Situation Analysis of Vulnerable,Excluded and Discriminated Children in Moldova by UNICEF Moldova

Situation Analysis of Vulnerable, Excluded and Discriminated Children in Moldova

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Situation Analysis of Vulnerable, Excluded and Discriminated Children in Moldova

UNICEF MOLDOVA Country OfďŹ ce November, 2011

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CONTENTS

Introduction ............................................................................................ 15

General Country Overview....................................................................... 17

2.1.1

Economic trends............................................................................ 17

2.1.2

Demographic trends ...................................................................... 19

2.1.3

Politics ......................................................................................... 20

2.1.4

Public administration...................................................................... 21

2.1.5

Inclusive Human Development ........................................................ 22

2.1.6

Gender equality and the empowerment of women.............................. 23

2.1.7

Environment and Climate change .................................................... 24

Health and Nutrition................................................................................ 27 3.1 Key Data ............................................................................................... 27 3.2 Child Health and Survival ........................................................................ 29 3.2.1

Infant and child mortality ............................................................... 29

3.2.2

Maternal Health ............................................................................ 31

3.2.3

Immunization ............................................................................... 33

3.2.4

Nutrition ...................................................................................... 35

3.2.5

Children with disabilities ................................................................. 38

3.3 Adolescent Health and Development ......................................................... 41 3.3.1

HIV/AIDS ..................................................................................... 41

3.3.2

Substance use .............................................................................. 46

3.3.3

Suicide ........................................................................................ 49

3.4 Access to Water and Sanitation ................................................................ 50 3.5 Capacity and Policy Gaps ......................................................................... 52

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

3.5.1

Institutional Capacity ..................................................................... 52

3.5.2

Policy Gaps and Solutions ............................................................... 58

3.6 Recommendations .................................................................................. 64 4

Early Childhood Development and Education........................................... 67 4.1 Key Data ............................................................................................... 67 4.2 Pre-primary Education ............................................................................ 68 4.3 Primary and Secondary Education ............................................................. 71 4.3.1

Access to Education ....................................................................... 71

4.3.2

Quality of Education....................................................................... 77

4.4 Capacity and Policy Gaps ......................................................................... 78 4.4.1

Institutional Capacity ..................................................................... 78

4.4.2

Policy Gaps and Solutions ............................................................... 83

4.5 Recommendations .................................................................................. 88 5

Child Protection....................................................................................... 91 5.1 Key Data ............................................................................................... 92 5.2 Separation and children without parental care ............................................ 93 5.3 Violence and Exploitation ......................................................................... 100 5.4 Children in contact with law ..................................................................... 104 5.5 Capacity and Policy Gaps ......................................................................... 107 5.5.1

Institutional Capacity ..................................................................... 107

5.5.2

Policy Gaps and Solutions ............................................................... 112

5.6 Recommendations .................................................................................. 117 6

Social Policy and Poverty ........................................................................ 121 6.1 Key Data ............................................................................................... 121 6.2 The international crisis and poverty in Moldova ........................................... 123 6.3 Child Poverty ......................................................................................... 128 6.4 Are the most vulnerable children protected? ............................................... 134 6.4.1

The social protection system ........................................................... 134

6.4.2

Efficiency of social assistance in protecting the children ...................... 136

6.4.3

The current reform of the system: welfare effects on children.............. 140

6.4.4

The current reform of the system: challenges.................................... 145

6.5 Recommendations .................................................................................. 147

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Media and childrenâ&#x20AC;&#x2122;s views...................................................................... 149 7.1 Media and children ................................................................................. 149 7.2 Children about their rights ....................................................................... 149 7.3 Adolescentsâ&#x20AC;&#x2122; participation in the community life .......................................... 154 7.4 Recommendations .................................................................................. 155

Conclusions and recommendations ......................................................... 157

References .............................................................................................. 169

10 Annex

................................................................................................... 179

List of Figures and Tables Figure 1. Gross domestic product per capita, constant prices ............................. 17 Figure 2. Population of Moldova by age categories (number of persons) ............... 20 Figure 3. Infant and under-five mortality rates ................................................ 29 Figure 4. Infant mortality rates at district level, per 1,000 live-births, 2009 ......... 31 Figure 5. Coverage rate with immunization ..................................................... 33 Figure 6. Share of underweight children aged 0-5 years (%).............................. 35 Figure 7. Main causes of children invalidity (per 1,000 children under 18 years old)38 Figure 8. Number of children with disabilities (0-18 years) and availability of relevant services by district .......................................................................... 40 Figure 9. Trends in HIV/AIDS in Moldova by age groups, 2000-2010 (100,000 inhabitants) ............................................................................................... 42 Figure 10. Trends in HIV/AIDS in Moldova by region, 2001-2009 (100,000 inhabitants) ............................................................................................... 42 Figure 11. HIV/AIDS incidence in Moldova, 2010 (number of reported cases) ....... 43 Figure 12. Indicators of knowledge, attitudes and practices in youth aged 15-24 years (%) ......................................................................................... 45

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Figure 13. Substance use among adolescents (15-19 years) in Moldova, 2006 and 2008 (%) ..................................................................................... 46 Figure 14. Suicide rate by sex among 15-19 year old in 2009 (deaths per 100,000 relevant population) ........................................................................ 50 Figure 15. Health staff to 10,000 inhabitants ................................................... 54 Figure 16. Family doctors to 10,000 inhabitants ............................................... 54 Figure 17. Number of young specialists in medical institutions from rural areas and districts who benefit from facilities in Moldova, 2006-2009 .................. 56 Figure 18. Gross enrollment, pre-primary (%) ................................................. 69 Figure 19. Gross enrollment rates by level of education and residence area (%) ... 72 Figure 20. Educational institutions in Moldova (number) .................................... 80 Figure 21. Rate of children in residential care (per 100,000 population aged 0-17 years) ................................................................................................ 94 Figure 22. Trends of absolute poverty at population level and the structure of poor population in 2010 by residence area (%) ...........................................123 Figure 23. Bars: Distribution of households by number of children and by residence area (number); Pies: Structure of households with children by number of children in each area of residence (%) ...........................................129 Figure 24. Trends of child poverty, absolute and extreme poverty rates (%) ........130 Figure 25. Coverage of social assistance cash benefits of households with children in 2010 (% population) ...................................................................139 Figure 26. Change between 2009 and 2010 in the social assistance of households with children .............................................................................141 Figure 27. Health-Related Millennium Development Goals, Current Situation and Targets for Moldova ..............................................................................179 Figure 28. Education-Related Millennium Development Goals, Current Situation and Targets for Moldova .................................................................181 Figure 29. Poverty related Millennium Development Goals ................................182

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

List of Tables Table 1. Anemia in children under five years of age (per 1,000 children of this age)37 Table 2. Morbidity of children under 18 years old: mental and behavior disorders (cases per 100,000 children) ........................................................... 40 Table 3. Gross enrollment rate in pre-school institutions, by residence area (% 3-6 years old) ....................................................................................... 70 Table 4. Student achievements in mathematics, science and reading (average scores)77 Table 5. Gross wages in Moldova in the social sectors by sector .......................... 81 Table 6. Crimes against children ...................................................................106 Table 7. Structure of disposable income per person by deciles of consumption expenditures, 2010 (%) ..............................................................................125 Table 8. Material deprivation of households from Moldova, 2010 (%)..................127 Table 9. Absolute and extreme poverty rates of children and distribution of households with children by consumption quintiles by residence area, in 2010 (%) .. 130 Table 10. Absolute poverty rates of children and distribution of households with children by consumption quintiles by presence of migrants, in 2010 (%) ......132 Table 11. Impact of social transfers on child poverty, 2010 ...............................139

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Acknowledgements This assessment of the situation of children and analysis of vulnerable, excluded and discriminated children in Moldova (Situation Analysis-SitAn) was commissioned by UNICEF Moldova in cooperation with the National Council of Child Rights Protection of the Republic of Moldova (NCCRP). The preliminary results of the SitAn were shared with partners at the regular NCCRP meeting in September 2011). This report presents the results of analytical work of international experts Manuela Sofia Stănculescu and Monica Marin. SitAn was done in collaboration between many individuals (representatives of the Government of the Republic of Moldova, LPA, NGOs, think-tanks, academia, independent experts etc.) and appreciation is extended to each of them. The authors would also like to acknowledge UNICEF country Office Moldova for support in development and coordination of this report. The analysis was based on a large number of studies, publications and statistical compilations for documenting the current situation of children in Moldova and represents a reflection of the research efforts of various experts working on issues with impact on child well-being in the Republic of Moldova. We wish to warmly thank to the experts we had the pleasure to interview in Chisinau, in April 2011.They have accepted to meet with us on a short term notice and they provided us very useful comments and materials for conducting this SitAn. We have collected valuable information and studies especially from Mrs. Stela Bivol and Mrs. Viorica Craievschi-Toartă. We are particularly grateful to Mrs. Maria Vremiș has kindly mentioned to us several experts with great knowledge on child’s situation in the Republic of Moldova. The opinions expressed in this report are those of the authors and contributors and do not necessarily reflect the policies or the views of UNICEF. The text has not aimed to follow official UNICEF publication standards. UNICEF accepts no responsibilities for errors.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Executive Summary Background The Situation Analysis of Vulnerable, Excluded and Discriminated Children in Moldova will serve as a tool for advocacy, source of information and milestones data for monitoring and evaluation of UNICEF support and interventions in Moldova that is lined up to planning of the new Country Program of UNICEF and the Republic of Moldova, UN Partnership Framework and national strategies Purpose/Objective The study aims at identifying the key vulnerabilities, progress and remaining challenges for the improvement of the well-being of the most vulnerable children in the Republic of Moldova, with special attention to equity, based on available data and studies. The main objectives of the situation analysis (SitAn) are to answer two questions: (i) are the key issues making children vulnerable: situation and trends? (ii)What systems and practices respond to the needs of vulnerable children? Methodology The study has been conducted based on an extensive desk-review and interviews with the relevant Government partners, NGOs, UNICEF and independent experts. With the purpose to bring the voices of the children within this situation analysis, children were consulted regarding the problems that they personally face in achieving their rights. Main Findings The main finding is that inter-sectoral coordination at all levels (central and local, national and international donors) is critical for child well-being in the Republic of Moldova. The multitude of strategies and action plans requires links, coordination and operationalization of interventions to adequately address the needs of the vulnerable groups of children.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Under increased fiscal budgetary constraints and growing demand of social protection, a change in the focus of social policies from poverty reduction to social inclusion becomes a must. Additionally, efficiency gains in the social sectors could be achieved by developing prevention side at community level. The problem of monitoring and evaluation in all sectors contributing to child well-being is essential for ensuring that vulnerabilities are properly identified and addressed. In the last years there have been both positive and negative trends in all areas under study: health, education, child and social protection. Infant and under-five mortality rates have been reduced, but maternal mortality rate increased. Share of under-weight children aged 0-5 years decreased, but anemia in children under five years is on an upward trend. Immunization rate against measles is high, still incidence of HIV/AIDS for the 15-24-year age group increased. Enrollment rates in pre-primary education increased, while enrollment rates in compulsory education decreased. The number of institutionalized children greatly decreased, yet the cases of family reintegration for institutionalized children remain few. There are also structural problems which affect child well-being such as discriminatory attitudes of both general population and social sectors professionals towards children with HIV/AIDS or children with disabilities, limited parental and youth knowledge on health problems, low children participation in decisions affecting their rights. Moreover, urban-rural disparities are important for most indicators. Rural areas tend to accumulate multiple disadvantages such as high poverty, high number of children left behind by migrant parents, poor quality of services, underdeveloped transport, water and sewage infrastructure, low coverage with professionals and a general high level of material deprivation. The study identified three clusters of vulnerable groups, most of them on several dimensions. Economically disadvantaged are poor children (especially from households with many children), children from rural areas (particularly with both parents employed in agriculture) and children left behind by migrant parents in households in poverty. The cluster of â&#x20AC;&#x2DC;invisibleâ&#x20AC;&#x2122; children groups Roma children, children with disabilities, victims of trafficking or different forms of abuse/ violence, street children, graduates of residential institutions, teenage mothers, children

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

out-of-school and children from Transnistria. Their situation is poorly documented in both official statistics and studies. Finally, there are more than a few of ‘differently affected’ children. This broad category includes children affected mainly by one dimension, which in turn creates deprivations in other areas. It groups children with HIV/AIDS, children using substance (drug, tobacco or alcohol), children left behind by migrant parents, children in residential institutions, children of 0-3 years and children in contact with law. In terms of systems and practices which respond to the needs of vulnerable children, there is a long list of recommendations. Some refer to data and statistics, while others put forward the gaps at sector level (legislation/ policy development, financing, services, human resources, infrastructure, participation and communication). The challenge for the Government of the Republic of Moldova is quite high: to succeed in one of the poorest countries in Europe, in making more efficient use of its state budget funds (by measures such as optimization, deinstitutionalization, improved prevention), coordinate donors’ intervention and target the areas left uncovered in a systematic approach, while ensuring fulfillment of the equity agenda. If sustainable progress is achieved, Moldova might become a best practice example for countries in the region.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

1. INTRODUCTION

This report describes the situation of children in the Republic of Moldova, a ‘small country sandwiched between Romania and Ukraine’,1 one of the poorest countries in Europe,2 or a ‘country without parents’,3 with lots of households headed by children and consequently, lots of ‘deserted children’.4 Such labels render a rather pessimistic situation. However, official statistics show a fragile positive economic development, but with prospects for substantial improvement still on a long-term basis. The current situation analysis of children in Moldova aims at identifying, based on available data and studies, the key vulnerabilities, progress and remaining challenges for the improvement of the well-being of the most vulnerable children in the Republic of Moldova, with special attention to equity. The study has been conducted based on three information sources. An extensive desk-review of existing evidence, data, research, national state program documents and policies affecting children rights as well as the latest available official and administrative statistics was carried out in JulySeptember 2011. It has been based on more than 200 documents either collected by the experts or provided by interviewees and UNICEF. Consultations with the relevant Government partners, NGOs, UNICEF and independent experts working on children issues have been performed with 22 interviewees, in the period of July 10-15, 2011, in Chisinau. The selection 1 Kids Alive International, http://www.kidsaliveuk.org/Groups/90709/Kids_Alive/Where_We_Work/Europe/Moldova/ Moldova.aspx 2 CIA, The World Factbook 2011, https://www.cia.gov/library/publications/the-world-factbook/geos/md.html 3 The New York Times, Isabel Castro, Children Heading Households in Moldova, November 29, 2010, http://lens.blogs. nytimes.com/2010/11/29/children-heading-households-in-moldova/ 4 BBC News, BBC radio, Julia Rooke, Helping Moldova’s Deserted Children, April 14, 2007, http://news.bbc.co.uk/2/hi/programmes/crossing_continents/6542385.stm

