Within the context of primary healthcare, UNICEF has undertaken a majoreffort to promote the use of oral rehy-drarion therapy for die treatment ofdiarrhoeal diseases. These represent thelargest single cause of sickness and deathin young children.

An estimated five million childrenunder five years of age die every year inthe developing world as a result of diar-rhoeal diseases, and an estimated 60-70 per cent of diarrhoea! deaths arccaused by dehydration. Oral rehydra-tion therapy (ORT) can correct dehy-dration and prevent most diarrhoea-associated deaths.

H

A child with acute diarrhoea beginsto lose essential water and salts fromthe onset of illness. The major break-through associated with CRT is thediscovery' that a solution in water con-taining glucose as well as commontable salt can be absorbed through thewall of the intestine even during acutediarrhoea. This method of replacingthe lost fluid and salts greatly simplifiesthe treatment of dehydration associ-ated with diarrhoea.

While oral rehydration therapy hasrevolutionized the treatment of seri-ously dehydrated cases, the spread otdiarrhoeal infection also needs to becurtailed by preventive action. Manychildren suffer repeated bouts of diar-rhoea due to poor environmental sani-tation. Measures to improve watersupply and sanitation and to educatemothers in the importance of personalcleanliness are therefore essential to thecontrol of diarrhoeal disease: (seeWater and sanitation, page 19).

Progress in oral rehydration therapy(ORT) was made on many fronts in1983: advocacy, provision of oral rchy-dration salts (ORS); national produc-tion of ORS; dissemination of infbrma-tion about home-prepared ORS mix-tures; and technical advances in the for-mulation and packaging of ORS.

In June 1983, WHO, UNICEF andUSAID co-sponsored an InternationalConference on ORT in Washington,where WHO and UNICEF published a"Joint Statement on the Managementand the use of OraJ Rehydra-ion Therapy". In November, some4,000 delegates to the InternationalCongress of Pediatrics in Manila heardauthoritative endorsements ofWHOftJNICEF policies on the pro-morion of ORT. UNICEF also sup-ported the training of health care pro-fessionals and community level healthworkers in the use of ORT in many-countries.

Material and technical help was givento 21 countries to produce their ownORS, either on an industrial scale orthrough small-scale manufacture.More than 30 countries now meetmost of their needs, producing up-wards of 100 million packets of ORS ayear. Thailand, Philippines and Indo-nesia are among those moving towardssell-sufficiency. UNICEF also pro-vided in 1983 over 29 million packetsof ORS to approximately 80 countries.Concerned bilateral agencies, includ-ing die Swedish International Devel-

opment Agency (SIDA) and USAID,also supplied large quantities.

A packet of ORS includes prescribedamounts of salt, potassium chloride,sodium bicarbonate, and glucose, forsolution in one litre of water. Due tothe instability of the bicarbonate,relatively expensive aluminium packag-ing is required. Research now indicatesthat citrate may be used in place of bi-carbonate, enabling the mixture to bepackaged more cheaply. Commonlyavailable starches, such as rice starch,are also being tried out. For home use,some countries are packaging ORS inamounts suitable tor local measuringunits in place of a litre; in Thailand, forexample, the dosage is designed to bemixed in a Mekor$ whiskey bottle,which contains 75 centilitres.

The use of home-prepared oral rehy-

Thc use of bmHt'-ptrptired oralrekydmtton solution is being stronglyencouraged. In Pakistan, a father^veshis child a home-prepared mixture totreat diarrhoea.

dration solutions is being strongly en-couraged. Continued and augmentedfeeding, especially the continuation ofbreast-feeding, is recognized as beingof the utmost importance in combat-ring the cycle of malnutrition and diar-rhoea. Health education to counterthe common belief that food and liq-uid should be withheld from a childsuffering from diarrhoea is of vital im-portance. Like all aspects of primaryhealth care, the ORT programme isfirmly based on community involve-ment and participation.

12

The promotion ofbreast-feeding

Studies published in 1983 confirmedthat breast-feeding still predominatesin the rural areas of almost all develop-ing countries, but that in the growingmetropolitan areas bottle-feeding is onthe rise. Estimated global sales of in-fant formulas rose from US$1.5 billionin 1978 to US$4 billion in 1983. Inthe light of this trend, anxiety aboutchanging maternal feeding patterns cannot be restricted to urban areas. Mostof the increase in formula sales occur-red in the more rapidly industrializingdeveloping countries. The aim ofUNICEF and WHO co-operarionwith countries in the promotion ofbreast-feeding is to protect and rein-force the practice of breast-feeding inrural areas, and to help urban mothersresist the trend towards bottle-feeding.

Continued efforts to strengthen theapplication in individual countries ofthe International Code of Marketingof Breast-milk Substitutes, adopted bythe World Health Assembly in 1981, isone element of the overall campaign insupport of breast-feeding.

A considerable number of newstudies published in 1983 reinforcedthe arguments against bottle-feeding.In rural Jamaica, tor example, it wasfound that diarrhoea incidence increas-ed directly with the degree of bottle-feeding, and was three times as highamong exclusively bottle-red comparedwith exclusively breast-led infants. InCongo, a UNICEF-sponsored study(see profile, inset) echoed the evidenceaccumulating from all over the worldthat infant malnutrition is frequentlyco-related with a reduced period ofbreast-feeding, and warned that thesocial changes that bring this about arefar more complex than is sometimes im-plied by the "breast versus bottle" pro-tagonists.

The use of the media to promotebreast-feeding was reported frommany countries. In Brazil a UNICEF-assisted multi-media National Breast-feeding Programme won the "Top dcMarketing" award, the country's"Oscar" in marketing. There waswidespread distribution of breast-feeding booklets and posters in Egyptand Saudi Arabia, and in the Philip-pines, the Nursing Mothers Associa-tion published, with UNICEF assis-tance: "Breast-feeding-A guide for

Breast and bottle CONGO

In Congo, practically all infants arebreast-fed after birth, and mostcontinue to be given some breast-milk until 14 months of age. Butfew infants are exclusively breast-fedfor the recommended period (birthto between four and six months),and the use of commercial formulasand other supplements during theearliest months of life appears to beincreasing, with serious health im-plications. These findings are re-ported in a study on currentbreast-feeding behaviour commis-sioned by UNICEF*.

The advertising, promotion, andsale of imported infant foods iswidespread in the country. Butcertain social changes - commonlyregarded as signs of progress - arealso contributing to a reduction inbreast-feeding. These include thedecline of polygamy, increasedenrolment of girls in secondaryschool, and a rise in hospital births.

Formerly, exclusive breast-feeding was discontinued onlywhen teething began (about sixmonths), or when the infant wasable to sit. At this stage, smallportions of the family food wouldbe gradually added to the baby'sdiet. Breast-feeding continued forat least two years, during whichthe mother was subject to a stricttaboo against sexual intercourse.With the increase in monogamousmarriages, husbands have no otherwives to turn to, and the sextaboo has therefore beenmodified. This has shortened thetotal duration of breast-feeding.

The trend towards a shorterperiod of exclusive breast-feedingcorrelates with the increase inschool enrolment, according tothe report. Most young womenconceive their first child at 14 or15 years, though formal marriage,which depends on die final pay-ment of the bride-price, usuallytakes place later. Mothers still insecondary school have the highestpercentage of bottle-ted infants.

Another change affecting breast-feeding behaviour appears to bethe enforcement of compulsoryhospital childbirth. The stress ofunfamiliar surroundings may in-hibit the mother's milk-producingreflex. When this happens, manyhospital staff routinely prescribeformula feeding.

Infant-feeding practices are alsoaffected by the attitudes of themothers themselves towardsbreast-milk, which - they believe -can be contaminated: diarrhoea isalmost always attributed to thiscause. Consequently, the breast isusually withheld from a child withdiarrhoea or vomiting.

Mothers' lack of appreciation ofbreast-milk's properties are rein-forced by the advice they receivefrom nutrition educators, who ad-vise mothers to start supplemen-tary feeding very early, at two tothree months, or less. Meanwhile,formula promotion misleadsmothers into believing that earlysupplementary feeding is necessary.

The upshot, according to the re-port, is that 45 per cent of two-months-old infants are receivingother foods than breast-milk, and atthree months the figure is 78 percent. For one child in two, the firstsupplementary food is an importedcommercial product. A local infantfood, bmtillie fie mazs (maize por-ridge), is sold in local markets andoften used by poorer mothers. Ineither case, diarrhoea due to theunsuitability of the food or its un-hygienic preparation is common.

Studies such as this Congo exam-ple, which analyze changes inbreast-feeding behaviour, are an im-portant prelude to any campaign topromote or reinforce breast-feedingas one of the keys to a healthy startin life.

'Infant Feeding Practices in the Peoples Republicof Congo - A.H.F. Slothoubcr

Trainhig mtrses and health JiwAm how [a encourage Invast-feeditig is a key child swvimlactivity. A seminar in a hospital in Bangladesh.

ft

nurturing your baby".UNICEF provided financial support

to the International Organization ofConsumers Unions (lOCU) to conductregional and national workshops inSouth-east Asia, East Africa, the Carib-bean, Latin America and South-centralAsia on the protection and promotionof breast-tee ding for leading NGOs.The IOCU also produced prototype-radio scripts that were supplied to 43Asian broadcasting networks as a WorldFood Day project.

The attitudes, knowledge and prac-tice of the medical profession arc a ma-jor factor in the promotion of breast-feeding, and efforts were made in 1983to include thorough orientation onbreast-feeding in all UNICEF-supported training programmes. Un-fortunately, the normal routines inmany hospitals still discourage, or atleast inhibit, breast-feeding. Practiceswhich support breast-feeding includegiving the infant to the mother to startbreast-feeding immediately after deliv-er}'; and "rooming-in": keeping thenew-bom baby with the mother in-stead of in a special nursery. Rooming-in is now growing as a hospital practicein the Philippines, Indonesia, andmany Caribbean and Latin Americancountries. Kenya held a national work-shop on infant feeding practices, andsubsequently endorsed these practicesto all medical officers and hospitals.

The promotion of breast-feeding in

urban areas cannot succeed in theabsence of measures to support urbanmothers, many of whom are wage-earners and have to provide tor theirfamilies. Preliminary results of a surveyin Mauritius, a small island country thatis almost entirely urban or suburban,indicated that few Mauritian womenbreast-fed tor more than three months.Another survey in Burma revealed that34 per cent of poor urban workingmothers of infants under three-months-old were bottle-feeding.

There was progress in 1983 in theadoption of the International Gx1e otMarketing Breast-milk Substitutes,but implementation tended not to besufficiently forceful. More than 20countries have now adopted the Code,and close to 1(X) more are engaged inactions related to the Code. But mostnational regulations are weak in a legalsense, and there is little monitoring ofviolations. Vet many of the most dam-aging practices of infant formulamanufacturers-extensive media adver-tising, distribution of free samples inhospitals, and the use of saleswomendressed as "milk nurses'"-are certainlydecreasing. In Papua New Guinea, forexample, it was reported; "Baby bot-tles have disappeared from pharmaciesand stores. One no longer sees womenin the streets of urban Port Moresby orin rural villages feeding babies from un-sanitarv bottles,"

Immunization

UNICEF has joined WHO in acceler-ated support to the expanded programme of immunization (EPI) to im-munize all children against diphtheria,pertussis (whopping cough), tetanus,measles, poliomyelitis and tuberculosis.Immunization against tetanus forwomen of childbearing age is alsoincluded.

UNICEF proxies direct support toEPI in 80 countries, and is also pro-viding indirect aid to EPI in LatinAmerica through a US$500,000 contri-bution to a regional revolving fund forvaccine procurement. LINICEF re-mains the main international providerof vaccines, buying each year more thanUS$4 million worth, and has helpedcountries produce their own supplies.

In 1983, despite significant progress,die goal of universal childhood immun-ization remained distant. Immuni-zation programmes have been under-way for some years in many developingcountries, but their achievements aretoo often marred by low coverage. Thisresults from a combination of lack oflogistical organization; difficulties inmaintaining the "cold chain", such aslack of a steady power supply to ensurevaccine potency; and lack of under-standing among mothers and com-munity leaders of the preventive healthvalue of childhood vaccination.

DPT (diphtheria, pertussis, tetanus)and polio immunization require aseries of three shots each for full pro-tection. A mother unconvinced oftheir importance is not motivated toreturn with her child tor the secondand third shots, particular!}' when thisinvolves a long trek on foot to a healthcentre many miles away.

During 1982/83, national EPI re-views were underway in many coun-tries. The reports indicated that, inAfrica, where coverage is lowest, only19 per cent of children under 12 monthsof age have been immunized with allthree DPT shots, while 31 per centhave been vaccinated against tuber-culosis. In South-east Asia, wherereports on the extent of immunizationare much more complete, only 10 percent of children surveyed have receiveda third polio shot, In the Middle East,28 per cent of the children have re-ceived a third polio shot and 24 percent a third DPT, figures which com-pare favourably with the 22 per cent

14

They thought one shot was surely enough PHILIPPINES

In 1976, the Philippine Ministry ofHealth, with assistance fromUNICEF and WHO, launched aprogramme to immunize all youngchildren against six communicablediseases for which low-cost and ef-fective vaccines are available: diph-theria, pertussis and tetanus (DPTshots); tuberculosis (BCG vaccine),poliomyelitis, and measles. By1983, immunization of eligiblechildren had reached 60 per centfor DPT, 56 per cent tor polio, and78 per cent for BCG. The measlescampaign was launched last, in1982, with UNICEF providing thevaccine, and reached 48 per centcoverage in 1983.

Tills has been a most encouragingstart to the programme, given thatit meant overcoming enormous or-ganizational problems in a countryof 50 million people living on 11major islands and hundreds ofsmaller ones. But before the cam-paign could develop such momen-tum, serious human relations prob-lems also had to be surmounted.Many mothers who brought theirbabies for the first DPT shots tailedto return for the second ones. Andwhen mothers asked what theshots were for, most healthworkers responded merely that:"They are medicines. Good foryour baby." Traditional barrio(neighbourhood or village) leaderswere unimpressed by the pro-gramme — they had no shots whenthey were young, yet they were stillalive and healthy.

To address these problems ofmisunderstanding and lack of moti-vation, a series of five-day commu-nications workshops was intro-duced as a pan of the healthworkers' training tor the expandedprogramme of immunization (EPI).The six immunizable diseases werefully explained so that healthworkers could transmit this infor-mation to mothers, and a majoremphasis was placed on how tocommunicate the information ef-fectively and stimulate the interestand involvement of the commu-nity.

One of the places where thisnew emphasis on better human re-lations has paid off is San Pablo, amunicipality of 153,000 peoplewhere in 1980 only 21 per cent ofmothers and children had beenimmunized. Today, only a handfulhave not been reached. Accordingto San Pablo's city health nurse, aseries of communication workshopsheld for local midwives and otherimmunization workers turned theride. During each workshop, thenurses and midwives went out in-to the remotest neighbourhoodsof San Pablo, talking to commu-nity leaders, convincing them ofthe importance of bringing thechildren for immunization. "Iguess it's easy now," says the headnurse. "We've already establishedgood contacts with the village cap-tains. They know that the pro-gramme is for their children. And

the city mayor's information offi-cer helps by announcing ourschedule for giving vaccines on hisradio show.1*

Today in San Pablo, the 17 mid-wives assigned to the immuniza-tion programme have worked ouran efficient strategy. They post thedate of their neighbourhood visiton the health unit's bulletin boardand make sure it is announced onthe radio too. Three days beforethe visit, a midwife reminds theBan-io captain, who then helpsround up the mothers and chil-dren, spmetimcs with the help ofthe local mothers1 group. The im-munization team is careful to ex-plain to the mothers just what im-munizations are being given andwhy "one shot is not enough".Today, San Pablo's coverage of im-munization among young chil-dren exceeds 95 per cent.

I f -

The "midhusbands*' of Bali INDONESIA

In Bali, Indonesia, the traditionalrf«jfew»-mid wife—is still the keyhelper at most childbirths. Thisrole is normally the exclusivepreserve of women, but in Balialmost all dukuns are men.

Hinduism as practised by theBalinese contains no taboo againsta man touching intimate parts of awoman's body, as long as the aimis to aid or heal, and neither(iukuns nor mothers express anyawkwardness about what, in manyother traditional societies, wouldbe quite unthinkable. Dukuns,they say, need mystical powers tocounter evil spirits which, it isbelieved, arc likely to strike at themoment of birth. To acquire thesepowers, they must practise medita-tion in a graveyard after midnight,and undertake other rigorousforms of preparation not regardedas suitable for women.

One of the oldest and mostfamous of Bali's dukuns is Jadeng,who claims to be 85-years-old.Over the years, patients have comefrom every1 part of Bali for con-sultations. Jadeng began lite as abalean, or medicine man, andturned to delivering babies in the1960s at the suggestion of a doc-tor in the local hospital. Instead ofthe familiar traditional birth atten-dant kit, Jadeng sports a littleblack bag, like a doctor. Jadeng isunusual in that he considers hisprimary occupation to be that ofdukun. Most are not professionals:midwifery~or midhusbandry—is aservice they perform for the com-munity, with no payment exceptin kind. They are mainly farmersor land labourers, and some arequite poor, earning as little asRp 200 (about US20 cents) a day.

Increasing contact with the restof the world is introducing changein Bali. Many women are begin-ning to prefer deliver)' by profes-sionally trained midwives-bidnm~m the health centres. Thedukuns' numbers are slowlydiminishing; those remaining aregenerally old, and few young onesare joining the ranks. However,

the dukuns provide tremendouspsychological and spiritual supportro many women in labour, and astrusted members of the commu-nity and a revered "institution",they are in an ideal position topromote new health messages.

