UNICEF Pakistan Annual Report 2012 - UNCEF / Headbumped Studio

PAKISTAN ANNUAL REPORT

2012

© United Nations Children’s Fund (UNICEF) Pakistan September 2013 UNICEF Pakistan Street 5, DiplomaƟc Enclave Sector G-5, Islamabad, Pakistan Telephone: +92 51 2097700 Fax: +92 51 2097799 www.unicef.org Cover photo: © UNICEF Pakistan/2012/Asad Zaidi

2012 PAKISTAN ANNUAL REPORT

Contents

I

CONTENTS 1/ Foreword

4/ Maternal, New-born and Child Health Care

18/ Water, Sanitation and Hygiene

28/ Education

36/ Child Protection

44/ Financial Resources

48/ Private Sector Partnerships

52/ Risk Management

56/ Acronyms, Glossary and References

Annual Report 2012

1

UNICEF Pakistan

FOREWORD This annual report of 2012 summarises how the United Nations Children’s Fund (UNICEF) in Pakistan, our government counterparts and implementing partners worked together during another exciting year to achieve results for children, making a positive difference in the lives of the most vulnerable and disadvantaged.

It is well known that children and women in Pakistan have a great many opportunities but at the same time face many constraints and challenges, some of which UNICEF has a mandate and comparative advantage to help address. Our 2012 report shows some remarkable results achieved in key areas such as nutrition, water, sanitation and hygiene promotion, as well as education. Some of these achievements constitute international best practice; as such Pakistan is contributing to knowledge and lessons learned that will help development in other parts of the world. It is important to recognise achievements and successes as an inspiration for all partners to strive even harder and go even further to ensure the rights of children.

At the beginning of the year the key priorities for UNICEF Pakistan and our partners were polio eradication, routine immunisation, maternal, newborn and child health, malnutrition, sanitation, out-of-school children and child protection - a tall order by any measure. Amidst these priorities, 2012 ushered in new challenges and opportunities. The adoption of Article 25a to the Constitution added a right for children aged five to 16 years to access free and compulsory education. At once a great chance, and also a huge task to respond to by all those responsible for making it happen. Not all the additional challenges came

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with good news. The social fabric and resilience of millions of children and women were tested once again in 2012 with devastating floods in Sindh, Balochistan and Punjab. At the same time, the continued dislocation of communities in parts of Khyber Pakhtunkhwa (KP) and the Federally Administered Tribal Areas (FATA) combined with returns in other areas increased the magnitude of basic needs unmet. UNICEF is grateful to the partners who responded with us to help meet core commitments for children in humanitarian situations.

The contrast of challenge and opportunity was especially evident in our maternal, new-born and child health care programme. The weaknesses in the Routine Immunisation system were put in the spotlight with the outbreak of measles in Sindh in late 2012 - a suspected 4,000 cases and over 300 deaths. At the same time, as just one example among many, UNICEF and provincial governments used the Mother and Child Health Weeks to reach 34 million children and their caregivers with key health messages and services.

While the malnutrition rates continued to be of concern, stakeholders galvanised their commitment in 2012 to eliminate malnutrition, with the Pakistan Integrated Nutrition Strategy and the accompanying, tailored provincial strategies. Thanks to the enormous

Foreword

2

Dan Rohrmann, UNICEF Representative in Pakistan, with students of the Government Girls Primary School, Bherkund, Mansehra district, Khyber Pakhtunkhwa. © UNICEF Pakistan/2010/Sami Malik

commitment and engagement of government counterparts at federal, provincial and district levels, partners, civil society organisations, parliamentarians and media as well as many other actors, 2012 became the year when the tide changed. I am proud of how UNICEF continues to be part of the driving force for these exciting developments that are essential steps towards generations of well-nourished children in Pakistan.

The enormous success of the Pakistan Approach to Total Sanitation (PATS), which in 2012 engaged more than 2,900 additional communities with 4.5 million people in changing social behaviour of open defecation and promoting hygiene and sanitation, demonstrated that the years of preparation and investment, and working closely with the communities and families, can lead to lasting change. This change not only benefits health and nutrition but also the economic livelihood and potential for all members of the family that change their behaviour. The benefit goes well beyond the family and the community as the estimated negative impact of poor quality water and sanitation on the Pakistan GDP is six to eight per cent. Focusing on sanitation for the most vulnerable and disadvantaged is not only realising children’s rights in principle and practice but it also makes good economic sense.

As education continues to be one of UNICEF’s top priorities in Pakistan, 2012 saw some breakthroughs in both the upstream work in Sindh and Balochistan on strategies and sector plans, as well as advancing childfriendly learning in KP and FATA. We broke new ground in ensuring humanitarian response contributed to development with 95 per cent of 2011 flood-affected children who attended the Temporary Learning Centres (TLCs) being mainstreamed into government schools during early recovery programming in 2012. What is more, 41 per cent of those children were ‘First Timers’ who had never been to school.

Our Child Protection efforts in 2012 continued to be a catalyst for genuine reform and streamlining of the public child protection systems. Building on the prior years’ legislative, administrative and institutional reforms, major advances were made in mapping strengths and gaps in the public child protection system at federal and provincial levels, and advancing birth registration. Alongside this systems development, UNICEF’s Protective Learning and Community Emergency Services (PLaCES) model developed in the prior flood responses continued to provide an integrated approach to supporting flood-affected children and women.

Finally,

a

prominent

theme

that

demanded attention across UNICEF Pakistan and the entire country was the polio eradication effort, scaled up to an unprecedented level and sophistication in 2012. UNICEF’s roles include vaccine procurement, communication and social mobilisation. The number of polio cases in 2012 dropped to only 58 as compared with 198 cases in 2011.

With a continued focus on equity, and anchoring UNICEF’s programme firmly in the second cycle of the One United Nations Programme, the foundation is solidly laid not only for 2013 but for the next five years. From this foundation, we push forward with strategic shifts towards adolescents, urban settings, disaster risk reduction, resilience, social cohesion and, ultimately, social justice. As we move forward with our counterparts and partners we expect to be constantly challenged and held accountable for our contributions to respecting, protecting and fulfilling the rights of the most vulnerable children and women.

This annual report is just a snapshot of that energy, that vigour, found in Pakistan’s children who inspire us to go the extra mile to support them.

Dan Rohrmann Representative UNICEF Pakistan

Annual Report 2012

3

UNICEF Pakistan

JOINT GOVERNMENT OF PAKISTAN AND UNICEF 2012 ACHIEVEMENTS

1.7mil.

1.5 mil.

accessed safe drinking water

children received educational support

4.5 mil.

1.9 mil. & children

700,000

accessed improved saniation

pregnant and lactating women screened for malnutrition

1.6 mil.

were provided with micronutrient supplements

678,000

children and women benefitted from various protection services – protective spaces, helplines, childfriendly police stations and more

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+ more than

23

policies, strategies and legislation supported

8.47 mil.

doses of essential childhood vaccines procured for the Expanded Programme for Immunisation

MATERNAL, NEW-BORN AND CHILD HEALTH CARE

4

Expenditure (USD) Total Regular Resources

52,720,383 6,022,735

Other Resources (Regular)

28,996,030

Other Resources (Emergencies)

17,701,617

Š UNICEF Pakistan/2012/Asad Zaidi

Annual Report 2012

5

UNICEF Pakistan

MATERNAL, NEW-BORN AND CHILD HEALTH CARE Many underlying factors contribute to building a healthy environment for children wherein their basic health and nutritional needs are met. These range from literacy levels, especially for mothers, gender equality and social inclusion, to access to safe water and improved sanitation, to levels of employment and household poverty, as well as the capacity of public health authorities to provide the necessary quality services and supplies.

hospitals or clinics.1 Approximately half of deliveries in rural areas are assisted by skilled birth attendants.2 One out of ten Pakistani children die before their fifth birthday,3 and over half of those die before completing the first month of life.4 The most common causes of children dying before their fifth birthday include birth asphyxia, infections, Pnemonia, diarrhoea and severe malnutrition. Great disparities remain related to socio-economic status and geographic location.

Some notable progress has been made in providing the children of Pakistan with a better start in life, particularly in urban areas where over two fifths of childbirths take place in

Immunising children from vaccine preventable diseases has proven to be the most cost effective way to reduce under five child mortality.5 Significant progress was made in

2012 towards the eradication of polio, with only 58 polio cases reported from Pakistan in 2012, compared to 198 in 2011. Nevertheless, Pakistan remains one of only three countries in the world with endemic polio. Furthermore, challenges remain for Routine Immunisation access and coverage in both urban and rural settings, as evidenced by the 2012 measles outbreak that affected thousands and killed hundreds.

The Lady Health Worker (LHW) programme remains one of the key pillars of health care provision to rural women and children in Pakistan at door step or at household level, and is on track to provide full coverage across Pakistan by 2015. However,

FIGURE 1: Adjusted* neonatal, infant and under 5 child mortality rate per 1000 across wealth quintile

116

104

101

94 84

92 83 70

Under 5 M

75

ortality Rat

75

e

67

Infant Morta

63

lity Rate

56

50

45 Neonatal Mortality Rat

e

Poorest

Poorer

Middle

Richer

* Adjusted for sex of child, rural - urban residence, mother’s education, father’s education, mother’s occupations and father’s occupation

1 2 3 4 5

Pakistan Social and Living Standards Measurement (PSLM) Survey, 2008-09, p.35 Pakistan Social and Living Standards Measurement (PSLM) Survey, 2008-09, p.35 UNICEF, The State of the World’s Children 2011, UNICEF New York, February 2011 UNICEF Pakistan Situation Analysis for Children and Women, 2011 HNP, World Bank discussion paper, 2012

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Richest

Maternal, New-born and Child Health Care

130,000

6

people are living with human immunodeficiency virus in Pakistan

2,900 coverage is only one element. The challenges to ensuring that LHWs can provide the anticipated level and quality of care are not just linked to public sector capacity and resources but also deeply embedded cultural practices that hinder women from accessing health services outside their housing compounds. More LHWs are needed for remote areas and provincial governments vary in their capacity to sustain and strengthen the LHW programme.

pregnant women in need of anti-retroviral drugs for the prevention of mother to child transmission of HIV

spouses working abroad and risky sexual activity. Women outside the key affected populations are mostly acquiring HIV from their husbands, hence the importance of regular testing and treatment of those at risk to avoid transmission. The most recent data available estimated 130,000 people were living with HIV in Pakistan, including an estimated 2,900 pregnant women in need of anti-retroviral drugs for the prevention of mother to child transmission.6

of a million children were identified with either moderate or severe acute malnutrition, many of those in rural and hard-to-reach areas. Many have a low weight at birth, a strong indication of the need for prevention measures among mothers and potential mothers, especially adolescents.

Nationwide, the global acute malnutrition rate is above the international emergency threshold at 15.1 per cent.

Tackling malnutrition has become a top priority after decades of neglect by the public health sector. A child who is chronically malnourished when young can never fully realise his or her cognitive and growth potential. He or she is also much more susceptible to disease. Nearly half of children under five are stunted in Pakistan.7 A quarter

security means “at all times having access to sufficient, safe and nutritious food to maintain a healthy and active life.�8 While more than 70 per cent of households do not experience moderate or severe hunger, this masks provincial differences, such as in Sindh where in fact 72 per cent of families do experience food insecurity.

Furthermore, food security within a household can vary with gender; of those children admitted for nutritional

For children to grow without stunting and maintain a healthy weight, food security is critical. Household food

A Lady Health Worker conducts a health education session for a group of women during the UNICEF-supported Mother and Child Health week in Nankana Sahib district, Punjab province. Š UNICEF Pakistan/2012/Asad Zaidi

Overall human immunodeficiency virus (HIV) prevalence remains below one per cent of the population. However, the HIV epidemic in Pakistan has steadily established itself among key affected populations with 27 per cent of injecting drug users and a small percentage of sex workers infected. Since 2008, several localised epidemics have also occurred among the general population, likely caused by unsafe medical injections,

6 UNAIDS Report on the Global AIDS Epidemic 2012 7 National Nutrition Survey, 2011 8 World Food Summit, 1996 Annual Report 2012

7

UNICEF Pakistan

ACTION UNICEF supports the Government to reach the most vulnerable and marginalised children and women with integrated basic health services, particularly in the midst of several humanitarian situations.

therapeutic treatment in 2012, 59 per cent were girls and only 41 per cent were boys.9

Strengthening provincial and community health care Providing technical support to provincial governments to strengthen the health systems remains a priority for UNICEF. At the close of 2012, UNICEF had assisted more than 48 district hospitals to provide emergency new-born care and enabled 33 districts to initiate essential new-born care, including training midwives in the Federally Administered Tribal Areas (FATA). The success of the UNICEF-supported, Government of Punjab ‘CHARM’ Initiative in providing emergency obstetric and neo-natal care attracted wider commitment.

UNICEF assisted three provinces to revitalise their Lady Health Worker programmes and assisted six provinces to identify how to deploy and retain Community Midwives, both linchpins in the effort to reduce child and maternal mortality. Seventeen million parents and caregivers were reached with important health messages and an equal number of

48 33 more than

district hospitals assisted to provide emergency newborn care

districts enabled to initiate essential new-born care

children between two to five years old were de-wormed twice in 2012 with UNICEF’s support during the Mother and Child Health Weeks.