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

of interviewees has been based on the reports and studies collected before the country mission. Six focus-group discussions were conducted with children, on the problems they encounter in achieving their rights, by UNICEF Moldova, in May 2011. Participants included 56 children aged between 9 and 19 years, of which 34 girls and 22 boys. They have been recruited based on the projects developed in Calarasi, Tibirica, Ungheni, Comrat, Chisinau and Balti. The main limitation of the study refers to data availability. Although the analyses and studies under the covered topics are quite numerous and rich in information, there have been cases in which data are outdated, inconsistent or simply missing. The report is organized in six chapters. The first chapter presents a general country overview, including the main socio-economic and development trends. The next five chapters address the areas of interest: health and nutrition, early childhood development and education, child protection, social policy and poverty, and media and childrenâ&#x20AC;&#x2122;s view. The final chapter summarizes the key findings and the main recommendation of the situational analysis. The progress towards the Millennium Development Goals is reported in the Annex.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

2. GENERAL COUNTRY OVERVIEW

This chapter contains a brief but wide-ranging country profile, including main socio-economic and development trends. The important issue of emergencies and natural disasters and how the Government of Moldova is prepared to manage as well as diminish their impact is also briefly addressed. 2.1.1 Economic trends The Republic of Moldova started as an independent country in 1991 as one of the poorest countries of Europe and of CIS. After two decades, due to the delay of economic reforms (at least in the early years of the transition), distorted privatization, low foreign investments and lack of own natural resources, the situation did not significantly change. Figure 1 shows that the economic growth, achieved after 2000, was stopped by the economic recession in 2009, followed by a return to growth in 2010. Figure 1. Gross domestic product per capita, constant prices 4,000 3,544.56

3,500

3,000 2,639.95 2,500 2,188.34 2,000

1,500

1,000

Data source: International Monetary Fund, World Economic Outlook Database, September 2011, www. imf.org. Data on GDP per capita, constant prices (national currency, billions), population (persons) from the National Bureau of Statistics, latest actual data: 2010. Estimates start after 2010.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

The decrease registered in 2009 was mainly caused by the lower level of exports, lower remittances inflow (due to the global recession) and by negative expectations on the country’s economic development. The economic sectors most affected by recession were construction, industry, agriculture, transport and communications. The financial crisis had a negative impact on people’s incomes which caused a decrease of the consumption expenditures.5 Remittances also played a key role in the growth registered in 2010-2011. Solid growth of remittances and wages, accompanied by strong investments created the prospects for the economic recovery. By mid-2011, exports rose, GDP growth reached 7½ percent and unemployment declined to 6.2%.6 The estimates provided by IMF predict a growth of GDP per capita, in constant prices (figure 1) for the period of 2011-2016. However, downturn in the global economy will most likely affect Moldova’s economy. The economic migration is a widespread phenomenon in the Moldovan society. In 2010 there were 311 thousands persons, mostly from rural areas (71%).7 Most migrants from Moldova are men, from rural areas, married, with an average age of 35 and with vocational or high school as the highest level of education achieved. 8 The men work mainly in construction, industry and agriculture, while women work in the services sector (cleaning, care services, commerce).9 Beside the positive contribution of the remittances inflow, which have a substantial contribution at the country’s GDP, the economic migration comes also with negative effects on the children left at home by their parents. Overall, in 2010, 17.1% of all children below 18 years old (or around 133 thousands) had one or both parents left for work abroad.10 Agriculture represents the main branch of national economy of the Republic of Moldova, with half of the production exported.11 Its production is however vulnerable to climate risk, as shown in the sub-section on Environment and Climate Change. It is estimated to have a high growth potential, but its impact on GDP is not direct, as large part is untaxed.

5 The most aﬀected were people living in rural areas, as 40% of the incomes here are from remittances and from agricultural activities. Ministry of Economy, Raport privind Sărăcia și Impactul Politicilor 2009, 2010: 4. 6 International Monetary Fund, Moldova – Concluding Statement of the IMF Mission, September 22, 2011, www.imf.org. 7 National Bureau of Statistics, Labour force in the Republic of Moldova – employment and unemployment in 2010, 2011, www.statistica.md. 8 Ministry of Labor, Social Protection and Family, Annual Social Report 2009, 2010. 9 Destinations for the migrants are the CSI countries, especially the Russian Federation, and the European Union, especially Italy, Greece, Portugal and Spain. 10 Ministry of Labor, Social Protection and Family, Annual Social Report 2010, 2011. 11 Contribution to GDP was about 12 percent in 2010, and 17 percent together adding the food processing industry. Country Analysis- UN Moldova, May 2011.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

2.1.2 Demographic trends The total population of Republic of Moldova was of about 3.5 million inhabitants, at the beginning of 2011,12 out of which 58.4% live in rural areas and 41.6% in urban area. The most recent Census, from 2004, showed the following ethnic structure of the population: Moldavians 75.8%, Ukrainians 8.4%, Russians 5.9%, Gagauz 4.4%, Romanians 2.2%, Bulgarians 1.9% and other 1.4%. The same data indicates that more than 90% of the population is Christian Orthodox. The population has continuously declined after 1990, due to decreasing fertility, rather high mortality and quite high emigration of workforce. The rate of natural population growth has considerably dropped in the last 20 years (to -0.4 in 2009 from 9.7 in 1989). The aging tendency of the country population is rather accentuated, particularly among the female population from rural areas.13 The proportion of children and adolescents (0-19 years) in the total population has decreased from almost 33% in 2000 to less than 24% in 2011. In contrast, the proportion of elderly over 60 years old has constantly increased, from 11.6% of total population in 1980 to 12.6% in 1990 and 13.9% in 2011 respectively. Thus, the Republic of Moldova is confronted with a decline of the share of children, which is expected to continue.14 Consequently, in the following years, the state policies are expected to focus on elderly people and so the proponents of child care reform need to ensure that the children are not left aside. 15

12 Data from National Bureau of Statistics. Starting with 1998, data on population have not included population situated on the left bank of Nistru and Bender municipality. However, it is expected that the new Census of population (planned for 2012) will determine the population present in the country, because due to the high migration for work abroad, the population statistics are not considered reliable, particularly taking into consideration the temporary nature of emigration. 13 National Commission for Population and Development, UNFPA, Cartea Verde a Populatiei Republicii Moldova, 2009: 10. 14 According to the most pessimistic scenario of the demographic forecast done by the Academy of Science of Moldova (2009), by 2050, the proportion of elderly is expected to reach a high 30.3% of population, while the proportion of children will decline to a low 11.8%. Academy of Science of Moldova (2009), Îmbătrînirea populaţiei în Republica Moldova: consecinţe economice și sociale . http://www.unfpa.md/images/stories/publicati/imbatrinireapopulatieirm_book_color_out.pdf 15 EveryChild, Oxford Policy Management, UNICEF: Assessment of child care system in Moldova and technical assistance to the Government of the Republic of Moldova to host the sub-regional consultation on child care system reforms in ENP countries, 2009: 31.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Figure 2. Population of Moldova by age categories (number of persons)

3.000.000 20-64 years

2.338.648

2.500.000 2.000.000 0-19 years 1.500.000 1.000.000

826.585 65 or more

500.000

329.557

0 1980

1985

1990

1995

1998

2000

2005

2006

2007

2008

2009

2010

2011

Data source: National Bureau of Statistics. Note: Since 1998, data do not include Transnistria.

The number of newly born in 2010 (40,474) was one of the highest in the last ten years as the larger generations of mid ‘80s reached the reproductive period. The birth rate was of 11.4 in 2010 compared to 10.5 in 2005 and especially to 10.2 newly born at 1,000 inhabitants in 2000.16 The general mortality rate has slightly increased since 2000, reaching 11.8 deceased persons at 1,000 inhabitants, in 2009. This indicators positions Moldova in range with the South-East European countries, which however is higher than the EU-27 average of 9.7 cases at 1,000 inhabitants. The situation is nevertheless much worse in rural areas where the mortality rate is considerable higher. Migration for work abroad is the third demographic phenomenon that contributes to the ageing process, as previously mentioned under the Economic trends. 2.1.3 Politics During 2009 and 2010, the country experienced considerable political uncertainty, marked by three general elections and four presidential ballots in parliament. Following the November 2010 parliamentary elections, a reconstituted Alliance for European Integration (AIE), coalition of three parties formed a government, yet it still needs two votes to elect a president.

16 The birth rate is higher in rural areas (12.2‰) than in urban ones (10.2‰) and in some regions (such as Găgăuzia, Criuleni or Ialoveni) than in others (the lowest birth rates were registered in districts Basarabeasca, Cimișlia and Ocniţa). The number of children born out of wedlock has increased too, both in rural and in urban areas. In 2010, children born out of wedlock represented 22.4% of all newly born. National Bureau of Statistics, Situaţia copiilor din Republica Moldova în anul 2010, 2011, http://80.97.56.163/newsview.php?l=ro&id=3418&idc=168.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

From 1991, Moldova is part of the Commonwealth of Independent States (CIS). Also, Moldova has developed its relationships with the European Union, with focus not only on cooperation, but on gradual economic integration and a deepening of political cooperation. The EU/Moldova European Neighborhood Policy (ENP) Action Plan sets strategic objectives in order to ensure that the political, economic and institutional reform are effectively implemented by the country which now has common border with the EU (since Romania became an EU member state). The current Government Activity Program is named in relation to the European Integration – Freedom, Democracy, Welfare, set as one of the priorities of foreign policy.17 European Commission is also an important donor in the field of child protection. 18 Part of the negotiations with the EU is also the problem of the breakaway region of Transnistria. The frozen conflict in this region continues to be a threat to the political stability. Moreover, children from Transnistria do not take part in many social programs and their situation is very fragmentally documented. The ones that are documented, as is the case of HIV/AIDS, require strong efforts for improvement. 2.1.4 Public administration The administrative-territorial organization system of the Republic of Moldova is very fragmented: 902 first-level administrative-territorial units (towns and municipalities)19, 32 districts (rayons), 3 municipalities (Balti, Bender, and Chisinau), one autonomous territorial unit (Gagauzia), and one territorial unit (Transnistria). The capital city of the country is Chisinau. Fragmentation results in small-size localities,20 unable to efficiently deliver local public services. Local governments have primary responsibility for water supply, health, sanitation, roads construction, maintenance, and heating.21 The low administrative capacity at local level is both in terms of human as well as financial resources. Human resources management22 is identified as the primary cause of poor performance of local public administration. Rural localities are at special disadvantage, as 94% of them lack the necessary capacities to deliver public services. Correspondingly, children from rural areas are vulnerable in terms of access to public services, as shown in this report. 17 Government of the Republic of Moldova (2011) Programul de activitate al Guvernului ‘Integrarea Europeană: Libertate, Democraţie, Bunăstare’ pentru anii 2011-2014 (Activity Program Government of the Republic of Moldova for 2011-2014 European Integration: Freedom, Democracy, Welfare), www.gov.md. 18 SIDA, Joint Evaluation of Impacts of Assistance to Social Sector Reforms in Moldova, 2011. 19 In 2008. Government of the Republic of Moldova, National Decentralization Strategy, draft for public discussion, 2011. 20 A quarter of localities are under 1,500 inhabitants. 21 Country Analysis- UN Moldova, May 2011. 22 Especially recruitment policies in the public sector. Government of the Republic of Moldova, National Decentralization Strategy, draft for public discussion, 2011.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Additionally, from child well-being point of view, the emphasis on community services has to consider the low level of institutional capacity at local level. Transferring the responsibility at locality level will not automatically result in an improved service delivery. This is in particular true as multiple efforts in development of community services are currently carried out with internationally funded support. At central level, the reform process aims primarily at improvements in efficiency of public spending.23 The current assessments conclude that in 2011, implementation of reforms has been slow, also due to the political instability (frequent elections), insufficient financial resources or brain drain process. Especially important for the situation of vulnerable children reforms should be focused in the following Ministries: Ministry of Labor, Social Protection and Family, Ministry of Education, Ministry of Health.24 2.1.5 Inclusive Human Development The Human Development Index25 had a value of 0.623 for Republic of Moldova, in 2010. This is below the index for Europe and Central Asia (0.717) and much below the EU-27 average (0.850), but on an upward trend compared to 2000 (0.55). Moldova is included among the medium human development countries. The three dimensions of the Human Development Index are: (1) health (measured as life expectancy at birth), (2) education (with two indicators: mean years of schooling and expected years of schooling) and (3) living standards (gross national income per capita).26 The life expectancy at birth, although has constantly improved since 2000, was 69.1 years in 2010, which is almost 1.5 years higher than the average of CIS countries, but as much as 10 years lower than the EU-27 average.27 The mean years of schooling of adults28 is in 2010 of 9.7 years, slightly lower 23 This is not the only area, it also tackles issues related to organization, legal frameworks, decision making processes, human resource management and public finance management. UN Country assessment 24 Ministry of Justice is also important for the problem of children in contact with law and Ministry of Internal AďŹ&#x20AC;airs is important for the problems of monitoring the migrant parents, human traďŹ&#x192;cking, domestic violence, etc. 25 International Human Development Indicators database http://hdrstats.undp.org/en/tables/default.html. 26 The Human Development Index (HDI), http://hdr.undp.org/en/statistics/hdi/. 27 The life expectancy at birth is 8.4 years higher for females compared to males (73.4 years compared to 65.0 years respectively) and 4.6 years higher in urban compared to rural areas (72.0 years compared to 67.4 years respectively). National Bureau of Statistics: Statistical Database, www.statistica.md. 28 Average number of years of education received by people ages 25 and older in their lifetime based on education attainment levels of the population converted into years of schooling based on theoretical durations of each level of education attended. Source: Barro, R.J and J.-W.Lee.(2010) in UNDP, International Human Development Indicators, http:// hdr.undp.org.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