The Bali health authorities havetherefore, with UNICEF assis-tance, taken steps to enhance thedukuns* capabilities, giving themnew, scientific knowledge abouthow to ensure safe delivery. Theyare also taught to recognize com-plications and refer them to ahealth centre, so the training helpsestablish a formal link between thedukum and the official healthservices.

The dukuns are also taught toencourage mothers to earn' outsimple health precautions. Theydistribute vitamin A and iron

tablets, and show mothers how touse oral rehydration salts. Andthey are required to give monthlyreports on the number of birthsthey attended, the sex of eachbaby, the weight, and whetherthe baby lived or died.

In introducing new health pro-cedures, health officials take carenot to denigrate older practiceswhich do no harm, or to interferewith the spiritual functions. Butthere have been questions aboutthe dttkuns? ability to carry out theextended functions in which theyare being trained, and these havenot been answered to everyone'ssatisfaction. Most of the dukunsare simple people, and many areilliterate. But while dukutts likeJadeng still have great authority inthe community, their role in thecare of Balinese mothers and theirnewborn cannot be ignored.

lo

tor both BCG and measles (one shoteach].

The expanded programme ot" im-munisation his made remarkable pro-gress in China, Thailand, and Philip-pines. Other countries with relativelyhigh coverage include Egypt, Jordan,Lesotho and the Seychelles. In manyother countries, especially in Africa,EPI is still largely restricted to urbanareas.

UNICEF, with WHO, has helpedorganize many national training pro-grammes in EPI management and log-istics. Mass media channels are beingused to inform mothers of the impor-tance of vaccination, and special atten-tion is being given to the training ofcommunity health workers and TBAs.

Where EPI has been ini t ia l ly carriedout as a special service, it is now beingintegrated where possible 'into the

maternal and child health (MCH) andprimary health care services, with theparticipation ol health care workersand community leaders. This has beensuccessfully accomplished in Indo-nesia, Thailand and the Yemen ArabRepublic, but not in other countries,including Nepal, where the districthealth services were not yet manager-ial! y and logistically able to absorb theEPI programme.

It is clear that to reach the vastnumber of young children needing im-munization and to maintain the thrustof EPI for succeeding generations, itmust be possible for vaccinations to beprovided eventually through the per-manent primary health core infrastruc-ture. The task of educating commun-ity leaders and gaining their lastingsupport in reaching mothers is vital inreaching a high level of immunizationcoverage. ~i

The expandedproymmme ofimmunization,spearheaded byWHO andUNICEF, is givingspecial training tncommunity healthworkers so that theycan give vaccina-tions. A Colombianchild is a nluctantbeneficiary.

UNICF.F 132/83/Mcra

Child nutritionThe attack on hunger and malnutri-tion among children is inseparablefrom the spread of mother and childhealth (MCH) and primary- health care(PHC) services. All the special mea-sures which UNICEF is emphasizingfor children's survival and develop-ment have a direct bearing on theirnutritional status.

The mutually reinforcing relation-ship between disease and malnutritionis the greatest threat to a young child'shealth: both respirator)' and diarrhocalinfections flourish where a child isalready under-nourished. Weight losscan also be triggered by an immuniz-able disease such as measles, causing anabrupt and sometimes fatal dip in thechild's growth curve. Meanwhile,breast-feeding provides optimal nutri-tion during the early months ol life;and the purpose of promoting growthcharts is to encourage mothers tomonitor at home their children's diet-ary intake and growth.

However, in addition to the fourspecific components of the child sur-vival revolution, other measures specif-ically related to the ability of mothersto provide a healthy diet for theirchildren continued during 1983 to bean important emphasis in UNICEF'sco-operation.

These included supplementary feed-ing programmes in areas wheredrought or civil disturbance hadcaused crop failure. A high priority wasalso given to the control of dietary defi-ciency diseases, such as anaemia,goitre, and night-blindness, by thedistribution of iron/folate tablets,iodized salt, vitamin A, and other foodsupplements. Distribution of thesewas carried out with UNICEF assis-tance in many countries, includingLebanon, Angola, Indonesia, Zim-babwe, Egypt, and Haiti.

The introduction of appropriateweaning foods at the correct age is vitalto the health and sound nutritionalstatus of the young child. UNICEFhas long been active in this field, whichdovetails with the increased emphasison the protection of breast-feeding.Among low-income families, properweaning is often more difficult to pro-mote than breast-feeding, which iscost-free. Some mothers, in fact, con-tinue breast-feeding exclusively for fartoo long because they are not aware of

17

CHILD NUTRITION:In 1983 UNICEF

ux>perated in nutr i t ionprogrammes in 93 countries:39 in Africa, 20 in theAmericas, 25 in Asia, and 9 inthe Middle East and NorthAfrica regionhelped to expand appliednutrition programmes in19,600 villages, equippingnutrition centres anddemonstration areas,community and schoolorchards and gardens, fish andpoultry hatcheriesprovided stipends to train20,400 village-level nutritionworkersdelivered some 24,438 metrictons of donated foods(including wheat flour, non-fatdry milk, special weaning foodsand nutrition supplements) fordistribution through nutritionand emergency feedingprogrammes

the child's need tor additional foodsafter four to six months of age. Theydo not know how to prepare balancedsupplemental-)' foods in a hygienicmanner, and sometimes cannot affordto teed their children adequately.Many mothers in the expanding cityslums are the sole earners tor theirfamilies, and they have little rime toprepare the nglu kind of food. Mean-while, commercial alternatives areexpensive.

In many countries, measures are be-ing token to address this issue. In ruralareas, the emphasis is on home andcommunity production of weaningfoods, with recipes based on locallyavailable ingredients. Such activities,normally including a large motivationand education component, are cur-rently being supported by UNICEF inIndonesia, Iraq, Ethiopia, Tanzania,and Brazil. In Thailand, villagers arebeing taught to identify malnourishedchildren in the weaning and post-weaning age group, and to run thenecessary supplementary Feeding pro-

grammes through women's anil youthorganizations.

UNICEF is also supporting the in-dustrial production of low-cost sup-plementary weaning foods, mostly foruse in urban areas, in Algeria, China,and Laos. During 1983, the establish-ment of fruit and vegetable gardens inhousehold and school compounds,and the preservation and storage ofhome-grown foodstuffs, were sup-ported in many countries, includingJamaica, Uganda, Guatemala, Mexicoand South Korea.

A leading cause of infant deaths inthe developing world is low birthweight . Low birth weight babies ac-count for 10 to 15 per cent of birthsand between 30 and 40 per cent of in-fant deaths. The chief factor appears tobe maternal malnutrition. A study inIndia has shown that hirthweights canbe raised to normal levels by a modestdaily supplement of calories and pro-tein for women in their last threemonths of pregnancy. In primaryhealth care programmes, the impor-tance of better maternal nutr i t ion isbeing increasingly emphasized.

A major WHO/UNICEF nutritionprogramme

A five-year Joint WHO/UNICEFNutrition Support Programme (JNSP)proceeded in 1983. Approved by theUNICEF Executive Board in 1982, theUS$85.3 million programme is beingentirely funded by the Italian Govern-ment. The programme represents acommitment by WHO and UNICEFto provide special co-operation in cer-tain countries where the problem ofchild malnutrition is particularly acute.Around 18 countries committed toprimary health care will eventually beinvolved.

By the end of 1983 concrete projectoutlines, with an emphasis on conver-gent activities, had been drawn up forimplementation in 14 countries. Inthe Segou region of Mali, for example,the main components will be immuni-zation, community participation instrengthening the PHC network, childgrowth monitoring, home-madeweaning foods, nutrition education,family health education, oral rehydra-tion, and child care. In Sudan's RedSea ProvinLre. activities in both ruraland urban areas will include the in-volvement of" primary schools in nutri-tion, education and child develop-ment. In Tanzania's Innga region,preparations i n c l u d e d feasibi l i tystudies on rural sanitation, foodstorage, small .scale fcx>d processingand preservation, and low cost tech-nology to reduce the workload ofmothers.

In three Andean countries, Bolivia,Ecuador, and Peru, a JNSP projectaims at reducing the prevalence ofiodine deficiency disorders includinggoitre and cretinism. The incidence ofgoitre in these countries now rangesfrom 20- to 60 per cent in differentareas. In Burma, project plans providetor improving nutrition for pregnantwomen and children under three-years-old in all villages with a residentmidwife or auxiliary midwife. In Nepal,the project plans include credit for

At a nuttition afitre in Kerala, Indui,children stand on the scale to sec whether theyarccp-owiiui ami gninhifl nvuihi.

L8

women's economic activities and smallscale food production through a linkwith the Small Farmers1 Credit Schemeof die International Fund for .Agricul-tural Development (IFAD).

In Haiti, a national campaign for con-trol of diarrheoal diseases and improve-ment ot child nutrition was launchedin mid-1983 with considerable sup-port from private enterprise and fromNGOs. ORT and breast-teed ing arcemphasized, as well as environmentalsanitation.

As indicated by these examples, thejoint WHO/tJNICEF programme isencouraging a broad range of activitiessuited to local conditions and designedto reinforce each other's impact onchildren's nutritional status. Broadproblems of agricultural productionand rural development are not directlyaddressed by the programme, butJNSP has developed close working re-lations with IFAD which assists coun-tries in these contexts. D

Home preparation qfircaniiifj foods,nutrition education, family health, andchild care arc atmmfj the activitiesencompassed by the "WHO/UNICEFnutrition proffmmme.

Other basic services for children

Safe water supplies and sanitation

UNICEF co-operation in water supplyand sanitation programmes around theworld in 1983 amounted to nearlyUS$68 million, making the financiallevel of this category of assistance se-cond only to that of child health andnutrition combined.

UNICF-F has been closely involvedfor many years in the provision of cleandrinking water and the sanitarydisposal of human excreta and otherwastes in poor rural and urban com-munities, recognizing their vital con-tribution to the control of infection,disease, and malnutrition amongyoung children. Since the declarationby the UN of an International Drink-ing Water Supply and Sanitation De-cade, with its goal of "clean water andsanitation for all by the year 1990,"UNICEF has further intensified its ef-forts ro promote the installation oflow-cost community systems, empha-

sizing not only the importance of cleanwater but of water in sufficient quanti-ties for personal and household clean-liness.

UNICEFs sharper focus in the pasttwo years on the health and nutritionalstatus of the very young child has en-couraged a strengthening of the linksbetween primary health care program-mes and water and sanitation services.In many countries water and sanita-tion installations, and the healtheducation activities associated withthem, are providing a springboard for amil-scale attack on infant and childmortality and morbidity.

In certain projects, the curriculumfor village-based workers being trainedin association with borehole and hand-pump programmes includes child nu-trition and the treatment at home ofchildhood infections, by oral rchydra-tion therapy for example. The messagethat safe water, waste disposal, andgood health arc inextricably linked isconstantly reinforced, In Nigeria's InioState, an immunization programmehas recently been grafted onto thewater and sanitation project, using thenew village-based worker network toreach the maximum number of new-horns and infants. This example of in-tegration between water supply andprimary health care services is pro-viding a model for project planningand implementation elsewhere inNigeria. (Sec profile on page 20.)

In financial terms, the majorUNICEF inputs are the provision ofhigh-speed drilling rigs, pipes, andcement'for the construction of latrineslabs, catchment tanks, and otherinstallations. However, in 1983UNICEF made at least an equal con-tribution toward meeting the goals ofthe Water Decade by emphasizingtraining for community personnel andthe mobilization of human resources.These have become important ele-ments in almost all country1 program-mes for co-operation in water supplyand sanitation services.

A more energetic effort is also beingmade to identify NGOs involved inwater and sanitation programmes and

19

Spreading the good news about water andsanitation NIGERIA

For 20 years, no good water hadbeen struck in Ohaozara, a remotearea in Nigeria's northeastern ImoState. Then a UNICEF drilling rigcame, with a team of experttechnicians, and in the words of" alocal chief: L'Good water wasstruck from the rock to the sur-prise of all, and people wen:jubilating."

But in Ohaozara as in otherparts of Irno State, whereUNICEF is co-operating with gov-ernment and local communities ina water and sanitation project,striking good water is not thewhole story. What is unusual, ifnot unique, about the project isthe way in which health educatorsare trying to revolutionize people'sdeepset attitudes about water useand excreta disposal,

Rural water supply projects indeveloping countries have oftenbeen slow to bring about betterhealth. An abundant supply ofclean water is vital to good health,but it will be a limited blessingunless it is accompanied by betterhousehold and community sanita-tion.

In each village, the "good newsabout water and sanitation" is firstbrought by the project's mobiliza-tion team, who encourage volun-teers to come forward for training

as village-based workers. A trainingteam follows, then a sanitationteam, one of whose concerns is see-ing to the construction of pit-latrines. The last team to arrive isthe drilling team — the "miracleworkers" of the operation — tobore the tubcwclls and fit thehandpumps.

Around six village-based healthand Sanitation workers - at leasttwo of whom must be women -are chosen from each community.Those selected must be literate,permanently settled, and married,preferably with children. Traininglists 10 weeks - the first two ofwhich are devoted to a residentialcourse, the next seven to "practi-cal" work in the village, and theremaining week to clarification andfollow-up.

Once trained, the job of thehealth workers is the delicate oneof spreading "the news about waterand sanitation" by pointing out totheir friends and neighbours thedangers to which they arc subjec-ting their families by leaving food-stufts exposed in the kitchen, waterpots with their lids ajar, and bydefecating in the bush instead of ina latrine. "It is necessary," saysGrace Norman, a health officer, "topersuade people to change theirhabits".

Although their job is vital, it isby no means easy, involving suchproblems as infrequent compensa-tion by their villages, local preju-dices, and lack of status to influ-ence their neighbours. But in spiteof this, there are grounds for opti-mism. As one village health workerreported: "When 1 spoke to the \il-lagers about excreta disposal theydid not welcome it. I told them; 'ifyou do your defecation in thebush, a fly will enter your com-pound and put germs on yourfood.' Gradually, I think they arebeginning to understand. In time Ithink we can convince them. Thepeople like us; they listen to whatwe say."

The Imo State project includes animportant fact-finding component."Enumerators" visit the projectareas to count compounds, inter-view heads of households, and findout as much as possible about ex-isting habits concerning water col-lection and storage, food prepara-tion, and waste disposal. Theduties of the enumerators includeobtaining stool specimens from pri-mary school children to determinethe extent of diarrhoea and parasiticinfestation.

As the project progresses, theenumerators will return to eacharea to follow up: how have prac-tices changed? Has the rate of para-sitic infestation decreased? Has theincidence of cholera and guineaworm (respectively the most fearedand the most loathed diseases inImo) been affected? The answers tothese questions should illuminatethe project's strengths and weak-nesses.

While the US 5250,000UNICEF drilling rigs provide thedrama as they drill through thesandstone to strike clean water, it isthe related work of motivation,evaluation, and above all healtheducation that make this a uniquewater and sanitation project. Overtime, if the village-based workerscontinue their efforts at persuasionand example, a major improvementin children's health is assured.

20

hnfntnvments in sanitation for use at village level include the VIP (ventilated improved pit]latrine, here shown under construction in mml Tanzania.

munity needs, is gradually proving apersuasive argument in rheir favour.

Improvements in sanitation techno-logy also met with support during1983, notably at community level. Aninteresting feature is the introductionbeyond Southern Africa of" the ven-tilated improved pit (VIP) latrinedeveloped by the Blair Institute in Zim-babwe. It is now in use in a number ofcountries where UNICEF is cooperat-ing in sanitation programmes often inpartnership with UNDP and the WorldBank.

In spite of the obvious interactionbetween a safe water supply, properwaste disposal, improved hygiene, andpeople's health and well-being, it hasproved difficult to evaluate preciselythe impact of UNICEF-assisted waterand sanitation programmes. This prob-lem derives partly from the difficulty ofidentifying key indicators and measur-ing them in isolation from influencesother than the new water supply or

to work in co-operation with them. InHaiti, UNICEF has brought a numberof NGOs into contact with the ServiceNational cfEau Potable (SNEP), andthereby assisted their drilling opera-tions and handptimp installationsthrough UNICEFs own programmeof country co-operation. UNICEFalso continued to support and partici-pate in the work of regional traininginstitutions, such as the Training Cen-tre for Water Technicians at Wad-elMagboul, near Khartoum.

The need to improve communitymotivation and the increased impor-tance attached to health educationhave prompted adaptations of existingtraining curricula, and an expansion ofactivities for some community-levelcadres. While water supplies are fre-quently a deeply felt need in thirdworld rural communities, disposal ofhuman wastes is often not perceived asa problem and latrines arc rarelygreeted with enthusiasm. In manytraining programmes, therefore, moreemphasis is being placed on the ill-effects of inadequate waste disposal,and the need for improved personalhygiene, such as washing hands afterdefecation and before handling food.

In Pakistan, community motivatorsare being trained to introduce simplesanitation practices and hygiene con-cepts along with the construction oflatrines. In Nepal, where there seems-

unusually-to be a real demand forsanitation at village level, teachingmaterials on sanitation have beendeveloped for use in primary schools.During their annual refresher courses,Nepal's water and sanitation techni-cians have been taught the use of oralrchydmtion therapy for diarrhoeacases, and village tap caretakers havebeen given vegetable seeds so that theycan use the waste water in the tap areato plant vegetable gardens. In Indo-nesia, UNICEF has assisted in thetraining of village volunteers in themaintenance of water systems, provid-ing them with tools and spare partssuch as washers, nuts and bolts—an ap-proach originally developed some yearsago in India.