9 Nutrition Information System, 2012 www.unicef.org

Immunisation, including Polio Eradication UNICEF significantly ramped up support to polio eradication efforts alongside a strong line-up of Government and donor partners, supporting public awareness efforts and behaviour change at the national and community levels. UNICEF supported studies on knowledge, attitudes and practices to capture a sense of community perceptions of the vaccine and the programme. This helped guide the development of an effective communications strategy, including a national mass media programme that reached over 100 million people at least three times during the year.

Included in that outreach effort were more than 1,100 community mobilisers who helped communicate the

100 mil. over

1,100

people reached 3 times during the year through the development of an effective communications strategy on Polio vaccine

more than

community mobilisers who helped communicate the importance and safety of polio vaccination

importance and safety of polio vaccination at the household level, at bus and train stations and along highways with the National Highway and Motorway Police. UNICEF also worked with 700 influential religious figures in FATA, KP, Punjab, Sindh and Balochistan provinces to develop fatwas on polio eradication, resulting in an increase to one quarter

Maternal, New-born and Child Health Care

100

journalists from print, electronic and online media trained on ethical reporting practices for covering Polio issues

of parents saying they had heard about the vaccine from their local religious leader. In addition, UNICEF supported the training of 100 journalists from print, electronic and online media on ethical reporting practices for covering Polio issues. Unfortunately, the Polio Eradication Initiative came under attack in the latter part of 2012 with nine polio vaccinators killed by militant activists (See ‘A New Polio Paradigm’ below).

A NEW POLIO PARADIGM The enormous success in the Polio Eradication Initiative (PEI) in 2012 was tragically disrupted by the killing of nine volunteer polio workers in December.

Such targeted violence against community health workers is unprecedented in Pakistan, requiring UNICEF and the PEI partners to redesign the programme amidst this new operational reality. The PEI is moving to a lower visibility approach, including the way in which UNICEFsupported social mobilisation, media coverage, targeting and monitoring takes place. UNICEF is sparing no effort to keep our staff and those of our partners safe in the field.

As part of the Global Alliance for Vaccines and Immunisation (GAVI), UNICEF supported the Government of Pakistan to be the first country in South Asia to add the Pneumococcal Vaccine to the set of nine vaccinations available to every child under age five. This is important because one fifth of all child mortality is due to pneumonia. UNICEF provided support by designing and executing an integrated communication strategy

35

cold rooms provided for the storage of Pneumococcal vaccine

1.9 mil.

including interpersonal communication training for health workers.

To complement the launch of the Pneumococcal Vaccine, with the support of GAVI, UNICEF provided 35 cold rooms for the storage of vaccines, to ensure the vaccines remain potent and of a high quality until they reach the children. Solar powered ice lined refrigerators and cold chain equipment were also provided to the remote areas of Pakistan-administered Kashmir, GilgitBaltistan and Balochistan where the electric supply was either absent or

8

targeted in 23 districts of Balochistan for Immunisation against both measles and pneumonia

and strengthening the health systems’ policies and strategies, to make sure planning, service delivery and community awareness are improved.

In response to the measles outbreak, UNICEF provided vaccines and supplies as well as support to mobilise communities for a follow-up campaign targeting 1.9 million in 23 districts of Balochistan for immunisation against both measles and pneumonia.

There have been some major successes towards eliminating polio and pneumonia, however, in the area of

A Lady Health Worker, Gul Bano, administers polio drops to a child in the flood-affected village Sono Solangi, Khairpur district, Sindh province. © UNICEF Pakistan/2012/Asad Zaidi

compromised.

As part of the ‘equity approach’ aimed at reaching the most disadvantaged, UNICEF Pakistan supported the ‘Reaching Every District’ strategy that sought to provide immunisation to children from the most marginalised groups in the 15 districts with the highest numbers of children not immunised. This means working closely with civil society organisations

routine immunisation, significant challenges remain, with the 2012 measles outbreak being the evidence of this. UNICEF is providing support to the provinces in evaluating progress and chalking out mid-course corrective measures to improve performance. Provinces are working hard with UNICEF’s financial and technical support to strengthen their capacity and identify gaps and access issues in service provision.

Annual Report 2012

9

UNICEF Pakistan

1.9 mil. children

&

700,000

pregnant & lactating women

screened for malnutrition

Nutrition In 2012, UNICEF supported the screening of almost 1.9 million children and almost 700,000 pregnant and lactating women for malnutrition, and the provision of micro-nutrient supplements to 1.6 million children below the age of two and over 140,000 pregnant and lactating women. These figures represent the beginning of a substantial effort by Federal and provincial governments with UNICEF and NGO partners to implement the curative component within the Pakistan

1.6 mil.

HIV and AIDS children below the age of 2

&

140,000

pregnant & lactating women

provided micro-nutrient supplements

In conjunction with the Joint United Nations Programme on HIV/AIDS (UNAIDS), UNICEF provided technical support to four provincial governments to develop their AIDS strategies as well as support to both Federal and provincial governments to develop a national HIV Counselling and Testing Strategy for Pakistan.

The Prevention of Parent-to-Child Transmission (PPTCT) Model, launched with concurrent national guidelines in 2011, was scaled up to

A health worker checks the nutrition level of a child using the Mid-Upper Arm Circumference (MUAC) method in a UNICEF-supported mobile health centre in Pyaro Khoso village, Badin district, Sindh province. Š UNICEF Pakistan/2012/Asad Zaidi

Integrated Nutrition Strategy (PINS).

The integrated preventive component remains a large challenge.

UNICEF remains a respected convening and technical partner for the Government in the bid to eliminate malnutrition. In 2012 in particular, UNICEF developed the Multi-Sectoral Nutrition Strategy, within the PINS. This strategy was rolled out under the leadership and ownership of the

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Planning Commission at Federal level and the Planning and Development Departments at provincial and regional levels. Key players from the sectors that have causal links to nutrition, such as agriculture, food, education, water, sanitation and hygiene, actively participated in this process. UNICEF’s support also included technical assistance to all these sectors through sectoral working groups.

five more districts in Punjab and Sindh where there are key affected populations. UNICEF also supported a study about the treatment outcomes of children with HIV and an evaluation of the district-model approach to identify cases of women of childbearing age and children with HIV. Forty three pregnant women with HIV received anti-retroviral drugs for the prevention of mother-to-child transmission. UNICEF provided various training

Maternal, New-born and Child Health Care

10

EMERGENCY RESPONSE UNICEF’s support to providing critical health care during humanitarian situations continued in 2012, particularly for the communities displaced due to insecurity in the north-western and western parts of the country, and the on-going recovery for the 2011 and 2010 floods as well as responding to fresh floods in 2012. to hundreds of LHWs, physicians, associated health care providers and NGO staff, relative to their professional responsibilities, on how to identify, refer, deal with and manage HIV patients or those at risk. As part of the decentralised approach, UNICEF supported the Government of Punjab to purchase a CD4 machine for Gujarat district, where a high number of people living with HIV have been identified.

2011 Floods: Early Recovery10 Early recovery work continued for the areas still affected by the 2011 floods.

More than 440,000 children under two years were provided with routine immunisation, including against polio and measles. With UNICEF’s support, LHWs treated 56,000 cases of diarrhoea and 30,000 cases of acute respiratory infection or pneumonia, and provided health education to over 760,000 mothers. More than 308,000 children under five and 167,000 pregnant and lactating women were screened for malnutrition. Over 12,300 were children diagnosed with severe more than

440,000

children under 2 years were provided with routine immunisation including polio and measles

56,000 30,000

&

cases of diarrhoea treated by LHWs

cases of acute respiratory infection or pneumonia treated

acute malnutrition (SAM) and admitted to therapeutic feeding programmes.

More than 22,400 pregnant and lactating women were identified with moderate acute malnutrition and were admitted to the World Food Programmesupported Supplementary Feeding Programme (SFP).

12,300 more than

children diagnosed with severe acute malnutrition

2012 Floods: Emergency Response11 In addition to the 2011 early recovery efforts, UNICEF responded to renewed flooding in early September 2012. UNICEF supported the LHW programme to treat over 320,000 children suffering from diarrhoea by mid-January 2013. In addition, almost 153,000 children were treated for respiratory infection, and over 104,000 Long Lasting Insecticide-Treated Nets were distributed to reduce the risk of malaria. More than 555,000 mothers were provided with health education messages. Over 59,000 children were vaccinated for measles and more than 30,000 received Vitamin A supplements. With UNICEF’s support, skilled

320,000 153,000 more than

children suffering from diarrhoea treated through LHW programme

children treated for respiratory infection

birth attendants assisted more than 4,300 deliveries and provided antenatal check-ups to over 16,600 pregnant women.

Over 208,000 children under five were screened for malnutrition. Of those, 11,510 children suffering from severe

10 UNICEF 2011 Floods One Year Later Report – 26 October 2012 11 UNICEF 2012 Floods Situation Report – 18 January 2013 Annual Report 2012

11

UNICEF Pakistan

Iram Inyat, a breastfeeding counsellor, conducts a health session for a group of women at the UNICEFsupported mobile health centre in Pyaro Khoso village, Badin district, Sindh province. Š UNICEF Pakistan/2012/Asad Zaidi

acute malnutrition were admitted to the Outpatient Therapeutic Programme (OTP) and 24,058 children suffering from moderate acute malnutrition were admitted to the SFP. In the case of Punjab province, LHWs have been able to take over this nutrition response within the Community

555,000 59,000 30,000 more than

mothers provided with health ed. messages

more than

children vaccinated for measles more than

Crisis in Khyber Pakhtunkhwa and Federally Administered Tribal Areas12 During 2012, almost 50,000 children were vaccinated against measles and over 80,000 were provided with Vitamin A supplements and vaccinated against polio. Just over 1,000 deliveries were assisted by skilled birth attendants and 8,800 women received ante-natal care. Health education was provided to over 75,000 women of child-bearing age and 10,000 pregnant women and new

children received Vitamin A supplements

Khyber Pakhtunkhwa

90,000

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more than

15,000 & 6,000 children

women

recieving further treatment or supplements

receiving further treatment or supplements. Unfortunately, a critical funding gap led to the suspension of some maternal and child health services for displaced persons at the end of 2012. more than

80,000

50,000

children provided Vitamin A supplements and vaccinated against polio

children vaccinated against measles

75,000 more than

pregnant and lactating women screened for malnutrition and received counselling on infant and young child feeding

12 UNICEF 2012 KP and FATA Situation Report – 4 January 2013

almost

almost

more than

Management of Acute Malnutrition (CMAM) programme with on-going support from UNICEF. Around 90,000 pregnant and lactating women were screened for malnutrition and received counselling on infant and young child feeding, including the importance of exclusive breastfeeding.

mothers were provided with Long Lasting Insecticide-Treated Nets.

Around 127,000 children under five and more than 55,500 pregnant and lactating women were screened for malnutrition with almost 15,000 children and over 6,000 women

women of child bearing age provided Health Education more than

127,000 Federally Administered Tribal Areas

more than

children under 5 years of age

&

55,000

pregnant and lactating women

screened for malnutrition

Maternal, New-born and Child Health Care

2013 AND BEYOND

PARTNERSHIPS

FROM THE FIELD

UNICEF will be working with the Government and partners to:

UNICEF’s key partnerships in the area of maternal, new-born and child health include the provincial health departments, especially in the support provided to Sindh and Balochistan in the development of their provincial health sector plans. At a Federal level, UNICEF cooperates closely with the Prime Minister’s Polio Coordination and Monitoring Cell as well as the Ministry of Inter-Provincial Coordination. In 2013 this partnership includes the new Ministry of National Health Services, Regulations and Coordination. UNICEF remains part of the H4 initiative, along with the United Nations Population Fund (UNFPA), the World Health Organisation (WHO) and the World Bank, committed to tackling maternal health issues. In addition, UNICEF’s partnerships with the Bill and Melinda Gates Foundation, Global Alliance for Vaccines and Immunisation (GAVI) and Rotary International remain critical in the fight against polio, and similarly for UNICEF’s cooperation with the Global Fund for AIDS, Tuberculosis and Malaria. UNICEF continued to lead the nutrition cluster in the 2012 humanitarian context, working alongside the Government, civil society, NGOs and United Nations Agencies to deliver critical health services.

Nutrition assistance goes a long way in flood-affected Sindh

Increase the number of children under five who are fully immunised with nine antigens, including polio; Increase the number of births attended by skilled assistants, and education on ‘kangaroo care’; Develop evidence-based policies and budgets and provide maternal and child health services focused on the most marginalised children and women; Support the provincial governments to develop nutrition strategies; Embed disaster risk reduction in provincial health plans; Refine the approach to polio eradication in light of the new operational reality of attacks on polio workers; Expand coverage of 24/7 emergency obstetric and neo-natal services to further districts; Help communities eliminate social norms that discriminate against vulnerable women and children in healthcare; Increase the coverage of Mother and Child Health Weeks; Increase the number of households consuming iodised salt and children under six months who are exclusively breastfed.