than of the neighboring Romania (10.6) or Ukraine (11.3). Same is true for expected years of schooling29. The gross national income per capita of Moldova is rather low in the region. Nevertheless, as pointed out in the section on Economic trends it increased from 2009. Higher levels of human development cannot be achieved under conditions of persistent social exclusion as shows the National Human Development Report 2010/2011 of the Republic of Moldova. Social exclusion is linked to individual vulnerabilities such as low education, poor qualification or having a disability. In the same time, the weak institutional support mechanisms, inequitable or inadequate legal framework, political and institutional obstacles, discriminatory social values and cultural practices as well as geographical factors shape an environment that leads to social exclusion of various groups of population. Among them, situation of different groups of vulnerable children (such as poor, with HIV/AIDS, with disabilities, with migrant parents, in residential care etc.) will be detailed in the following chapters and summed-up in the final section on Conclusions and Recommendations. 2.1.6 Gender equality and the empowerment of women The Republic of Moldova has undertaken important legislative reform in the area of gender equality.30 Despite the legislative framework put in place by authorities, the traditionalist norms of the Moldovan society are still resistant to change. The women are still expected to be the family caretakers and housekeepers, which impedes their participation in economic and public life. Women are under-represented in decision-making positions in Parliament31 and other state and local governmental offices (public service, judicial system, diplomatic posts). The higher is a position in the jobs hierarchy, the lower is the number of women holding it, comparing with the number of men. Correlated, the average women income in Moldova represents 73% of the average men income.32 Both domestic violence and human trafficking remain important issues of the 29 Number of years of schooling that a child of school entrance age can expect to receive if prevailing patterns of age-specific enrolment rates were to stay the same throughout the childâ&#x20AC;&#x2122;s life. UNESCO Institute for Statistics in UNDP, International Human Development Indicators, http://hdr.undp.org. The values are of 12 years for Moldova compared to 14.8 for Romania or 14.6 for Ukraine. Value for EU: 17.2 years in 2009 (School expectancy, Eurostat database). For this indicator, Romania has however 16.6 years in the Eurostat database for 2009. 30 Republic of Moldova has ratified several international human rights conventions, gender equality provisions included in the Constitution, the Law on Equal Opportunities for Women and Men and the National Strategy on Gender Equality for 2008-2015. 31 After the 2004 election, the women hold only 25% of the Parliament seats. 32 Ministry of Labor, Social Protection and Family, Annual Social Report 2009, 2010.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Moldovan society. Domestic violence against women is still perceived as ‘normal’, as ‘the women need to know their place’ or ‘they are the ones who instigate to violence’. Policy implementation33 faces problems like insufficient resources, managerial issues, observing the legal rules, poor access of the victims and potential victims to the necessary assistance and protection. Different forms of violence and abuse against women are associated with forms of violence and abuse against children and will be referred to in the section on Child Protection. 2.1.7 Environment and Climate change The key environment issues in Moldova relate to air quality, water quality, waste management, nature protection and hazard management. Regarding the air pollution, although the air emissions almost halved from 1995 to 2002,34 the concern remains in relation to emissions generated by the road transport, which represents an increasing proportion of total emissions.35 The water-quality issues relate to access to safe drinking water and to waste water collection and treatment. Sustainable access to safe water sources has increased in recent years to 55% of population in 2009. Nevertheless, the MDG target in this area is unlikely to be achieved in 2010 (set at 59%) and is uncertain about 2015 (65%). The progress towards construction, development and renovation of centralized waste water collection systems and waste water treatment stations was slow. In 2009, just 47.9% of population had access to improved sewage systems. Therefore, the MDG targets for 2010 (50.3%) and 2015 (65%) will probably not be achieved. In the same time, only 45.9% of population has access to improved sanitation facilities, which indicates that neither the intermediate nor the final MDG target (51.3% for 2010 and 71.8% for 2015) is likely to be realized.36 The waste management still represents a significant issue concerning prevention, as well as collection, treatment, recovery and final disposal. Rural communities in Moldova have no organized solid waste collection and disposal. Nature protection challenges relate to soil degradation and loss of biodiversity due to agricultural practices and unsustainable logging. Although Moldova has the advantage of a high-quality soil, it is at risk of losing it due to a persistent 33 Ministry of Labor, Social Protection and Family, Report on monitoring implementation Strategy for the National Reﬀerral System for protection and assistance to the victims and potential victims of human traﬃcking for 2010, 2011. 34 European Commission, European Neighbourhood and Partnership Instrument, Republic of Moldova, Country Strategy Paper 2007-2013. 35 Moldova acceded to the Kyoto Protocol in 2003 and has the support of the European Commission to implement the relevant provisions, policies and measures in order to reduce greenhouse gas emissions. Also, Moldova is part of other regional and international conventions and programs that address environment issues, such as the use and protection of shared waters – in particular the Danube River and the Black Sea. 36 Government of the Republic of Moldova, Report on the Evaluation of the National Development Strategy Implementation During the Period 2009-2010, 2010: 17-18.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

process of degradation mainly caused by the human factor. In the last 30-40 years, the quality of soil dropped from 70 to 63 points37 on a scale of 0 to 100 and the soil degradation process speeded up in the mid 90s. Regarding biodiversity, Moldova has already achieved the specific MDG targets since 2007, by increasing the share of state-protected areas for maintaining biological diversity. Nevertheless, progress has been low towards the target of increasing areas covered by forests. Given the cuts in public expenditures that were made due to the economic crisis and the little forestation work done in the last years, these targets are unlikely to be accomplished. 38 Moldova is also confronted with different kinds of natural hazards (drought, floods, severe weather, earthquakes and landslides). High frequency of droughts with negative impacts was felt on the entire economy, as the agriculture sector has an important role in the Moldovan economy. Losses in agriculture further result in poor nutrition (including that of children). Another effect of drought is the reduced access to potable water, especially in rural areas, relying on wells as main source of drinking water. Furthermore, there are studies39 that warn that floods could become a regular risk in Moldova. The negative adverse impact of floods on GDP is estimated at 0.15. The assessment carried out after the floods in 2010 concluded that the most affected sectors were agriculture and transport. However, social sectors have not been excluded. Some families with children have been totally displaced, part of the educational infrastructure destroyed, activity of several health institutions stopped, etc. Disasters affect large groups of people but several groups are especially vulnerable. Children are among them, together with the poor, marginalized female-headed households, elderly, and people with disabilities. These groups are already disadvantaged before the hazard occurs. Priority interventions should be directed to them in order not to further increase their vulnerability.40 Solutions include creating a psycho-social component to the emergency response system.41 In this view, children should be targeted through schools for a period of three years after the disaster, for mitigating the acute trauma and post-trauma effects. These facts reinforce the need of an integrated disaster risk management plan. 37 UNDP, National Human Development Report, Social-Economic Impact of Climate Change, 2009. 38 Government of the Republic of Moldova, Report on the Evaluation of the National Development Strategy Implementation During the Period 2009-2010, 2010: 17-18. 39 Government of the Republic of Moldova, Post Disaster Needs Assessment Floods 2010. 40 Ibid., 2010: xii. 41 Colliard, C., Creating a psychosocial component to the Moldovan Emergency Response System, Assessment Report, UNICEF Moldova, 2009. SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

3. HEALTH AND NUTRITION

Convention of the Rights of the Child Articles This section analyzes the right to health and access to health services, according to Article 24 of the Convention of the Rights of the Child.42 The article stipulates the right of all children, without discrimination to the ‘highest attainable standard of health’. This includes the right to safe water as one ‘essential for securing an adequate standard of living, particularly since it is one of the most fundamental conditions of survival’.43

3.1 Key Data What are the key issues making children vulnerable: situation and trends? Infant and under-five mortality rates have been substantially reduced. However, infant mortality rate (11.7 per thousand live-births) is much higher than the EU-27 average (4.3 per thousand live-births). Infant and under-five mortality rates are disproportionately higher among children from rural areas, boys, children from households within the lowest quintile, Roma children and children from the South region. Maternal mortality is still high and very far from the European average. The proportion of children under two years immunized against measles is very high. The proportion has, however, decreased, making not likely achievement of MDG target. 42 43

UN, 1989, Convention on the Rights of the Child. United Nations Committee on Economic, Social and Cultural Rights.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Share of underweight children aged 0-5 years has considerably decreased. Morbidity through anemia remains a major problem, with a constant increase between 2001 and 2010. Mental disorders rate for children has increased between 2005 and 2010. HIV/AIDS rate for the 15-24-year age group is on an upward trend in 2009-2010. There is a shift in transmission routes of HIV/AIDS from injecting drug behavior to sexual intercourse. Incidence of HIV/AIDS is much higher in the left bank of the Nistru than on the right bank. Adolescents (15-19 years) have a considerably lower level of knowledge about STIs than do the 20-24 age group. In addition, only about one third of rural youth have correct knowledge of HIV transmission. Stigma and discrimination against people living with HIV (PLWH) are widespread both among population and professionals from health and education sectors. There is an increase in the alcohol use and a rather constant proportion of present smokers among teenagers 15-19 years old. The prevalence rate of injecting drugs among youth is higher in Moldova than in the EU member states. Suicide rate for teenagers (15-19 years) places the Republic of Moldova on an average position within the region. Childrenâ&#x20AC;&#x2122;s access to safe water sources, sanitation and hygiene conditions is much lower in rural schools than in urban ones. Family doctors to inhabitants ratio has undergone a decrease. Lack of medical insurance for about 20% of the population, poor knowledge of parents and adolescents on health issues, underdeveloped transport infrastructure, out-of-pocket money, discriminatory attitudes of heath personnel and adults represent factors that hinder access to health services.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

3.2 Child Health and Survival 3.2.1 Infant and child mortality The Republic of Moldova has substantially reduced the infant and under-five mortality rates reaching 11.7 per thousand live-births in 2010 for infant, respectively 13.6 per thousand live-births for under-five. The Millennium Development Goals (MDG)44 for 2010 and 2015 has been already achieved for both indicators.45 This is mainly the result of various health programs implemented by the Government with the support of country development partners,46 such as the regionalization of perinatal medical assistance, establishing a national system of monitoring and observation of perinatal medical assistance or implementing in vitro transportation. However, constant efforts in reducing child mortality further are still needed since the infant mortality rate in Moldova is more than two times higher than the EU-27 average of 4.3 per thousand live-births.47 Figure 3. Infant and under-five mortality rates 26.0 24.0

22.9

23.9 23.3

22.0 20.0 18.0

17.5

18.2

18.3

20.3 18.2 17.8

16.3

16.0

14.7

14.4

14.0

15.3 12.2

15.7 12.4

14.0

11.8

12.0

14.0

11.3

14.5

12.2

14.3 12.1

13.6 11.7

10.0 1998

1999

2000

2001

2002

Infant mortality rate

2003

2004

2005

2006

2007

Under-five mortality rate

2008

2009

2010

Data: TransMONEE 2011 DATABASE, released in May 2011. Data do not include Transnistria.

The infant mortality decreased also in Transnistria, according to the data provided by the region authorities, reaching in 2009 an infant mortality rate of 8 per thousand and an under-five mortality rate of 10 per thousand.48

44 These targets are set to 16.3 per 1,000 live births in 2010 and 13.3 in 2015 for the infant mortality and 18.6 per 1,000 live births in 2010, and 15.3 in 2015 for the under-five mortality rate. 45 This is also the result of two facts, (1) the revision in 2007 of the MDG goals based on a wrong presupposition (that statistics provided by medical institutions within the monitoring mechanism would under-estimate infant mortality) and (2) the adoption in 2008 of the definition of live-birth recommended by WHO, according which for measuring infant mortality rate are taken into consideration death after 22 weeks of pregnancy and a child weight of 500 g (instead of 28 weeks of gestation and 1000 g respectively). The adoption of the new methodology resulted in a sharp increase of the infant mortality rate in 2008, which however declined in 2009-2010. 46 Government of Japan, Switzerland, European Bank for Reconstruction and Development, UNICEF, Swiss Agency for Development and Cooperation, and World Bank have provided financial assistance to reduce child mortality. 47 Eurostat database, date of access: August 8, 2011. 48 UNICEF, Ensuring survival, care and protection of young children in Moldova: extension of the IMCI Initiative in Transnistria, 2010: 6. In Transnistria old definition of live birth is used (starting with 1,000 gr).

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

The most important causes for infant mortality are related to maternal and infant health during pregnancy. Among infant and under-five deaths, perinatal causes were the most common in 2010 (39.9%), followed by congenital malformations (29.4%), respiratory illnesses (13.4%), traumatic injuries and poisonings (6.5%) and infectious diseases (3.4%). Consequently, although the national system of pre-natal care has been developed, it still needs improvements particularly regarding the surveillance during pregnancy of women who migrated for work abroad. Still almost 20% of deaths of children49 under-five happen at home, the majority of cases from preventable causes of deaths such as injuries, poisoning, infectious and respiratory diseases. Most of these cases occur among vulnerable children. For example, a WHO study shows that in Eastern Europe the infant respiratory deaths are linked to the poorer economic and environmental situations, which account for a greater proportion of severe acute respiratory infections. 50 Infant and under-five mortality rates are disproportionately higher among:51 children from rural areas, for both female and male infants;52 boys, as fewer girls were born every year than boys;53 children from households within the lowest quintile; and Roma children.54

49 Center for Health Policies and Analysis in Health, UNICEF, Evaluation of Integrated Management of Childhood Illnesses Initiative in the Republic of Moldova Years 2000-2010, 2011: 57. 50 Highest rates of respiratory diseases contributing to overall post-neonatal infant death rate were recorded in Romania, Kyrgyzstan and the Republic of Moldova. Source: World Health Organization Europe, Infant Mortality from Respiratory Diseases, Fact Sheet 3.2, December 2009, data for 2006. http://www.euro.who.int/__data/assets/pdf_file/0004/96997/3.2-Infant-mortality-from-respiratory-diseases-EDITED_ layouted_V3.pdf. 51 Centre for Health Policies and Studies, UNICEF, Maternal and Child Health Equity Analysis, 2009: 24-25. 52 The urban-rural gap has widened since 2000 for infant mortality as well as for under-five mortality. 53 Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010. 54 UNDP, Roma in the Republic of Moldova, 2007.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Figure 4. Infant mortality rates at district level, per 1,000 live-births, 2009

Data onal Centre forfor Health Management. Datasource: source:Nati National Centre Health Management. Map elaborated using SPD2, NCHM Map elaborated using SPD2, NCHM (http://www.cnms.md/areas/statistics/indik/)

(http://www.cnms.md/areas/statistics/indik/)