UNICEF field staff continued to par-ticipate in the development and testingof a number of technological innova-tions, including adaptations of watercatchment and gravity-flow systemsand better shallow and deepwelJ hand-pumps. The considerable support beingprovided to these technological devel-opments by UNICEF, the WorldBank, the UN Development Pro-gramme (UNDP) and others has led toa better acceptance on the part ofgovernments of low-cost approaches.The possibility of reaching man)' morepeople with installations which do notrequire expensive maintenance, andwhich are as effective in meeting com-

•-I WATER ANDSANITATION:In 1983 UNICEF

co-operated in programmes tosupply safe water and improvedsanitation in 97 countries:39 in Africa, 19 in theAmericas, 30 in Asia and 9 inthe Middle Fast and NorthAfrica regioncompleted approximately75,271 water supply systems,including 72,919 open/dugwells wi th handpumps,661 piped systems, with435 motor-driven pumps and1,256 other systems such asspring protection, rain watercollection and wafer treatmentplantsbenefited some 12.9 mill ionpersons {40 per cent of themchi ldren) from its rural watersupply systemscompleted 312,698 excretadisposal instoJlations benefitingsome 2,823,500 people

,.M

ff We need water, not gold*— BURMA

"We need water, not gold", readsthe notice. It is posted in a villagein Burma's Central Dry Zone, avast area in this otherwise well-watered country characterized byseasonal stream beds, dry bush anddust. Occasional green paddy fields,a stark contrast to the surroundingaridity, show what can be donewhen water is available. It is to ad-dress this urgent problem thatUNICEF, in co-operation with theAustralian Development AssistanceBureau, is assisting the govern-ment's rural water supply projectin the Drv Zone.

ICEF 9373'Ltiipungha

Since 1978, some 1,800 tube-wells have been drilled, with 3,200more to be completed by 1986.The big Failing Rigs provided byUNICEF briefly dominate thescene in the villages in which theyoperate. But village co-operation is

necessary to make the project asuccess. While the tube well is pro-vided free, villagers must run andmaintain the pump and provide alllabour and costs for the storagetank and pump house. Accordingto one village chairman, each fam-ily pays what it can afford. Well-to-do donors are willing to meetadditional expenses because theyfeel that giving water is as merito-rious as putting an umbrella on apagoda, long regarded in Burma asone of the crowning acts of Bud-dhist piety.

In communities where the vil-lagers have played their part andwhere the problem of sanitationhas also been addressed, healthbenefits are already observable. InKyunhobin village, for example, atubewcll was drilled in 1980, andthere is little evidence now of tra-choma and other eye diseases thatplague children elsewhere. The vil-lage's energetic Health Officer ex-plains that the community alsobenefitted from a UNICEF-assistedpilot project to install improvedsanitary pit-latrines. The combina-tion, he says, has brought about asignificant drop in the incidence ofgastro-intestinal disease, and a dra-matic decline in the level of worminfestation among children.

In nearby Wayaung, the newwater supply has also given a boostto the village economy, A pro-ducers1 co-operative using about700 gallons of water a day and em-ploying 25 villagers, processes thebark of the thatiaka tree into cakesof a national cosmetic, also calledthanaka.

Although the Dry Zone has at-tracted the largest volume ofUNICEF assistance in water sup-ply, other areas of Burma have notbeen overlooked. UNICEF is in-volved in gravity-flow systems inthe hilly regions, rehabilitation ofexisting water systems in lowerBurma, and a country-wide envir-onmental sanitation project.

sanitation facility; and partly frommost countries' lack of human andtechnical resources tor the collectionand analysis of water and health-related data. This situation is begin-ning to change, under the combinedimpact of bio-medical research, whichhas made recent advances in identify-ing particular contamination agentsincluding viruses responsible for diar-rhoea; and the extensive experiencethat has now been gained worldwide inplanning and putting in place com-munity water and sanitation services.UNICEF is working closely withWHO, the World Bank and such insti-tutions as the London School ofHygiene and Tropical Medicine toassist in the collection of data and thedevelopment of appropriate evaluationtechniques. In Burma, Nigeria, andsome other countries, UNICEF is par-ticipating in health impact evaluationsof particular projects, which shouldprovide important insights into howto maximize the impact of water andsanitation programmes on children'shealth.

Water is often a deeply felt wed.Impnwing a mil in Tamil Nadu, India.

22

Formal and non-formal education

* • C -̂J." "^•'Tx. ~^-^pfc 4* --(i_^* "̂-"i;'1'**".'_ •• ^-*•«•> f^^™^ FJ™W-t *'

'" ̂ Ct^^f.^Jv.'.- * "' -

"•K

While remarkable progress has beenmade hi the spread of educationti]opportunities tor children in the pasttwo decades, the task ahead remainsdaunting. According ro official esti-mates, 86 per cent of primary agechildren in developing countries wereenrolled in schools in 1980, comparedto 60 per cent in 1960; bur of these,one in two do not complete the fullprimary education cycle, and in thepoorest regions and communities, theequivalent figure is tour in five. Therate of illiteracy for the total popula-tion is 40 per cent, while almost halt otall women over 15 years of age indeveloping countries .ire illiterate.

The low literacy level among womenis particularly disturbing because of itsnegative implications for the welfare otchildren. It has been consistentlyfound, in countries at all stages of

development, that the higher the levelof the mother's education, the lowerthe mortality rate of infants.

To reach a sustainable level of educa-tion, at least four years of primary edu-cation, or its equivalent in non-formaleducation or literacy, is normallynecessary. But even women who haveparticipated in a more limited educa-tional experience are more receptive tonew ideas, and more inclined to takeadvantage of health services and pro-grammes designed to improve thewelfare and life prospects of theirchildren.

UNICEFs efforts to improvewomen's access to education are,therefore, included in the range of•activities designated as necessary fora child survival revolution. Emphasiswithin country programmes has beenplaced on measures that facilitate a

UNICEFS support fm- basic atui f}-i»iajyeducation foctases o» duadvantaged children,specially those m peer families liwtuj in remoteareas.

greater participation of girls and womenin primary education and literacy pro-grammes, and support has been givento special education projects tor womenin "family lite training centres", in coun-tries such as Ethiopia, Haiti, and Chad.Curricula in such centres usually com-bine skill training for income generationwith literacy and domestic activitiessuch as child care and sound nutrition.

Basic education institutions, such asprimary sehtxjls and literacy centres, in-adequate as their numbers are in mostdeveloping countries, are still morewidely spread than other social services.They can, therefore, make an impor-tant contribution towards efforts topromote the health and survival of theyoung child. Primary schools, for exam-ple, with the collaboration of teachers,parents, and students, can promotehealth consciousness throughout thecommunity, and spearhead campaignsto explain the use and preparation inthe home of oral rehydration mixture,for example.

In 1983, as in previous years,UNICEFs support for the extension ofprimary and basic education focussedon disadvantaged groups such as chil-den of poor families and families livingin remote and underdeveloped areas.Improving the quality of" instructionwas another principal area of educa-tional co-operation. In Bangladesh,Ethiopia, Sudan and Zimbabwe, assis-tance was given to pre-service and in-service training for primary schoolteachers. In remote and thinly popu-lated areas of Syria and Indonesia,UNICEF assisted in the developmentof one-room multi-grade schools. InEthiopia and Oman UNICEE sup-ported the production of literacy andpost-literacy materials, and in Laos,the production and distribution ofbasic school supplies, such as black-boards and chalk.

Many UNICEF-assisted educationprogrammes, both formal and non-formal, aim to relate the subject matterof basic education directly to the

."•

The clay-potsavings scheme BANGLADESH

The women's literacy programmein Uttapara, a small and relativelyinaccessible village in Bangladesh,grew out of what seemed like acasual visit by Ms. HosnearaMinu, a field worker from theVillage Education and ResourceCentre. VERC was originallystarted by the Save the ChildrenFund (USA), and incorporated in1977 with financial and technicalassistance from UNICEF. Dedi-cated to the principles of self-reliance and voluntary participa-tion, VERCs development workerswill wait months, even as long as ayear, tor the villagers themselves todecide what problems need to betackled.

At first some villagers thoughtMrs. Minn was a government offi-cial who had come to assess theirhouseholds and land. But as shecontinued to pa}' the village regu-lar \isits, sometimes apparentlyjust to chat, the women began todiscuss with her their needs andaspirations.

Most of Uttapara's families arequite poor, and over half of themare landless. One problem manyfaced was how to provide for thekind of wedding that traditiondemands for their daughters" mar-riages.

"Have you ever thought of start-ing to save?" Mrs. Minu asked. Atfirst the idea seemed strange."How do you save?11 asked a35-year-old housewife namedSamirunnessa. "Where would Iput the money?"

Mrs. Minu explained that shecould put aside one taka (US 4cents) each week safely in one ofher clay household pots.

After several months, Mrs. Minusuggested to Samirunnessa that sheshould spread the idea among herfriends. Soon she became theleader of a "clay-pot savings group11

among the village women.The next step was the formation

of a women's society. VERC sent agroup of young people into Utta-para to put on plays and sketches

about village life. One play showedhow a women's society enabled itsmembers to earn some money byweaving, sewing, painting, andraising goats. The women of Utta-para then transformed their clay-pot savings group into a properwomen's society.

The literacy programme wasn'tlaunched until tour years afterMrs. Minu's first visit. By thisstage, the village women hadcome to recognize their need to •keep proper records of theirmoney-making activities and theirsavings.

To write her own name, letalone be able to read, seemed likea dream to Samirunnessa, untilthe VERC workers staged anotherdrama in Utrapara. This time,they showed how literacy hadcome to a similar village. Thenthey took clay letters out of apaper bag. "It's simple. Look atthese letters and imitate the shape.That's the first step." After half anhour's discussion, 17 out of the33 women's group members agreedto join a literacy class.

VERC staff don't like to predictwhat the next step will be afterthe literacy programme rakes hold."It's up to the women of Uttaparato decide."

health and welfare of communities. InKenya, for example, A school radioprogramme includes a series on basichealth measures. And the KenyanDepartment of Adult Education hasplanned a booklet on growth monitor-ing, oral rchydration. breast-feeding,weaning and immunization for use inthe national literacy programme. InEgypt, reading materials on health,hygiene, and nutrition for use inschools and literacy classes have beendistributed to rural areas.

In addition to the regular pro-gramme, in 1983 the UNICEF Exe-cutive Board approved a US$30 mil-lion co-operative programme withUNESCO, to be financed throughspecial contributions, to supportuniversal primary education andliteracy, initially in five countries:Bangladesh, Ethiopia, Nepal, Nicara-gua and Peru. In approving the pro-gramme, the Board endorsed the ini-tiative of UNICEF to collaborate withUNESCO, national governments andothers in their efforts to advancetowards die goal of "education for all"by the end of the century. Countriesto be assisted are low on the develop-ing world's socio-economic scale, withhigh infant mortality and low percapita income.

24

A growing share of UNICEFresources is being devoted to non-formal community activities tor earlychildhood care and education. At therequest of the Executive Board, apolicy review entitled '"'Early Child-

Urban basic services

131®® EDUCATION:In 1983 UNICEF

» co-operated in primary andnon-formal education in101 countries: 43 in Africa,21 in the Americas, 26 in Asiaand 11 in the Middle East andNorth Africa region

» provided stipends for refreshertraining of some78,900 teachers including50,500 primary-school teachers

» helped to equip more than61,900 primary schools, andteacher-training institutionsand 500 vocational trainingcentres with teaching aids,including maps, globes, science-kits, blackboards, desks,reference books andaudio-visual materials

» assisted many countries toprepare textbooks locally byfunding printing units,bookbinding and paper

hood Development" has been pre-pared for the consideration of the 1984Executive Board session. The reportexamines the programme approachesappropriate for the intellectual, social,and emotumal development (>f theyoung child in the light of experienceand knowledge gained by UNICEFand others. It identifies programme ac-tions necessary in different socio-economic situations, building onUNICKF's advocacy of a child survivaland health revolution. This policyreview is intended to enable UNICEFto help promote the total develop-ment or" the child during the criticalearly years.

In 1983 UNICEF offices reported an alarming increase in nialnumtion anmig childrenliving in the third world's cwwdfd .dinns and fhnntics.

During 1983 UNICEF continued toexpand support to community-basedactivities in the slums and shanty-towns of third world cities, accordingto policy guidelines approved by the1982 Executive Board. Nearly 50 coun-tries now receive urban basic servicesco-operation. Priority programme areasinclude reducing infant -and child mor-tality and malnutrition, increasingwomen's income-earning potential,providing day-care facilities, improvingwater supplies and environmental sani-tation, and reintegrating abandonedchildren into society.

In 1975 about 840 million peoplelived in the urban areas of the develop-ing world. With at least two-thirds ofthe population increase in the develop-ing countries now taking place in theirtowns and cities, this figure is expectedto rise to more than 2,120 million bythe end of the century. Whereas in the1960s and 1970s, slum and shantydwellers represented between 30 and60 per cent of urban populations, thisfigure now rises as high as 79 per centin some cities. This steady expansionof urban poverty and squalor is causingdramatic social upheaval throughoutthe third world, with important conse-quences tor women, children, andfamilv life.

While widescale urban poverty is afamiliar phenomenon in Asia andLatin America, the trend is less visiblebut at least as disquieting in Sub-Saharan Africa. By 2000, Sub-SaharanAfrica is expected to be 38 per centurban, with 59 per cent of populationgrowth occurring in towns and cities.Moreover, these projections do nottake into account the continued strifeand prolonged drought in many Afri-can countries, which arc promptingthe forced immigration into popula-tion centres of large numbers of ruralpeople whose way of life has tempo-rarily, and in some cases permanently,collapsed.

Often as a result of these conditions,UNIGEF field offices have reported analarming increase in malnutritionamong urban children. A high propor-tion of the infants and young childrenwho succumbed last year to a com-bination of malnutrition and infectiondied in the slums, shantytowns and in-fested tenements of the third world.The rural poor can usually depend lortheir food and shelter on what theycan grow or harvest from the land orthe sea, but the urban poor dependupon cash. When the economic situa-tion worsens and work is unavailable,there is even less cash than usual, and

'-

UN ICE F in action: programme com

The programme commitments shown on this map arc tor mulnye.irperiods, and art- exclusively rhosc from UNICEFs general resources.Those commitments being proposed to the April/May 1984 ExecutiveBoard session are shown in colour, and should he regarded as tentative.

In the case of certain countries, particularly chose where a specialprogramme has resulted from drought, famine, war or other emer-gency, the level of already funded supplementary programme com-mitments is high enough to make a significant difference to the sizeof the overall programme. However, since many projects "noted" andapproved tor supplementary funding arc not yet funded, only thoseprogramme commiminus from general resources are shown.

Higher-income countries, where UNICEF does not have aspecific commitment from general resources over a givenperiod, but co-operates in the provision of technical oradvison' services, are shown without programmeamounts or durations. The 1983Executive Board approved a blockcommitment of US$2 million peryear for these countries.

GUATEMALA1983-86: $2,518,00(1HONDURAS __1984-86: $616,000EL SALVADOR _1984-85: $328.000NICARAGUA1984-85: 5315,000rr«TA pir-A1983-86: 5110,000P A N A M A1983-86: $77,000COLOMBIA

/ // /

_/ ,

CUBA1983-86: $178.000JAMAICA1984-88: $138,000HAITI1982-86: 55,114,000DOMINICAN REPUBLIC14X4-87: 51,405,000

• EASTERNCARIBBEANISLANDS1984-88: 51,500,000ANTIGUA ANDBARBUDA1983-85: $70,000DOMINICA1982-85: 583,000ST. LUCIA1983-85: $75,000

TRINIDAD &TOBAGOBARBADOS

1984-87: $5,790,000ECUADOR1984-85: $916,000GUYANA1981-84: $544,000SURTNAME1975-79: $130.000PERU1982-85: $3,000,000PARAGUAY1982-84: $665,000CHILE1981-84: $218,000

Altogether, UNICEF currently co-operates inprogrammes in 113 countries: 43 in Africa; 33 inAsia; 26 in Ijtin America; 11 in the Middle Eastand North Africa.

This map is dranvt acairditia to Peters' 1'rajtctwn and fhfInmndarics dt< nut express am opinion of the I. hiiteii Nation.

TUNISIA1983-86: $1.507,000MOROCCO1981-85: $7.612,000 ,

:.•-/ '

MAURITANIA1982-86: .SI.995,1100

CAPE VERDE1982-85: 5252,000

SENEGAL1984-86: SI,230,1)0GAMBIA1984-86: $389.000

GUINEA-BISSAUI9.S4-.SR: SN)O. (MM)

GUINEA[979-83: S4.9-HUIOOSIERRA LEONE19K2-X5: $1,427.000LIBERIA1982-84: S1J80.000UPPER VOLTA1985-8": $3,935.000IVORY COAST1983-85: $2,006.1)00

GHANA1983-85: 52,463,000TOGO!9,S4-,SS. S3.533,000

BENIN[U85-8S .S3,154.000

'Liiluik-s Si N'mccni.Si Christfiphcr-Ncvtt,tia'ii.kl.i. Hnif.li X ' - ' - i i 'slailils, Moncsfir.irMiiil ' I nrlt1.