12

The battle against child malnutrition in Pakistan’s flood-affected Sindh province reached even small isolated villages with the help of UNICEFsupported community mobilisation teams.

Meena, a young mother of two from Sinjoro, Sindh, saw her one year old malnourished daughter, Lachmi, slip into a critical condition over a matter of days. Community nutrition workers encountered her while visiting her Union Council to assess nutrition levels of children, and referred her to the nearest health facility. Once Lachmi had recovered, Meena brought her back home, with information on diet regimen and healthenhancing behavior. Armed with this new knowledge, Meena can give little Lachmi the care that can keep her healthy.

Lachmi is among thousands of children who silently face the threat of acute malnutrition. Natural disasters, rising food prices and poor environmental conditions aggravate the situation. The magnitude and severity of the problem requires a blend of community and facility-based solutions. About five to 10 percent of acute cases need hospital-based treatment, while the vast majority of cases can be managed with outpatient treatment by distributing ready-to-use therapeutic and/or supplementary food packets, along with teaching mothers about the causes of infection and malnutrition and simple skills for infant and young

Annual Report 2012

13

UNICEF Pakistan

A Lady Health Worker, Amina, conducts a health and hygiene session for a group of women and children in the flood-affected Wahid Dino Notiar village, Badin district, Sindh province. © UNICEF Pakistan/2012/Asad Zaidi

child feeding. This approach is appreciated by mothers like Meena who have other young children to take care of, and little money to spare for long visits to distant doctors and hospitals.

By becoming aware of the importance of healthy nutrition for themselves and their children, including proper feeding practices and the provision of food supplements through health practitioners when required, mothers can ensure that their children not only survive but also thrive.

A health worker explains to a mother the benefits of breastfeeding during the UNICEF-supported Mother and Child Health Week in Nankana Sahib district, Punjab province. © UNICEF Pakistan/2012/Asad Zaidi

* Not actual name www.unicef.org

From Purdah to Community Health Worker: the story of Wafaa from FATA

not gain access to homes due to the cultural norms keeping men and women separate, Wafaa’s interactions with women and children resulted in immediate health and nutrition improvements.

Wafaa* was an exception to the rule in the Federally Administered Tribal Areas, bordering Afghanistan. Unlike most women, confined to the home due to the Islamic principle of purdah and the danger of frequent conflict, even to the detriment of their health, Wafaa had parents who allowed her to go to primary school. With that extra level of education, Wafaa was one of the few women available to staff the health and nutrition interventions taking place in her area, Mohmand Agency, with the support of UNICEF and a local community based organisation. While male staff could

However, not everyone saw things that way. On her first day of work, influential community leaders created hurdles and tried to stop her work as a community health educator. Neither she, nor her family, knew how to persuade the community leaders to change their minds, but Wafaa did not give up. To avoid threats, Wafaa was shifted to the main town, where she was fully trained in community mobilisation, including persuasive communication. With that extra motivation and training, she bravely returned to her community and managed to get

Maternal, New-born and Child Health Care

14

A health worker administers polio drops to a newborn child at the UNICEFsupported Mother and Child Health Week in Nankana Sahib district, Punjab province. © UNICEF Pakistan/2012/Asad Zaidi

the community leaders on side. She became highly respected and trusted within the community, and hence, very effective at her job. All this led to her being promoted to the position of Nutrition Assistant. The promotion increased her income, bringing financial stability to her family, as well as a place for her at the table in family decision-making. She has become a role model in improving health and nutrition, with her knowledge and opinions sought by all, and especially to encourage other young women to follow in her footsteps.

of the misconceptions about the polio vaccine that prevail among certain groups and individuals in his area.

Religious leaders help change misconceptions about polio vaccine

“Earlier, when our Lady Health Workers went to the field [to vaccinate children against polio], they faced a lot of resistance,” said Dr. Noor Khan, Medical Officer of the Basic Health Unit in Fakirkale, a locality of Pajagai.

“But now, due to the efforts of the health staff, UNICEF, WHO and the Ulema, the public perception has changed.”

A sermon by an imam may change misconceptions about the polio vaccine in some communities in Khyber Pakhtunkhwa province, in northwest Pakistan. The imam of the local mosque is a central source of religious and cultural knowledge, and is referred to for guidance on controversial matters.

Imam Asim, who heads the Idara-eTaleem-ul-Quran school and mosque in Pakha Ghulam, a Union Council in the suburbs of Peshawar, is well aware

In order to dispel these misconceptions and to support the National Immunisation Days campaign, he emphasises the importance of giving polio drops to every child under age five during the Friday sermon and prayer sessions.

“We try to present our point of view to the people in a firm manner during the Friday congregation and other prayer congregations,” he said.

UNICEF continues to engage religious leaders and harness their influence to educate the public about polio and its prevention. In collaboration with the Ministry of Religious Affairs, UNICEF and partners have held briefing sessions across the country for religious scholars from all schools of thought, securing their unconditional support for efforts to eradicate polio from Pakistan.

“Earlier, when our Lady Health Workers went to the field [to vaccinate children against polio], they faced a lot of resistance. But now, due to the efforts of the health staff, UNICEF, WHO and the Ulema, the public perception has changed.”

Dr. Noor Khan Medical Officer Basic Health Unit Fakirkale, Pajagai, Peshawar district, Khyber Pakhtunkhwa

Annual Report 2012

15

UNICEF Pakistan

FOCUS: CHARM INITIATIVE Pakistan’s maternal, neo-natal and infant mortality rates remain far higher than those of the Millennium Development Goals (MDGs), even if they have been gradually reducing over the past decade. UNICEF’s support to the Punjab Chief Minister’s Health Initiative for Attainment and Realisation of Millennium Development Goals (CHARM), however, has yielded further promising results in 2012, by tackling the gaps in service delivery with low-cost assistance and system

Background Prior to the 2010 floods, emergency obstetric and neo-natal care services were negligible in southern Punjab. A typical health facility servicing up to 40,000 people would, as a monthly average, provide ante-natal checkups for only around 25 women, maybe assist in one delivery but not always, and only a couple of women would return for post-natal check-ups.

The reasons for such low performance were complex, including fragmented service delivery between district and national programmes, challenges to accountability, a shortage of female health staff – especially skilled birth attendants – and insufficient equipment and supplies, along with a number of socio-cultural and

transport barriers for women seeking to access assistance.

The 2010 and 2011 floods highlighted these challenges and brought them to the attention of the Government and international community. In addition, the 18th Amendment to the constitution, devolving many federal responsibilities to provincial levels, provided a unique opportunity to address the gaps and enable the most marginalised women to access adequate obstetric care.

The CHARM Initiative Out of this was born the CHARM Initiative. UNICEF and UNFPA along with a private telecommunications

company provided technical and financial support to the Punjab Provincial Department of Health to ensure basic obstetric and neo-natal care services, including referrals to 24/7 delivery care, in seven flood-affected districts. Among these, UNICEF directly supported 52 health facilities servicing 1.8 million people in five severely flood-affected districts of southern Punjab. UNICEF provided essential support to the provincial government in analysing the bottlenecks and the obstacles that were preventing health facilities providing adequate obstetric services and women accessing them. This included providing 80,000 Pakistani rupees (approximately USD 820) to each health facility on a monthly basis to provide or supplement the human resource capacity, fuel for ambulances, Rabiya Bibi, mother of 13month-old Mariyam, seeks advice from the doctor during a routine checkup for her child at a Basic Health Unit in Haji Ghazi, Dera Ghazi Khan district, Punjab. © UNICEF Pakistan/2011/Sami Malik

www.unicef.org

Maternal, New-born and Child Health Care

16

A Lady Health Worker gives a de-worming tablet during Mother and Child Health Week in Nankana Sahib district, Punjab province, Pakistan. © UNICEF Pakistan/2012/Asad Zaidi

midwifery kits and equipment and more.

One of the key elements of success was a robust flow of information and monitoring. UNICEF accompanied district health officials in their monthly visits to each health facility. Standardised checklists provided the foundation for health officials to report back to provincial colleagues and identify immediately any challenges or problems that needed solving.

As a result of such dedication on the ‘supply’ or service delivery side, an enormous increase was seen in the number of women seeking out antenatal, obstetric and neo-natal care, far beyond the provincial averages.

Health facilities in the districts of the CHARM initiative had almost four times the number of ante-natal visits and almost eight times the number of post-natal care visits per month than health facilities in other districts.

Assisted deliveries in CHARM health facilities increased to more than six times the provincial average.

This major success has resulted in the provincial government’s commitment to scale up the CHARM initiative to more districts across Punjab, with this commitment galvanised in the Integrated Program for Reproductive Health, Primary Health Care and the Nutrition Planning Commission One stretching until 2015. The World Bank

and the United Kingdom’s Department for International Development have subsequently pledged their support also.

The CHARM initiative has also provided a gateway to implement further the Community Management of Acute Malnutrition (CMAM) model as well as ensuring infant and young child feeding (IYCF) practices are promoted strongly within the public sector health system.

Emergency situations and disasters can provide a critical ‘window of opportunity’ to not only save lives in the immediate term, but to translate such response into a longer term solution and integrate those efforts into government policy and budget commitments. Rather than creating new structures, the CHARM Initiative demonstrated that the strengthening of existing systems and filling of gaps can reduce maternal and child mortality.

FIGURE 2: Average Monthly Basic Health Unit Obstetric and Neo-Natal Service Delivery in Five Under-served and Flood-Affected Districts of Southern Punjab

78 194 40

9 2

are

na

6

tos

1

43

C tal

P ry

e eliv

25

D

are

na

C tal

A

nte

ne eli cial s Ba ovin e Pr verag M A ARage H r C ve A

Annual Report 2012

17

UNICEF Pakistan

“

Tackling the determinants or causes of health inequalities requires a different approach to simply tackling the determinants or causes of ill health. It is about ensuring a fairer and more equal society, where people with the least access to resources and opportunities are able to enjoy the standard of living and the opportunities that many take for granted.

�

- Punjab Health Sector Strategy 2012 - 2020

www.unicef.org

WATER, SANITATION AND HYGIENE

18

Expenditure (USD) Total

28,490,694

Regular Resources

5,266,642

Other Resources (Regular)

2,052,483

Other Resources (Emergencies)

21,171,569

Š UNICEF Pakistan/2012/Asad Zaidi

Annual Report 2012

19

UNICEF Pakistan

WATER, SANITATION AND HYGIENE Access to safe drinking water, adequate sanitation and basic hygiene knowledge is a basic need and a human right. Without these, diarrhoea and other diseases such as typhoid, dysentery, parasites and skin diseases often present themselves and have a devastating impact in communities. Polio is transmitted through poor sanitation; and conditions such as malnutrition are aggravated by diarrhoea.

According to some reports, Pakistan

However, in urban areas, where almost two-thirds of the population have access to piped water, the burgeoning population, especially in slum areas, is increasing pressure upon this infrastructure. In many rural areas, women and children have to walk long distances to get water, raising protection concerns.

Pakistan is off-track to meet the MDG related to sanitation. Just 48 per cent of the population has access to improved sanitation; how-

exposed to physical danger and sexual harassment the further they must travel; this is also the case when safe and nearby sanitation facilities do not exist.

Furthermore, the responsibility for water collection and the lack of access to separate and clean water, sanitation and hygiene facilities in schools contributes to low enrolment and high school dropout rates, especially for adolescent girls.

In addition, assistance in school for adolescent girls to manage their menstrual hygiene is rarely facilitated,

A woman washes dishes at a UNICEF installed water hand pump in Wahid Dino Notiar village, Badin district, Sindh province. Š UNICEF Pakistan/2012/Asad Zaidi

has achieved the Millennium Development Goal (MDG) on water and succeeded in providing 92 per cent of its population with access to an improved water source. However, the types and quality of access varies greatly with only 35 per cent accessing water via tap and most rural residents using hand pumps as opposed to piped water.13 Urban and rural inequities also exist, with 89 per cent of rural populations versus 96 per cent of urban populations having access to an improved water source.14

ever this translates into just 34 per cent of the rural population versus 72 per cent of the urban population.15 As a result, open defecation remains a major health hazard, still practiced by approximately 40 million people in Pakistan.

Children and women are the most at risk when access to safe drinking water, adequate sanitation and hygiene knowledge is limited.

Frequently responsible for collecting water in rural areas, women and children are

13 UNICEF Situation Analysis of Children and Women in Pakistan, 2011 14 UNICEF/WHO Joint Monitoring Programme Report on Progress on Drinking Water and Sanitation, 2012 15 Ibid. www.unicef.org

causing girls to miss school and even drop out when appropriate facilities are not available.

Pakistan is one of the ten countries in the world most vulnerable to the impact of climate change, as evidenced by several years of recurring floods and other natural disasters, which will likely continue in the coming years.

Water, Sanitation and Hygiene

20

ACTION UNICEF’s Water, Sanitation and Hygiene (WASH) programme is comprised of large scale humanitarian response, community sanitation, high-level policy and strategy development, advocacy and technical support.