There is significant variation in the incidence of child mortality across regions. Infant mortality rates are higher the South region of the country compared to Chisinau region where children have the highest survival chances in the first five years of life. The districts with the highest rates of infant mortality in 2009 were Basarabeasca, Glodeni, Calarasi, Cahul, Leova, Hancesti, Criuleni and Floresti. 55 3.2.2 Maternal Health Similar to infant mortality, the indicator on maternal mortality rate is used for assessing the country general development, including the efficiency of health systems. Yet, it has to be cautiously interpreted as the indicator (ratio to 100,000 live-births) is highly sensitive to any increase in absolute number of cases. Thus, the 18 cases registered in Moldova in 2010 increased the maternal mortality rate to 44.5 cases per 100,000 babies born alive. 56 However, Moldova registered progress in the period of 2001-2007 and, even though the value of the indicator is very far from the target set for 2010 (15.5 per 100.000 live-births), the latest MDG report positively evaluates countryâ&#x20AC;&#x2122;s probability of reaching the MDG 2015 target of 13.3. In order to correct errors in computation of this indicator due to the small number of live births, Moldova follows now the World Health Organization recommendation and has reported in the Annual Health Report from 2010 a three-year-average (2008-2010) of 33.4 cases per 100,000 live-births. Even with the new computation method, the value of the indicator on 55 National Centre for Health Management, SPD2 2009-2013. 56 Compared to 38.4 cases in 2008, corresponding to 15 cases, or to 17.2 per 100,000 live-births in 2009, corresponding to 7 cases.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

maternal mortality is still very far from the European average of 4.28 cases per 100,000 babies born alive.57 Structure of maternal mortality in 2008 indicates hemorrhages as main cause, followed by late gestosis, septic states, thromboembolism, hepatic cirrhosis and anesthetic complication. Further analysis attributes 47% of maternal deaths to social causes, such as: (i) women working abroad; (ii) migratory life-style which includes women mostly from rural areas, working in seasonal activities, in hard conditions, considered as a risk for health; and (iii) patients not seeking medical help – attributed to the low level of information and knowledge. For the year of 2008, 58% of deceased women were from the rural area.58 In what concerns the other MDG maternal health related target, Moldova has already reached the target set for 2010, as 99% of births were assisted by medical staff. Still, rural and income disparities in access to health services cannot be ignored. Anemia accounts for other complications during pregnancy and childbirth, and the situation worsened in 2009, as the number of anemic pregnant women increased.59 Situation of teenage mothers is a key factor for maternal health. The reported average age at first birth, although it has declining in the past 10 years, is the lowest in Moldova (22.5) across SEE, CEE and CIS regions. Correspondingly, the birth rate in the age group 15-19 years is high (28.7 per 1,000 live-births in 2006). 60 In 2010, there were 3790 live-births with mothers under 20 years which represented 9.4% of total live-births61. 80% of them are located in the rural area. Adolescent fertility rate is much higher in Moldova than in the European Union.62 Teenage mothers face a higher risk of dying from maternal causes compared to women aged 20s or 30s. Adolescents under 16 have a risk of maternal death four times higher than do women aged 20 plus. Their babies have a higher risk of death also. Moreover, they face various other risks, including school dropout, child abandonment, poverty, unemployment or human trafficking. 63 57 Ministry of Health, Raport Anual în Sănătate 2010, 2011: 66. 58 Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010: 67. 59 Ibid., 2010: 68. 60 UNICEF, Ministry of Health, Mid-Term Review, UNICEF – Government of the Republic of Moldova Country Programme of Cooperation 2007-2011, Leadership Area, Adolescent Health and Development, 2009: 29. 61 68 live births with mothers under 16 years old, of which 54 in rural areas. Source: National Bureau of Statistics, http:// www.statistica.md/newsview.php?l=ro&id=3376&idc=168. 62 Adolescent fertility rate is the number of births per 1,000 women ages 15-19. For 2009, the rate for Moldova is 31.9, compared to the European Union where is 13.5. Source: United Nations Population Division, World Population Prospects in World Bank, World Development Indicators, http://data.worldbank.org/indicator, October 16, 2011 63 World Health Organization, Adolescent Pregnancy, MPS Notes, Vol. 1, October 2008.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Roma women as well as women from low-income households address the prophylactic health services to a much less extent than do women from better-off households. These two categories tend to contact a gynecologist only during pregnancy, when they are covered by medical insurance, or for a specific health problem. The main barriers for them to access the system refer to the transportation related costs, out of pocket money or other hidden fees.64 3.2.3 Immunization The proportion of children under two years immunized against measles is very high in the Republic of Moldova, according to the WHO among the highest in the world.65 The proportion has, however, slightly declined from above 96% in the period 2005-2007 to 94.4% in 2008, which puts in danger the reach of the MDG target for 2010 (no lower than 96%). The accomplishment of this MDG greatly depends on the implementation of National Immunization Programs and actions for increasing awareness of the positive effects of child vaccination against measles. The situation is much worse in the Transnistrian region where immunization coverage is only 71.3%.66 Figure 5. Coverage rate with immunization

Source: Center for Health Policies and Analysis in Health, UNICEF (2011), p.53.

64 UNDP, Roma in the Republic of Moldova, 2007. 65 Government of the Republic of Moldova, Moldovaâ&#x20AC;&#x2122;s Report on IADGs Implementation. Annual Ministerial of the ECOSOC, 2010: 9. Based on the Nation Master world-wide database including data gathered from sources such as the UN, OECD, and Central Intelligence Agency. 66 UNICEF Moldova, September 2011.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

The immunizations for other diseases follow a similar trend to that of the measles, an upward trend up to 2007, followed by a decline in the period of 2007-2009. Resistance of parents to immunization is mentioned in several reports as an obstacle to an increased coverage rate.67 Although the majority of caregivers have a yellow immunization card, in some territories like Cahul, Ciadir Lunga and Bender, these cards have not been systematically provided. Equity analysis shows a negative correlation between mother’s level of education and the rate of immunization. Children from urban area and those from North and Chisinau municipality have a lower rate of immunization compared to the children from South and Centre part of the country. Explanations relate to the stronger ties in the rural areas, enabling an easier mechanism of convincing the population. On the other side, better information level of women with higher levels of education regarding the secondary effects of immunization leads to a lower rate of acceptance.68 Another gap relates to the Roma children, less covered by immunization program. Among children under 14 years old, 11% of Roma children are not vaccinated in comparison with 3% of non-Roma. Reasons mentioned by Roma respondents include lack of insurance policy and of information ‘did not know it was necessary to be vaccinated’. 69 3.2.4 Nutrition Good nutrition is the foundation for survival, health and development. At the macro-level, a well-nourished population has higher productivity, lower health care costs and greater economic output. At the micro-level, ‘well-nourished women face fewer risks during pregnancy and childbirth, and their children set off on a firmer developmental path, both physically and mentally. Well-nourished children perform better in school, grow into healthier adults and are able to give their own children a better start in life.’70 Opposite, undernourished children have lower resistance to infection and, during their life, may be locked into ‘the vicious cycle of recurring sickness and faltering growth, often with irreversible damage to their cognitive and social development’. (ibid.) 67 Center for Health Policies and Analysis in Health, UNICEF, Evaluation of Integrated Management of Childhood Illnesses Initiative in the Republic of Moldova Years 2000-2010, 2011: 46; Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010. 68 Center for Health Policies and Analysis in Health, UNICEF, Maternal and Child Health Equity Analysis, 2009: 32. The study took into consideration the case of immunization with DTP3 and hepatitis B3. 69 UNDP, Roma in the Republic of Moldova, 2007. 70 UNICEF, Progress for children. A Report Card on Nutrition, No. 4, 2006:2.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Figure 6. Share of underweight children aged 0-5 years (%) 25 20.9

19.8 18.6

19 17.1

16.7 14.3

12.8 11

10.6

0 2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Data source: National Bureau of Statistics

In the Republic of Moldova, the rates of malnutrition71 have considerably decreased for children in the first year of life as well as for children under five years old.72 After 2000, the share of underweight children aged 0-5 years has had a sharply declining trend, reaching in 10.6% in 2009, almost a half of the 2000 value (figure 6). The positive trend in malnutrition is correlated with the good evolutions in the rate of exclusive breastfeeding in the first six months of life, which increased from 73.6% in 2000 to 87.7% in 2010. The second MDG report acknowledges the positive changes in the area of nutrition, by improvements in the share of underweight children aged 0-5 years and infant malnutrition. Nevertheless, the Republic of Moldova is still above the EU average for this indicator. 73 An equity analysis indicates that underweight children are concentrated in poor households. 74 In the same time, the prevalence of food deprivation among general population is correlated with household income, households of three or four members, and urban population.

71 Malnutrition data, only as a disease, is collected based on administrative data. Data regarding stunting and underweight is collected only through household based surveys (Multiple Indicator Cluster Survey -MICS and Demographic Health Survey -DHS). 72 Center for Health Policies and Analysis in Health, UNICEF, Evaluation of Integrated Management of Childhood Illnesses Initiative in the Republic of Moldova Years 2000-2010, 2011: 54. 73 Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010: 24. 74 Center for Health Policies and Analysis in Health, UNICEF, Maternal and Child Health Equity Analysis, 2009: 27 and 35. Data for 2005 regarding underweight children and data for 2006 regarding food deprivation, which is measured as the share of population for which the caloric intake is less than the necessary minimum of 2500 kcal.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

In rural areas, the incidence of food deprivation is lower, as agriculture represents the main source of income for most households. Nevertheless, the quality of nutrition is rather poor.75 Of the children aged 0-7 years, one in every six from rural areas and one in every five from low-income households have three meals per day or less. Moreover, children from rural areas as well as children from low-income households have a rather monotonous diet consisting in fruits and vegetables, dairy and meat products considerable less compared to the children from urban areas or those from better-off households. Thus, the most important predictors for the quality of nutrition are the socio-economic status and residence area, rural areas being at disadvantage compared to urban areas. However, the quality of nutrition appears as a widespread issue within the country since less than 33% of children 0-7 years eats meat or fish products daily, only 50% consume dairy and 62% of them benefit on fruits and vegetable every day. Given the coping strategies of households in response to the economic crisis, in 2010-2011, the quality of nutrition is likely to being decreased while food deprivation to being increased. During the crisis, consumption expenditures of households decreased significantly. The highest fall in spending was reported in food expenditures (-13% at the national level), both in low-, mid- and high-income households, in households with and without children, in complete as well as incomplete families. As result, people shifted from high and mid-priced staples to cheaper food products. The rural areas were less affected as in kind food consumption is the main coping strategy of rural households. In cities, and particularly in small towns, the drop in food expenditures was much more important. Consumption of food in lower quantities and of lower quality could lead to a deterioration of the health status of population, particularly of children. There is still no empirical evidence that the health situation is worsening, but the phenomenon should be closely monitored, especially if the crisis continues.76 Morbidity through anemia remains a major problem, with a constant increase between 2001 and 2010, to 116.2 per 1,000 children under five years old.77 In the first year of life, morbidity through anemia is even 75 UNICEF, National Study on Knowledge, Attitudes and Practices of Families in the field of early childhood development and care, 2010. 76 UN, The World Bank, Impact of the Economic Crisis on Poverty and Social Exclusion in the Republic of Moldova, 2009: 39-45. 77 Center for Health Policies and Analysis in Health, UNICEF, Evaluation of Integrated Management of Childhood Illnesses Initiative in the Republic of Moldova Years 2000-2010, 2011: 54.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

higher, 237 cases of every thousand infants (in 2010), and has followed the same upward trend in the last ten years.78 Nonetheless, this increase is attributed mainly to a better screening, as part of the Integrated Management of Childhood Illnesses Initiative (IMCI Strategy), supported by UNICEF Moldova.79 So, the problem is not necessarily bigger, but it becomes increasingly visible. Table 1. Anemia in children under five years of age (per 1,000 children of this age)

Anemia in children under 5 years

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

74.1

69.3

81.7

86.9

91.2

102.2

103

106.6

107.5

106.3

116.2

Change 2010/2000 1.57

Source: Center for Health Policies and Analysis in Health, UNICEF, Evaluation of Integrated Management of Childhood Illnesses Initiative in the Republic of Moldova Years 2000-2010, 2011: 55

The situation is different in Transnistria.80 There is a significant decrease in anemia cases among children under five from 1,723 in 2007 to 1,208 in 2009.81 Anemia of children under one year is closely linked to maternal anemia. High rates of anemia among children reflect the higher likelihood of these children to live in poor socio-economic conditions, where women are more susceptible to poor diet and infection and more likely to undertake physically demanding work during pregnancy or breastfeeding. Correspondingly, the incidence of anemia among children significantly varies with residence, region, motherâ&#x20AC;&#x2122;s level of education and income level, besides the childâ&#x20AC;&#x2122;s age. Children from rural areas, particularly in the Center region, with poorly education mothers and from low-income households have a higher risk of anemia.82 A National Program addresses this problem through ensuring a supplement of iron and folic acid for pregnant women as part of the basic package of 78 National Bureau of Statistics. However, for the children in the first year of life, anemia represents only the second cause of morbidity. For example, in 2010, the main cause of morbidity was respiratory diseases (725 cases per 1,000 children), followed by anemia (237 cases per 1,000 children), perinatal pathologies (151 cases per 1,000 children) and diseases of the nervous system (104 cases per 1,000 children). 79 Center for Health Policies and Analysis in Health, UNICEF, Evaluation of Integrated Management of Childhood Illnesses Initiative in the Republic of Moldova Years 2000-2010, 2011. 80 UNICEF, Ensuring survival, care and protection of young children in Moldova: extension of the IMCI Initiative in Transnistria, 2010: 6. 81 Morbidity through anemia reported by authorities is higher than in Moldova, but it has decreased as result of improvements in detection and treatment. 82 Center for Health Policies and Analysis in Health, UNICEF, Maternal and Child Health Equity Analysis, 2009: 28, 65.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

prevention services and treatment of anemia. Nevertheless, the persistent high levels of morbidity through anemia among children call for a more efficient implementation plan. 3.2.5 Children with disabilities Figure 7. Main causes of children invalidity (per 1,000 children under 18 years old) 22 20

18.8

20.1

19.7

18.8

20.1

Total

18 16

Congenital malformations and chromosomal anomalies

14 12

Mental and behavior disorders

10 8 6

Diseases of nervous system

4 2 2005

2006

2007

2008

2009

2010

Data: National Bureau of Statistics, Situaţia copiilor din Republica Moldova în anul 2010, 2011, http://80.97.56.163/ newsview.php?l=ro&id=3418&idc=168

The number of children invalidity cases increased from 12,859 in 2005 to 15,321 in 2010.83 Main causes of children invalidity are represented by congenital malformations and chromosomal anomalies (increased from 4.1 in 2005 to 5.5 per 1,000 children under 18 years old, in 2010), mental and behavior disorders and diseases of nervous system. Article 23 of the Convention of the Rights of the Child mentions, among others, the right of the disabled child to enjoy the effective access to education, health care services, rehabilitation services, preparation for employment, and recreation opportunities. Non-discrimination as intrinsic principle of the Convention should guide policy-makers in ensuring that all children, including those with disabilities, enjoy full access to public services. Access to the health care services of children with disabilities is problematic, even in the first stages of child development. Early intervention services, community based services as well as inclusive education have been developed only in three districts of the country (Chisinau, Criuleni and 83 National Bureau of Statistics, Situaţia copiilor din Republica Moldova în anul 2010, 2011, http://80.97.56.163/newsview.php?l=ro&id=3418&idc=168

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Balti), whereas in seven districts none of those are available. In most districts, only the community based services have been put in place. The National Centre of Mother and Child from Chisinau provides complex services during prenatal and postnatal period for approximately 1,000 children from the whole country. However, its location in the capital city prevents access for a part of the parents, including visits for follow-up services.84 Aside that relevant services are underdeveloped the existent ones are poorly endowed with equipments. Accordingly, many doctors involved in early intervention detection, therapies and prevention, use outdated methodologies. Thus, upgrading professional capacities of those doctors is critical for improving the system performances. This is especially true for doctors working in remote districts. Furthermore, the facilities for people with disabilities are deficient both in public institutions and in the public transportation system. Although various strategic documents have been formulated, the provisioned activities are still at a general level and there are no clear mechanisms of implementation, control and evaluation. 85 Another major problem is the late diagnosis for many children with a disability. Under the conditions of a weak system, the late diagnosis occurs particularly when parents do not know to identify the signs or symptoms related to a disability, even more so when the family is poor and/or lives in a remote area. The phenomenon is even more accentuated in the case of disabilities with no visible signs, such as those caused by mental and behavior disorders. Generally, the diagnosis takes place when the child enters in the first grade of school, a phase from which the child continues with the mainstream education or is referred to a special school.