. in.! i , i k i i > , Kl.ind.s

26

iimitmeiits in the developing world

-&

TURKEY.1983-84

$460,1101.1

..U~!.IHHi

ES.U 1TJ1

SAUDIARABIA W_/

BAHRAIN yA r'

/UNTIEDARAB

EMIRATES

•SYRIAN ARAB REPUBLIC 1982-S4: S1.460.0UO

'LEBANON 1980-82; 5630,000

•JORDAN 1982-84: $547,000

•In addition 1984 I"X~SI,950,000 for Palestinians

AFGHANISTAN197S-82

.si9,.wi«,oon

5^

IRAQ— NEPAL

1982-Sd512,710.0(10

— KUWAIT.BHUTAN

l'JSl-8552,1)86,000

INDIA1981-S3

$107,887,000

1GKRWl-83C,S8,000 SUDAN

CHAD 1981-851981-83 S22.-Sf i . IXMr

$3,614.000

iERIA£3-85~l r> ,1)0(1

HONG KONG

r YEMEN-/1981-83: $4,3-5,000

ETHIOPIA1984-88

527,950.000

1̂_ DEM YEMEN19K1-83: S1.363.0(Wi

—n- DJIBOUTI7 1983-85: 5224,000

B-SOMALIAr 19H4-tT: S5.03S.OIHJ

ZAIRE1982-85

SUf. 166.000

UGANDAI9K5-H6: S5,102,000

1 L,/ KENYA1982-84: $6,125,1)00

RWANDA1983-85: $2.186,000

' -S8J LANKA.'1985-8853,313,000

MALDIVESI9K-B7

I,i5y,0(«)

MADAGASCAR1982-85

^3,062.00"

SEYCHELLESI l '84-Sft: S124.0IK)

COMOROS1985-X": S178.()(K)

MALAWI|y^i^S7: $5,724,0(10

MAURITIUS1983-85: $420.000

ZIMBABWE1984-86: 54,260,000

MOZAMBIQUE1981-84: $3,990,000

SWAZILAND1985-88: S594.000

LESOTHO1982-85: $1,203,000

BOTSWANA1984-86: 5486,000

*M••'•

4^-~^~

SJNGAPORf

-" \r si*

r-

INDONESIA\W-H? -iSa.lHXMMl

REPUBLIC OF KOREA1982-86: $2,716,000

BURMA1982-86; 527,000,000

BANGLADESH1982-85: $50,000,000

LAO PEOPLE'SDEMOCRATIC REPUBLIC1982-86: $4,2S6,000

THAILAND1982-86: $14,740,000

PHILIPPINES1984-87: $10,827,OIH)

KAMPUCHEA19X4-SS' ,S2,4W,000

VIETNAM1983-86: $27.142,000

MALAYSIA1983-84: $1,062,000

PAPUA NEW GUINEA1983-85: $591,000

•PACIFICREGION1983-85

51,164,000

"Inautks Cook IsUnds, l-i]i,Kinhjti, Niiit, Samua,Sulnmon Islands, TcikcLm."["inijfi. "InvjJti , VjjiiLiru.l-fdt-r.ict-il .Srjrcs otMiinnu-M-i , M.in.JuJIbf.indi .mil I'.il.ui

ZAMBIA 1984-86: SL47~. )«H)

CONGO 1984-86: 5334,000

SAO TOME AND PRINCIPE 1981-84: 5192,000

UNITED REPUBLIC OF CAMEROON 1982-85: 51,722,00(1

EQUATORIAL GUINEA 1984~«7: »3~4,(J(»0

CENTRAL AFRICAN REPUBLIC 1984-88 52,294.001*

UNICF.F.s prugranime expenditure in different countncs is dllotutcd ac-cording tu three criteria: infiint mortality rate (IMR: annual number ofdtatli* <>("infants under one year ot'agc per 1,000 live binhs"); income level(GNP per capita); aiid the size uf the child population. This year, the IMRcriteria is .shown, as follows:

^ IMR 150 and above [12 countries']• IMR 100-149 (43 countries;

IMR 50-99 [33 countries,

IMR under 50 (31 countries.!

27

even less food, therefore, for infantsand children.

Child malnutrition occurs at anearlier age and is frequently moresevere in cities than in rural areas. Acontributing factor is the decline in theduration and incidence of breast-feeding. Urban mothers, who areoften the only income-earners to sup-port their children, are obliged to takepaid employment in circumstanceswhere they cannot be accompanied bya baby at the breast. As a result, theintroduction of bottle-feeding, with itsattendant hazards of improper dilu-tion and poor hygiene, often takesplace at a very early age. A larger set ofhealth problems also contributes tomalnutrition in high-density urbanareas, where sanitation facilities andrefuse disposal services are all but non-existent. Diarrhoea, measles, parasiticinfestation, and respirator)' infectionsflourish in these insanitary living con-ditions.

UN1CEF is working with govern-ments and NGO partners to attackunnecessary infant and child deaths,illness, malnutrition and related prob-lems through the primary health care(PHC) framework. UNICEF andWHO have together worked out aprogramme of joint collaboration forthe expansion of PHC sen-ices in poorurban areas. In the Philippines,UNICEF is supporting the DavaoMedical Foundation in Davao City in amulti-faceted programme to reduce ill-ness and malnutrition. In the light ofthe number of child minders in slumareas who are themselves children,"child-to-child" instruction is animportant feature of the programme.

A recent and dynamic initiative inurban PHC is that taken by die city ofAddis Ababa, Ethiopia. The munici-pality has taken on the challenge ofreducing the infant mortality rate(now 150) by two-thirds within sevenyears. The strategy includes the pro-motion of breast-feeding, selectivesupplementary feeding, immuniza-tion, and the use of locally-producedoral rehydration solutions. In Peru,UNICEF-assisted primary health careand pre-school services now cover anurban community of 500,000 and in-clude growth monitoring and oralrehydration.

It is estimated that tens of millions ofchildren live without family support.Abandoned children, refugee children,abused children and children working

A sense of comradeship

Rio de Janeiro's 1.8 million slumdwellers have a gift tor joint enter-prise, and enjoyment, despitetheir life of hardship. At Carnivaltime, their sandm bands play aleading role in the city's celebratedfestivities.

When Rio's Department of So-cial Welfare asked UNICEF tohelp start a basic services pro-gramme in Rocinha, the city'slargest fiivcla, or slum, it was thisvitality and sense of comradeshipof the slum dwellers themselvesthat gave the programme much ofits promise.

The Rocinha pilot programme,which UNICEF has been support-ing since 1979, relies exclusivelyon community decision-making.With 80,000 people, Rocinhaoccupies a hillside overlooking thepicturesque beach district of Sao

Conrado. Today Rocinha has Rio'smost active community associa-tion.

Divided into working commit-tees addressing problems of sanita-tion, health and education—thecommunity's own priorities-Rocinha's residents have learnedhow to work with church groupsand local philanthropic organiza-tions. They have also learned howto lobby for greater co-operationfrom the local authorities, suchas the city's water, sewage andelectric sen-ices. According toRocinha Sanitation Group Presi-dent, Jose Martins de Ofiveira:"We have learned how to negoti-ate with the bureaucracy. Now wego to the Municipal Secretariatand we say: 'You give us thematerial we need and well providethe man power1."

28

BRAZIL

Through such co-operation anda very large measure of self-help, the Rocinha association haslaunched teacher training andschool renovation projects, healthinformation services, and an im-pressive public health constructionprogramme. The association alsosponsors theatre groups, and evena community newspaper. The latestventures are the rebuilding of a

' sewage canal and the installationof sewage and garbage collection

t chutes for residents of the upperreaches of the hillside slum.

Labour is supplied by Brazil'straditional wwf/rao, a communityself-help system. "Even,1 Sunday ismtttirao day," says Adilson Car-valho, who is helping on the newproject. "Each person docs whathe can. The work goes fast, andit's done well.11 He points to a rc-cenrly finished concrete retainingwall fitted with plastic drain tubes."We have a lot of constructionworkers living in Rocinha," heexplains, "and they know whatthey're doing."

The state secretariat, withUNICEFs assistance, is nowextending the Rocinha approachto other jmvlas. One of these isMorro de Dona Mara, anotherhillside slum. Residents are de-lighted with their new 7,000 litrewater tank, which, with its sevengleaming taps, supplies water todozens of slum dwellers whowould otherwise have to trudgedown narrow footpaths to fetchwater from the bottom of the hill-side. The water tank was installedby people from the communityworking weekends and holidays,and using materials solicited fromlocal building suppliers.

It was the Jnrvla's largest sambaand carnival organization that mo-bihzed the supplies and man powerfor the water tank. Now that or-ganizations like this are taking aninterest in community projects,the basic services programme inRio's slums is beginning to marchahead to a samba bear.

under intolerable conditions are foundin urban areas throughout the devel-oping world. UNICEFs approach tothis problem has focussed on backingnon-conventional and non-institu-tional activities for street children andhelping governments and voluntaryorganizations learn from such experi-ences. In Brazil, a project to helpreintegrate street children into theircommunities was taken up at a muchfaster pace than had been expected,with over 120 state and local pro-grammes participating. But the pro-blem of how to reach the great numberor" abandoned and street children inthe third world cities still remains analmost overwhelming challenge.

Problems such as malnutrition andabandoned childen arc closely relatedto the whole complex of problems facedby the urban poor: housing, sanita-tion, education, and employment.UNICEF, therefore, continues toemphasize and support multi-sectoralprogrammes. The urban basic sen-icesprogramme in Mexico, for example,which is being initiated in four pilotcommunities in the states of Veracruzand Tabasco, includes a core of activ-ities focussed on child health, as well aslow-cost water and sanitation technol-ogy, housing, food production, andincome-generating. Since unemploy-ment and underemployment are soprevalent, small family and commu-nity enterprises are being especiallyencouraged. D

m SOCIAL SERVICESFOR CHILDREN:In 1983 UNICEF

cooperated in .soci.il sen-icestor children in 98 countries:42 in Africa, 25 in theAmericas, 20 in Asia and 11 inthe Middle Eist and NorthAfrica region

supplied equipment to morethan 22,900 child welfare andday-care centres, 22,500 vouchcentres and clubs and20,400 women's centres

provided stipends to more than43,300 women and girls fortraining in child care,homecrafts, food preservationand income-earning skills

provided stipends to train some29,700 local leaders to helporganize activities in their ownvillages and communities

provided equipment andsupplies to 700 traininginstitutions for social workers,and training stipends for51,100 child welfare workers

Street children, forced to contributesomehow to their tnwi and their families".tKm'm/, arc an iwrcasinft concern,(farticularly in Latin America.

. »• —-V^BI?

•'.'

Women's activities

An analysis of reports from UNICEFsHeld offices for 1983 reveals a moreprofound appreciation of women'smultiple roles in programme planningand implementation. As a startingpoint, some UNICEF offices, notablyOman, Ethiopia. India, and Burma,have initiated situation analyses andneeds assessments to help improve thedesign ot programme components af-fecting or involving women.

The critical role that women playboth in the home and the communityin the health, nutrition, and well-being of children, has always beenrecognized by UNICEF. But in recentyears there has been a deepeningrealization of roles other than thedomestic and nurturing ones tradi-tionally emphasized.

Support to women's involvement inall aspects of basic health and nutrit ionremains, however, a central considera-tion in UNICEFs co-operation in thefield of health. Women's ful l participa-tion is needed to ensure widespreadapplication of the child survival anddevelopment techniques identified byUNICEF as crucial to a "revolution" inchildren's health. Correspondingly,the Joint WHO/UNICEF NutritionSupport Programme (see page 18) in-cludes a dynamic women's compo-nent. Activities in three areas will be

emphasized: the protection ofwomen's health and nutritional statusduring the childbearing cycle; the pro-motion of women as economically ac-tive and independent agents; and thepromotion of supportive services, suchas day-care, to minimize the effectsthat increased women's involvementin economic activities might have onchild care in the home.

During 1983, a number of stepswere taken to consolidate UNICEFsupport for programmes designed toimprove women's income-generatingcapabilities. Increasing numbers ofwomen, particularly in urban areas, aretoday playing a vitaJ role, often entirelywithout support from a male "head ofhousehold11, in providing for theirfamilies. As a result, UNICEF hasstepped up its assistance to income-generating activities tor women in re-cent years and tried to shirt the focus inthese programmes away from handi-crafts and piecework, and bring themcloser to the economic mainstream.

An important development is thepolicy of "infiltrating'1 national levelbanking systems, to enable women'sgroups to tap previously inaccessiblesources of credit. In Bangladesh, CostaRica, Colombia and Nepal, UNICEFhas helped develop programmes whichare integral components of nationwide

Manv nwwt'H in urban areas have to providejw~ their families without support from a male"bead of 'household". In Zimbalnre, womenplay R vital role in community projects.

credit schemes and manpower trainingsystems. The problem faced by manywomen trying to pool their efforts in asmall productive enterprise is that theyhave no banking, credit, business, ormanagement expertise. Skills train-ing, in such circumstances, is notenough. In programmes such as theone in Costa Rica (see profile inset),UNICEF can open up a channel froma much larger source of credit thanUNICEF could itself provide togroups of disadvantaged women.

In Bangladesh, working with theGrameen Bank Project, a scheme espe-cially designed to provide credit to thelandless, UNICEF helped train 120women bank workers to decentralizecredit services to the village level, andalso trained 834 village women groupleaders in savings and credit manage-ment. To date, under the GrameenBank's programme, more than 8,000women's group members have beengranted loans to initiate income-generating activities, and their repay-ment rate has been 99.5 per cent.UNICEF's policy of promotingwomen's access to credit is continuingto expand through establishing revolv-ing funds within national bankingsystems.

In many developing countries,women are extremely active in theagricultural sector. UNICEF is there-fore supporting women's economicactivities in enterprises such asvegetable production, raising poultry,small livestock projects, fish process-ing, and cattle fattening in many coun-tries, including Egypt, Korea, andSurinam. Fast food and food cateringprojects have been fiandcd in Ethiopiaand Swaziland.

Training activities for women areanother key component of UNICEF'sefforts to improve the quality of familylife. The traditional form of UNICEF-assisted training is that given towomen in home economics, healtheducation, child care, and handicrafts.This forms part of country program-mes almost everywhere. Training pro-grammes for community workers,extension agents, and women com-munity leaders are most prominent in

30

Crocheting may not be the answer COSTA RICA

Isabel Montcs lives in Palmares, asmall city in Costa Rica. She sharesa house with her mother, whoearns a few cents each day sweep-ing the town square. But Isabelherself has no regular job, and hasthree small children to support.

When she heard about a groupof women organizing themselvesbecause they badly needed to earnsome extra income, Isabel joinedin the hope of finding some wayto feed her little boys. Like manyother women's groups in a similarpredicament, they turned to a tra-ditional domestic occupation: cro-cheting. It was not a success.

The group started out in 1981with 20 members. The idea wasthat anyone who knew how to dosomething would teach the rest.One woman knew how to cro-chet. So they started crochetingblouses which they sold to some-one in the export business for US20 cents each. It was too little, sothe women began to look for theirown markets.

As Christmas 1982 approached,the women had hopes of selling toshops in Palmares and San Jose",the capital. They applied to theBanco Popular, where UNICEFhas placed funds for urbanwomen's income-generating activi-ties, for a loan of US $5,000 tobuy a year's worth of materials.

Cruz Mary Prado, a Bank em-ployee supported by UNICEF, vis-ited them and recommended a loanof US S/00-just enough for whatthey thought they could sell thatChristmas. The women were veryupset at getting such a small loan.But by February 1983/they weregrateful to Cruz. Christmas was adisaster. They worked hard, butsold very little.

Isabel Montes and the otherwomen in the Palmares group dif-fer from the vast majority of urbanwomen in Central America mainlyin the fact that they are organized.They are typical m that they arepoor, easily exploited, and tend toturn to traditional women's activ-ities such as sewing and knitting to

earn extra money.uWe try to discourage women

from turning to these temalc activ-ities as a way of setting up viablebusinesses", says Athenia Montcjo,a UNICEF consultant. "In thelong run, it is very difficult forwomen working by hand or withsimple household machines tocompete with multinational indus-tries like Textiles de Palmares (asubsidiary of a US garment manu-facturer). The)1 should be organiz-ing themselves to produce othergoods and services in fields wherelarge firms are less likely to under-sell them.11

The fact is that the women ofPalmares can't succeed if they don'thave a viable business. "They arevery determined," Cruz reported,"but they have no quality control.Hand-crocheted goods have a verylimited market. The women don'teven know what prices to chargebecause they haven't analyzedtheir costs. Right now, we're try-ing to help them get their businesson a sound tooting."

A few months ago, at Cruz's in-

stigation, the Palmares womenmet with government agencieswho promised to help them byconducting a feasibility study andlooking for markets in nearbycountries. The Labour Ministryoffered to help set up day servicesfor the children.

UNICEFs urban programme inCosta Rica supports groups such asthese by helping set up the credit,technical assistance, supply andmarketing systems they need tobecome viable small businesses.Those that have a good chance offinding reliable markets are en-couraged to keep doing what theydo already. But if-like IsabelMontes and the other women ofPalmares-they are competing withlarger industries, they may have tobe coaxed away towards somethingmore economically practicable.

The important thing about thewomen's group in Palmares is thatthey are self-started and self-managing, [f they do decide even-tually to switch to another prod-uct, it will be because they havedecided there is a better alternative.

n

Africa, notably rural extension agentsin Ethiopia and home economicsagents in Sudan.

A growing category of UNICEF-assisted training is in occupationalskills. Of special interest is UNICEFspromotion of women's training inconstruction-related skills. In Swazi-land, where most of the men work ascontract labourers in South Africa,UNICEF is supporting training pro-grammes in block-making and weld-ing, which are extremely popular.UNICEF also supports trainingcourses in management and credit forwomen's co-operatives.

As increasing numbers of womenenter the labour force, a higher priorityis being attached by many govern-ments to the need for day-carefacilities. UNICEF has responded withsupport for the expansion of creches,kindergartens, and other pre-schoolfacilities in Thailand, Iraq, the Philip-pines, the Caribbean, and elsewhere.

UNICEF's support for pre-schools,which not only look after the health,welfare, and learning needs of youngchildren, but which provide an entrypoint for a variety of community ser-vices, is exemplified by country pro-grammes in Korea and India. In Korea,innovative day-care centres are linkedto an integrated basic services projectin underserved areas, and incorporateexperimental programmes developedby the Korea Institute of BehaviouralSciences. One of these centres hasgenerated a training programme forunemployed mothers, a job placementcentre which bargains ibr standardwages, and a women's communitybank.