UNICEF’s support to increase access to sanitation through continued implementation of Pakistan Approach to Total Sanitation (PATS) as part of rural sanitation in flood- and polio-affected areas resulted in improved access to sanitation facilities for 4.5 million, including around 1.8 million children, by ensuring local communities are engaged in the process of determining what they need. This ensured solutions that were culturally appropriate, such as separate walled facilities Improved access to sanitation facilities for

4.5 mil. out of which

1.8 mil. around

were children

culturally appropriate facilities for girls and women and childfriendly facilities reaching over

600,000 3,800

children in more than

schools

for girls and women and child-friendly facilities reaching over 600,000 children in more than 3,800 schools.

More than a million parents and caregivers now know about improved hygiene practices.

The Rural Sanitation in FloodAffected Districts (RUSFAD) Prog-

ramme continued to apply the PATS at scale in 2012. The PATS strategy aims to eliminate open defecation in entire communities in a sustainable and permanent way and increase the use of improved sanitation facilities and improve hygiene practices. PATS requires community ownership because the benefits of being open defecation free are only accrued when an entire community makes it happen.

Communities make this happen with the support of UNICEF through a combination of locally designed advocacy, the stimulation of demand for sanitation and the training of local specialists and suppliers to affordably fulfil the demand. In 2012 alone, over 2,600 villages, home to over 2.9 million, were certified as ‘Open Defecation Free’ (ODF) and an additional 300 villages, home to 1.6 million, are on the way to achieving this status.

UNICEF’s strength also lies in providing technical expertise and support to the formulation of quality government policy and support to governments to meet their international commitments.

To this end, UNICEF facilitated the Sanitation and Water for All (SWA) process in Pakistan, resulting in government commitments based on a Joint Sector Review and increased visibility on the international stage for water and sanitation challenges in Pakistan. This is the first step towards a Sector Wide Approach (SWAp) aimed at bringing national and provincial governments, donors and all stakeholders together to establish a set of principles to guide all efforts to meet international commitments to the Accra Agenda for Action.

Being more resilient as communities and as a nation can save lives and reduce the impact of disasters. In the wake of three years of flooding, UNICEF remains strongly committed to strengthening provinces and communities, providing training in 2012 to 332 government counterparts in WASH across the provinces on WASH emergency preparedness and response. This included the development of national and provincial contingency plans.

more than

more than

2,600 2.9 mil. villages, home to

certified as ‘Open

Defecation Free’ more than

500,000 children across the country were reached with messaging on the importance of hand washing with soap

UNICEF joined forces with UNILEVER, Mobilink and the Federal Ministry for Climate Change for the celebration of Global Handwashing Day 2012. Together over 500,000 children across the country were reached with messaging on the importance of hand washing with soap. Mobilink’s mass distribution of text messages encouraging good hygiene practices were linked with UNICEF’s provision of soap to 250,000 children and lessons to half a million children on hand washing and other good hygiene practices.

Annual Report 2012

21

UNICEF Pakistan

EMERGENCY RESPONSE When disaster strikes, water, sanitation and hygiene are among the top priorities to keep people alive and avoid outbreaks of disease. With many communities still recovering from several years of flooding, a new round of floods in 2012 again set back the achievement of the MDGs. Emergency response and recovery is both about saving lives and getting progress back on track.

The 2012 floods hit northern Sindh and eastern Balochistan provinces the hardest, but also affected southern Punjab, while instability continued in the northwest region of the country.

Thus UNICEF’s WASH programme remained heavily focused on emergency response and early recovery in 2012, utilising just over USD 21 million in humanitarian funding.

2012 Floods: Emergency Response16 Rapid response from UNICEF enabled the supply of safe drinking water to over 500,000 flood-affected people through water tankering, the installation of water treatment units and hand pumps, plus the rehabilitation of water supply schemes. More

500,000 more than

flood-affected people supplied safe drinking water through water tankering, the installation of water treatment units and hand pumps.

more than

more than

people were provided with soap

people were provided with hygiene kits

330,000

600,000

than 330,000 people were provided with soap and over 600,000 with hygiene kits. Approximately 600,000 women and children received critical information to prevent WASH-related illnesses, especially diarrhoea.

2011 Floods: Early Recovery17 UNICEF’s WASH response transitioned to early recovery in January 2012. Prior to the transition, UNICEF was supporting water provision to over 1.2 million people including 635,000 children. Continued response under early recovery enabled UNICEF to provide sustainable support to over 635,000 people with access to safe drinking water and nearly 600,000 people received hygiene kits and information. Early recovery interventions in sanitation under the PATS approach have already been mentioned on the previous page. Seventeen water supply schemes were rehabilitated in partnership with the Sindh Public Health and Engineering Department, benefitting approximately 100,000 people and including a disaster risk reduction (DRR) component in the scheme design.

Asma Bibi, nine, collects safe drinking water from a UNICEF installed water hand pump in Shado Khan Village, Layyah district, Punjab province. © UNICEF Pakistan/2010/Shehzad Noorani

16 UNICEF 2012 Floods Situation Report – 16 December 2012 17 UNICEF 2011 Floods One Year Later Report – 26 October 2012 www.unicef.org

Water, Sanitation and Hygiene

Crisis in Khyber Pakhtunkhwa and Federally Administered Tribal Areas18 UNICEF continued to support those affected by insecurity in the west and northwest regions, providing safe drinking water to more than 200,000 throughout 2012 – over half of those being people displaced and living in host communities, the rest being those residing in camps. Reaching out to those beyond the camps is always more challenging and a lack of funding hindered UNICEF’s prioritisation of assistance in this regard. However, more than 90,000 displaced persons in three camps were more than

2013 AND BEYOND

PARTNERSHIPS

In 2013 and beyond, UNICEF will focus on:

UNICEF Pakistan’s government partners in the area of WASH are the provincial Public Health and Engineering Departments and Local Government Rural Development Departments. In addition, UNICEF coordinates with and supports the Ministry of Climate Change on WASH sector advocacy, development of sector guidelines and sector representation in international fora.

Sector reforms, including technical support to provincial governments to develop strategies relating to drinking water, sanitation and hygiene and action plans for ensuring that service provision reaches the underserved areas, including relevant capacity building as required; Further scaling up of the Pakistan Approach to Total Sanitation (PATS), reaching out to 1.3 million people in approximately 1,900 villages in 2013, to achieve ‘Open Defecation Free’ (ODF) status through sustained social change and stimulation of demand for and supply of adequate sanitation facilities;

200,000 90,000

Supporting provincial governments to integrate disaster risk reduction into their water, sanitation and hygiene sector plans;

more than

Increasing cohesion and integration with UNICEF’s other thematic areas, recognising the links between WASH and education, health, nutrition and child protection;

more than

people provided with safe drinking water

displaced persons in three camps were provided with sanitation services

300,000 525,000 children and women were reached with key hygiene messages

more than

received hygiene kits

provided with sanitation services to international humanitarian SPHERE guidelines through the maintenance of thousands of washrooms, latrines, washing pads and solid waste collection points. Over 300,000 children and women were reached with key hygiene messages both on and off camp and over 525,000 received hygiene kits.

22

Continued support to crisisaffected populations in the northwest and humanitarian response in other areas if required, based on strong contingency preparedness.

In 2012, UNICEF continued to co-chair, with the United Nations Development Programme (UNDP), the ‘Delivering as One’ Joint Programme on the Environment, and act as the convening agency for the component on water and sanitation.

Both at policy and project implementation levels, UNICEF provided leadership on the United Nation’s work related to the environment. In 2012, this particularly took the form of leading and convening the Programme.

UNICEF continued to lead the WASH cluster nationally and in provinces, with the simultaneous response to both 2011 and 2012 floods and the on-going situation in KP and FATA regions.

UNICEF’s commitment to engaging with the private sector and leveraging opportunities for corporate partnerships continued in 2012, particularly in relationship with UNILEVER, Mobilink and others for Global Hand Washing Day.

18 UNICEF 2012 KP and FATA Situation Report – 4 January 2013 Annual Report 2012

23

UNICEF Pakistan

FOCUS

FROM THE FIELD Girl’s Clay Models Stimulate Sanitation Dialogue: Early Recovery Scaling up of Rural Sanitation in Flood-affected Districts of Pakistan While the other students prepared their skits and performances for World Water Day, Maira, 19, had different ideas. As a Junior Community Resource Person in the Total Sanitation Project being implemented in her community by UNICEF, Plan Pakistan and the Punjab Rural Support Programme, Maira knew first-hand how hazardous the conditions were in which many of her community lived.

The village area was littered with faeces, with few latrines, and children almost never used soap. “All this bothered me very much,” she said.

Maira knew she needed an out-ofthe-box idea to motivate her community to improve the sanitation facilities, buy and use soap and construct latrines – in a financially sustainable way. She found her solution by simply digging some clay from the field nearby and adding a little water.

and hygiene practices. With a latrine in one corner, the kitchen in the other, and a gate or curtain over the entrance for privacy, the clay creation was literally the ‘model’ compound.

Maira’s model won first prize at her school on World Water Day 2012.

More importantly, her model stimulated sanitation dialogue amongst the community, government officials and children, making sanitation a priority concern. Maira’s conviction is ever stronger, especially with the support of her family: “Hygiene education at home and in schools is important and must continue. It can bring change as it has done in our village,” she concludes proudly.

48%

Approximately 40 million people defecate in the open in Pakistan. With just 48 per cent of the population (34 per cent rural and 72 per cent urban)19 having access to improved sanitation, Pakistan faces a major challenge in achieving the MDG target of 64 per cent access to improved sanitation by 2015. Open defecation particularly puts children at risk of diarrhoea.

Diarrhoea remains the leading cause of mortality for children under five; over 116,000 children under the age of five die due to diarrhoea each year, translating into the loss of life of 13 Pakistani children per hour.20 Children also suffer disproportionately from sickness due to diarrheal disease with almost 25 million cases reported annually.21

of the population have access to improved sanitation diarrhoea remains the leading cause of mortality for children under five

40 mil. approx.

people defecate in the open

Working through the night, she tried and re-tried moulding a typical family compound, finally visualising one compound she had recently visited for a family of eight, with an old dying man lying in the corner surrounded by filth and wheat grain.

more than

25 mil. almost

After completing that first model, Maira made another model demonstrating the ideal compound of a family that adopts basic sanitation

Open Defecation and Diarrhoea

children suffer disproportionately from sickness due to diarrheal disease

116,000

children under five die due to diarrhoea each year

13 / hr Pakistani children die per hour

19 Joint Monitoring Programme 2010 20 Pakistan Demographic and Health Survey 2007-08 21 Pakistan Social and Living Standards Measurement Survey 2006-07 www.unicef.org

Water, Sanitation and Hygiene

24

Community members construct a latrine with training and materials provided

by UNICEF in Basti Abdul Khaliq Tanwari, Rajanpur district, Punjab province. Š UNICEF Pakistan/2012

The Pakistan Approach to Total Sanitation (PATS) The 2010, 2011 and 2012 floods devastated much of the water supply and sanitation infrastructure and spread pollutants, exposing hundreds of thousands to increased risk of diseases stemming from water-borne pollutants and human waste.

Following the 2010 mega floods, UNICEF and the Government of Pakistan entered into a partnership to scale up a proven model of community-led sanitation, targeting people in the flood-affected areas. In these areas, access to sanitation, understanding and practice of good hygiene and access to safe water were already low before the floods; the flood devastation made their situation even direr. Building on the community-led total sanitation model applied in other countries, and on the National Sanitation Policy of Pakistan from 2006, the Pakistan Approach to Total Sanitation (PATS) was developed as a comprehensive strategy for promoting improved sanitation and hygiene outcomes in peri-urban and rural areas. PATS focuses not only on ending the practice of open defecation and transforming hygiene behaviour, but also sanitation marketing, waste water collection, solid waste disposal and drainage.

How does PATS work?

PATS is built upon four pillars:

Pillar 1: Sanitation Demand Creation for Open Defecation Free (ODF) Communities

entrepreneurs and sanitation enterprises; Facilitation of the development of linkages with microfinance institutions; Incentivising outcomes (School WASH, constructed wetlands, nonWASH community facilities).

Pillar 3: Participatory Health and Hygiene Promotion

Launching an Information, Education and Communication (IEC) campaign built on baseline information regarding communities’ knowledge, attitudes and practices (KAP) and formative research findings;

IEC material on key active health and hygiene messages with a communications strategy;

Mobilising communities through community activists and community resource persons, including Lady Health Workers, adapting a cascading model and establishing Sanitation Village Committees.

IEC campaigns promoting low-cost, appropriate and informed sanitation solutions.