84 UNICEF, Assessment and Recommendation on Child Disability Prevention and Care System in Moldova, 2009. 85 Ombudsman Institution, Thematic Report â&#x20AC;&#x2DC;People with special needsâ&#x20AC;&#x2122; access to social infrastructure: reality and necessityâ&#x20AC;&#x2122;, 2010.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Figure 8. Number of children with disabilities (0-18 years) and availability of relevant services by district

Source: UNICEF, Assessment and Recommendation on Child Disability Prevention and Care System in Moldova (2009), p. 52

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Table 2. Morbidity of children under 18 years old: mental and behavior disorders (cases per 100,000 children) 2005

2006

2007

2008

2009

2010

Total persons, of which

523.9

626.6

645.9

590.6

614.9

636.7

Psychotic disorders

33.7

25.1

24.4

29.9

30.2

35.9

Mental non-psychotic disorders

366.8

465.1

496

453.3

460.2

517.3

Mental retardation

148.9

150.2

138.9

126

146

111.9

Source: National Bureau of Statistics, Situaţia copiilor din Republica Moldova în anul 2010, 2011, http://80.97.56.163/ newsview.php?l=ro&id=3418&idc=168

Moldova has a high prevalence of mental disorders in the general population as compared to new EU countries and CIS region. 86 Previous reports draw attention on the difference in the classification system as being the most probable explanation for the high prevalence of mental disorders in Moldova. In addition, they point out that in Moldova the cases of mental retardation are over-estimated while psychiatric disorders are misdiagnosed in the case of some psychological and social issues related to conflict situation.87 The incidence of mental and behavior disorders among children aged 0-18 years is higher compared with the adults.88 More worrying is that the mental disorders rate for children has increased between 2005 and 2010 from about 524 to 637 cases per 100,000 children respectively. Main factors contributing to children mental disorders refer to family conflicts, family separation and parents’ migration, as well as conflicts at school.89

3.3 Adolescent Health and Development 3.3.1 HIV/AIDS Incidence of HIV/AIDS in the general population has decreased since 2008 reaching 17.12 cases for every 100,000 inhabitants in 2010. The HIV/AIDS rate for the 15-24-year age group has followed a different trend. After a sharp drop in 2008, it resumed the upward trend in 2009-2010, coming back at the high 2007 level, about 21 cases per 100,000 inhabitants. Thus, in 2010, the stable pattern of considerable higher rates of HIV/AIDS for the young (15-24 years) was restored. 86 UNICEF, Ministry of Health, Mid-Term Review, UNICEF – Government of the Republic of Moldova Country Programme of Cooperation 2007-2011, Leadership Area, Adolescent Health and Development, 2009: 34. 87 Ibid. 88 UNDP, Analiza stării de sănătate a populaţiei Republicii Moldova prin prisma indicatorilor statistici, 2010: 48. 89 UNICEF, Ministry of Health, Mid-Term Review, UNICEF – Government of the Republic of Moldova Country Programme of Cooperation 2007-2011, Leadership Area, Adolescent Health and Development, 2009: 35.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

The MDG targets set for the general population, as well as for the 1524-year age group, were revised downwards in 2007, as a result of a continuous deterioration on these indicators. However, given the existing trends, the targets set at 8 and 10 per 100,000 inhabitants (for 2010 and 2015 respectively) are very improbable to be achieved, even after these revisions. Figure 9. Trends in HIV/AIDS in Moldova by age groups, 2000-2010 (100,000 inhabitants) 24 22

21.01

20 18

17.12

16 14 12

10.38

10 8 8

5.5

6 4

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

General Population

15-24 years Population

Data: Ministry of Health, Raport Anual în Sănătate 2010 (2011), p. 55

Figure 10. Trends in HIV/AIDS in Moldova by region, 2001-2009 (100,000 inhabitants)

70 60 50 40 30 20 10 0 2001

2002

2003

2004

Malul drept

2005

Teritoriile de est

2006

2007

Media pe republică

2008

2009

Source: Ministry of Health. Informative Note. Situation in HIV/ AIDS infection and pregnancies for 2010, National Scientific-Practical Centre of Preventive Medicine, February 23 (2010), p.1.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Figure 11. HIV/AIDS incidence in Moldova, 2010 (number of reported cases) 140

123

120 100 75

80 60

40 20

24 8

0 Moldova

Transnistria 0-14

15-19

20-24

Total

Data: UNAIDS, http://aids.md

Various studies and reports regarding HIV epidemic set out the specific characteristics and trends for the Republic of Moldova: (I)

There is a shift in transmission routes of HIV/AIDS from injecting drug behavior to sexual intercourse. In 2010, 86.8% of the newly registered cases were attributed to sexual transmission.90

(II) Four groups of population (irrespective age) have a disproportionally high risk of HIV/AIDS infection, namely injecting drug users, commercial sex workers, men who have sex with men and inmates.91 (III) There are significant differences between the right and the left bank of the Nistru. The incidence in the Transnistrian region is of 42.25 cases per 100,000 inhabitants, which is more than three times larger than the rate of 12.42 cases of the right bank of Nistru.92 On both banks, the young of 15-24 years account for similar proportions of all reported cases, 21.6% in the right bank and 23.8% in the left bank of Nistru.93 (IV) The ratio between male and female changed in 2004, most probably affected by the introduction of mandatory testing for women during pregnancy. The Second MDG report draws attention on the problem of high prevalence of gender violence, which leads to a decreased 90 UNAIDS, Data Synthesis on Tendencies of the HIV epidemic and Impact of HIV prevention interventions in the Republic of Moldova 2011, 2011; Ministry of Health, Raport Anual ﾃｮn Sﾄハﾄフate 2010, 2011. 91 UNAIDS, Data Synthesis on Tendencies of the HIV epidemic and Impact of HIV prevention interventions in the Republic of Moldova 2011, 2011; Ministry of Health, Assessment of Risk of HIV Infection among Most at Risk Adolescents (MARA), 2009; Bivol (2010). 92 Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010: 76. 93 UNAIDS, http://aids.md

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

negotiation power of women in what concerns condom-use for high-risk sexual relationships. Adding to this the limited condom availability, especially in rural areas, women vulnerability to HIV is quite high.94 (V) Mother-to-child HIV transmission rate greatly decreased from 10% in 2004 to 1.7% in 2008 and afterwards it has remained below 2%. Nevertheless, considering that the prevalence of HIV among pregnant women has continued to rise, the services system for prevention of HIV transmission from mother to child requires improved efficiency. A recent assessment of this system identifies the following areas for development: ‘oversight mechanism, management and coordination, sustainability and continuum of service provision, access and quality of services’.95 There is significant variation in the youth’s knowledge about safer sex behavior across areas of residence as well as age groups.96 In 2008, only about one third of rural youth have correct knowledge of HIV transmission. Adolescents (15-19 years) have a considerably lower level of knowledge about STIs than do the 20-24 age group. Between 2006 and 2008, the level of knowledge has increased (with 15% about HIV and with 12% about condoms),97 but continues to be low among adolescents. Figure 12. Indicators of knowledge, attitudes and practices in youth aged 15-24 years (%) 80

70.8

63.5

60 48 47.8

51.9

40.8

40 26

30 20 10

8 10

15.9 9.75

2008

0 HIV testing

Tolerant attitudes towards PLWH

Multiple sexual partners

2006

HIV Knowledge Knowledge Condom knowledge of at least about use at last one condoms sex with sympton of occasional STI partner

Data: Scutelniciuc et al. (2006), (2008), p. 26-27. Notes: PLWH – People Living With HIV. STI – Sexually Transmitted Infections.

94 Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010: 77. 95 Ministry of Health, Evaluation of Prevention of HIV Mother to Child Transmission Services in the Republic of Moldova, 2009: 9. 96 Scutelniciuc et al. (2008). (2006). 97 HIV knowledge is an index composed based on correct answer to four questions: (i) ‘Can HIV infection risk be reduced through a correct use of condom at every sexual intercourse?’; (ii) ‘Is HIV infection risk reduced if having one faithful and non-infected sexual partner?’; (iii) ‘Can HIV be transmitted by having lunch using the same cover with an infected person?’; and (iv) ‘Can a person apparently healthy be HIV infected?’. Similarly, knowledge about condoms is an index computed of correct answers to three questions: ‘Can HIV infection risk be reduced through a correct condom use at every sexual intercourse?’, ‘Can STI infection risk be reduced through a correct condom use at every sexual intercourse?’ and ‘Can an unwanted pregnancy be prevented through a correct condom use at every sexual intercourse?’.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Tolerant attitudes towards people living with HIV (PLWH) have remained alarmingly low among young, despite the significant efforts to reduce stigma towards PLWH. The sexual preventive practices of young did not improve between 2006 and 2008. Only 5-6% of young (15-24 years) took voluntarily HIV testing and know the result, of which very few from rural areas. The condom use at last sex with an occasional partner did slightly decrease from 75% to 71%. More, less than half of the young use condoms consistently with commercial sex workers. An increasing share (from about 10% to 16%) had multiple sexual partners during the last 12 months. Various prevention programs have been implemented and rapidly extended. Nonetheless, they failed to keep up with the pace of HIV evolution as some of them were only partially implemented.98 They are unequal in geographic and sub-population coverage. There is a clear insufficiency of services addressing the adolescents, particularly of those of social inclusion, accompanied by a low access to condoms and harm reduction programs. In addition, prevention programs focus on raising awareness rather than behavior change. People living with HIV (PLWH) face serious social inclusion problems. A survey report from 2008 99 shows that less than half of the respondents (44.3%) hold a health insurance,100 only 38% of them are employed, and approximately half of PLWH parents with children have incomplete families.101 Therefore, most of them have a low income and live in poor conditions. Stigma and discrimination against PLWH are widespread both among population and professionals from health and education sectors. Half of respondents declared they felt discriminated because of their HIV status. Respondents infected through injecting drugs reported more frequently discrimination episodes than those infected probably through sexual intercourse. In addition, the qualitative study revealed that many PLWH parents face resistance when trying to access educational institutions. In this way, the discrimination against parents may affect the childâ&#x20AC;&#x2122;s chances to education. As a survival strategy, many PLWH parents with children 98 Bivol, S., (2010); Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010. 99 National Centre of Health Management, Baseline Situation Analysis of Children and Families AďŹ&#x20AC;ected by HIV and People Living with HIV in the Republic of Moldova, 2008. 100 Data refer only to the right bank of the Nistru. 101 Divorced, separated, widowed and single.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

going to school or kindergarten avoid informing the institution that the child belongs to a family affected by HIV. Confidentiality regarding PLWH is also problematic, as many medical professionals do not observe this rule. Almost half of respondents declared that people knew about their HIV positive status from someone else, including physicians and other people whom they previously told. 3.3.2 Substance use A study102 on youth’s knowledge, attitudes and practices carried out in 2006 and 2008 shows an increase in the alcohol use and a rather constant proportion of present smokers, among teenagers 15-19 years old. In terms of gender disparities, significantly more boys and girls adopt these risk behaviors, drinking alcohol and/or smoking. Figure 13. Substance use among adolescents (15-19 years) in Moldova, 2006 and 2008 (%) 100

83.3 70.7

76.3 64.7

79.4 67.2

2006

2008

16.1

16.4

0 Total Smoke tobacco, such as cigarettes or pipes?

Males

Females

Total

During the last months have you drink at least one alcoholic beverage?

Sources: Scutelniciuc et al. (2006), (2008), p. 62.

The alcohol use is spreading both among boys and girls. High share of adolescents who drink alcohol is alarming, even more so considering that the alcohol consumption is considered a ‘problem’ by fewer young than the smoking. Thus, the peer group environment is rather restrictive regarding smoking but it is tolerant and provides an anticipatory socialization into drinking alcohol.103 This is a major source of concern knowing the strong links between high-risk drinking, violence, unsafe sexual behaviors, traffic and other accidents, permanent disabilities and death.

102 Scutelniciuc et al. (2008). 103 IDIS Viitorul, Tinerii in Moldova, 2008 cited in UNICEF, Ministry of Health, Mid-Term Review, Mid-Term Review, UNICEF – Government of the Republic of Moldova Country Programme of Cooperation 2007-2011, Leadership Area, Adolescent Health and Development, 2009.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

A survey on school-going adolescents showed that 83% of adolescents declared that would like to quit smoking.104 Although the Republic of Moldova has approved the Law on Framework Convention on Tobacco Control in 2007, the laws against underage smoking are not enforced: shops continue to sell to teenagers. An effective way to tackle this issue would be a tax increase on cigarettes, as Moldova still has the lowest price of cigarettes in Europe.105 Moldova is a source-country for cannabis, which alongside poppy is a cultivated drug. Cannabis represents the most commonly used drug in the general population of the country. 106 The first European School Survey for Alcohol and Other Drugs (ESPAD), carried out in 2008, indicated a life-time prevalence107 of cannabis of 4.8% among school children born in 1992, with a much higher prevalence for boys than for girls. At the level of the youth aged 15-24 years old, both the life-time and the last year prevalence are much lower in Moldova than the EU-27.108 Disaggregated statistics for 15-19 age group indicate gender and residence area disparities. Both life-time and last year prevalence is higher for males than for females and higher in urban versus rural areas. 109 The overall number of drug users is not known, as there are no reliable estimations of the number of injecting drug users (IDUs) in the Republic of Moldova. However, recent studies set out several findings useful for guiding policy interventions: The prevalence rate of injecting drugs (assimilated to opioid drug use) among youth is higher in Moldova than in the EU member states.110

104 Calmic V. Global Youth Tobacco Survey (GYTS), national report. Chisinau, Ministry of Health of the Republic of Moldova, National Scientific and Applied Center for Preventive Medicine, 2004:12, cited in UNICEF, Ministry of Health, Mid-Term Review, UNICEF – Government of the Republic of Moldova Country Programme of Cooperation 2007-2011, Leadership Area, Adolescent Health and Development, 2009. 105 UNICEF, Ministry of Health, Mid-Term Review, UNICEF – Government of the Republic of Moldova Country Programme of Cooperation 2007-2011, Leadership Area, Adolescent Health and Development, 2009: 20. 106 European Monitoring Centre for Drugs and Drug Addiction, The State of Drugs Problem in Europe, Annual Report, 2010: 41;, UNICEF, Ministry of Health, Mid-Term Review, UNICEF – Government of the Republic of Moldova Country Programme of Cooperation 2007-2011, Leadership Area, Adolescent Health and Development, 2009: 21. 107 Life-time prevalence is any use of a specific drug during one’s lifetime, regardless of other characteristics (quantity, frequency). 108 European Monitoring Centre for Drugs and Drug Addiction, The State of the Drugs Problem in Europe, Annual Report, 2010: 4 43; Scutelniciuc et al., Drug Situation in the Republic of Moldova, 2009:21. 109 Scutelniciuc et al., Drug Situation in the Republic of Moldova, 2009: 21-22. 110 Still, no data are available for prevalence of opioid use in youth aged 15-25 years in the European countries. UNICEF, Ministry of Health, Mid-Term Review, UNICEF – Government of the Republic of Moldova Country Programme of Cooperation 2007-2011, Leadership Area, Adolescent Health and Development, 2009: 22. SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