In India, more than 40,000 womenhave been trained to staff community-based anganwadis or "child-care court-yards". In addition to pre-schooleducation, these provide supplemen-tary feeding, serve as deliver)' points forimmunization and health check-ups,and promote sound weaning practicesand health education to mothers. D

At the National Institute for the Blind inBogota, C/iiambia, Cesar receives special

pre-school training. UNICEF encourages thedetection and treatment of childhood

impairments in the community, and themaintenance as far as possible of the normalcycle of child development. Cesar will soonjjo

to a regular school with syfhted students.

Childhood disabilitiesIn 1983 there was substantial progressin programmes for the early identifica-tion and prevention of disabilitiesamong children, and for the rehabil-itation of the already impaired.UNICEFs increased emphasis on im-munization and other aspects ofprimary health care was an importantcontribution toward the prevention ofdisabilities. But recent research isbeginning to confirm that in thosecountries where there have been recentdeclines in infant mortality, theprevalancc of disabilities tends to in-crease with the survival of a com-parative!)' higher number of weaker in-fants. UNICEF expanded its supportto the training of mothers and com-munity workers in the early identifica-tion of impairments, sponsoring ofworkshops in Indonesia, Zambia, SriLanka and Kenya. Some of theseworkshops followed up surveys con-ducted in 1981 during the Interna-tional Year for Disabled Persons(IYDP), whose results were analyzedin 1982. In Zimbabwe, a national planbased on an IYDP survey is beingdeveloped, and legislation has passedfor the duty-free importation of equip-ment for disabled persons.

The problem of childhood dis-abilities in developing countries,though widespread, has not in the pastreceived aver\ r high priority. Advocacyefforts which were launched in 1981

tor the IYDP have now led to pilotprojects in many countries, and thesein turn arc leading to wider coverage.In Afghanistan, with UNICEF sup-port, teachers are being trained todetect visual, hearing and other healthrelated disabilities, using materialsdeveloped jointly by the ministries ofeducation and public health.

In UNICF.F-assisted early educationprojects in Korea and Thailand, theconcept of disability has been extendedto include behavioural disabilities re-sulting from insufficient physical, in-tellectual and emotional stimulationduring the period between birth andsix-years-old.

In Indonesia, a two-year project tointegrate hearing-impaired childreninto regular classes was completed in1983. To complement this, UNICEFis providing financial assistance to anon-governmental organization in In-donesia for a project tor blind childrenand youth in rural areas; the goal is totrain these blind children to get abouton their own and to develop skills thatwill enable them to become productivemembers of their communities.

Rehabilitation International con-tinued to co-operate closely withUNICEF in technical support on theprevention of childhood disabilitiesand the rehabilitation of disabledchildren. D

52

AppropriatetechnologyImproved low-cost technologies, usingskills existing in the community andlocal or easily obtainable materials, canplay an important role in improvingthe conditions of family lite. Fifty-fiveUNICEF-assisted country programmesnow include the application of appro-priate technology ideas and devices inhealth care schemes, food processing,conservation and preparation, watersupply and sanitation projects, and inthe alleviation of the drudgery enduredby women in the performance of theirdaily domestic and agricultural chores.

Lorenastove

Sushila needs a newkitchen stove NEPAL

.Wir; /4-nfitwM1

(Viniwui\\TTA. IW2I

f-WiTif'

In recent years, the household fuelcrisis in the developing world has givenrise to increasing concern. One of ruralwomen's most arduous burdens, whichtheir children help to bear from an earlyage, is the gathering of firewood. TheUN Food and Agriculture Organiza-tion (FAO) estimates that by the endof the century three billion people willbe living in areas of acute fuelwood de-ficiency. Concern about the increasedtime, energy, and costs faced bywomen in poor societies in meetingtheir household needs for fuel, ledUNICEF to publish a special report in1983 entitled "UNICEF and theHousehold Fuels Crisis". UNICEF isnow assisting in the development anduse of fuel-efficient cookstoves in 24countries, as well as in the develop-ment of bio-gas generators using ani-mal, human and agricultural wastes,and in the planting of community

Most of her fellow Nepalesewould regard Sushila as a modernwoman: she has taken a chance onreplacing her traditional cookingstove with an improved model.Like other families, Sushila livesin extreme hardship. Clinging to asteep hillside, the farm providesthe mast meagre living. They aredependent on a tew animals, andon the crops they manage to coaxfrom the narrow terraces of theirsmall plot, Sushila and her chil-dren clamber for hours a day overrocky paths to fetch water, fodder,and bundles of firewood. But gath-ering wood is becoming more andmore difficult. Nowhere is the de-veloping world's firewood crisismore evident than in Nepal, wheredeforestation leads to runaway ero-sion, landslides and Hoods.

Nearly every household inNepal uses wood for cooking,whether on a simple three-stonefireplace, or an elaborate clay-mocielled four-burner stove. Mostconsume wood inefficiently, andalso allow smoke to fill the room,creating an environment whichhas been blamed for many eyeand respiratory problems.

Sushila's new stove, an im-proved "smokeless chula\ wasrecently installed by workers fromher village's Small Farm FamilyProgramme. Costing the equiva-lent of US 75 cents for installa-tion, the stove will save up to 40per cent of her firewood, and will

leave her kitchen smokeless. It isone ot a new prefabricated designmade by traditionally trained pot-ters working in several locationsaround the country.

Fuel-efficient stoves are not newto Nepal, but until recently effortsto introduce them concentrated ontraining individual families to buildtheir own—a time-consuming andnot always successful job. Theadvantage of the prefabricatedmodel is that the precise dimen-sions for vents and flues are identi-cal in all the stoves, thus keepingintact the fuel-saving design.

The introducton of prefabricatedfuel-efficient stoves into Nepal isbeing supported by several aid pro-grammes. UNICEF, in collabora-tion with Nepal's AgriculturalDevelopment Bank, has devised asystem by which villagers likeSushiJa can acquire a stove free. Astove costs US $5 to make, and itis hoped that after the introduc-tory fre'e offer-UNICEF is provid-ing 1,000 stoves over the pro-gramme's first year-potters will beable to promote and sell the stovesat this price.

Sushila is pleased that she will nolonger need to spend so muchtime gathering fuel, and that herchildren will no longer cough.Even though the new model stoveis not yet perfect, it is tromwomen like Sushila who use itthat the most important sugges-tions for improvement will come.

•

woodlots.Substantial appropriate technology

components have now been incorpo-rated in country programmes inEthiopia, India, Kenya, Senegal, Nepa]and Indonesia. In Ethiopia UNICEE isassisting the government's BasicTechnology Centre at Burayo, nearAddis Ababa, where work is pro-ceeding on fuel-efficient clay stoves,water storage containers, solarcookers, and wheelbarrows. In India,UNICEF is assisting training in ruralcrafts, and is promoting two types ofimproved grain storage: a modifiedversion of the traditional mud-brickand plaster bin, and silos which can befabricated in the villages from galvan-ized sheets.

In Kenya, where appropriatetechnology centres established withUNICEF assistance outside Nairobiand in Nakuru provide a resource base,training and outreach covered all partsof the country in 1983. The latest itemto gain public response is an insulatedversion of the popular portable char-coal bucket-stove, designed to facil-itate fuel savings. In Senegal, UNICEFhas supported the development ofpower-operated millet grinders andrice threshers which are fabricated inlocal workshops, and operated andmaintained by specialty-trained villagepeople.

In Nepal, UNICEF's assistance toappropriate technology activities is co-ordinated under the Small Farms Fam-ily Programme. Low-cost water supplyand waste disposal systems are beingpromoted, and the conservation andstorage of food. To lighten the dailytasks of women and girls, improvedwater mills and cookstoves, bio-gasplants and community woodlots arcbeing introduced. In Indonesia, aUNICEF-preparcd report, "VillageTechnology': a Sourcebook**, has beenpublished in Indonesian. Develop-ments cover a wide spectrum, fromredesigned child weighing scales to theplanting of a type of tree called theLamtoro (Leucaena) that provides bothfodder and fuel, and fertilizes the soil.

In November 1983, a successfulworkshop was held in Nepal torgovernment officials, UNICEF fieldstaff, and NGOs working in severalcountries. The workshop paid particu-lar attention to how appropriate tech-nology can be used to reduce infantmortality and improve the health andwelfare of children and mothers. D

Programme support activities

Monitoring andevaluation

UNICEF has given increasing attentionto evaluative activities as a means ofhelping countries improve programmeimplementation and service delivery.These activities include a mix of pro-spective studies, monitoring, pro-gramme and project evaluations, peri-odic reviews of field co-operation, andprogramme auditing. Evaluations havebeen most extensively undertaken inthe East Asia and Pakistan region,followed closely by South Centra] Asiaand Eastern Africa.

Progress in this field is still hamperedby several constraints. Government of-ficials sometimes perceive evaluation asa fault-finding exercise. Evaluations arefrequently couched in very generalterms or come too late to be useful, anda major problem remains the lack inmany countries of experience andexpertise, especially in the processingand interpretation of data.

As part of their regular work,UNICEF field stiff invested consider-able time in following up on projectimplementation with their nationalcounterparts. The day-to-day assess-ment of projects, through numerousfield trips and consultations, contri-buted greatly to project monitoring.There was, in addition, increased at-

tention to the development of im-proved formal evaluation procedures.To strengthen the evaluation of villagewater supply and sanitation projects,arrangements were made for UNICEFprogramme officers and governmentofficials from Ethiopia, Haiti, Paki-stan, Sri Lanka and Zimbabwe to at-tend a special course at the RoyalTropical Institute in Amsterdam, Thistraining, which is being extended tostaff involved in the extension of pri-mary health care services, aims to de-mystify evaluation and strengthen it as aproject activity. Also emphasized arepractical evaluation techniques for use-in countries lacking sophisticated datagathering and analyzing facilities.

Steps were taken at UNICEF Head-quarters to establish a global inventor)'of studies and evaluations. Selectedreports have been abstracted andentered into an experimental compu-terized data base system-a "memorybank" of project experiences. Field of-fices were asked to try to help govern-ment departments improve their use oflessons learned from evaluations to im-prove programme implementation.UNICEF support to the developmentof information bases in several countrieshas contributed to improved pro-gramme planning, monitoring andevaluation.

UNICEFfield staff"follow up on projectimplementation; with pre-schoolers inBale, Ethiopia at the new village pump.

Programme supportcommunications

Programme Support Communications(PSC), in the UNICEF context, is theuse of development communicationtechniques, ranging from interpersonalcommunication to mass media, in sup-port of programmes at all levels.

Field offices in 1983 found increasingopportunities to co-operate with na-tional media to motivate the public inmeasures needed to reduce infant andchild mortality. In Zambia, 13 child-care radio programmes were produced,along with 20 episodes of a radiodrama series promoting primary healthcare. Television films and video tapesto promote oral rehydration therapyand breast-feeding were prepared inBrazil, India, Colombia, and SaudiArabia. In Lebanon, an integratedmass media campaign, involving TVspots, posters, radio programmes, andnewspaper features, was mounted tosupport a polio vaccination campaign.

The communication component ofIndonesia's Family Improvement Pro-gramme, primarily directed at preg-nant women and mothers of childrenunder five, included posters, pressadvertisements, and radio spots pro-moting breast-feeding and regularchild weighing; while comic strips,posted on village bulletin boards, en-couraged good health and nutritionpractices prescribed by Islamic texts.

A n urn ber < >f PSC efforts weredirected specifically at policy makers inthe developing countries. Publicationin India of regional language versionsof the 1983 edition of the State of theWorld''* Children report extended itsreach and increased its impact. InGuatemala, UNICEF produced a slideset in collaboration with the NationalCommission tor Breast-teed ing Pro-motion to orient policy-makers.UNICEF also is helping to highlightwhat has been learned from the suc-cessful Brazilian breast-feeding promo-tion campaign so that other countriescan profit from the experiences.

In many UNICEF-assisted program-mes, there is a new emphasis on build-ing up production capabilities for non-formal educational materials and im-proving the communication skills ofgovernment extension and field staff. InBelize, UNICEF supported the trainingof technicians from the ministries ofhealth and education in the production

of community-level educational mater-ials. In the Yemen Arab Republic,UNICEF supported a workshop tormedia and health staff on communica-tion support for primary health care.Liberia, with UNICEF assistance,established a health education produc-tion unit to produce health bookletsand radio programmes. In Kenya,UNICEF supported a six-week trainingcourse in communication tor womenextension officers in agriculture, healthand community development. In theEastern Africa region, UNICEF isfinancing the production of nineregionally-oriented Held manuals onPSC techniques tor use in extensiontraning institutions.

Inter-agencycollaboration

UNICEF continued to strengthen itslinks with other United Nationsbodies with renewed vigour during1983. Close working relations with theUnited Nations Development Pro-

The new etnpbasisis an Imildififi uplocal productioncapabilities ((»•educationalmaterials. Visualaids n'inforcc thekamittf} process in alito-acy class inBangladesh.

| < > I - 'M3S.TIi.nn.is

gramme (UNDP) continued in New-York and the field, with UNDP beinginvolved in country programmes,previews and reviews. The Joint Con-sultative Group on Policy, originallycomprised of UNDP, the United Na-tions Fund for Population Activities,and UNICEF, welcomed the WorldFood Programme as a new member ofdie group. The special linkage estab-lished with the World Bank in 1982 isbeing strengthened, and ail WorldBank missions in population, health,and nutrition now collaborate closelywith UNICEF field offices for supportand follow-up.

UNICEF's long-standing close rela-tionship with WHO was furtherstrengthened in L983. The ExecutiveDirector of UNICEF and the Director-General of WHO had a number ofconsultations, particularly in regardto the 1984 State af the World's Chikin'nreport, which ensured a consensus andjoint action in advocacy tor improvedchild health and survival. Relationswith UNESCO, in educational pro-gramming, and with ILO, in income-generating activities tor women, werealso strengthened. D

35

Advocacy for children

Launch of the "childsurvival revolution"

At its 1983 session the Executive Boardstrongly endorsed the heightened im-portance of UNICEFs external rela-tions activities in both industrializedand developing countries. While ad-vocacy on behalf of children has beenan important function of UNICEFsince the organization's inception, it hasassumed an even larger role since 1979,the International Year of the Child,which helped, to create new oppor-tunities for effective advocacy andco-operation with NGOs and otherpartners,

In a world where economic retrench-ment has distracted resources and at-tention from third world issues, thereis a renewed urgency to increase apopular understanding of the needs ofchildren in the developing world andto mobilize puhlic and private supporton their behalf.

The Executive Director's 1983 and1984 State of The WarWs Childrenreports, which-dramatized the possibil-ities of sharply reducing infant mortalityin the developing countries throughlow-cost measures, struck a responsivechord in the media throughout theworld. In addition to echoing themessages on what has become known asthe "child survival revolut ion"throughout UNICEFs own films andpublications, a number of collaborativeefforts were undertaken to reach wideraudience;.. The BBC, tor example, pro-duced a second "global report" on alter-native health systems and devoted onehalf-hour programme to the techniquesof the child survival revolution, as car-ried out by health {nvnwtoras in Colom-bia (see profile on page 8). An issue ofthe International Planned ParenthoodFederation's magazine, Peopk\ wasdevoted to primary health care expan-sion at the initiative of. and with finan-cial help from, WHO and UNICEF.

Regional journalists"1 workshops on"Women, Children and Population",.sponsored by UNICEF and the UNFund for Population Activities andorganized by the Press Foundation ofAsia, were held in Manila and Jakarta,and included discussion of how devel-

oping world journalists could helpfurther the child survival revolution, InAbu Dhabi, a regional seminar on therole of media in social development andchild \\clfare, attended by 50 journalistsand officials from the Arab Gulf, tookthe 1984 State of the WmWs Childrenreport as its point of departure.

In its review of external relations atthe May 1983 session, the Board em-phasized the need to extendUNICEFs reach by intensifying jointeftbrts with other UN agencies, gov-ernments, UNICEF's National Com-mittee partners, and its allies in thenon-governmental world: nationaland international voluntary agencies,religious groups, parliamentarians,professional associations, and businessgroups. Many of these took strongpositions on child survival revolutionmeasures, and ga\c them increasedemphasis in their assistance pro-grammes in developing countries.

In 1983, advocacy efforts byUNICEF offices in developing and in-dustrialized countries alike led toseveral important policy decisionsrelated to child survival. The Govern-ment of Bangladesh, for example,formally adopted the InternationalCode of Marketing of Breast-milk Sub-stitutes, and a nation-wide immuni-zation campaign with assistance fromUNICEE and the UK Sa\e the Chil-dren Fund was launched in Uganda.

In September 1983, the AmericanAcademy of Pediatrics adopted a reso-lution endorsing the child survival ob-jectives and practices advocated byUNICEF and WHO; and at its globalmeeting in Manila, the InternationalPediatric Association (IPA) likewiseendorsed these measures, calling upon"Regional, National and Local Pedia-tric Societies, and upon all individualparticipants, to join in this effort". TheIPA also agreed to collaborate on threeregional meetings on immunization,oral rehydration therapy and othersolutions to the major avoidable causesof childhood mortality and morbidity.To further promote joint action atfield level, the NGO Committee onUNICEF called on its 139 members toprovide detailed information on theiractivities in countries preparing pro-grammes for consideration by theBoard in 1984 and 1985.