Pillar 2: Supply Side Intervention Technical training of masons; Construction of low-cost environmentally friendly gender sensitive latrines for demonstration of technical solutions; Piloting the concept of sanitation marts and trainings of sanitation

Mass media/communications campaign;

Pillar 4: Attaining 100 per cent Adequate Drainage and Wastewater Treatment Advocacy for waste water disposal in a hygienic way; Advocacy for underground/covered drainage system; Advocacy for wastewater treatment through oxidation ponds/constructed wetlands;

Annual Report 2012

25

UNICEF Pakistan

A rural sanitation mart set up in Ehsanpur village, Muzaffargarh district district, Sindh province, as part of the Pakistan Approach to Total Sanitation (PATS) for which UNICEF is a lead partner. © UNICEF Pakistan/2012

Ensuring adequate drainage design with the support of Public Health Engineering Department;

Making it happen in partnership

Piloting drainage and wastewater treatment in selected villages.

The successful implementation of PATS on a large scale is made possible by partnership and collaboration amongst all levels of the Government, local civil society organisations, non-governmental organisations (NGOs), and most importantly, the community members.

UNICEF’s role includes programme management, overall programme monitoring, strategy development and technical advisory services in all areas of PATS, while Plan International is contracted to implement the programme jointly with local NGOs. In addition, UNICEF entered into a partnership with WaterAid to independently monitor all programme

processes at village level, based on agreed upon and documented implementation standards using different monitoring tools, such as household surveys, process observation and focus group discussions.

The partnership model focused on the co-development of ideas, trust and goodwill, and was consequently of value to all. Promoting the attitude of ‘sharing is winning’ was especially important for the newly applied monitoring arrangement.

Children practice hand washing with soap after attending a health and hygiene session organised by UNICEF. © UNICEF Pakistan/2012

www.unicef.org

Water, Sanitation and Hygiene

26

Girls at the one of the UNICEF constructed schools in Gari Habibullah in Pakistan-administered Kashmir, demonstrate hand washing that they had learnt through a UNICEF supported School WASH programme. Š UNICEF Pakistan/2012/Asad Zaidi

The results in 2012 Declared ODF

ODF

Number of villages

2,912

2,613

Population in villages

4,529,119

2,890,835

3,220,000

What next?

Continuing to implement PATS in partnership at scale while shifting the management of implementation to provincial UNICEF offices and strengthening the capacity of the Government to oversee the PATS programme at all administrative levels;

2.

Refining and further standardising the PATS programme concepts with a focus on School Led Total Sanitation, monitoring and evaluation, IEC material review, the subsidy concept, public private partnerships, microfinancing and support to the Government to take up PATS implementation;

Wetlands including Sewer Lines constructed

3.

Further institutionalisation of knowledge management;

742,000

4.

Continuing output and process monitoring system to monitor key areas of PATS to facilitate Management for Results (Level 3 Monitoring and the Monitoring Results for Equity System);

3,983 113

Demo Latrines constructed

sanitation marts facilitated and operating

16

households with soap anywhere in the dwelling

Ensuring evaluations conform to global guidelines.

UNICEF is committed to scaling up PATS to 15,000 villages, reaching 20 million people by the end of 2017.

However there are number of essential areas that require focus over the next few years, to accelerate Pakistan’s progress towards the Millennium Development Goals (MDGs). This includes: 1.

people reached with appropriate hygiene messages

5.

Annual Report 2012

27

UNICEF Pakistan

“

It is political leadership that will put Pakistan's water and sanitation sector high on the agenda. This is a precondition for increased budget allocation and improved sector performance. We must now hold ourselves accountable.

�

- Pakistan Representative at the Global Sanitation and Water for All High Level Meeting Washington D.C., April 2012

www.unicef.org

28

EDUCATION Expenditure (USD) Total Regular Resources

29,836,559 3,410,109

Other Resources (Regular)

14,647,244

Other Resources (Emergencies)

11,779,206

Š UNICEF Pakistan/2012/Asad Zaidi

Annual Report 2012

29

UNICEF Pakistan

EDUCATION cient investment by the Government in education, across Pakistan.

Some factors that hinder access to school include limited social mobility, long distances between home and school, security risks especially for girls, competing economic priorities in the household, and in-school quality issues such as a lack of basic materials and infrastructure, teacher absenteeism and corporal punishment. There is insuffi-

Nevertheless, given the high profile events of 2012, much potential exists to accelerate progress for children’s, especially girls’, education in Pakistan, particularly as the provincial education departments put in place sector plans and increase budgetary commitments to education in the coming years.

FIGURE 3: Percentage of Pakistan’s population aged 15+ who are literate

80

60 67 64 72

30 42 45

le Fe

ma

n

le

ur al al

R To t

Only 18 per cent of primary school-aged children in the richest quintile are out of

55

Ma

rb a

Education in Pakistan attracted worldwide attention in 2012 with the highprofile militant shooting of teen education activist, Malala Yousafzai, from KP. At the invitation of the Government of Pakistan, United Nations Secretary General’s Special Education Envoy, former United Kingdom Prime Minister, Gordon Brown, visited Pakistan following the shooting to discuss how Pakistan could work towards improving education and accelerating progress towards the MDGs. These events came at a critical time when education performance across the country is marked by deep disparities based on gender, wealth, location, religion and ethnicity.

For example, while 60 per cent of those ten years and above in Punjab province are literate, that figure becomes 68 per cent for men and only 51 per cent for women. The gap is even wider between urban and rural Punjab, at 75 and 53 per cent respectively.23

school, whereas the figure is 49 per cent for the lowest quintile.24

U

2012 was a hallmark year as the first provincial Right to Free and Compulsory Education Bill passed into law in Islamabad Capital Territory, setting the example for the rest of provinces of Pakistan. With 9.2 million children currently not in primary or secondary school,22 the challenge continues for all other provinces and areas to follow and translate this into practice, and accelerate progress towards the Millennium Development Goals (MDGs). The notable gender gap in literacy and school attendance in Pakistan is a significant factor in low achievement and gender disparities in other socioeconomic indicators.

Tot a

l

Source: Pakistan Social and Living Standards Measurement, 2010-11

22 UNICEF Out of School Children Study, 2012 23 Multiple Indicator Cluster Survey Punjab, 2011 24 UNICEF Out of School Children Study, 2012 www.unicef.org

Education

30

ACTION UNICEF’s Education programme aims at increasing access to education for all children, especially for girls, and for the poorest children, improving the quality of education and the school environment and strengthening the education system.

Overall, 1.5 million girls and boys participated in some form of UNICEF-supported education programme during 2012.

UNICEF played a critical role in the advocacy effort along with other key partners, to support the passage of the first provincial Right to Free and Compulsory Education Bill into law in the Islamabad Capital Territory. This is the next step for provinces and areas following the constitutional amendment (Article 25a) in 2010. Simultaneously, an intensive nationwide ‘Every Child in School’ campaign focused on getting children who had never been to school into the classroom. The campaign reached millions of people through a 12 programme series of radio broadcasts, 12 television telecasts,

Establishing reliable statistics can be challenging, especially with respect to the numbers of children out of school.

In 2012 UNICEF completed an analysis on the profiles of children out of school. This Out of School Children Study is a useful planning document that identifies policies and strategies that provincial and government partners can employ to accelerate access for children out of school.

For three years, the Welcome to School Initiative has supported returnee communities to provide community-driven education services such as teacher training and school

enables schools to become inclusive and academically effective, and to provide a safe, secure, healthy and protective environment that allows for active and democratic participation of children, parents and communities.

Currently, around one million children from public schools benefit from the Child Friendly approach with the support of UNICEF.

supplies to improve girls’ enrolment and overall retention rates. Since 2010, over 494,000 children, 44 per cent girls, have benefitted in KP and FATA.

on-going. Disaster risk reduction is embedded in these plans. Teaching children how to respond to disasters and how to reduce the risks is critical to strengthening Pakistan’s resilience towards natural disasters. In Pakistanadministered Kashmir, UNICEF completed the construction of 705 earthquake resistant schools and supported the development of a

UNICEF provided critical technical support to Balochistan and Sindh provinces in the development of their Education Sector Plans. Balochistan has completed theirs and Sindh is

Maryam, six, reads the English alphabet on the blackboard in a UNICEFsupported school in Jalozai camp, Khyber Pakhtunkhwa, Pakistan. © UNICEF Pakistan/2012/Asad Zaidi

community meetings, door-to-door contact by ‘young champions,’ street theatre and social media engaging more than 23,000 people. The campaign emphasised the importance of girls’ education, disaster preparedness and the parents and teachers’ responsibility to educate their children.

UNICEF continued to support provincial governments to mainstream the Child Friendly School approach in 50 districts. The Child Friendly approach

Annual Report 2012

31

UNICEF Pakistan

EMERGENCY RESPONSE For a third consecutive year, UNICEF’s Education programme supported several humanitarian responses, overlapping from one emergency to the next, with USD 13.7 million of funding in 2012. UNICEF continued to lead the Education Cluster, responsible for coordinating all humanitarian education activities within Pakistan.

Schools’ and Educational Building Safety Plan of Action.

Building social cohesion and tolerance to strengthen peace in Pakistan can be done not just with adults but also among youth and children. UNICEF supported a group of youth participating in the OneMinuteJr.org video project.

These youth learned basic media and video production skills in order to creatively express both the challenges and hopes they have for life in Pakistan. The 16 one minute videos produced are being used for advocacy; most of the children chose to focus on the importance of education and gender equality.

Dropout rate % (primary education in FATA): in school

37%

63%

boys

2,000 more than

23%

dropout

77%

girls

children from highly disadvantaged backgrounds who had previously dropped out of school participated in accelerated learning programmes

Insecurity in KP and FATA significantly hampers children’s access to primary education, with the dropout rate in FATA at 63 per cent for boys and 77 per cent for girls.25 However, with UNICEF’s support, more than 2,000 children from highly disadvantaged backgrounds who had previously dropped out of school participated in accelerated learning programmes in KP and FATA.

2011 Floods: Early Recovery26 From January to September 2012, UNICEF supported the Government to transition over 95,000 children, almost half of those being girls, from Temporary Learning Centres (TLCs) into more than 2,000 government primary schools in ten districts. In addition, 400 schools benefitted from education supplies provided by UNICEF. Funding constraints meant

95,000 2,000 more than

children transitioned from TLCs into

over

government primary schools in ten districts

that UNICEF was unable to provide additional training to teachers and education officials on disaster risk reduction, psychosocial support and contingency planning, nor to members of School Management Committees, which would otherwise have greatly strengthened the educational environment in the flood-affected areas.

25 UNICEF Situation Analysis of Children and Women in Pakistan, 2011 (Annual School Survey, 2009-10) 26 UNICEF 2011 Floods One Year Later Report – 26 October 2012 27 UNICEF 2012 Floods Update – 18 January 2013 www.unicef.org

2012 Floods: Emergency Response27 The early recovery efforts from the 2011 floods were scarcely coming to a close before the 2012 monsoon rains arrived. UNICEF moved quickly to support the setting up of 510 TLCs to sustain the schooling of more almost 36,000 children, 42 per cent of those being girls, whose education had been disrupted by the 2012 floods.

These TLCs continued until March 2013, at which point the children were mainstreamed into government schools. Over 770 TLC teachers were trained on teaching in difficult circumstances, including how to promote health and hygiene and provide psychosocial support to students.

Enrolment campaigns were integrated into the Balochistan flood response where parents were mobilised to take an active role in the restoration of educational services and to enrol their children in school. almost

510 36,000 42% TLCs set up to sustain the schooling of

were girls

770 more than

TLC teachers were trained on teaching in difficult circumstances

children

out of which

Water, Sanitation and Hygiene

2013 AND BEYOND Complex Emergency in Khyber Pakhtunkhwa and Federally Administered Tribal Areas28 Insecurity had a major impact on children’s access to education, including militant attacks on schools similar to 2011. UNICEF supported schools in the three displaced persons’ camps to enrol almost 9,500 children, more than half being girls and 40 schools outside the camps to enrol over 4,600 children. Parent Teacher Councils were established in 84 schools both in the camps and in host communities to actively engage parents in the support of their children’s education. UNICEF supported the launch of a media campaign via radio and the provision of school supplies to encourage out-of-school children to be enrolled.

Support an expanded vision of access to basic education and assist the governments to meet their commitments to free and compulsory education for children aged five to 16 years old.

Build or strengthen partnerships through Sector Wide Approaches (SWAps) at provincial and area level.

Go beyond Child Friendly Schools to Child Friendly Education Systems, especially through support to provincial Education Sector Plan development and federal advocacy.

Support the alternative provision of basic education through distance learning modalities such as Accelerated Learning Programmes and Community Learning Centres to reach children out of school.

Continue the ‘Every Child in School’ campaign, encouraging parents and caregivers to enroll their children and making sure learning environments are protective places, especially for the most marginalised.

Support the mainstreaming of Early Childhood Education and early grades into the school system, to build a solid foundation for learning and ensure holistic development of children.

Strengthen the capacity of Education and Disaster Management Authorities and teacher training institutes on child- and gender-sensitive disaster risk reduction.

In all areas, target girls, and especially girls in underserved areas, as well as other disadvantaged groups.

32

PARTNERSHIPS The provincial governments’ education departments remained UNICEF’s key partners, along with the Federal Ministry of Education and Training.