The average length of time on injecting drugs has increased. Opium extract is the most frequently injected drug, followed by ephedrine, ‘vint’, tranquilizers and heroin.111 Injecting drug users have high risks of experiencing health problems, such as blood-borne infections (HIV/AIDS, hepatitis) or drug overdose.112 Low proportions of adolescents injecting drugs benefit from services of Harm Reduction Programmes during a year (less than 28% in the case of IDUs aged 15-17 years). Most of them benefited of distribution of condoms, needle exchange, distribution of disinfectants, and information materials.113 The coverage of HIV prevention interventions is very low for children 12-14 years as well as for adolescents 15-17 years (about 11%).114 Design and implementation of dedicated policies and practices should take into account the reported high rates of indirect sharing as well as sexual risky behavior, especially among young injecting drug users.115 Respondents from Tiraspol are more likely to practice indirect sharing compared to Balti and Chisinau respondents. The Annual Report on Drug Situation in the Republic of Moldova from 2008 concludes that no progress has been made in improving the monitoring of drug-related deaths on the basis of an internationally accepted definition, as only a small number of cases have been reported by the Centre of Forensic Medicine.116 111 Scutelniciuc et al., Drug Situation in the Republic of Moldova, 2009: 29. Based on the Behavioural and Sentinel Surveillance Survey conducted in 2007 on IDUs using Harm Reduction Programs (HRP). 112 The prevalence of Hepatitis C among drug users beneficiaries of Harm Reduction projects was reported in 2007 to be 42.7%, HIV 21.0%, chronic carriage of Hepatitis B at 6.8% and syphilis at 12.1%. UNICEF, Ministry of Health, Mid-Term Review, UNICEF – Government of the Republic of Moldova Country Programme of Cooperation 2007-2011, Leadership Area, Adolescent Health and Development, 2009: 23-24. 113 Ministry of Health, Assessment of Risk of HIV Infection among Most at Risk Adolescents (MARA), 2009: 53. Data from 2008. An IDU was considered to be someone aged 12-24 years who has injected drugs at least once during the 12 months prior to the interview. The study covered the district centers and rural communities neighboring Chisinau, Balti and Tiraspol municipalities. 114 Although most IDUs know where they may take a HIV test, only 5.3% of 12-14-year-olds and 14.1% of 15-17 years old IDUs have ever taken such a test. Ministry of Health, Assessment of Risk of HIV Infection among Most at Risk Adolescents (MARA), 2009: 51-53. Data from 2008. An IDU was considered to be someone aged 12-24 years who has injected drugs at least once during the 12 months prior to the interview. The study covered the district centers and rural communities neighboring Chisinau, Balti and Tiraspol municipalities. 115 Indirect sharing of syringes in the last month accounts for 85.3% of respondents and decreases with age from 100% in the 12-14 year-olds, compared to 81% in 20-24 year-olds. The highest rate of multiple partners and non-steady partners in the last year was found in the 15-17 years age group, of which 65.3% have 4.2 sexual partners on average. Ministry of Health, Assessment of Risk of HIV Infection among Most at Risk Adolescents (MARA), 2009: 9 and 43. Data from 2008. An IDU was considered to be someone aged 12-24 years who has injected drugs at least once during the 12 months prior to the interview. The study covered the district centers and rural communities neighboring Chisinau, Balti and Tiraspol municipalities. 116 Scutelniciuc et al., Drug Situation in the Republic of Moldova, 2009:7.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

In conclusion, adolescent IDUs are at greater risk of HIV and Sexually Transmitted Infections compared with IDUs aged 18-24 years. Primary prevention of drug use is limited. Treatment options available to drug users are also limited, as the main service is detoxification both in public and private sectors. Detoxification is mainly provided, with no additional treatment modalities. Methadone substitution treatment covers insufficiently those in need. Rehabilitation services for IDUs are underdeveloped, especially for young people below 18 years old. The few existing services have a small number are of beneficiaries and are offered the National Center for Narcology and a few NGOs. Moldova has an extended network of harm reduction services, but the range of provided services has decreased with the shrinkage of funding from the past years. Given that HIV transmission in IDUs is presently linked to indirect sharing and high-risk sexual behaviors, which both are specific to adolescents aged 15-17 years, this will likely translate in higher HIV/STI transmission rates in the future. 117 3.3.2 Suicide Moldova is a high suicide rate country, with more than 17 suicides per 100,000 people.118 At the population level, suicide rates are rather constant, with higher shares for men.119 In 2009, the suicide rate for youth aged 1519 was 5.1 deaths per 100,000 relevant population.120 Figure 14 shows that the suicide rate for teenagers (15-19 years) situates the Republic of Moldova on an rather low position within the region. Among teenagers, the rate of suicide is higher for males than for females.

117 UNICEF, Ministry of Health, Mid-Term Review, UNICEF â&#x20AC;&#x201C; Government of the Republic of Moldova Country Programme of Cooperation 2007-2011, Leadership Area, Adolescent Health and Development, 2009: 8, 25. 118 World Health Organization, Suicide Rates, Republic of Moldova, http://www.who.int/mental_health/media/repmol.pdf. 119 Death rates due to suicide: 32.43 deaths per 100,000 inhabitants of respective age and sex, in 2009, for males compared to 5.13 deaths per 100,000 inhabitants of respective age and sex for females. National Bureau of Statistics, Statistical Yearbook of the Republic of Moldova 2010, 2010: 54. 120 UNICEF, TransMONEE 2011 Database.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Figure 14. Suicide rate by sex among 15-19 year old in 2009 (deaths per 100,000 relevant population) 35.0 Females

30.0

Males

25.0 20.0 15.0 10.0

Georgia

Bulgaria

Armenia

Azerbaijan

Tajikistan

Slovakia

Serbia

Moldova, Republic of

TFYR Macedonia

Croatia

Czech Republic

Romania

Slovenia

Hungary

Kyrgyzstan

Latvia

Estonia

Poland

Ukraine

Belarus

Russian Federation

0.0

Lithuania

5.0

Source: UNICEF, TransMONEE 2011 Database.

However, statistics on suicide are not accurate. Different agencies provide divergent data. National suicide prevention services are very limited. The available community services are highly dependent on external donor support. As in the case of mental health disorders, suicide attempts are treated in psychiatric hospital or special institutions for children, whereas long-term interventions to help family and community reintegration are scarce.121

3.4 Access to Water and Sanitation The share of people with access to improved water sources has considerably increased in Moldova, from 38.5% of population in 2002 to 55% in 2009. However the large urban-rural disparities persist. Maintaining the investments rhythm from the last years, which requires a large funding from both State Budget and external donors, is critical for attaining the 2010 (of 59%) and 2015 MDG targets (65% of population). For this reason the second MDG report on Moldova evaluates as ‘(probably) unlikely’ the country’s chances to reach the targets related to access to improved sewerage and sanitation systems, despite the extensive project supported by the European Commission on water supply and sewage.122 121 UNICEF, Ministry of Health, Mid-Term Review, UNICEF – Government of the Republic of Moldova Country Programme of Cooperation 2007-2011, Leadership Area, Adolescent Health and Development, 2009: 36. 122 Project of 45 millions euro to improve access to water and sewage facilities in Moldova. UNICEF, Summary Report Study on the Quality of Water, Sanitation and Hygiene Practices in the schools of Moldova, 2010: 91.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

There are significant regional disparities regarding the availability of drinking water, with the south part at disadvantage.123 Furthermore, in the next years, the country is expected to face a risk of water-scarcity.124 Childrenâ&#x20AC;&#x2122;s access to safe water sources, sanitation and hygiene conditions was the focus of a study in the schools of Moldova.125 This study brings additional evidence on the urban-rural disparities: Approximately one third of schools from rural areas do not have a water supply system. The share of schools connected to water is lowest (less than 20%) in Soldanesti district. 80% of schools that do not comply to the sanitary protection zones for water sources are located in the rural area. Interruptions in water supply, which are associated with higher risk of microbial pollution of water, occur most often in the southern area. One in every six pupils in Moldova is at risk of acquiring acute diarrheal diseases due to polluted water. Also, one in every ten children uses WCs non-compliant with the sanitation norms, which increases the risk of acute diarrheal and parasite diseases. One in every four pupils is exposed to a major health risk due to water consumption at school.126 Risk factors are microbial, nitrate, fluoride and boron pollution of water for human consumption. The districts falling within the major health risk127 category are Soldanesti, Edinet, Donduseni, Ungheni, Soroca, Gagauzia (CiadirLunga), Criuleni, Ialoveni, Stefan Voda, Taraclia and Falesti. Share of schools with unsatisfactory hygiene conditions is higher in the rural areas comparative to urban areas. Schools from rural areas lag behind both regarding the availability and satisfactorytechnical conditions of the wash-basins, soap, single use towels, hand-dryers and water closets. For example, 19.2% of rural schools have wash-basins in poor condition (compared to 3.7% in urban area) and 29.2% lack soap (compared to 11.8 in urban areas). Nearly all rural schools (95%) have outside WCs on the cesspool. This means that about 55% of all students lack inside 123 Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010: 95. 124 UNDP, Human Development Report 2009-2010, 2011. 125 UNICEF, Summary Report Study on the Quality of Water, Sanitation and Hygiene Practices in the schools of Moldova, 2010. 126 Ibid., 2010: 14. 127 The health risk is assessed based on the proportion of students exposed to the risk factors.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

WCs. Furthermore, in rural areas, only 22.7% of children have tap water at home, which represents an important obstacle for them in following hygiene practices.128

3.5 Capacity and Policy Gaps 3.5.1 Institutional Capacity Financing and medical insurance The reform of the health system has been marked by the introduction of the mandatory health insurance in 2004. The system is financed from the Mandatory Medical Insurance Fund, the state budget and internationallyfunded programs dedicated to specific health problems. State Budget allocations to health has been increased in the last years, amounting to 6.5% GDP in 2009,129 which has been higher than those in the neighboring countries, Romania and Ukraine, but less than the EU-27 average.130 Equity problems arise in what concerns coverage with health insurance.131 A study conducted by the National Bureau of Statistics in 2009 showed that 79.7% of population was covered with medical insurance, of which 51.3% was insured by the state, 26.7% by paying the monthly insurance and only 1.7% have bought their own medical insurance. The same study pointed out that as much as 30% of the population with the lowest income (first quintile) did not hold a medical insurance. The majority of population uncovered by the medical insurance was self-employed in agriculture (48.9%), while the others were employees (21.9%), unemployed (19.2%), or self-employed in non-agricultural activities (9.9%). All children of the age group 0-18 years are covered with health insurance. Additionally, children under 5 years of age and pregnant women are provided medicines free of charge.

128 UNICEF, Summary Report Study on the Quality of Water, Sanitation and Hygiene Practices in the schools of Moldova, 2010: 15-18. 129 General government expenditures on health represented 4.9% of GDP in 2007, 5.4% in 2008 and 6.5% in 2009. IMF Country Report No. 10/232, July 2010: 11. 130 EU-27 average for health in total general government expenditure was of 7.4% of GDP in 2009. Data source: Eurostat, general government expenditure by function, date of accession: August 8, 2011. 131 European Observatory on Health Systems and Policies, Moldova, Health System Review, Health Systems in Transition, vol.10, no.5/2008; National Bureau of Statistics, Rezultatele studiului privind sănătatea populaţiei și accesul la serviciile de sănătate în Republica Moldova, 2009.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Organizational structure and human resources The administrative level responsible for primary and secondary care is the district level with the municipal one for Chisinau. The primary care is within the responsibility of family doctors. In rural areas, especially small localities are not covered with family doctors, but have access to family medical assistants. The secondary care is performed through hospitals located at district level. The Ministry of Health has in its direct subordination emergency services and specialized medical institutions, mostly located in Chisinau. In order to improve the health state of the country population, the government has put an increasing emphasis on the development and enhancement of family medicine. A Primary Medical Assistance Development Strategy 2010-2013 was approved. The primary medical assistance was legally separated from the hospital and specialized ambulatory services. The separation procedure has started at the beginning of 2008. The number of Health Centers, which operate on the basis of contracts concluded directly with the National House of Medical Insurance, was raised to 54 compared to 32 in 2009. The rate of allocations from the Mandatory Medical Insurance Fund to primary medicine has been kept to 30%, in accordance with the legal provisions. 132 There has been a constant decline in absolute numbers of family doctors, from 2,136 in 2002 to 1,873 in 2010. Accordingly, the family doctors to inhabitants ratio has undergone a decrease from 5.8 in 2003 to 5.3 in 2010, which is much lower than the EU-27 average of 8.5 family doctors for every 10,000 inhabitants. The deficit of family doctors is highly accentuated in districts Cantemir (2.4), Hancesti (2.9), Leova (3) and Cimislia (3.1). The northern districts and the capital Chisinau are much better covered with family doctors.133

132 Government of the Republic of Moldova, Report on the Evaluation of the National Development Strategy Implementation During the Period 2009-2010, 2010. 133 Ministry of Health, Raport Anual ﾃｮn Sﾄハﾄフate 2010, 2011.

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Figure 15. Health staff to 10,000 inhabitants 90 77.5

80 64.6

70 60 50 40 30

29.8

32.3

20 5.3

8.5

0 Doctors -total

Health staff with secondary schooling Moldova

Family doctors

Sources: Ministry of Health (2011), p. 25, data for 2010, and National Centre for Health Management. Map elaborated using SPD2, NCHM, data for 2009. (http:// www.cnms.md/areas/statistics/ indik/)

Figure 16. Family doctors to 10,000 inhabitants

The deficit of family doctors at the country level is estimated at 290 doctors. In one year, only 25 out of 60 family doctors new graduates choose to work in the rural area. Provided that this proportion will not increase, it takes up to 12 years to cover the deficit of physicians in the rural area.134 Considering all doctors, not only the family ones, the gap between Moldova and the EU member states diminishes. However, Moldova remains at disadvantage with 29.8 doctors for every 10,000 inhabitants compared to over 32 the EU-27 average. Furthermore, statistics135 regarding specialized doctors reveal a worrying situation for the health of child and women. Merely one third of the total number of gynecologists trained during 2003134 Ibid. 135 Galbur (2010).