Much of the very encouraging officialand public response to the 1983 and1984 State of the uvrhfs Children reportsin the industrialized countries was dueto the work of the National Commit-tees for UNICEF. Along with theirfundraising, main of the NationalCommittees engaged in extensive infor-mation and education campaigns ondie child survival revolution. The SwissCommittee, for example, distributedthe reports to leaders of professional,voluntary and religious groups, seekingreaction and support for furtherdissemination. The United States Com-mittee launched a series of meetingswith educators and with NGOs in theUSA on child survival and developmentissues. In November, 27 NationalCommittees took part in an externalrelations workshop in Rome, the first ufits kind, leading to a frank exchange i >nhow best to promote UNICEF's objec-tives and, through their informationand development education activities,to gain support for measures to reduceinfant mortality in the third world.

Development education is anotherimportant aspect of UNICEF's exter-nal relations work, and in partnershipwith National Committees and otherNGOs, UNICEF made considerableprogress in 1983 in spreading the mes-sage of North-South solidarity in sup-port ol the child survival revolution.UNICEF maintained a developmenteducation resource centre in Geneva,and its staff participated in numcruusworkshops and meetings. There wasclose collaboration with groups invarious countries, and UNICEF help-ed to introduce development educa-tion materials into school classrooms.

The Picasso UNICEF Christtttas card: amother breast-feed my her ihild.

36

International YouthYear

The UN Gener.il Assembly hasdesignated 19X5 .is Iiiternarion.ilYouth Year with three themes: Partici-pation, Development and Peace. IVYpresents an opportunity for UNICEFto promote the participation of youthin development, through "Youth inSen-ice to Children" acti\ ities aroundthe world. In ant icipat ion of IVY, theUNICEF National Committees in theindustrialized countries arc encourag-ing greater youth participation intundraising and in advocacy tor thechild survival revolution. In thedeveloping world, UNICEF field of f i -ces will co-operate closely with na-tional IVY committees.

Already, in 1983, a strong coalitionwas developing between UNICEF andorganizations such as the World ScoutBureau, the League of Red CrossSocieties, and the World Council ofChurches to encourage the participa-tion of youth groups in child survivaland development activities duringIYY. Youth groups have already co-operated actively \\ irh UNICEF at thecountry level. The Sri Lanka Scouts,for example, have helped install v i l lagewater pumps, and Scouts from theUnited Kingdom raised Rinds to sup-port the project- Examples of the suc-cessful mobilization of youth can befound in many developing countries,including Chile, Colombia, Ethiopia,Kenya, Mexico, the Philippines, andUpper Volta.

UNICEF's "goodwillambassadors" andspecial fundraisingevents

Special events, ranging from majorgalas to popular sports events, con-tinued to play an important role inUNICEFs information and fundrais-ing. 1983 marked the 30th anniversaryof Danny Kaye's voluntary help forUNICEF. Active as ever, he visitedCanada, Denmark and Finland andspoke as UNICEF's Goodwill Ambas-sador at events in the USA.

Liv UUmann visited the Philippines,Colombia and Ecuador, and partie-

/./V Ullwauti, t"i\VC£f'r Goodwill Aftt&assadtir, tfttiufiiyf time with a family in n poorurban neighbourhood littnnfi her risit to Colombia.

ipated in UN1CFT- benefits in Aus-tralia, North America and Europe. InCanada she briefed the press on the1 9 8 4 S t f t i f t i f t / j f H'fBiWVChildren report,speaking out as effectively as ever onbehalf of mothers and children in thedeveloping world. Her television ap-pearance in the Federal Republic ofGermany alone resulted in more than amillion dollars in donations.

Peter Ustino\ filmed Greeting( ard spots in four different languages.Pelc, David Frost, John Denver, Cata-riiia Valentc, Malini Fonsekn, CarolaFlagjrkvist, Corrine Hermes, RaviShankar and Ben Kingsley also madeimportant appearances for UNICEF.

Benefit premieres of Sir RichardAttcn borough's film "Gandhi" wereheld in some 30 cities around theworld, raising more than USS75U,0()()for UNICF-F\ assistance programmes.

Photo exhibits on the child survivalrevolution were shown in Manila,Port-au-Prince, Washington, Brussels,Pans and New York; and a children'sart exhibit on the theme "Water forAIT, rcsLildim from a contest organizedjointly b\ UNICEF and the OPECFund for International Development,was shown in New York, Vienna andLondon. Certain special events, like\\ . i lks for UNICEF in several F.uropeoncountries and "Take a Child to Lunch"in Canada, have become an annualtradition for mam1 L'NICEF National

Committees. In the Sudan, theSupreme Council for Sport and Youthestablished the UNICEF Soccer Cupas an annual event for advocacy andfundraising.

The UNICEF greeting cards againbrought pleasure to millions of peoplein all walks of l i f e , providing a major-vehicle for bringing I'NICEFs namebefore the public eye, bringing a senseol reward to all those on its volunteersales networks. The Greeting CardOperation has now embarked on alarge-scale promotional campaign insupport of the child survival revolu-tion. The first theme card, a Picassopainting of a mother breast-feeding herchild, is going on sale in packages often with a message on breast-feeding.In the -1983/84 season, messages onthe child survival revolution were in-cluded in boxes ot year-round notecards, and the message: "Spread theWord: Join the Child Survival Revolu-tion", is featured on thousands ofsticker-sheets and shopping bags.

JNICEF's SpecialEnvoy

1983 marked the fourth year sinceHRH Prince Talal Bin Abdul Aziz AlSand undertook his mission asUNICEF Special Envoy, in the serviceof children throughout the wor ld . He

3

continued his strenuous and dedicatedefforts, carrying his message on thecaici.il development aspect ofUNICEFs work to leaders anddecision-makers in the Philippines,Bangladesh (his second offici.il visit),the Maldives, Sri Lanka, PortugaJ,Sweden and Spain. He also made threetours in the United States, visitingeight major cities, generating wide-spread discussion and broad mediacoverage of the needs of third worldchildren and UNICEFs efforts to meetthose needs.

In recognition of his work on behalfof the world's children, the Govern-ment of France named HRH PrinceTolal "Grand Officier de la Legiondlionneur" on 23 September 1983.

HRH Prince Tatal Bin Abdul Aziz AlSattd, UNICEFS Special Etnm, uudiTttJok a

sccomi mission to Bangladesh durittfj 1983,ami i.\ pictured here with children in Dhakti.

AGFUND

The Arab Gulf Programme for theUnited Nations Development Organi-zations (AGFUND) was formally es-tablished in April 1981 on the initia-tive of HRH Prince TalaJ Bin A/iz AlSand, who was elected President of theProgramme. Its Administration Com-mittee - composed of representativesfrom the seven member stares ofBahrain, Iraq, Kuwait, Oman, Qatar.Saudi Arabia and the United ArabEmirates—convenes regularly to con-sider project proposals and to decideupon the allocation of funds and thetimetable of fund disbursement.

AGFUND is the only institutionworld-wide to channel all its assistancethrough the United Nations - andparticularly UNICEF - specifically forsocial development programmes.

Despite the prevailing difficult inter-national situation and significantlylower oil revenues, AGFUND mem-ber states demonstrated again in 1983their commitment to the social devel-opment work of the United Nations.

Activities benefiting fromAGFUND's assistance cover countriesthroughout the developing world andinclude projects in water, sanitation,health, education, food and agri-culture, environment, women's de\el-

AGFUND Contributions to

AGR'XDi-ISL'.l) YL'JP.

Other Governments throughauspices of AGFUND . . . .

Private contributions through

UNICEF

1981/82 1982'83 1983,84tn dati: "

US S millitat?

25.0 21.9 12.0

8.7

4.0 0.1 6.0

37.7 22.0 18.0

Totalto dace

58.9

8.7

10.1

77.7

'Further contributions for fiscal year 1983/1984 an expected.

opmeiu, and childhood disabilities.

Contributions to UNICEF throughAGFUND and its member states, andthrough the auspices of AGFUND,from the - r ime of AGFLINITs incep-tion in 1^81 until the end of 1983, oreshown in the adjoining table.

Other benefiting agencies of the UNsystem are FAO, UNDP, UNEP,UNESCO, WHO, and the UN TrustFund for the International Year ofDisabled Persons.

In addition to AGFUNIVs .success inchannelling contributions from itsmember states to UN organizations,the Programme has been instrumental- through its direct and indirect aus-pices - in raising funds exclusively torUNICEF from other governments andprivate sources. Above and beyond itsfunding role, AGFUND lias also beeneffective'in further focussing the atten-tion of governments and individualsupon the development activities andachievements of the United Nationssystem with special emphasis onUNICEF.

Though AGFUNlTs member statesare still in the process oi" establishingand strengthening their own socialsen-ice infrastructures, their genuineconcern tor the whole of the develop-ing world is reflected in the world-widescope of assistance and in the broadspectrum of development projects. D

58

Emergency relief and rehabilitation

DisasterassistanceIn 1983, UNICEF provided emergencyassistance to 29 countries. Fourteen ofthese were in Africa, where devastatingdrought struck countries extendingsouthwards from Ethiopia to Mozam-bique on the continent's eastern sea-hoard, and from Cape Verde toAngola in the west. In most countries,UNICEF was a close partner withother UN organizations, with theInternationa! Committee of" the RedCross, the League of Red Cross Soci-eties, various bilateral aid agencies, anda wide spectrum of non-governmenraJorganizations. In general, UNICEFfocussed on the restoration of normalliving conditions and services formothers and children, linking theseefforts wherever possible u-irh thestrengthening of ongoing child sur-vival and nutrition programmes in-cluding nutrition surveillance and oralrehydration therapy.

In Lebanon, which was the scene ofUNICEFs largest relief effort in 1982,the UNICEF reconstruction pro-gramme continued in 1983, alongwith the procurement and distributionof relief supplies-blankets, soap andfoodstuffs, for example-as new fight-ing broke out. To combat diarrhoealdisease and dehydration, packets oforal rehydration salts, along withinformation materials in Arabic, werewidely distributed to hospitals, healthcentres and mobile clinics. Continuingits assistance to water supplies,UNICEF helped the government re-pair 14 damaged water mains in westBeirut and the city's southern suburbs.In the southern part of the country,UNICEF engineering staff weredeployed in Qana, wherj: they con-tinued to help with the majorUNICEF/Government of Lebanon pro-gramme for the rehabilitation ofschools, water supplies, and otherservices.

A woman and her two children, bemfkiaricsof a fiedhiff fmxjwmmf in Uganda, Stye car-ries the charts on which her children '$ nutri-

fumal tvcorety is being recanted.

The emergencyin AfricaSeventy-three per cent of the fundsreleased from the Executive Director'sEmergency Reserve Fund went toAfrica. In Ethiopia, UNICEF allocatedUS$310,000 in March tor medicines,blankers, clothing, and transport for

food and relief supplies. AnotherUS$200,000 was made available inOctober for a pilot project carried outin collaboration with the EthiopianRelief" and Rehabilitation Commissionand the Catholic Secretariat in AdclisAbaba. Under this scheme, assistancewas provided to some of the most des-titute victim;, of the drought to buyfood, seeds, draught animals, fodder

39

Seeing it coming just wasn't enough

Many African countries arestricken by severe drought everyfew years according to a cyclicalpattern, and with drought comesthe threat-and sometimes thereality—of famine. In 1973 and1974 a devastating drought cut abroad swath across the continent;and in 1983 the pattern mani-fested itself again, with 22 Africancountries on FACTs "Food Alert"

In 1973 the drought broughtfamine to Ethiopia. The feudalregime of Emperor Haile Selassietailed to appeal for internationalrelief until hundreds of thousandsof people had died, a failure whicheventually cost the Emperor histhrone. To ensure that no repeti-tion of this tragic loss of lifeshould ever occur, Ethiopia's newrevolutionary government insti-gated an early warning system,gathering and analyzing rainfalland crop reports from around thecountry.

In early 1983 it became clearthat a serious food emergency wasimminent in the northern, famine-

prone part of the country, and thegovernment appealed for interna-tional assistance. Aid on the mas-sive scale which the impendingemergency warranted was, how-ever, not forthcoming. By mid-year, drought and famine wereestimated to have affected overthree million people.

Reports from the relief camps inthe northern provinces of Wolio,Tigrc, Gondar, and Eritrea echoedthe heartbreaking accounts of the1973 emergency. "A family of sixarrived at Ibnat shelter in Gondar,after having walked tor over sixdays. The oldest boy, 14, hadbeen suffering from severe malnu-trition-he was skin and bones puttogether. He could hardly lookup. Neither could he eat whateverwas set before him. The father andtwo of the children shortly died."

There were many other tragic ac-counts from the relief workers atIbnat. "One woman in her latetwenties was over three monthspregnant when her husband leftfor an unknown destination tolook for food for the family.Months passed; he did not return.

After ten months she left, carryingher new baby on her back, andthey found shelter at Ibnat afterwalking four days. The children'schance to survive is still very shakyand doubtful. We tried to talk tothe mother; she could not talk,only cry."

The Ethiopian Relief and Reha-bilitation Commission coped aswell as it could with the emer-gency, transferring 100,000 tonsof grain from urban distributionchannels to teed the affected pop-ulation, counting on its replace-ment by international assistance.Canada, the EEC and a few otherdonors pledged some grain contri-butions.

In May 1983, UNICEF launchedan appeal for US S3.5 million tofinance supplementary feeding forchildren and mothers, sheltermaterials, drugs and medical sup-port, as well as water supplies. Bythe end of November, only US$596,550 had been received in re-sponse to this appeal, andUNICEF added US 5500,000 fromits general resources to support

s

40

ETHIOPIA

child survival and health activities.

Included was a pilot project toprovide families with cash assist-ance to build up their Ibod re-serves by purchase from localmarkers to tide them over untilthe 1984 harvest. This scheme wasintended, on a small scale, to keepto the minimum the number offamilies with small children reducedto starvation and forced to leavetheir homes and trek to the shel-ters. This cash assistance was pro-vided to families in co-ordinationwith Ethiopia's Relief and Rehabil-itation Commission and the Ethio-pian Catholic Secretariat.

UNICEF has liaised closely withother UN agencies, and with themany non-governmental organiza-tions active in relief work. Amongthose which provided personneland supplies for the shelterwere the Red Cross, Concern, andOXFAM; and many others includ-ing CARE, Catholic Relief Ser-vices, Save the Children Fund andthe American Friends ServiceCommittee, also took part in theoverall relief operation.

,md other necessities ro tide themselvesover until they were able to anticipateanother harvest. In May, UNICEF ap-pealed tor USS3.5 million in specialcontributions to finance an extensionof its emergency programme, but bvthe end of 1983, only US$500,000had been received. UNICEF commit-ted an additional USS500,0(X) fromgeneral resources to extend relief andrehabilitation activities as much aspossible (see profile on facing page).

In August UNICEF committedUS$400,000 for emergency assistanceto Angola. An appeal for a total ofUS$4.5 million in special contribu-tions was launched to help 600,000victims of drought mid civil disrup-tion, more than two-thirds of themwomen and children. Drought beganin 19.SO-82 in the central and southernprovinces and continued into 1983.The .situation was aggravated byconflict in some areas, resulting in

large-scale population movements.Along with basic shortages ol Ibodand medical supplies, there were crip-pling transport difficulties, TheUS$400,000 committed by UNICEFin August helped assure the earliestpossible arrival of urgently neededtruck spare parts, tools and equip-ment, basic drugs and soap. UNLCEFslogistical and transport assistance wasvital in helping to distribute 9,000tons of food donated by the U.S. gov-ernment, which began ro arrive inSeptember,

In October UNICEF releasedUS$250,000 from the Emergency Re-serve fund for the airlifting of urgentlyneeded drugs to Chad and for buyingvehicles for mobile medical reams. Thiswas in direct response to continueddrought and the renewal of fightingduring the spring and summer, whichforced many people to migrate fromthe northern provinces. Many of theseinternal refugees had walked for morethan 30 days with no belongings andlittle food. This latest UNICEF actionwas a continuation of its emergencyassistance to Chad, carried out in closeco-operation with NGOs such asMedecins sans Frontieres and theLeague of Red Cross Societies. In addi-tion, UNICEF worked closely with amedical mobile team from RaddaBarnen, Sweden (Save the Children J .For several years the UNICEF pro-gramme has supported supplementaryfeeding, medical assistance, andlogistics.

The impact of the African droughton child survival and health wasclearly apparent in Mozambique,where UNICEF committed US$160,000to airlift medicines and medical sup-plies. For two years severe drought hasbeen affecting most of the country. Asurvey in October in one of the hardesthit areas showed high infant mortalityrates in the villages. Around 40 percent of the children under four weresuffering from some kind of sickness,and three-quarters of these were suffer-ing from malnutrition and diarrhoea.

By the end of 1983, there were indi-cations that the situation in many partsof Africa was further deteriorating,especially in the Sahel. The Secretary-General of the United Nations launcheda campaign to mobilize a major co-ordinated effort by the World Com-munity. UNICEF is participating inthe Secretary-General's advisory andworking groups on the African emer-

gency, and believes that child survivalrevolution measures arc particularlysuited to such emergencies as theyhave a high life-saving impact at rela-tively low cost and employ com-munity-based services rather thanweight)' infrastructures. UNICEFsorganizational response to the ongoingemergency in Africa will be the subjectof a special paper to be discussed at the1984 Executive Board session.