UNICEF collaborates closely with the National and Provincial Disaster Management Authorities as part of emergency education response and in order to integrate disaster risk reduction into the education framework. UNICEF remains the coordinating agency for the Global Partnership for Education for Balochistan and Sindh. UNICEF, along with the United Nations Educational, Scientific and Cultural Organisation (UNESCO), was the co-chair of the Joint Programme on Education in 2012 and will be a co-convener of the Strategic Priority Area within the new One UN Programme that includes education and other social services.

UNICEF is highly active in the Pakistan Girls’ Education Initiative, playing a pivotal role in forming provincial parliamentary caucuses.

These caucuses provide a platform for stakeholders from the Government, civil society, media and international organisations to increase awareness about gender equity issues in education and the need to improve financial commitments to girls’ education in particular.

UNICEF and the governments’ efforts to improve education go alongside those of numerous local NGOs and community-based organisations, international donors, NGOs and multilateral partners as well as other UN agencies, the media and the private sector.

28 UNICEF 2012 KP and FATA Situation Report – 4 January 2013 Annual Report 2012

33

UNICEF Pakistan

FROM THE FIELD Bringing girls and sports together in Sindh Twelve-year-old Zainab pauses in the midst of a frenetic ball game. “This is fun!” she says breathlessly. “I used to be fed up and didn’t want to come to school. Now I want to stay here all the time.” Twenty-two year old sports teacher, Shahla, watches keenly over Zainab and her classmates playing in the playground.

Zainab is a student at a Government Girl’s Primary School in Umerkot district, Sindh province and her school was severely affected by the flooding in both 2010 and 2011. However, the challenges to Zainab’s education were there long before the floods.

Poor quality teaching and an unwelcoming environment – including corporal punishment and little in the way of basic water and sanitation facilities – were common for students like Zainab. Furthermore, girls like Zainab were often expected to work in the home or the fields. Combining learning and playing – especially physical activities – was rare.

Combining learning and playing is part of the Child Friendly School model – a holistic approach to education – and is recognised in the Convention on the Rights of the Child as essential to childhood. To make this a reality for around 50,000 children like Zainab, UNICEF and a local partner, Right to Play, recruited and trained sports teachers in the area to encourage the integration of sport into children’s daily routine. The effort wasn’t without resistance – this was going against the grain for many.

www.unicef.org

FOCUS

However, persistence paid off.

Shahla is the first to admit that she has seen a major change in the girls of Zainab’s school since she began teaching them in November 2011. “In the beginning they were shy and afraid of participating in games. Now they are more confident, are arguing and want to compete. They are having fun while I focus on their physical, spiritual, health and social development.” With Shahla’s encouragement, participation in sports has opened a new world for Zainab and her friends.

“In the beginning they were shy and afraid of participating in games.

Now they are more confident, are arguing and want to compete.

They are having fun while I focus on their physical, spiritual, health and social development.”

Shahla Sports Teacher Government Girl’s School Umerkot district Sindh

Transitioning children from TLCs to government schools Disastrous floods and monsoon rains in 2010, 2011 and 2012 affected millions across Pakistan and severely disrupted education services. The 2010 floods disrupted the education of 1.8 million children whose schools were partially or fully damaged or used for IDP shelters. After the 2011 floods, more than 400,000 children were without a place to go to school.

In 2012, 500,000 children had their schooling disrupted once again.

In response to this enormous need, UNICEF worked in collaboration with the Sindh Provincial Government and NGO partners to set up Temporary Learning Centres (TLCs) that provided a secure learning environment for flood-affected children.

2010

2011

2012

TOTAL

TLCs

4,250

2,120

425

8,273

Children attending TLCs

94,000

101,970

27,525

423,495

Percentage who were ‘First Timers’

40%

41%

33%

-

UNICEF’s strategy for TLCs was based on a three-way partnership between the Government of Sindh (Education and Literacy Department and District Education Officers), NGOs and UNICEF. The Education

Water, Sanitation and Hygiene

and Literacy Department took the lead, deploying male and female government teachers, distributing textbooks and monitoring the quality at all TLCs. The NGOs mobilised communities for the enrolment of children, set up TLCs and trained TLC ‘para-teachers’ as well as Government teachers on classroom management skills. UNICEF provided school supplies, technical support and quality monitoring.

Not only did these TLCs serve children whose education had been interrupted, they also reached out significantly to those who had never previously attended school, otherwise known as ‘First Timers’.

Reaching out to almost 200,000 children with more than 6,000 TLCs over three years, it was essential that the ‘First Timer’ children had the opportunity to enrol in a government primary school and continue their newfound access to education. This required strong advocacy on the part of UNICEF, in cooperation with both the Provincial Disaster Management Authority and the Department of Education. A series of field visits, discussions on data in humanitarian reports and consultative meetings with Provincial Government officials, including the Education Secretary and the Minister, resulted in the Education and Literacy Department of the Government of Sindh agreeing to mainstream all children attending TLCs into the formal school system.

District-specific Action Plans were jointly developed by the Provincial Government, NGO partners and UNICEF to ensure children attending TLCs were enrolled in nearby government schools in March and April 2012.

If a school did not exist nearby or had been damaged by flooding, TLCs were moved from their temporary displacement site, to a new community site. In Sindh, as the academic year ends in March and the new academic year starts in April, the mainstreaming process was also linked with general enrolment drives to enrol more children in schools.

Following the 2011 floods, 95,432 flood-affected TLC children (43 per cent girls), inclusive of First Timers, were enrolled in 2,090 Government Primary schools in ten districts of Sindh and given ‘General Register’ numbers to ensure their stay in the education system. District education officials along with NGOs physically verified the schools to make sure they had the capacity to handle an increased number of students and that all technical modalities were in order.

1.8 mil.

34

more than

children’s education was disrupted in 2010 floods that partially or fully damaged their schools.

400,000 500,000 more than

After 2011 Floods

children were without a place to go to school more than

After 2012 Floods

children had their schooling disrupted

UNICEF, the Government and NGO partners leveraged the opportunity of an emergency response to mainstream flood-affected children from TLCs into the government school system, most especially ‘First Timers’ who had never previously been enrolled in school, and particularly girls.

Moving forward, UNICEF is a lead partner in a new Sector Wide Approach (SWAp) to Education in Sindh, and plans to leverage this role to strengthen the public school system, reducing dropouts, including of children who moved from TLCs, and improving learning outcomes.

Annual Report 2012

35

UNICEF Pakistan

“

The state shall provide free and compulsory education to all children of the age of five to sixteen years in such a manner as may be determined by the law.

�

- Article 25A-A 18th Constitutional Amendment of Pakistan

www.unicef.org

36

CHILD PROTECTION Expenditure (USD) Total

10,118,539

Regular Resources

2,243,175

Other Resources (Regular)

3,197,138

Other Resources (Emergencies)

4,678,227

Š UNICEF Pakistan/2012/Asad Zaidi

Annual Report 2012

37

UNICEF Pakistan

CHILD PROTECTION The Pakistani culture considers children a gift. Yet more needs to be done for children who suffer from social exclusion, neglect, abuse or exploitation, both inside and outside the home. The risks are highest for girls, poor or disabled children or those from a minority group.

The Government of Pakistan is committed to incorporating the provisions of the United Nations Convention on the Rights of the Child into its domestic laws. Legislative and policy progress has been made in the last few years to address children’s protection and welfare concerns, particularly in FATA, KP, Gilgit-Baltistan and Balochistan. Legal recourse, however, remains a distant option for many of the most marginalised children, due to a variety of social, economic and systemic barriers. While child marriage, for example, is outlawed, 70 per cent of girls in Pakistan are married by the age of 18, and 20 per cent are

70%

of girls in Pakistan are married by the age of 18

Birth registration is afforded to just over a quarter of Pakistani children, with noticeable disparities between provinces and urban and rural areas.

UNICEF is committed to assist the Government of Pakistan to improve the birth registration system to ensure that all children, everywhere, are given at the very least this critical point of access to social and protection systems and services throughout their lives. Birth registration is also important for ensuring that children can claim their rights to identity, juvenile justice, participation and to having a voice.

20%

all ages

of girls in Pakistan are married by the age of 13

18 yrs.

of age

13 yrs.

of age

29 UNICEF Situation Analysis of Children and Women in Pakistan, 2011 www.unicef.org

married by the age of 13.29 Corporal punishment remains lawful in Pakistan and is one of the major causes of school dropouts. Children, especially adolescent girls, and women are at risk of violence and abuse, including sexual exploitation and harassment, acid throwing, honour killings and other harmful traditional practices.

Child Protection

38

ACTION UNICEF’s Child Protection programme assists the Federal and Provincial Governments to strengthen child protection systems, particularly, the public child protection system, with a focus on three components: 1. policy, legislative and institutional frameworks aiming at increased compliance with the provisions of the Convention on the Rights of the Child and international standards;

2. the administrative structures, at

tion are on the agenda of lawmakers.

UNICEF supported the Punjab Provincial Government to develop, through a consultative process, a five year Adolescent Strategy and Strategic Plan to cater to the needs and realisation of rights of the most excluded adolescents of Punjab.

Such high-level advocacy is only possible with a robust picture of the situation of children, and for this UNICEF supported the preparation of the first ever Government-endorsed State of Children in Pakistan Report

sively mapped and assessed. The unique project was conducted with the four provincial Social Welfare Departments, involving institutional assessment and a subsequent capacity development strategy to ensure they can better respond to children and their families’ welfare and protection needs.

and a major Child Social Exclusion study. The Child Social Exclusion Study analysed the ‘what’ and ‘how’ of the exclusion of children from opportunities generated by society and from taking part in, or benefitting from, cultural, political and economic life, in terms of their capabilities that are compromised by exclusion. The findings underpin UNICEF’s equitybased programming and encourage the development of socially inclusive and equitable policies.

reliable data and information about the types of abuses and violations of rights to protection, which are foundational for the planning of the social services and budgets required to ensure effective protection.

Similarly, throughout the country, UNICEF is supporting the introduction of an information management system designed to provide more

A Child Facilitator conducts a recreational activity with children outside a UNICEF-supported Protective Learning and Community Emergency Services (PLaCES) in Jalozai Camp, Nowshera district, Khyber Pakhtunkhwa province. © UNICEF Pakistan/2012/Asad Zaidi

3. provincial and local levels, mandated to implement the protection of children from violence, abuse, exploitation and neglect;

4. institutional capacity, capability and the professionalisation of child caretakers such as wardens, social workers and probation officers.

UNICEF successfully advocated for the establishment of a National Commission on Child’s Rights within the Ministry of Human Rights with the express commitment of the Prime Minister, as well as the creation of a Parliamentary Forum on Child Rights to ensure that child rights and protec-

Pakistan is now one of only two countries in South Asia where Child Protection systems have been comprehen-

UNICEF assisted the Government to establish 21 Child Protection Units, 93 Child Protection Centres, 135 non-formal literacy centres for children involved in labour at brick kilns and 12 centres for street and working children. UNICEF also supported Pakistan Bait-ul-Maal’s conditional cash transfer programme linking cash incentives for 9,000

Annual Report 2012

39

UNICEF Pakistan

EMERGENCY RESPONSE vulnerable families, including 29,000 children, with their decision to send their children to school. Over 90 per cent of complaints from children and caretakers regarding the malfunctioning of public administration or services received a response through the UNICEF-supported Child Complaints Offices. In addition, 200,000 children had their births registered in emergency-affected settings.

Strengthening the birth registration system remained a focus in 2012. For the first time in Pakistan, several comprehensive key studies were launched to identify the gaps at multiple levels, including service delivery, in Balochistan, KP and Sindh.

Studies on the potential to harness cellular technologies, a cost analysis of a functioning and universal system and the success of Punjab where birth registration sits at around 80 per cent, were also conducted to help inform the provincial efforts supported by UNICEF to universalise birth registration in Pakistan. The Communication Strategy on birth registration was rolled out in 2012, which sought convergence with the Lady Health Worker programme and the accessing of key ‘gatekeepers’ (teachers, health workers etc) who can take ownership of the importance of birth registration and encourage those in their respective spheres of influence.

UNICEF’s humanitarian role in Pakistan continued in 2012 with the on-going complex emergency in KP and FATA and another round of flooding while the 2011 flood recovery was still in process. UNICEF utilised a total of USD 4.6 million in humanitarian funding for child protection services.

2011 Floods: Early Recovery30 UNICEF provided Protective Learning and Emergency Services (PLaCES) to around 250,000 children and almost 100,000 women in floodaffected areas during both the relief

2012 Floods: Emergency Response31 The PLaCES model introduced during the 2011 response continued to be very successful during the 2012 flood response, as a way of creating an environment to improve the safety, protection and well-being of children, women and adolescents through integrated, community-organised, ageand gender-appropriate services.

Almost 1,600 children were referred through PLaCES for disability registration, social protection schemes, health and nutrition services and/or school enrolments. Over 170 Child Protection Committees were organised with around 2,000 community members, trained to prevent, identify and respond to child protection issues.

250,000 & 100,000 170 2,000 around

children

almost

women were provided Protective Learning and Emergency Services (PLaCES) in flood-affected areas

and early recovery phases of the 2011 floods from September 2011 to September 2012. Almost 160,000 people were reached through interpersonal communications, with messages on keeping children safe during emergencies, child labour, early marriage, violence against children and women and birth registration.