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

2009 work in the public health system, mostly in Chisinau. Just 30% of the trained pediatricians work in the health system. In seven districts, there is only one pediatrician working, one district has no pediatrician, and ten districts have no neonatologists. On mental health, the study136 on Adolescent Health and Development (2009) identifies several drawbacks on the provision of services. The first downside refers to the lack of psychologists and psychiatric staff in rural areas; only in 17 out of 35 districts there are child psychiatrists. Second is the lack of continuity with the primary health care system. The fragmentation of specialized care and the lack of coordination mechanisms between the psychological counseling system and the psychiatric system lead to deficiencies in data collection. Similar to other public health programs, the services developed at the community level have limited geographic coverage and strongly rely on international donor financing. Consequently, their sustainability is uncertain. In Moldova, in 2010, over 61 thousands persons were employed in the sector of health and social assistance. Employment is highly concentrated in the public sector (97%) and feminized (80%). After a sharp decline, the number of employees in health and social assistance has increased since 2008.137 This increase was linked to the social protection reform and the corresponding rise of the number of social assistants (see section on Child Protection). The number of employees in the health sector has continued to decline. The management of human resources in the health system is seriously affected by two negative aspects. First aspect is the mass migration of professionals. Over 9,000 doctors and nurses left the system between 1996 and 1999, and another 10,000 medical staff did the same in the period 2000-2008.138 An estimation of the phenomenon can be grasped through the number of certificates issued by the Ministry of Health for studies legalization, which are required for working abroad. Annually, Ministry of Health issues 200 certificates for doctors and 300 for medical staff with secondary schooling. The number can only be higher, especially for specialized staff with a secondary education degree, considering the informal jobs abroad. As result, for every 10,000 inhabitants, Moldova has less than 65 medical staff with secondary schooling as compared to 77.5 the EU-27 average. 136 An assessment of the coverage and quality of mental health services for children and adolescents is not available. UNICEF, Ministry of Health, Mid-Term Review, UNICEF â&#x20AC;&#x201C; Government of the Republic of Moldova Country Programme of Cooperation 2007-2011, Leadership Area, Adolescent Health and Development, 2009: 35-37. 137 National Bureau of Statistics, http://statbank.statistica.md. Data refers to the average monthly average of employees. Transnistria is not included. 138 UN, National Human Development Report 2010/2011, 2011: 83.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Figure 17. Number of young specialists in medical institutions from rural areas and districts who benefit from facilities in Moldova, 2006-2009 270

Employed

220

Dismissed

246

225

TOTAL=Employed-Dismissed

170

120 120 70

20 -30

2006

2007

2008 Doctors

2009

2006

2007

2008

2009

Medical assistants with general education

Source: Government of Moldova (2010), p. 70. Note: Data from the accounting reporting of the Ministry of Health.

Second aspect refers to the considerable disparities between urban and rural areas of the country, which have still remained important.139 Since 2006 the Government has made efforts for hiring of medical personnel in rural areas and districts, in particular young specialists.140 Thus, an increasing number of family doctors and medical assistants were distributed in the rural environment. In the first 8 months of 2010, 417 young specialists were hired (72 doctors and 345 medical assistants), and a total MDL 7.66 million were allotted for these specialists (MDL 30 thousand to each doctor and MDL 24 thousand to each medical assistant). In addition, for the improvement of the policy for medical personnel management, a human resource database in the field of health has been developed. Factors that hinder access to health services The lack of medical insurance impedes access to health services for about 20% of population. The access of Roma to health services is problematic in Moldova as in other countries. In 2005-2006, only 23% of Roma households did have a medical insurance, which represented at that time about half of the 139 Nemerenco, A., Republic of Moldova: children living in poverty â&#x20AC;&#x201C; implications for the health system, in World Health Organization Europe, Poverty and Social Exclusion in the WHO European Region: health systems respond, 2010: 141. 140 Government of the Republic of Moldova, Report on the Evaluation of the National Development Strategy Implementation During the Period 2009-2010, 2010: 70.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

proportion of general population.141 It is not clear whether the situation has improved or not in recent years as updated data is not available. The lack of insurance is even stronger considering the poor knowledge of parents and adolescents on health issues, including information on the universality of health insurance for children and pregnant women. Thus, the low level of information of the population, particularly among vulnerable groups such as poor, numerous families or Roma, represents an additional factor which obstructs access to health care. For example, in 2009, 61.1% of households with three or more children did not go to the doctor because they believed that they did not have a medical insurance.142 A survey carried out in 2008 by the Ministry of Health revealed that approximately one third of respondents did not know the medical services included in the health insurance.143 Underdeveloped transport infrastructure and transportation-related costs also represent factors, which hinder access to medical services, specifically because of the insufficient provision with health services in rural areas. The Annual Report on Health (2009)144 identifies 200 rural localities where a doctor comes only two or three times a week. In other 25 villages, there are no doctors at all. As result, 5.5% of households have limited access to health services due to location at long distances. The most disadvantaged groups include single parents with children, households with disabled persons and families with three or more children.145 Furthermore, for children with disabilities, early intervention services have been developed only in 4 districts (see figure 8). Alternatively, youth-friendly services are supplied only in 10 districts out of 35, and these do not outreach the most vulnerable or at risk adolescents.146 Other factors that hamper access to health services come from practices of the population but also of the medical staff. For example, very few adolescents test for HIV, although voluntary counseling and testing services are available starting with 2008 in all districts, and HIV testing is free 141 UNDP, Roma in the Republic of Moldova, 2007. 142 National Human Development Report, 2010: 87. Data from UNDP RBEC (2009). Regional study on Social Exclusion. 143 Ministry of Health, Rezultatele sondajului de opinie privind gradul de satisfacţie al pacienţilor la nivel naţional pe parcursul anului 2008, 2009: 24. 144 Ministry of Health, Raport Anual în Sănătate 2009, 2010: 32. 145 UNDP, National Human Development Report 2010/2011, 2011: 88. Data from the National Bureau of Statistics. 146 UNICEF, Ministry of Health, Mid-Term Review, UNICEF – Government of the Republic of Moldova Country Programme of Cooperation 2007-2011, Leadership Area, Adolescent Health and Development, 2009: 31-32. In the Republic of Moldova, a total of 12 youth-friendly clinics are available, which are located in Chisinau, Balti and in 10 raions. In these clinics, multidisciplinary teams oﬀer services. The oﬀered services are OB/GYN consultations, STI counseling and management, urologist, psychologist or psychiatrist, social worker, internal medicine specialist services. Informational activities are oriented towards reproductive health, mental health, personal skills and communication, violence prevention, healthy lifestyle, prevention of HIV, TB and Hepatitis, healthy nutrition, and children rights.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

of charge.147 The medical staff, on the other side, shows discriminatory attitudes and lack of confidentiality for children and families affected by HIV/AIDS. Another good example, the poor women as well as Roma women tend to address less the preventive health services due to their lower level of information, but also because of the prejudiced attitudes of the medical personnel (especially against Roma) and to the requested payments out of the pocket. 148 Out-of-pocket payments for health impede mostly poor households’ access to health services.149 They include direct payments for goods and services not covered by the health insurance, co-payment of goods and services included in the health insurance and informal payments to health personnel. Most of these expenditures go for payment of pharmaceuticals. In addition, a Transparency International study showed that health institutions ‘collect’ the highest number of informal payments from households. 150 Caregivers of persons with disabilities (including children) express the need for support, as the health insurance does not cover for the costs of many medicines and treatment. For going to the hospital, a family needs to rent a car which raises additional costs. Additionally, the cost of rehabilitation services is quite high. 151 Similar information regarding biased behaviors and attitudes of some doctors are reported by parents from poor families. For this reason, they tend to perceive the access to health services as unsatisfactory, particularly considering their consistent efforts to assure medical treatment when one of their children is sick. As coping strategy, they go to the doctor only in complicated cases, treating their children through traditional methods otherwise (in cases such as flues).152 3.5.2 Policy Gaps and Solutions Universal access to quality public health, medical and pharmaceutical services, including achievement of the MDG targets represents Moldova’s 147 Ibid. 148 UNDP, Roma in the Republic of Moldova, 2007. 149 European Observatory on Health Systems and Policies, Moldova, Health System Review, Health Systems in Transition, vol.10, 2008: 49-50. 150 An average of 200 informal payments, with an average ‘bribe’ of 783 lei. Source: Transparency International, Perceptions and experiences of household representatives and businessmen regarding corruption in the Republic of Moldova, 2009:21. 151 Oxford Policy Management, Needs assessment of persons with severe disabilities and their families, 2011: 9. 152 UNICEF, Impact of public transfer payments on poverty and well being of the most vulnerable families in the Republic of Moldova, in the context of transition from category-based to means-testing social assistance, 2011: 10.

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priorities in the health sector acknowledged within the Government’s Activity Program for 2011-2014.153 Statistics and studies An important problem related to monitoring access to health services is the quality of statistics. In this respect, the Republic of Moldova should make significant progress in supplying in a coherent and continuous manner the statistical indicators used at the international level in areas such as mental disorders. In the same time, detailed studies are needed in areas in which data are missing e.g. suicide, teenage mothers, etc. For designing evidence-based policies and programs, statistics should also be available disaggregated by age, gender, ethnic group, social criteria and geographic distribution (including Transnistria). Infant mortality In order to ensure better policy effectiveness, in 2010, the Government of the Republic of Moldova issued a Rule on inter-sectoral social and medical collaboration mechanism in the field of prevention and decrease of the infant and under-five mortality at home and first 24 hours of hospitalization.154 A pilot project for testing this mechanism was developed in four districts with the support of Lumos Foundation and UNICEF Moldova. This pilot project aims to develop and test the referral mechanism, expected to contribute to early identification of vulnerable families and to ensure referral to social and health services, ultimately contributing to prevention of infant and child mortality. UNICEF also supports the Ministry of Health in the elaboration of a Parents and Adolescent Guide aimed to improve parent’s knowledge and practices for child care and development.155 This initiative is highly relevant considering that in Moldova almost 20% of deaths of children underfive happen at home, the majority of cases from preventable causes of deaths. Nevertheless, its effectiveness remains to be seen, since parental education services are missing and the phenomenon may as well be linked to the large number of children left unsupervised by parents who left for work abroad. 153 Programul de activitate al Guvernului ‘Integrarea Europeană: Libertate, Democraţie, Bunăstare’ pentru anii 2011-2014, 2011: 72. 154 Governmental Decision no. 1182/ December 22, 2010. 155 Ministry of Health, Raport Anual în Sănătate 2010, 2011: 61.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Maternal health Improved access to healthcare, especially in rural areas, adequate level of implementation of the protocols for monitoring and treating pregnant women as well as decreased poverty levels are considered the policy priorities in reducing maternal mortality.156 On the other hand, reducing the teen pregnancy is critical. Knowledge about safer sex behaviors should be seriously improved as unsafe sex behaviors continue to be dominant among young, especially among mostat-risk groups, which leads to teen unwanted pregnancies and high STI incidence. Access to free modern contraception needs to be extended also. In this respect, the youth-friendly services may be extended and enhanced regarding the outreaching activities or free condoms programmes. Malnutrition Latest analyses on the economic crisis impact recommend enhanced efforts for prevention of child malnutrition (continuing distribution of food to pregnant women, lactating mothers and children under 3 years old during winter time) and extended coverage of the Early Childhood Development program, focusing on young children (0 to 7 years of age) as the most vulnerable to malnutrition. This is of special importance in times of crisis, when the reduction in food consumption, in both quantity and quality, represents the dominant coping strategy for all households, including the poorer which concentrate the households with many children.157 Children with disabilities Policy recommendations for children with disabilities focus on the development of early intervention services. Policy options158 include development of such services at family doctors centres, development of an early intervention information system, training courses of professionals, and legislative improvements (on methodology and practices of working with the family of disabled child and review of Law on social integration of disabled people according to the European standards).

156 Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010: 73. 157 UN, The World Bank, Impact of the Economic Crisis on Poverty and Social Exclusion in the Republic of Moldova, 2009: 39-45. 158 UNICEF, Assessment and Recommendation on Child Disability Prevention and Care System in Moldova, 2009: 28-30.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Mental health and suicide Evidence-based policy in this area is not possible as the current statistics do not provide accurate information on the incidence, distribution, structure and underlying causes of mental disorders in adolescents. The difference in classifications used by the European countries poses additional difficulties. Furthermore, the current monitoring system does not provide information to evaluate outcomes and key performance indicators for the mental health system. The mental health services are insufficient, and the shortage is even more accentuated in providing care to children and adolescents. The system is fragmented and lacks multi-sectoral coordination between education and health systems both in terms of the data collection or referral system. Actually, the referral mechanism between the two sectors is not regulated, and in reality, does not exist. Furthermore, long-term community services to help family and community reintegration for children with mental or behavior disorders are scarce and heavily depend on external donor financing. Adolescent health and development The main achievements in this area include both developments of the legal and policy framework as well as improvement of services. The government has initiated and implemented Youth Law, Youth Strategy 2009-2013, a budgeted Plan of Action for 2009. Health policies are well-defined and have youth-specific activities, including national strategy and programs that address healthy lifestyles, HIV and Sexually Transmitted Infections, Reproductive Health, and Mental Health. The free health insurance covers children and youth up to 18 years. With support from international donors, 12 youth-friendly clinics were developed (since 2008 covered from the Health Insurance Fund). A national network of centers of voluntary counseling and testing has become available starting with year 2008 in each district (35 centers covered from the Health Insurance Fund). Several mechanisms of youth empowerment and participation have been developed in the whole country. Several gaps remain, however, to be addressed. National policies and programs do not target most-at-risk adolescents or specific subpopulations in which the interventions may have the highest impact.159 Youth-friendly services have limited geographic coverage and do not have outreaching 159 UNAIDS, Data Synthesis on Tendencies of the HIV epidemic and Impact of HIV prevention interventions in the Republic of Moldova 2011, 2011; Ministry of Health, Raport Anual ﾃｮn Sﾄハﾄフate 2010, 2011.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

programmes to most-at-risk adolescents, such as rural youth, youth from incomplete and poor families or without parental supervision, youth practicing high-risk behaviors, etc. A coherent and nation-wide educational policy for compulsory health education curricula contributing to increased knowledge on HIV/AIDS but also on effective life skills is still missing.160 Health prevention services and activities are underdeveloped and severely under-funded. In the same time, they are not integrated with the treatment services. Finally, budget allocations do not cover all activities included in the national strategies or programmes, and usually cover human resources and infrastructure maintenance with little left for the implementation of activities. HIV/AIDS In response to the growing challenge posed by the HIV/AIDS epidemic, a new Governmental Plan has been adopted in 2010 for the period left for achieving the MDG targets, National Programme on Prevention and Control of HIV/AIDS and STI 2011–2015. The following fields are considered as priority interventions:161 development and extension of prevention activities for the general population, including the rural one, migrants and other high-risk groups; continuous development of services for counseling and voluntary testing; development of infrastructure for improved universal access to medical assistance and palliative care through decentralization of antiretroviral treatment.

Substance use There is no official estimation of the number of injecting drug users in the Republic of Moldova, which makes difficult a realistic policy design.