Other emergencyassistance

Owing to 1983"s unusual weather pat-terns, drought in some parts of theworld was matched bv disastrous

A% EMERGENCIES:In 1983 UNICEF

assisted 33 countries bit bydisasters, 13 in Africa, 8 inAsia, 5 in the Middle Easr andNorth Africa, 7 in theAmericasexpended USS3 million fromthe Executive Director'sEmergency Relief Fund andchannelled specialcontributions amounting toUS$9 million for shelter,medicaments, water supplyequipment, food supplements,and other essentialssupported the initiative of theUN Secretary-General inmobilizing extra resources lorvictims of drought, famine, andconflict in Sub-Saharan Africa;and continued to co-operate ina major UN programme inLebanonprovided relief for earthquakevictims in Colombia; formothers and children dislocatedby drought and conflict inEthiopia; and to containepidemics of meningitis inNepal

H

floods in others. Two emergencygrants were made to Nepal, totallingUS$130,000. The first, in May, wasfor medical supplies airlifted to counteran outbreak of meningitis in the heavilysettled Kathmandu Valley, where theGovernment was forced to close all theschools. The second, in September,was for emergency flood relief in the farwest of Nepal, where floods and land-slides due to heavy rainfall damagedhouses and food stores, disruptedcommunications., and led to heavy

crop loss. UNICEF provided immuni-zation supplies, general medical supplies,tarpaulins, and blankets, arranging forthem to be flown to the devastatedarea by chartered light aircraft.

The deviation of the Humbolt cur-rent off the west coast of SouthAmerica caused torrential rainfall innorthwest Peru, severely damagingdrainage and sanitation systems. Fear-ing a sharp increase in diarrhoeal dis-ease, the Ministry of Health requestedUNICEF to provide 100,000 packets of

oral rehydration salts, water treatmentsupplies, disinfectants and spray equip-ment. US$43,500 was committed fromthe emergency reserve.

In Bolivia, unusual weather patternsled to lowland flooding and highlanddrought. More than 1.5 million peo-ple, including 250,000 children undersix, were affected by scarcities of food,clean water and essential drugs, Re-sponding to a special appeal to theUnited Nations by President HernanSiles Suazo, UNICEF committed atotal of US$92,500 in emergencyassistance. This included funds tort(H)d distribution, the purchase ofpotato seeds, and preparation of mealsat education centres and mothers1

clubs. Also included was assistance tothe construction of windmills in thedry highlands to tap undergroundwater. As part of its support to effortsto reduce Bolivia's high infant mortal-ity rate of 168-the highest, in LatinAmerica-UNICEF provided 200,000packets of oral rehydration salts.

In close collaboration with the UNHigh Commissioner for Refugees inMexico, UNICEF has establishedhealth services for children andmothers among Guatemalan refugeesin Chiapas. A similar collaboration,aimed at basic education and healthservices for refugee children in CentralAmerica, awaits the commitment ofspecial contributions.

Other assistance provided from theEmergency Reserve Fund in 1983 in-cluded responses to floods in Ecuadorand Senegal; hurricanes in Fiji and theComoros; drought in Panama andCape Verde; earthquakes in Colombia,Guinea and Turkey; a health emergencyin Iran; yellow fever epidemics inGhana and Upper Volta; civil strife inUganda; refugees in Syria; and socialdisturbances in Sri Lanka. Early in1983 UNICEF airlifted US$305,000worth .of medical supplies to Ghana,Togo and Benin to replenish medicalstores depleted by the return ofworkers and their families who wereexpelled from Nigeria early in 1983. D

In Alanntania, women and children arc thevictims qfprokmffed drought and desertifica-tion. Special fceditifj is provided withUNICEF assistance.

42

UNICEF's finances: income, commitments,and expenditures 1983-1984

Income

UNICEFs income comprises volun-tary contributions from both govern-ments and non-governmental sources.The latter include fund-raising cam-paigns by National Committees forUNICEF, the sale of greeting cards,and individual donations.

Total income in 1983 came toUS$342 million. This represents a 10per cent decrease compared to thefigure for 1982 (US$378 million). Ifthe USS41 million in special contribu-tions made during 1982 for the Leba-non Emergency is excluded, the in-come level for 1983 was equivalent tothat of 1982. Various other factors alsocontributed to the relatively low levelof 1983 income compared to that of1982. The 1983 figure was depressedby over US$15 million due to the con-tinuing strength of the US dollar. Fur-thermore, in spite of increases in con-tributions by certain major donors,growth in contributions from certainother donor countries has been af-fected by global recession. Incomefrom governments and inter-govern-mental organizations accounted for 75per cent of UNICEFs total income in1983, with non-governmental incomeaccounting for 25 per cent. The piecharts on page 46 show the divisionbetween governmental and non-gov-ernmental income for the years 1979and 1983. The map on pages 44 to 45shows individual governmental contri-butions by country for 1983; a list ofnon-governmental contributions bycountry appears on page 46.

UNICEFs income is divided be-tween contributions tor general re-sources and contributions for specificpurposes. General resources are thefunds available to fulfill commitmentsfor co-operation in country pro-grammes approved by the ExecutiveBoard, and to meet programme sup-port and administrative expenditures.

General resources include contribu-tions from more than 150 govern-ments, the net income from the Greet-ing Cords Operation, funds contrib-uted by the public mainly through Na-tional Committees, and other income.

UNICEF Income1979-84(In millions of US dollars)

Contributions for specific purposesare those sought by UNICEF fromgovernments and intergovernmentalorganizations as supplementary fundsto support projects in the developingworld for which general resources areinsufficient; or for relief and rehabilita-tion programmes in emergency situa-tions which by their nature are unpre-dictable.

As illustrated on the bar chart on thispage, about 30 per cent of UNICEFstotal income over the period 1979-1984 was contributed for specific pur-poses.

Projects funded by specific purposecontributions are normally prepared inthe same way as those funded fromgeneral resources. Most are in coun-tries classified by the United Nations as"least developed" or "most seriously af-fected". The 1983 session of the Ex-ecutive Board undertook a review ofsupplemental)' funding, and askedthat a report be submitted to the 1985session identifying costs associatedwith specific purpose contributionsand detailing guidelines tor their use.

As a result of pledges at the UnitedNations Pledging Conference for De-velopment Activities in November1983, and further pledges made subse-quently, UNICEFs income for generalresources in 1984 is expected to totalUS$245 million. Some of the larger in-creases pledged so tar are from Finland,Federal Republic of Germany, France,Italy, Norway, and USA. Certain gov-ernments have yet to pledge.

The 1983 Executive Board approvedthe allocation of Minds to support pro-gramme activities directed at IMR (in-fant mortality rate) reduction, and alsoencouraged specific contributions forthese activities.

Expenditures

The Executive Director authorizesexpenditures to fulfill commitmentsapproved by the Board for programme

General resources Specific purposes

43

1983 governmental contributions ( i n thousands at"US dollars)

Contributions to UNlCEFs general resources are shown at right;additional contributions ror specific purposesare shown in colour, ,u left.

NORTH AMERICACanada1.038.3 10,731.7United States of America]IU, 42,500.1)

The World tin thi.- A/inunlial Equidistant Projectioncentered at NLAV York t'.itv.

Barbados5.0

44

Burma204. 1

China. . , 300 0

Cook Islands0.6

EUROPE

Austria476.4 758.9

B.S.S.R.

Belgium354.4 . . . 890 6

Bulgaria50.8

Czechoslovakia81.0

Denmark14,007 4 . . . 5,18(1.0

— MIDDLE E^

Arab Fund forEconomic andSocialDevelopment(AFESO)

Arab Gulf Fund1.882.0... 12,719.0

-AFRICAAlgeria

142.5

Angola10.2

Benin8.8

Botswana

Burundi

Congo16.1

Belize05

Bolivia16 0

Brazil. .100,0

Hong Kong

India

Indonesia

EuropeanEconomicCommunity2. 764 6 . . ."

Finland5] 5.0

France

Germany,DemocraticRepublic of

LSTBahrain

DemocraticYemen

Egypt

Djibouti

Ethiopia

Gambia

Ghana

Ivory Coast

Kenya

173

1,814.5

. .557.7

3,606.2

4,183.0

. .116.7

. . .15.0

. . . .6.4

. . .77.3

2 0

. .49.8

2 8

. .19.3

British VirginIslands

0 7

Chile

Colombia

. . 150.0

396.9

Japan10,

Lao, PeoplesDemocraticRepublic of

Germany, FedRepublic of1,332.4. , . . 4,Greece

Holy See

H ungary

Iceland

Ireland

Israel

Jordan

Kuwait

Lebanon7,264.9

Lesotho

Liberia

Libyan ArabJamahiriya

Malawi

Morocco

Costa Rica

Cuba

Dominica

421.4

5 0

era!

815.7

135.0

. 1.0

12 1

344.4

.50.0

.27.4

200.0

.50.0

. .2.5

. .9.2

, . 3.9

100.0

21 9

117.4

1.5

Dominican Republic. .20.0

Malaysia

Maldives

Mongolia

Italy18,108.5. .16Liechtenstein

Luxembourg

Malta

Monaco

Netherlands2,9"<S.5, . . .7

Oman

Qatar

SaudiArabia

1

Nigeria

Rwanda

Senegal

Somalia

Sudan

Ecuador

Guatemala

Haiti

Honduras

184.3

3 0

3.6

,116.4

. .2.0

15 5

. .4,8

. ,3.6

,862.5

50.0

200.0

,000.0

402.7

.2.9

.3.5

.32.1

.51.1

.53.4

11.8

. .20.0

Pakistan

Philippines

Republic of K

113.8

496.5

orea147.0

Norway4,107.8. . .16,617.1

Poland789

Portugal1 5

Romania

San Marino1.4

Spain

Syrian ArabRepublic

The Opec Fur635,0

Turkey

Swaziland

Tunisia

Uganda

UnitedRepublit ofCameroon

Jamaica

Mexico

Panama

Saint Vincentthe Grenadini

.15.0

. 10. H

282.7

25.6

id

151.8

6 0

.44.2

. . 1 . 5

.66.9

5 5

136.9

.44.0and3

. .0.8

Sri Lanka

Thailand

Viet Nam

Sweden7.171.8. . .19,

Switzerland4.147.7. . . .3,

Ukrainian S.S

U.S.S.R.

United Kingd14.6 9,

Yugoslavia

United ArabEmirates

Yemen

UnitedRepublic ofTanzania

Upper Volta

Zambia

Zimbabwe

St. ChristophiNevis

Trinidad andTobago

Venezuela

9 8

292.4

4 9

443.5

969.4

.R.153.7

843.7

urn178.0

205.4

694 6

1 4 4

23.4

. ,1.8

,54.5

26 0

:r-

. .0.8

.10.4

I99.~

1983 non-governmental contributions (in US dollars)

Countries where non-governmental contributions exceeded $10,000 (figures include proceeds from greeting card sales)

AlgeriaAngolaArab Gulf Fund -ArgentinaAustraliaAustriaBahrainBangladeshBelgiumBoliviaBrazil , , ,BulgariaCanadaChileColombiaCosta RicaCubaCyprusCzechoslovakia . . . . . . . .DenmarkDominican Republic . . . .

EcuadorEgyptEl SalvadorEthiopiaFinlandFrance

154,79852,932

. 6,051,323107,013838,271578,03033,37520,323

1,142,08511,329

1,621,175447.693

. 9,515,602118,671143,59822,70345,95111,700

102,346665,48833,33328,89933,368

10,52517,228

. 1,544,7357,059,371

German DemocraticRepublic

Germany, FederalRepublic of

GhanaGreeceGuatemalaGuineaGuyanaHungaryIndiaIndonesiaIraqIrelandItalyIvorv CoastJapanKenyaKuwait , , ' . . . „ . .

LebanonLiechtensteinLuxembourgMalaysia ,MexicoMonacoMoroccoMozambique . . . . . . . . . . .

83,513

12,438,181141,712242,438

19,09413,66320,52957,604

740,02235,082

44.436131,328

2.590,63527,961

2,735,89828,42115,93736,42148,077

106,59531,53955,82613,97334,54234,954

NetherlandsNew ZealandNigeriaNorwayPakistanPanamaParaguayPeruPhilippinesPolandPortugalQatar

Republic of KoreaRomaniaSaudi ArabiaSenegalSingaporeSpainSri LankaSudanSwedenSwitzerland ,Thailand

Trinidad & TobagoTunisiaTurkeyUnited Arab Emirates ,

3,773,337153,468256,948696,06546,05919,65137,745

136,12549,219

598,38847,19816,22616,62328,971

77,02124,94914,079

1,716,18816,35810,179

1,012,0353,870,562

50,347

13,66812,47]99,95735,029

assistance and for the budget. The paceof expenditure on a country pro-gramme depends on the speed of imple-mentation in the country concerned.

In 1983, UNICEFs total expendi-tures amounted to US$332 million.Of this total, expenditures for pro-tnra mines came to US$246 million:

US$98 million in cash assistance fortraining costs and other local expensesand US$148 million for supply assist-ance. The cost of programme support

1979-73%$185m

'Toul income from governments'and intergovernmentalorganizations

Totalincome$2 53m

UNICEFIncome

20%

_27%

53%

Specificpurposes

Nun-iinvvTnmcntal

income

GeneralR'MHira:s

19S375%,

$255mv

Total income from governments*.mil intergovernmental

organizations

21%

25% .

S4",,

TotalincomeS342m

46

United Kingdom ofGreat Britain andNorthern Ireland . ,

United Republic ofTanzania

United States ofAmerica . - •

UruguayVenezuelaYemenYugoslaviaZambiaContributions under

$10,000 . .

10

860,826

81,359

,701,27287,46914,18820,590379,29633,724

214,104

TOTAL 75,361,940

Less costs ofGreeting CardOperations* (15,871,044)

Net available forUNICEF assistance 59,490,896

Gists of producing cards, brochures,,freight, overhead.

UNICEFExpenditures1979-84(In millions of US dollars)

services was US$45 million and otheradministrative costs amounted toUS$41 million.

The bar chart on this page showsexpenditures on programme assistancefor 1979 to 1984. The bar and piecharts on page 48 show programme ex-penditures by sector from 1979 to1983, by amount and proportionrespectively.

Financial plan andprospectsThe difficult global economic situa-tion, whose worst effects are feltamong women and children in the de-veloping world, has at the same timereduced the flow of development as-sistance available to help them.

There has been a dampening efiecton UNICEFs own income expecta-tions. Meanwhile, UNICEF is strivingto maintain the value in real terms ot

its level of resources at a time when theeconomic and political trend is notflowing in favour of multilateral agen-cies generally. UNICEF is thereforeendeavouring to persuade donor gov-ernments at least to maintain theirsocial development assistance, and toincrease the level of their contributionsto UNICEF in real terms. UNICEF isalso encouraging the non-governmen-tal sector, through the National Com-mittees and NGOs, to further expandtheir important contributions.

At the May 1984 session of the Exe-cutive Board, proposals for new orextended multi-year programme com-mitments in 28 countries will be sub-mitted. UNICEF currently co-oper-ates in programmes in 113 countries.The proposed new commitments totalUSS102 million from UNICEFs gen-eral resources and US$59.6 million forprojects deemed worthy of support ifsupplementary funds are forthcoming.Programme commitments from generalresources for all the countries whereUNICEF co-operates are shown onthe map on pages 26-27, which alsoindicates those countries tor whichcommitments from general resourcesare specifically being proposed at the1984 Executive Board session.

A Medium Term Plan covering theyears 1983-1987 will be submitted tothe Executive Board at its May 1984session. In view of the decidedly mixedprospects for the world economy, theplan anticipates modest real increasesin income through 1987. Growth inexpenditures is planned to correspondwith the anticipated modest growth ofincome.

The biennial budget1984/85

UNICEF is committed to finding cost-effective solutions to programme plan-ning and deliver}'. Similarly, the organ-ization continues to be committed torinding the most effective and efficient

'In ll>82 lliL' Ji'liimiiin* Itjr "programme suppiirt" -mil ".iilntmistr.irivi:ctwra" expenditures were jliiTL-d

Cash assistance

Supply assistance

Programme support

Administrative costs

47

Expenditure on Programmes by Sector

BasicHealth

WaterSupply

Nutrition

SocialServices forChildren

Formal &non-formalEducation

Planning FETl •&: Project IdSsJ^ASupport ™

EmergencyRelief

SlOm S2(lrn S30m S40m SSOm SfiOm S7()m SSUm

67.8

Family p lanning component is included iii basic health.

means tor using budgetary resources tomeet increasing and changing work re-quirements.

Accordingly, the 1984/85 budget forprogramme support services and ad-ministrative costs at Headquarters inNew York and Geneva, as well as inCopenhagen, Sydney and Tokyo, andin UNICEFs 87 field offices aroundthe world, reflected a policy of consoli-dation and integration. The two-yearbudget approved by the 1983 Execu-tive Board amounted to US$218 mil-lion: USS123 million tor programmesupport services and US$95 million forother administrative costs.

A policy of budgetary restraint andof no overall growth in professionalstaffing levels has been'applied. Theconsolidation of the UNICEF supplyfunction in Copenhagen has, how-ever, permitted the redeployment of anumber of posts to Sub-Saharan Af-rica. This decision stems from donorgovernments1 perceptions that this isthe area of the developing world wherewomen and children are most in needof increased assistance. UNICEF's or-ganizational response to the crisis inAfrica is to be the subject of a specialpaper submitted to the 1984 ExecutiveBoard session.

1979

* M

1983

The process of reallocating budget-ary resources to countries with high in-fant mortality rates and weak UNICEFrepresentation is to be continued.These priorities will be reflected in the1986/87 budget, within the context ofa continuing policy of budgetary re-straint, designed to ensure that therare of growth in budget costs does notexceed that of planned expediture onprogrammes.