UNICEF supported the establishment of Child Protection Committees that attracted over 6,100 members. Fifty seven per cent of these members were women. almost

160,000 30 UNICEF 2011 Floods One Year Later Report – 26 October 2012 31 UNICEF 2012 Floods Situation Report – 18 January 2013 www.unicef.org

people were reached through interpersonal communications

more than

around

child protection committees organised

community members trained to prevent, identify and respond to child protection issues

1,600 almost

children were referred through PLaCES for disability registration, social protection schemes, health and nutrition services and/or school enrolments

Child Protection

2013 AND BEYOND Crisis in Khyber Pakhtunkhwa and Federally Administered Tribal Areas32

The focus for 2013 and beyond includes: Enhance capacity of provincial, area and district authorities to implement legal and policy reforms and strengthen child protection systems to provide an enabling protective environment and justice for children, especially the most vulnerable;

UNICEF supported 31,000 vulnerable children and 8,000 women through 107 protective spaces. Fourteen thousand children in KP and FATA were linked up with appropriate social services via referral mechanisms.

Life-saving Mine Risk Education was provided to almost 42,000 children and 23,000 community members and caregivers in displaced persons camps, return areas and host communities to prevent casualties due to land mines and unexploded ordnances. around

31,000 almost

children

&

8,000

women

supported through

107 protective spaces

Strengthen the capacity of human rights institutions at all levels, particularly the Ministry of Human Rights and the National Commission for Child Rights; Strengthen the capacity of the Child Ombudsperson, provincial/area Social Welfare Departments and other key accountability mechanisms; Finalise key studies and research on birth registration and utilise this evidence to support policy formulation at provincial levels; Support the use of innovative technologies to address barriers in birth registration; Encourage the use of robust evidence, research and analysis to strengthen advocacy, policies, legislation, budgets and plans in favour of gender equality, social justice and the reduction of child protection risks during emergencies; Support improved monitoring and implementation of the Convention on the Rights of the Child and the Convention on the Elimination of All Forms of Discrimination against Women.

40

PARTNERSHIPS UNICEF maintains a wide range of partnerships for the advancement of child rights in Pakistan, including the Government, civil society organisations, NGOs and academic institutions.

The impact of the 18th Amendment to the Constitution meant that UNICEF’s working relationship with the Federal Law and Justice Commission was devolved to the provincial law enforcement authorities, including the Social Welfare Departments and Child Ombudsperson and Child Complaints Offices. Pakistan Bait-ul-Maal remains a key government partner whereby UNICEF supports several conditional cash grant programs designed to encourage families to enrol their children in school. At a national level, UNICEF’s key partner in Child Protection efforts is now the Ministry of Human Rights, in particular, the newly established National Commission for Child Rights.

In addition, UNICEF continues to work closely with the local government departments and the National Database and Registration Authority in partnership with other concerned functionaries, on the path to universalising the birth registration system in Pakistan.

Partnerships with the National and Provincial Disaster Management Authorities (NDMA and PDMAs) supported the establishment of Gender and Child Cells in three provinces and continue to strengthen the integration of child protection in disaster management planning, policies and capacity development.

32 UNICEF 2012 KP and FATA Situation Report – 4 January 2013 Annual Report 2012

41

UNICEF Pakistan

FROM THE FIELD With the on-going humanitarian situations, UNICEF remained the lead agency for the Child Protection SubCluster, coordinating preparedness and response alongside the Social Welfare Departments, NDMA, PDMAs and around 100 NGOs and civil society organisations throughout Pakistan.

UNICEF renewed its partnership with Barclays after the highly successful ‘Building Young Futures’ project. The new programme aims to help tackle youth unemployment by improving the prospects of 6,000 disadvantaged young people in Punjab, strengthening their economic and social resilience against the devastating challenges of chronic poverty, inequality and changing economic circumstances.

Irfan Ullah, 13, has been living in the Jalozai camp for the last four years due to insecurity in his home area of Bajaur Agency, Federally Administered Tribal Areas (FATA). © UNICEF Pakistan/2012/Asad Zaidi

www.unicef.org

Irfan, a young champion in Jalozai Camp In his spare time, 13-year-old Irfan Ullah practises spin bowling, copying his favourite Pakistani cricketer, Shahid Afridi. Handy with a bat, Irfan hopes to represent Pakistan’s national team one day.

“I like Shahid Afridi because he bats, bowls and fields well. He’s a great all-rounder,” says Irfan.

The same can be said for the articulate boy from Bajaur Agency, who has been living in Jalozai camp in Khyber Pakhtunkhwa for more than three years. Since insecurity near Irfan’s home forced his family to move to safety, he has devoted his energy to learning and planning for the future – and to teaching, encouraging and advocating for other children.

From escape to advocacy In July 2008, Irfan’s family fled from from fighting to Jalozai camp with only the clothes on their backs and a little bit of food.

Since then, Irfan has kept himself busy in the camp, acting as a role model and advocate for his six brothers and sisters, as well as for other children. “Each morning, I get up early, wash my face and go to school, where I’m the head of the student union,” Irfan says. “I provide health and hygiene information – and, if children have problems, I let the service providers in the camp know.”

“I also encourage children who aren’t going to school to enroll,” he adds, explaining that education contributes to keeping people safe and the environment clean. “I invited my friends who didn’t go to school to come with me, and I introduced them to the teachers.”

Child Protection

42

Irfan Ullah, 13, reads tips about health and hygiene from a Meena book while other children listen to him sitting in a UNICEF-supported Protective Learning and Community Emergency Services (PLaCES) in Jalozai camp, Nowshera district, Khyber Pakhtunkhwa province. © UNICEF Pakistan/2012/Asad Zaidi

Towards peace of mind After school, Irfan attends one of Jalozai’s 21 UNICEF-supported Protective Learning and Community Emergency Services (PLaCES), where children and women enjoy a safe, protective space to discuss their problems, receive referrals to other services and learn skills. Children can play with other children. As well as integrating health, nutrition, water, sanitation and hygiene services, each facility includes a dedicated space for women and adolescent girls to encourage their participation.

PLaCES also help children and women to recover from trauma and hardship caused by their experiences.

Irfan has learned to draw and now teaches other children. He also enjoys playing sports. He says that, when he arrived in the camp, these activities helped ease his distress. “Hearing the gunshots in our village had a stressful impact on us. The activities here gave us other things to focus on. And gradually our frame of mind changed,” he says.

Encouraging good health

Plans to benefit his community

Irfan’s family also received a hygiene kit, including soap and toothpaste.

“These things are given so we can wash our hands and keep ourselves clean. Cleanliness is half of our faith,” he says.

Irfan says he is particularly keen to share what he has learned at school and PLaCES with children and families when he returns to his home community, as they have not had the same learning opportunities. “I miss my home,” he says, “may God make my land prosperous and be re-established, so we could return.”

Irfan shares his health and hygiene knowledge with other children at PLaCES. At home, he mentors his siblings, taking them to UNICEFsupplied tap stands and toilets to teach them how to wash their hands with soap.

“I’m afraid they’ll get sick. They’re kids – they play with whatever’s in the house,” he says. “When we don’t wash our hands, germs can go onto our food. Then our stomach gets upset.”

Irfan is also aware of the dangers of polio. “If someone doesn’t receive polio drops, they could become disabled,” he says, a message his hero Shahid Afridi, as Pakistan’s Celebrity Polio Champion, is also sharing to help eradicate polio in the country.

“Irfan is a role model for his family and for others in the Jalozai camp community because he is motivated to change his and others’ circumstances and work for his dreams.”

Wafaa Saeed Chief of UNICEF’s field office Peshawar

Chief of UNICEF’s field office in Peshawar, Wafaa Saeed, says Irfan is an inspiration. “Irfan Ullah’s experience demonstrates how UNICEF and partners’ support can empower a child and his or her family, and help them to recover from the impact of emergencies,” she says, “Irfan is a role model for his family and for others in the Jalozai camp community because he is motivated to change his and others’ circumstances and work for his dreams.”

Annual Report 2012

43

UNICEF Pakistan

“

We need to implement a multipronged strategy for promoting a protective environment for children, which includes: addressing the capacity of families and communities; filling in gaps in legislation and enforcement; promoting open discussions with civil society and media; brushing up [on] children's life skills, knowledge and participation and ensuring essential protection services to address abuse of all forms. On top of all this, there is a need to put in place monitoring, reporting and oversight mechanisms.

Children are our future, our hopes and aspirations. The Government is alive to its responsibility and would undertake every possible measure to protect their rights.

�

- Prime Minister Government of Pakistan on the occasion of the National Conference on Child Rights, October 2012

www.unicef.org

FINANCIAL RESOURCES

44

© UNICEF Pakistan/2012/Asad Zaidi

Annual Report 2012

45

UNICEF Pakistan

FINANCIAL RESOURCES UNICEF had USD 137 million available for programming in 2012, which was the last year of the four-year Country Programme Cycle. From the available funding, USD 62 million went towards humanitarian response and USD 75 million was utilised for development activities.

FIGURE 4: Fund Allocation in 2011 and 2012 159.64 137.33 SD) Millions (U

Compared to 2011, 2012 saw a 13 per cent decrease in overall fund allocations. This was due to a 40 per cent decrease in funding towards humanitarian response programmes as the 2011 flood early recovery programmes came to an end. The decline was largely offset by an increase of 34 per cent in funding towards development activities (FIGURE 4).

Fund utilisation in 2012 is depicted in FIGURE 5 showing the utilisation of both humanitarian and development funds by programme. The greatest increase in utilisation of development funds was in the Maternal, New-Born and Child Health Care programme, which includes nutrition and polio eradication.

In 2012, there was an important

103.49 56.15

75.26 61.84

Develo pmen t

2011

Huma nitaria n

Total

2012

increase in utilisation of development funding in the areas of Maternal, New-born and Child Health Care,

FIGURE 5: Fund Utilisation by Programme in 2011 and 2012

40

38.42

Humanitarian

35.02

30.02

Development

Millions (USD)

30 24.26 21.00

20

18.24

18.08

17.70 15.36

11.78

10

7.69 6.47

0 Maternal, New-born and Child Health Care

2.93 Water, Sanitation and Hygiene

5.46

7.30

2.67

4.70 1.95

Education

2011

Child Protection

Planning, Monitoring, Evaluation and Reporting

Maternal, New-born and Child Health Care

Water, Sanitation and Hygiene

Education

2012

Child Protection

2.17 1.29 Planning, Monitoring, Evaluation and Reporting

Financial Resources

Education, and Water, Sanitation and Hygiene (WASH).

Humanitarian spending decreased proportional to the decrease in fund allocations as depicted in FIGURE 4.

The charts to the right depict the fund utilisation in 2012 by programme and type of funding. The Maternal, Newborn and Child Health Care programme was responsible for the highest fund utilisation in 2012 with over USD 52.7 million utilised. This was 38 per cent of the total programme utilisation by UNICEF Pakistan in 2012. Of this, 55 per cent of funding was from development funding from donors and 34 per cent from humanitarian funding. The remaining 11 per cent was utilised from UNICEF’s regular resources.

The second highest utilisation was in the Education programme, which accounted for 22 per cent of the total programme utilisation by UNICEF Pakistan in 2012. Of the USD 30 million utilised, 49 per cent was from development funding and 39 per cent from humanitarian funding. Utilisation of regular resources was similar to the Maternal, New-born and Child Health Care programme and stood at 11 per cent.

The overall WASH programme utilisation in 2012 was similar to Education and stood at 21 per cent of the total programme utilisation by UNICEF Pakistan but with a significant difference in the type of funding utilised.

Nearly 74 per cent of the funds utilised were from humanitarian funding whereas development fund utilisation was only seven per cent. The remaining utilisation of 18 per cent was from regular resources.

In 2012, the Child Protection and

Planning, Monitoring, Evaluation and Reporting programmes together accounted for 10 per cent of the total programme utilisation by UNICEF Pakistan. As the charts illustrate, the utilisation in the three fund categories of humanitarian, development and regular resources was quite similar for both programmes. However, this was in contrast to the other three programmes where at least one funding type made up more than 50 per cent of the total utilisation.

Child Protection

In addition to the five programmes, UNICEF’s fund utilisation in relation to cross-sectoral and operations amounted to USD 12.7 million and was funded through humanitarian, development

1,294,140

Mother, New-born and Child Health Care

6,022,735 28,996,030 17,701,617

3,410,109 11,779,206 14,647,244

Water, Sanitation and Hygiene

5,266,642 2,052,483 21,171,569

Other ResourcesEmergency (USD) 2,243,175

Regular Resources (USD)

3,197,138

Other ResourcesRegular (USD)

Planning, Monitoring, Evaluation and Reporting

Other ResourcesEmergency (USD)

4,678,227

1,040,599

1,126,184

Regular Resources (USD) Other ResourcesRegular (USD)

Other ResourcesEmergency (USD)

and regular resources at 43, 16 and 41 per cent respectively.