Liquidity Provision

UNICEF works with countries toprepare programmes so that commit-ments can be approved by the Execu-tive Board in advance of major expen-ditures on these programmes. UNICEFdoes not hold resources to cover thecost of these commitments, but de-pends on future income to coverexpenditures from general resources.The organization does, however, main-tain a liquidity provision to cover tem-porary imbalances between income re-ceived and spent, as well as to absorbdifferences between income andexpenditure estimates. Q

48

What UNICEF is and does

Origins and currentmandateThe United Nations InternationalC h i l d r e n ' s Emergency F u n d(UNICEF) was created on 11 Decem-ber 1946 by the General Assembly ofthe United Nations during its first ses-sion . In its first years, UNICEFsresources were largely devoted tomeeting the emergency needs ofchildren in post-war Europe andChina tor food, drugs and clothing. InDecember 1950, the General Assem-bly changed UNICEF's mandate toemphasize programmes of long-rangebenefit to children of developingcountries. In October 1953, the Gen-eral Assembly decided that UNICEFshould continue this work indefinitelyand its name was changed to "UnitedNations Children's Fund", althoughthe well-known acronym "UNICEF"was retained.

In 1976, the General Assembly pro-claimed 1979 as the International Yearof the Child (IYC) and designatedUNICEF as the lead agency of theUnited Nations system responsible torco-ordinating support for IYC activi-ties, undertaken mainly at nationallevel. In 1979, at the end of the IYC,the General Assembly designatedUNICEF as the primary agency of theUnited Nations system for IYC follow-up. UNICEF thus assumed the res-ponsibility of drawing attention toneeds and problems common to chil-dren in developing as well as in indus-trialized countries. Although this ex-tended UNICEF's area of concern, itdid not diminish the Fund's overridingpreoccupation with the problems ofchildren in developing countries.

Combining humanitarian and devel-opmental objectives, UNICEF co-operates with developing countries intheir efforts to address the needs ofchildren. This co-operation occurswithin the context of national devel-opment efforts, and its ultimate goal isto enable even' child to enjoy the basicrights set out in the International Dec-laration of the Rights of the Child.Emphasis is placed on the survival andupbringing of children in a fami ly andcommunity environment designed topromote their health and well-being.Recognition is also given to the intrin-

sic value of childhood, and to nurtur-ing the imagination and spirit of thechild. UNICEF believes that all chil-dren should have the opportunity toreach their fu l l potential and, in time,make their own contribution to theircountry's development and prosperity.

UNICEF is unique among the or-ganizations of the United Nationssystem in its concern tor a particularage-group rather than a particular tieldsuch as health or education. UNICEFnot only seeks support for its pro-grammes of co-operation, but also triesto increase public awareness concern-ing children's problems by means ofadvocacy with governments, civicleaders, educators and the publ ic atlarge. For this reason, UNICEF placesgreat importance on its relationshipswith the National Committees forUNICEF and with non-governmentalorganizations.

OrganizationAlthough UNICEF is an integral partof the United Nations system, itsstatus is semi-autonomous, having its

own governing body, the ExecutiveBoard, and a secretariat.

The Board is composed of 41 mem-bers who are elected on the basis ofannual rotation for three-year termsby the Economic and Social Council(ECOSOC) so as to give "due regard togeographical distribution and to therepresentation of the major contrib-uting and recipient countries". Themembership is constituted as follows:nine members from Africa, nine fromAsia, six from Latin America, twelvefrom Western Europe and other areas,and four from Eastern Europe. The41st sear rotates among these regionalgroups.

The Board establishes UNICEF'spolicies, reviews programmes, ap-proves expenditures for UNICEFswork in the developing countries andfor operational costs. The Board meetsannually tor a two-week main session,and considers programme mattersunder the agenda of a ProgrammeCommittee, and financial and relatedmatters under the agenda of a Com-mittee of Administration and Finance.Reports of UNICEFs Executive Boardarc reviewed by ECOSOC and theGeneral Assembly.

UNlCEPs rnvrridifiq concern is the welfare of children, who arc reached thtmyjh mothers,community iwrfcm, pre-schook mid health centres.

49

The Executive Director, who isresponsible for the administration ofUNICEF, is appointed by the UnitedNations Secretary-General in consulta-tion with the Board. Since January1980, the Executive Director has beenMr. James P. Grant.

UNICEF field offices are the keyoperational units for advocacy, advice,programming and logistics. Under theoverall responsibility of the UNICEFRepresentative in a particular country,programme officers assist relevant min-istries and institutions with the prep-aration and implementation of pro-grammes in which UNICEF is co-op-erating. In 1983, UNICEEmaintained87 field offices serving 112 countries,with 619 professional and 1,256 cleri-cal and other general service posts.

In 1983, 207 professional and 333general service staff were maintained inNew York and Geneva, to earn' outthe following functions: service of theExecutive Board; policy developmentand direction; financial and personnelmanagement; audit; information; andrelations with donor governments,National Committees for UNICEF,and non-governmental organizations.

Direction of supply matters contin-ues from New York, but by early 1984most of UNICEFIs supply operationswill have been transferred to Copen-hagen to a new centre which will re-ta in t he a c r o n y m "UNIPAC"(UNICEF Packing and Assembly Cen-tre), now short for UNICEF Procure-ment and Assembly Centre.

UNICEF co-operationwith developingcountries

UNICEF co-operates in programmesin a country only in consultation withthe government. The at'tual adminis-tration of a programme is undertakenby the government, and is the respon-sibility of the government, or of organ-izations designated by it.

UNICEF gives relatively greater sup-port to programmes bcnefitting chil-dren in the least developed countries.In apportioning UNICEFs limited re-sources among countries, the 1983Board decided that the infant mortal-it)' rate should also be taken intoaccount as a "guide both to the levelsand content of UNICEF programme

In Bhutan, a small Iwy takes care of his yonder brothers on the city streets. The problemsof children iti poo?' urban areas arc a major UNICEF priority.

co-operation", and this is now one ofthe principal determinants of theextent of UNICEF country assistance.

The problems of children require aflexible, coumry-by-counrry approach,and since no single formula can applyequally to countries at different levels ofcultural, social and economic develop-ment, with geographic diversities andwidely varying administrative struc-tures, UNICEF seeks to adjust the pat-tern of its co-operation to correspondto regional, national and sub-nationalvariations.

UNICEF co-operation emphasizesprogrammes benef i t ing c h i l d r e nthrough improved community andfamily services; planning and extensionof services; exchange of experienceamong countries; provision of fundsfor increasing training and tor orienta-tion of national personnel; and deliv-ery of technical supplies and otherforms of assistance in areas such aswater supply, child nutrition, educa-tion, improvement of the condition ofwomen and emergency relief and reha-bilitation.

Programme co-operation is providedthrough a number of sectoral minis-tries such as health, education, socialservices, agriculture, and those minis-tries or other authorities responsiblefor rural, urban, and community de-velopment, and water supply and sani-tation .

In general, however, problems in

poor communities are usually not per-ceived or experienced by sector, thustechnical support is often needed fromseveral ministries. The problem ofchild malnutrition, tor example, isusually the result of a combination ofpoverty, inadequate health services,and food shortages; it may also stemfrom lack of birth spacing, impurewater, and rudimentary sanitation, orfrom improper dietary habits. Since ef-forts in any one sector may fail if cor-responding efforts in others are notmade simultaneously, UNICEF re-commends a multiscctoral approachencompassing both the technical andsocial elements of programmes.

Basic services

Community participation is the keyelement of the "basic services strategy"advocated by UNICEF. Of particularconcern to UNICEF in recent yearshas been the continuing high level otinfant mortality in many developingcountries. Within the framework ofbasic services, UNICEF is now co-operating with these countries in spe-cial efforts to reduce infant mortalitythrough such cost-effective measuresas better growth monitoring, oral re-hvdration therapy, the encourage-ment of breast-feeding, and universalimmunization.

50

The basic services approach perceivessocial and economic improvement inlow-income rural and urban commu-nities as heavily dependent on theparticipation of the communit iesthemselves. The role of government,non-governmental organizations andexternal co-operation is: to stimulateassessment by the community of itschildren's needs and its agreement toparticipate in meeting some or'them;to strengthen the technical and admin-istrative infrastructure through whichfamily and community efforts can besupported; and to provide throughthis infrastructure financial and tech-nical inputs, as well as supplies andtraining opportunities which marchthe community's capacity to absorbthem.

An essential feature of this strategy isthe selection by the community of oneor more ot" its members to serve ascommunity workers after briet practi-cal training, which is repeated and ex-tended through refresher courses. Tosupport these community workers,the peripheral and intermediate levelgovernment sen-ices often have to beStrengthened, particularly with para-professionals.

Relations within theUnited Nations system

UNICEF is part of a system of co-oper-ative relationships linking the variousorganizations of the United Nations

system. It also works with bilateral aidagencies and non-governmental organ-izations, recognizing that the effec-tiveness of programmes intended tobenefit children can be substantially in-creased when a combination of finan-cial resources, and of technical andoperating skills is applied to theirdesign and implementation. This sys-tem of relationships helps UNICEFavoid spreading its co-operation toothinly among different sectoral con-cerns in the developing world. Eventhough in certain countries UNICEFscontribution to a particular problemmay be financially modest, its effectcan be catalytic, thereby providing aframework tor larger-scale co-opera-tion by means of which an approachmay be tested and proven before sub-stantial investments are made by otherorganizations with tar greater re-sources.

Within the United Nations system,collaboration ranges from the sharingof expertise at the country level in de-veloping programmes which require aninterdisciplinary approach, to system-atic exchanges between organizationson policies and relevant experience.These exchanges occur through themachinery of the Administrative Com-mittee on Co-ordination (ACC), aswell as through periodic inter-secre-tariat meetings held with other UnitedNations organizations such as theWorld Bank, the United Nations De-velopment Programme (UNDP), theFood and Agriculture Organization(FAO) and the United Nations Educa-tional, Scientific and Cultural Organi-

zation (UNESCO). Agencies also dis-cuss common concerns through theConsultative Committee on Policiesand Programmes for Children, the suc-cessor to the interagency advisorygroup established during the IYC,1979.

UNICEF's policies for co-operationin country programmes benefit fromthe technical advice of specializedagencies of the United Nations suchas the World Health Organization(WHO), FAO, UNESCO, and the In-ternational Labour Organization(ILO). At the country level, UNICEFdocs not duplicate services availablefrom the specialized agencies, butworks with them to support pro-grammes, particularly where ministriessuch as health and education are in-volved, and with which the relevantspecialized agency works. In addition,the specialized agencies from rime totime collaborate with UNICFF in pre-paring joint reports on particular pro-gramme areas. In particular, there is aJoint UNICEF/WHO Committee onHealth Policy (JCHP) which adviseson policies of co-operation in healthprogrammes and undertakes periodicreviews.

UNICEF co-operates in countryprogrammes together with other fund-ing agencies of the United Nationssystem, such as the World Bank, theUnited Nations Fund for PopulationActivities (UNFPA), and the WorldFood Programme (WFP}. It also workswith regional development banks andregional economic and social commis-sions on policies and programmesbenef i t ing chi ldren . Inc reas ing ly ,UNICEF has sought collaboration withbilateral agencies at field level in order toencourage them to channel more oftheir resources into programmes whichUNICEF cannot fund by itself.

In the case of emergencies, UNICEFworks with the Office of the UnitedNations Disaster Relief Coordinator(UNDRO), the United Nations HighCommissioner for Refugees (UNHCR),and other agencies of the United Na-tions system such as the WFP, as well aswith the league of Red Cross Societiesand the International Committee of theRed Cross.

A WMifj chiId in N'Djnmt-fia, Chad, drinksfiyw a UNICEF pump. A clean wafer supply,essential to healthy living, is seen as tmc of thekey links in the basic sen'ices chain.

. )

UN1CEF representatives in the fieldwork with the UNDP Resident Repre-sentatives, most of whom are des-ignated by the Secretary-General asResident Coordinators for operationalactivities. Although UNICEF is not anexecuting agency of UNDP, it ex-changes information with all the agen-cies involved in UNDP country pro-gramme exercises.

Relations withnon-governmentalorganizations

UNICEF has always worked closelywith the voluntary sector. Over theyears, UNICEF has developed closeworking relationships with interna-tional non-governmental organiza-tions (NGOs) whose work affects thesituation of children. Many of theseorganizations (professional, develop-ment assistance, service, religious,business, trade and labour) havebecome important supporters ofUNICEF, by providing a channel foradvocacy on behalf of children, and bytheir participation in tund-raising andother programmes.

National and local NGOs are alsoplaying an increasingly important rolein UNICEPs programme co-opera-tion in developing countries in thelight of UNICEPs emphasis on com-munity participation in basic services.Many NGOs have the flexibility andfreedom to respond to neglected prob-lems, or are represented in remote anddeprived areas where either inadequateor no service infrastructure yet exists.Such NGOs can act as vital linksbetween the community and gov-ernment authorities; and, unlikeUNICEF, can work directly with localcommunities to help them mobilizetheir resources and pla.ii basic services.In certain situations, NGOs are des-ignated by governments to earn' ourpart of the programmes with whichUNICEF is co-operating. Through in-novative projects, NGOs can experi-ment with models for developmentco-operation which UNICEF andothers can subsequently adapt in otherareas or undertake on a wider scale.

NGOs also provide UNICEF withinformation, opinion and recom-mendations in fields where they havespecial competence, and in some casesundertake studies on behalf of, or in

co-operation with, UNICEF. Follow-ing one such special study on child-hood disability undertaken by Reha-bilitation Internationa], an ongoingpartnership has developed between thetwo organizations to reinforce mutualefforts.

As a result of the IYC, many NGOsexpanded their activities, includingfund-raising and advocacy efforts, onbehalf of children. Such has been thescope of their expansion that amongthem were some organizations not tra-ditionally concerned with children.UNICEF is continuing to foster theserelationships (by providing informa-tion and by encouraging joint pro-grammes on issues affecting children indeveloping and industrialized coun-tries) between NGOs, governmentsand UNICEF.

National committeesfor UNICEFThe Nat iona l Committees forUNICEF, normally organized in in-dustrialized countries, play an impor-tant role in helping to generate a betterunderstanding ot the needs of childrenin developing countries and of thework of UNICEF. The Committees,of which there are now 33, arc con-cerned with increasing financial sup-port for UNICEF, either directlythrough the scale of greeting cards and

Two UNICEF Goodwill Ambassadorscross paths: Peter Ustinw has a nwdwith An' Ullmann. Both these interna-tional stars have immeasurably helpedUNICEF help children.

other fund-raising activities, or in-directly through advocacy, educationand information,

UNICEF generally receives about asixth of its income from funds col-lected by the Committees and fromthe Greeting Card Operation, forwhich the Committees are the mainsales agents. The increasing activism ofthe Committees has brought notableresults, particularly in fund-raising,promotional and informational activ-ities, and development education. Anumber of stars from the entertain-ment world, such as Liv Ullmann,Danny Kaye and Peter Ustinov, haveco-operated with the Committees asGoodwill Ambassadors for UNICEFand have raised large sums of moneythrough personal appearances andgalas. A number of Committees havebeen instrumental in attracting widepublic attention not only to the "loud"emergency situations affecting chil-dren, but also to the "silent emergen-cies" perennially confronting childrenof developing countries. In recentyears, there has been a closer relation-ship between the Committees andUNICEPs field operations, withCommittee members from a number

52

of countries undertaking collectivestudy tours to the field to enhancetheir knowledge of the needs of chil-dren in developing countries. An im-portant function of the Committees isadvocacy with their own governmentsfor increased assistance to meet theseneeds.

Greeting cardsUNICEF's popular greeting cards, cal-endars and stationery items are a signi-ficant source of income for the organi-zation's activities on behalf of children:The collaboration of National Com-mittees for UNICEF, NGOs, banks,post offices, business firms, school sys-tems, and co-operatives, to name atew, has made the Greeting Card Op-eration one of the most successfulfund-raising activities around theworld. The Greeting Card Operation'sunique asset is the opportunity it pro-vides volunteers and the public at largeto contribute personally to improvingthe quality of children's lives throughUNICEF. Reproduction rights of thedesigns are contributed by renownedartists, photographers and leading mu-seums throughout the world.

FundingAll of UNICEFs income comes fromvoluntary contributions-from gov-ernments, from organizations, andfrom individuals. Most contributionsare earmarked tor UNICEF's generalresources, or they may be allocated tosupplementary projects "noted" by theBoard for support as resources becomeavailable, or tor emergency relief andrehabilitation.

Although most of the funding is con-tributed by governments, UNICEF isnot a "membership" organization withan "assessed"" budget; it cannot chargegovernments a share of its expenses.However, almost all governments,In nil of industrialized and developingnations, make annual contributions,which account generally for more thanthree quarters of UNICEFs income.

Individuals and organizations arcalso essential sources of UNICEPs in-come. In its role as the "people to peo-ple1' arm of the United Nations,UNICEF enjoys a unique relationship

u i t h private organizations and thegeneral public throughout the world.Public support is demonstrated notonly through greeting card sales, buralso through individual contributions,the proceeds from benefit events(ranging from concerts to footballmatches), grants from organizationsand institutions, and collections byschool children. Often, these fund-raising efforts are sponsored by the Na-tional Committees.

developing support from other poten-tial sources.

Information on the funds contrib-uted by the recently created Arab GulfProgramme for United Nations De-velopmenr Organizations (AGFUND)appears in the main Review chapter ofthis report. The moving force behindAGFUND is its president, UNICEF'sSpecial Envoy, H.R.H. Prince TalalBin Abdul Aziz Al Saud of SaudiArabia. Q

1Local institutions an' becoming closer paitrws with UNTCEF in the pursuit of child sur-vival and development. Children arc \mnt0ht to be weighed at a health centre in Pakistan.

Despite modest financial resources,UNICEF is one of the largest sourcesof co-operation in national sen-icesand programmes benefiting children.Fund-raising for UNICEF is part ofthe larger objective of encouraging thegreater deployment of resources to\\ards sen-ices catering to the well-being of children.

UNICEF's fund-raising strategy aimsat meeting the financial projections inits medium-term work plan by activelyworking to increase contributionsfrom its traditional major donors while

Further information aboutUNICEF and its work maybe obtained from:

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