Regular Resources (USD)

The figures on page 47 show the utilisation of funds in 2012 by funding source.

Governmental and Inter-Governmental donors accounted for 44 per cent of total utilisation. UNICEF’s Pooled Thematic Funds made up 19 per cent and utilisation from Non-Governmental donors stood at 13 per cent. The remaining 24 per cent of the total utilisation in 2012 was funded from UNICEF’s regular resources to reach the total utilisation of USD 137 million.

Other ResourcesRegular (USD)

Other ResourcesEmergency (USD)

Education

46

Regular Resources (USD) Other ResourcesRegular (USD)

Other ResourcesEmergency (USD) Regular Resources (USD) Other ResourcesRegular (USD)

The highest fund utilisation in 2012 was of funds from the Global Thematic Humanitarian Response Fund. The utilisation of these unearmarked humanitarian funds constituted 37 per cent of total utilisation in the year. The second highest utilisation of 19 per cent was of funds from the Netherlands followed closely by Australia at 16 per cent. The utilisation of funds from the United States of America and the Bill & Melinda Gates Foundation each constituted 14 per cent of the total utilisation in 2012.

Annual Report 2012

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UNICEF Pakistan

Utilisation of Funds by Source

Governmental and InterGovernmental Donors

Austria Hungary Estonia Belgium Russian Federation Switzerland United Kingdom Italy Spain United Arab Emirates Norway Sweden Denmark Saudi Arabia Japan Canada European Commission/ECHO United States of America Australia Netherlands

0.01 0.01 0.03 0.11 0.12 0.16 0.40 0.42 0.66 1.26 1.59 3.16 4.30 4.66 4.97 5.00 5.54 7.89 9.17 10.95

0

2

4

6

8

10

12

Non-Governmental Donors

Millions (USD)

Unilever

0.01

Belgian Committee for UNICEF

0.01

Swiss Committee for UNICEF

0.04

Norwegian Committee for UNICEF

0.08

UNICEF UAE Country Office

0.10 0.29

Australian Committee for UNICEF OPEC Fund

0.36

Micronutrient Initiative

0.39

United Kingdom Committee for UNICEF

0.49

United States Fund for UNICEF

0.53 1.54

Rotary International

1.77

Consolidated Funds from NatComs

2.15

United Nations Foundation Inc.

2.60

The GAVI Fund

8.07

Bill & Melinda Gates Foundation

0

2

4

6

8

15

20

10

UNICEF Pooled Thematic Funds

Millions (USD)

HIV/AIDS and Children

0.11

Policy Advocacy and Partnership

0.21

Child Protection

0.28 3.57

Basic Education and Gender Equality Global Thematic Humanitarian Response Fund

21.37

0

5

10 Millions (USD)

www.unicef.org

25

PRIVATE SECTOR PARTNERSHIPS

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© UNICEF Pakistan/2012/Asad Zaidi

Annual Report 2012

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UNICEF Pakistan

PRIVATE SECTOR PARTNERSHIPS The business community in Pakistan is quite unique in size, commitment and engagement in corporate social responsibility (CSR) compared with many other countries in the world. UNICEF has recently started engaging with this vibrant sector, both in laying the foundations for UNICEF’s new Child Rights and Business Principles (CRBP) framework and in working with private entities including global UNICEF partners - to ensure sustainable, child-centric CSR initiatives.

Child Rights and Business Principles UNICEF is leading the way in Pakistan to introduce the Child Rights and Business Principles (CRBP) framework in Pakistan, the first comprehensive set of principles to

CSR Initiatives Our partners recognise our forwardthinking approach and our knowledge of the local business culture and family-owned business as key strengths in our ability to help them achieve their CSR goals. We work not Zareena, three, is one of many children benefitting from recreational learning in a UNICEF-supported Protective Learning and Community Emergency Services (PLaCES). Jalozai camp for IDPs, Nowshera district, Khyber Pakhtunkhwa. © UNICEF Pakistan/2012/Asad Zaidi

guide companies on the full range of actions they can take in the workplace, marketplace and community to respect and support children’s rights.

These guiding principles are very apt in the Pakistan context and highly applicable for both large multinationals, smaller enterprises and family owned businesses. Our CRBP toolkit supports CSR functions in moving towards child-centric CSR practices and ultimately supporting the mandate for children rights.

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only with businesses, but with business leaders, establishing shared trust and understanding of the commercial issues at stake.

We identify together the opportunities for collective impact. We collaborate on pre-existing initiatives as an entry point, building them as sustainable CSR initiatives that integrate across and within the business. For example, our locally developed partnerships with Telenor and ZonG have helped us not only reach out to a wider

Private Sector Partnerships

50

Shandana, three, is one of many children benefitting from recreational learning in a UNICEF-supported Protective Learning and Community Emergency Services (PLaCES). Jalozai camp for IDPs, Nowshera district, Khyber Pakhtunkhwa. Š UNICEF Pakistan/2012/Asad Zaidi

population in Pakistan, but also provide us with a better understanding of how technology can play a significant role in development initiatives.

We bring partners together for critical dialogue and knowledge exchange.

For example, in 2012, UNICEF Pakistan hosted our first Forum for Children, bringing together over 40 companies, philanthropists and CSR practitioners in a series of six roundtable discussions. We established our first multi-stakeholder Technical Advisory Group, bringing together all Telecoms operators, including Google, Telenor, Mobilink, ZonG, Asia Strategy Group, Intel and the Government of Pakistan to identify ways to improve birth registration through mobile phone technology. We are

now in initial discussions with companies in establishing Pakistan's first multi-level stakeholder Innovation Lab, which brings in additional academia.

Global UNICEF Partners Several global partnerships that UNICEF has established have also taken root within Pakistan. The Country Office has nurtured existing global alliances with IKEA in the battle against child labour; UNILEVER in the area of hygiene and sanitation; Star Alliance for education; Barclays for child protection and Rotary for polio eradication as well as other priority areas.

Kavita, 12, is one of many children benefitting from recreational learning in a UNICEF-supported Protective Learning and Community Emergency Services (PLaCES). Mirpur Khas, Mirpur Khas district, Sindh. Š UNICEF Pakistan/2012/Asad Zaidi

Annual Report 2012

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UNICEF Pakistan

“

The Pakistan Integrated Nutrition Strategy (PINS) is developed within a human rights framework that commits the nation to guaranteeing the rights of every child – boys and girls – to adequate nutrition, primary health care and basic education.

”

- Pakistan Integrated Nutrition Strategy

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RISK MANAGEMENT AND OPERATIONS

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© UNICEF Pakistan/2012/Asad Zaidi

Annual Report 2012

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UNICEF Pakistan

RISK MANAGEMENT AND OPERATIONS

Risk Management The Country Office conducts an annual enterprise risk management exercise covering all geographic areas and all programme areas. Risks are rated and mitigating measures identified and implemented.

For effectiveness and transparency, UNICEF Pakistan is strongly committed to both monitoring our programmes

management mechanism. Implementing partners (Government and NGOs) who receive USD 100,000 or more per year in cash and/or supplies are assessed by external professional auditors for financial robustness; partners who receive less are assessed by a UNICEF internal assurance team. In addition, supply and programmatic risk assessments are conducted by qualified UNICEF staff for all potential partners. Risk mitigation plans are prepared for the partner, Umme Hani, seven, enjoys safe drinking water taken from a water filtration plant installed by UNICEF in Samandarwala village, Muzaffargarh district, Sindh province. Š UNICEF Pakistan/2012/Asad Zaidi

and carrying out financial and stock assurance activities to make sure the resources provided by donors are being utilised in the way we promised.

There are seven sources of financial assurance information and seven sources of programme monitoring information, which are triangulated and assessed to trigger corrective actions where necessary.

The Harmonized Approach to Cash Transfers remains a key risk

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including deciding upon a cash transfer modality based on the risk level. Regular spot checks are conducted to verify financial transactions, programmatic progress and check compliance with the risk mitigation plan. Both scheduled audits and special audits are carried out by an internationally affiliated auditing firm. In 2012, out of 68 project audits conducted, 12 partners were classified as significant high risk and engagement was discontinued.

Findings and recommendations were

Risk Management and Operations

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Girls read Meena stories in one of the UNICEF-supported Protective Learning and Community Emergency Services (PLaCES) in Jalozai camp, Nowshera district, Khyber Pakhtunkhwa. © UNICEF Pakistan/2012/Asad Zaidi

shared with all partners, so that they could take actions to improve.

Operations Fast Facts UNICEF Pakistan’s procurement volume reached over USD 154.8 million in 2012, including ensuring timely vaccine supply for polio immunisation campaigns and critical support to the Government in the second quarter to avoid a country-wide stock out of Routine Immunisations.

UNICEF Pakistan has four field offices in Peshawar (Khyber Pakhtunkhwa), Karachi (Sindh), Lahore (Punjab) and Quetta (Balochistan)

and the capital office in Islamabad.

The UNICEF Pakistan team reduced in 2012, primarily due to the reduced magnitude of emergency response, from 456 staff at the close of 2011 to 386 staff nationwide (47 International Professionals, 169 National Officers and 170 General Services) at the close of 2012.

The Pakistan Country Office is leading in social media with the number of ‘Likes’ to the UNICEF Pakistan Facebook page increasing by more than tenfold to over 65,000 followers at the close of 2012.

In a country where gender equity remains an on-going challenge, UNICEF works hard to balance the staffing gender ratio. At the close of 2012, 34 per cent of UNICEF staff were women. Renewed efforts were made to reach out to potential female candidates during recruitment drives.

Girls carry notebooks and other stationary items provided by UNICEF on their way to one of the Temporary Learning Centres established in Jalozai camp, Nowshera district, Khyber Pakhtunkhwa. © UNICEF Pakistan/2012/Asad Zaidi

Annual Report 2012

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UNICEF Pakistan

“

We, the Political Parties of the Islamic Republic of Pakistan affirm our commitment to saving every Pakistani child from disability for life caused by the Polio virus.

”

- Joint Declaration made at the All Parties Conference ‘Polio: A National Emergency’ Islamabad, December 2012

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ACRONYMS, GLOSSARY AND REFERENCES

56

© UNICEF Pakistan/2012/Asad Zaidi

Annual Report 2012

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UNICEF Pakistan

ACRONYMS A C

D F G H I K L M N

AIDS

Acquired immunodeficiency syndrome

ANC

Ante-natal care

CHARM

Punjab Chief Minister’s Health Initiative for Attainment and Realisation of Millennium Development Goals

CMAM

Community Management of Acute Malnutrition

CRBP

Child Rights and Business Principles

CSR

Corporate Social Responsibility

DRR

FATA

GAVI

Federally Administered Tribal Areas

Global Alliance for Vaccines and Immunisation

Human immunodeficiency virus

IEC

Information, Education and Communication

IYCF

Infant and young child feeding

Open Defecation Free

OTP

Outpatient Therapeutic Programme

PATS

Pakistan Approach to Total Sanitation

PDMA

Provincial Disaster Management Authority

PINS

Pakistan Integrated Nutrition Strategy

PLaCES

Protective Learning and Community Emergency Services

PNC

Post-natal care

PPTCT

Prevention of Parent-to-Child Transmission

R

RUSFAD Rural Sanitation in Flood-Affected Districts

S

SAM

Severe acute malnutrition

SFP

Supplementary Feeding Programme

SWA

Sanitation and Water for All

SWAp

Sector Wide Approach

T

TLC

Temporary Learning Centre

U

UNAGTF United Nations Adolescent Girls Task Force

Khyber Pakhtunkhwa province

LHW

Lady Health Worker

MDG

Millennium Development Goal

MUAC

Mid-Upper Arm Circumference

NDMA

National Disaster Management Authority

NGO

Non-governmental organisation

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P

ODF

Disaster Risk Reduction

HIV

KP

O

UNAIDS

Joint United Nations Programme on HIV/AIDS

UNDP

United Nations Development Programme

UNESCO United Nations Educational, Scientific and Cultural Organisation

W

UNFPA

United Nations Population Fund

UNICEF

United Nations Children’s Fund

WASH

Water, sanitation and hygiene

WFP

World Food Programme

WHO

World Health Organisation

Acronyms, Glossary and References

GLOSSARY

REFERENCES

CD4

Key cells of the human immune system.

See the footnotes in each section.

Fatwa

Islamic religious ruling.

Imam

Islamic religious leader.

Kangaroo care

A technique practiced on new-borns, usually preterm, whereby the infant is held, skin-to-skin with an adult.

SPHERE guidelines

Internationally recognised set of common principles and universal minimum standards in life-saving areas of humanitarian response.

Purdah

Islamic and social institution of female seclusion.

Ulema

Islamic religious leader.

Union Council

The smallest unit of local government and a sub-unit of the tehsil or taluka.

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Annual Report 2012

Design and production by Headbumped Studio

United Nations Children’s Fund Pakistan Country Office P.O. Box 1063, Islamabad Tel: (+92) 51 209 7700 Fax: (+92) 51 209 7799 www.unicef.org/pakistan c United Nations Children’s Fund (UNICEF) 2013