160 Scutelniciuc et al. (2008); UNICEF, Ministry of Health, Mid-Term Review, UNICEF – Government of the Republic of Moldova Country Programme of Cooperation 2007-2011, Leadership Area, Adolescent Health and Development, 2009. 161 Ministry of Health, Raport Anual în Sănătate 2010, 2011.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

An extensive network of harm reduction (HR) services162 is available across the country. The volume of services they provide has continuously decreased due to shrinking financing after 2007. The financial sustainability of HR services should be considered on the longer term, as it is financed by the Government with 20%, while the rest is supported by international donors.163 The existing HR program lacks ‘breaking-the-cycle’ interventions. For becoming more effective it needs to find solutions for extending the range of available services and coverage of younger cohorts. Otherwise, specifically in the absence of a comprehensive national school-based drug prevention program and considering the dominant practices of adolescents injecting drug users (indirect needles sharing and unsafe sex practices, even among the beneficiaries of harm reduction services), new generations will continue to feed on the system. This will lead to a persistent large number of children injecting drug users and most likely to higher HIV/STI transmission rates in the future. The Framework Convention on Tobacco has been approved, but implementation lags behind. Possible effective measures include a significant increase in cigarette price, introduction of a smoking-cessation program for young, and education programs for preventing tobacco use. Regarding alcohol, there is no national program of prevention and consumption reduction targeted to the youth. This is a major gap considering the high and increasing proportions of adolescents who drink alcohol, both among boys and girls, as well as the tolerant attitudes towards alcohol use. Access to water and sanitation Improvements in access to safe water sources and sanitation facilities need substantial investments, which require a large funding from both State Budget and external donors.

162 Implementation of the Harm Reduction Strategy (started in 1997) has been supported mainly by the Soros Foundation Moldova, also with the support of other international donors. Harm Reduction programmes are available starting with 2000, with a geographic expansion in 2003. At the end of 2007, needle exchange services were oﬀered in 21 administrative territories (with extensions to rural areas) and in 6 penitentiary institutions. UNICEF, Ministry of Health, Mid-Term Review, UNICEF – Government of the Republic of Moldova Country Programme of Cooperation 2007-2011, Leadership Area, Adolescent Health and Development, 2009: 24-25. 163 Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010: 81; UNICEF, Needs Assessment Study Prevention of Mother to Child Transmission Programme in the Republic of Moldova, 2009: 10-11.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

3.6 Recommendations To improve statistics by adopting the international standard methodologies and by conducting detailed studies in the areas in which data are missing (e.g. mental health, suicide, injecting drug users, teenage mothers, etc.). For evidence-based programming, the national statistics should also be available disaggregated by age, gender, ethnic group, social criteria and geographic distribution (including Transnistria). To develop legal mechanisms for public sector to contract NGOs to provide youth-friendly services. To improve the legislation on methodology and practices of working with the family of disabled child and review of Law on social integration of disabled people according to the European standards. To provide financing from the National Insurance Fund and implementing mechanisms (also through contracting out services to NGOs), especially for preventive and health promotion activities. To develop at community level the early identification of vulnerable families and to ensure referral to social and health services, ultimately contributing to prevention of infant and child mortality. To develop a national referral mechanism between the education and health systems both in terms of the data collection and referral system for children and adolescents with mental and behavior disorders. To introduce parental education services, particularly for parents of children aged 0-3 years. To continue the distribution of food to pregnant women, lactating mothers and children under 3 years old during winter time and to extend coverage of the Early Childhood Development program, focusing on young children (0 to 7 years of age), for preventing child malnutrition during the period of crisis.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

To expand geographic access to youth-friendly services, especially in rural areas, and for most vulnerable ones (including Transnistria region). To increase the capacity of youth-friendly services to outreach the most vulnerable and to expand the range of preventive services such as free condoms programmes. To develop the specialized services addressing the most-at-risk groups of young people (e.g. harm reduction programme including â&#x20AC;&#x2DC;break-the-circleâ&#x20AC;&#x2122; interventions, drug and alcohol long-term rehabilitation services, smoking-cessation programme, etc.). To introduce a coherent and nation-wide educational policy for compulsory health education curricula contributing to increased knowledge on HIV/AIDS but also on effective life skills. To train professionals in contact with children and young (medical staff, social workers, particularly in rural areas). To develop transport infrastructure geographical access to medical assistance.

for

improved

To improve access to safe water sources, sewerage and sanitation in the schools from rural areas. To work with media to promote healthy lifestyle and to reduce the discriminatory attitudes towards vulnerable groups of children (e.g. Roma, people living with HIV, etc.).

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

4. EARLY CHILDHOOD DEVELOPMENT AND EDUCATION Convention of the Rights of the Child Articles This section addresses child’s right to education, recognized under Articles 28 and 29 of Convention on the Rights of the Child (CRC). The Convention acknowledges that the countries should achieve fulfillment of this right ‘progressively and on the basis of equal opportunity’.164 Ensuring access to general compulsory education is one of the Millennium Development Goals.

4.1 Key Data What are the key issues making children vulnerable: situation and trends? Rates of enrollment in pre-primary education have been constantly increasing. Nonetheless they remain far from the EU-27 average. Rural areas are in a constant disadvantage. There is minor progress in the use of positive childcare practices among families with small children (0-7 years) from Moldova. Pre-primary education services for children aged 0-3 years are not available. Parental education or counseling services are not developed either. Gross enrollment rates for primary and secondary education follow a declining trend. 164 UN, 1989, Convention on the Rights of the Child.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Groups of children vulnerable to access to compulsory education are children from low-income households (including households with many children and single parent families), Roma, children with disabilities, children with HIV/AIDS, children left behind by migrant parents, and children from Transnistria. Geographic access, poverty, teachers’ negative attitudes and poor skills hinder access of children to school. Intolerant attitudes among general population towards children with special educational needs are widespread.

4.2 Pre-primary Education Early Childhood Development faces new challenges in the Republic of Moldova. The cohort 0-4 years of age has increased starting with 2005, and the number of children left behind by migrant parents is high. Rates of enrollment in pre-primary education have been constantly increasing and are likely to achieve in 2015 the MDG target of 78% (for children aged 3-6 years). Nonetheless they remain far from the EU27 average (figure 18).165 In the same time, the official statistics166 on compulsory preparation to school show that the proportion of children enrolled in primary school in 2010/2011, who attended any form of early education, reached 97.7%, with an increase of 6.2% compared to 2009/2010.

165 The enrollment rate for the age-group of 6-7 years is diﬃcult to be objectively ‘captured’ in statistics, as at this age some of the children start primary education. It is considered to be on an upward trend. However, there are data discrepancies between the information provided for this indicator from the National Bureau of Statistics and the ones from the Ministry of Education (used for the 2007 MDG report and for setting the MDG targets for 2010 and 2015). Source: Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010: 36. 166 National Bureau of Statistics,http://www.statistica.md/newsview.php?l=ro&id=3211&idc=168.

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Figure 18. Gross enrollment, pre-primary (%)167 120,0 100,0

Europea n Uni on; 88,0 85,8

89,2

89,9

89,4

92,5

101,2

94,7

95,4

70,7

70,1

72,6

2006

2007

2008

80,0 60,0 40,0

Roma ni a 55,3 Mol dova ; 42,4

59,4

66,1

46,0

20,0 0,0 2000

2001

2002

2003

2004

2005

Data: United Nations Educational, Scientific, and Cultural Organization (UNESCO), Institute for Statistics, World Bank Development Indicators, World Bank, at http://data.worldbank.org/data-catalog/world-development-indicators. Notes: Gross enrollment ratio is the ratio of total enrollment, regardless of age, to the population of the age group that oﬃcially corresponds to the level of education shown. Preprimary education refers to the initial stage of organized instruction, designed primarily to introduce very young children to a school-type environment.

There are, however, major discrepancies between rural and urban areas. Rates of enrollment in pre-school institutions in urban areas have continuously been more than 1.5 times higher than those from rural areas (table 3). Enrollment in pre-school institutions in rural areas, although has significantly increased since 2000, reached just 47.7% of the 3-6-year age group in 2010. Actually, the coverage with pre-school institutions is much lower in rural localities. At the country level, in 2009 there still were 230 rural communities that lack pre-primary education institutions.168 At the regional level, the north region has the largest number of localities without kindergartens. At the district level, the most disadvantaged are Soroca, Fălești, Sângerei and Orhei.169

167 There are diﬀerences in computations of gross enrollment ratio in pre-primary education between various data sources (Eurostat, National Bureau of Statistics of the Republic of Moldova, TransMONEE 2011 database, UNESCO database). However, the diﬀerence in trends between EU, Romania and Moldova holds regardless of the computation method. 168 Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010: 37; UNICEF, Ministry of Education and Youth at the Republic of Moldova, Mid-Term Review of the 2007-2011 Program of Cooperation between the Moldovan Government and UNICEF, Equitable Access to Quality Education, 2009: 16. 169 IDIS Viitorul, Educaţia preșcolară în Republica Moldova din perspectiva incluziunii și a echităţii sociale, 2008: 20.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Table 3. Gross enrollment rate in pre-school institutions, by residence area (% 3-6 years old) 2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

Moldova

34.7

41.4

44.8

48.2

50.7

51.1

53.1

54.7

56.2

57.1

Urban

56.5

60.8

62.2

65.0

67.0

66.9

68.6

70.7

71.8

73.2

Rural

29.1

34.4

35.8

39.3

42.0

42.5

44.3

45.6

47.2

47.7

Data source: National Bureau of Statistics.170 Notes: Gross enrollment ratio in pre-school institutions is the ratio of children aged 3 years or more enrolled in pre-school institutions to the population of the age group that oﬃcially corresponds to the level of education shown (3-6 years old).

There are no gender disparities in accessing pre-school education. Nevertheless, three groups of children have considerably lower enrollment rates in the mainstream pre-primary education. These groups are the Roma, children from low-income families (including households with many children and single parent families) and children with disabilities.171 Several factors hinder access of children to pre-school education.172 Most important factors include poor transport and educational infrastructure, informal payments, parents’ level of education and their attitudes toward education. Mother’s level of education strongly influences participation of children to pre-school education. The higher the level of education the mother achieved, the higher is the child probability to be enrolled in early education. Besides education, attitudes toward the education count too. On the one hand, poor parents as well as parents from rural areas prefer to keep their children at home, instead of kindergartens, especially during the cold periods of the year. In this way, they save money in the periods when work opportunities are scarce, even more so, given the increasing necessary expenditures and the requested informal payments.173 Other parents consider that grandparents or other relatives offer a better earlychildhood care than do pre-school institutions.

170 National Bureau of Statistics, Education in the Republic of Moldova 2010/2011, Statistical Publication, 2011: 37. 171 Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010: 35; IDIS Viitorul, Educaţia preșcolară în Republica Moldova din perspectiva incluziunii și a echităţii sociale, 2008: 30. 172 UNDP, National Human Development Report, From Social Exclusion towards Inclusive Human Development, 2010: 7172. SADI data. 173 Ibid., 2008: 5. The average expenditures related to kindergarten of households with children aged 0-7 years increased almost two times between 2003 and 2009 (from 282 MDL to 538 MDL respectively). UNICEF, Government of the Republic of Moldova, National Study on Knowledge, Attitudes and Practices of Families in the field of early childhood development and care, 2010: 29.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

For children with disabilities, the concept of inclusive education at the pre-primary level is still quite far from being operational. In 2008, 33 kindergartens for children with special needs were working in specialized groups, and 2,267 children with mild disabilities attended. Children with medium level or severe mental disabilities are not integrated into the preschooling system at all.174 Furthermore, tolerant attitudes towards children with special educational needs are alarmingly low among families with young children (0-7 years old). Only 5% of them consider that children with disabilities could attend the kindergarten in their community and just 46% would allow their children to play with a child with disabilities.175 Parentsâ&#x20AC;&#x2122; knowledge, attitudes and practices play a key role in the earlychildhood development. A recent research176 reveals a minor progress in the use of positive childcare practices among families with small children (0-7 years) from Moldova. Between 2003 and 2009, the number of parents who play with their children increased to 92%. The share of parents who read to their children, on the other side, has decreased (from 37% in 2003 to 30% in 2009), under conditions of poor endowment with child books (26% of families have none) within households. Severely disadvantaged are children from low-income households and children from rural areas (with the note that the ethnic group of respondents was not registered). Pre-primary education services for children aged 0-3 years are not available. Parental education or counseling services are not developed either. Given the rather low knowledge and use of the positive childcare practices in Moldova, the specialists consider the age group 0-3 years as vulnerable from the educational point of view.177

4.3 Primary and Secondary Education 4.3.1 Access to Education The 2010 MDG target set at 95% for general compulsory education has not been met. Subsequently, the target of 98% for 2015 is not likely to be attained.

174 UNICEF, Assessment and Recommendation on Child Disability Prevention and Care System in Moldova, 2009. 175 UNICEF, Government of the Republic of Moldova, National Study on Knowledge, Attitudes and Practices of Families in the field of early childhood development and care, 2010: 21. Data from 2009. 176 Ibid., 2010: 25-26. 177 The second MDG report for Moldova recommends starting with parentsâ&#x20AC;&#x2122; education before conception, prenatal education, following with educational programs for parents with children in the pre-school institutions or child protection system.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

In the school year 2010/2011, the gross enrollment rate reached 93.6% in primary education and 88.1% for secondary schooling. Both rates have followed a declining trend since 2005. The highest loss was recorded in rural areas, where the rates decreased with about -6% both at primary and secondary levels. Consequently, the urban-rural gap has seriously widened. In the urban areas, on the other side, only the gross enrollment in primary education has increased, whereas that in secondary levels has followed the general negative trend. Figure 19. Gross enrollment rates by level of education and residence area (%) 110 105

102,4 100,5

100,9

101,6

102,4

Pri ma ry Urba n; 104

100 Seconda ry Urba n; 95,6 Pri ma ry tota l ; 93,6

95 90

Seconda ry tota l ; 88,1 Pri ma ry Rura l ; 88

90,3 87,9

87,3

86,3

Seconda ry Rura l ; 84,3

85,3

80 2005

2006

2007

2008

2009

2010

Data source: National Bureau of Statistics, Education in the Republic of Moldova, 2010/2011 and 2008/2009.

Other relevant indicators used usually for monitoring access to education comprise school drop-out and early school leavers rates. The first rate is not available in Moldova, while the second is computed only at request. This latter indicator shows that early school leavers178 represented 20.1% of the 18-24 years age group, in 2008, with large differences between urban and rural area (31% in rural compared to 7% in urban areas). The value is high in the European context, where the EU-27 average for 2008 is of 14.9%. This indicator is now used to monitor constantly, at the EU level, the Strategy for Smart, Sustainable and Inclusive Growth - Europe 2020.179

178 Eurostat definition: Percentage of the population aged 18-24 with the lowest level of secondary education at most (ISCED 0-3c) and not receiving any education or training. Data from the Labour Force Survey. 179 http://ec.europa.eu/europe2020/index_en.htm .

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Declining trends180 of the enrollment in compulsory education are driven by factors related to poor infrastructure in rural areas, attitudes and practices of teaching staff or other various aspects that prevent specific groups of children to access or to continue education. The groups of children with considerable lower enrollment rates in compulsory education refer to children from low-income households (including households with many children and single parent families), Roma, children with disabilities, children with HIV/AIDS, children left behind by migrant parents, and children from Transnistria. Children from poor families (including families with many children and lone parent families) as well as those from rural areas have significantly lower access to compulsory education, which is further reduced by the presence of informal payments.181 Households with children from the Republic of Moldova spend for education less than 1% of the total household budget. During the crisis, the monthly consumption expenditures per capita were considerably cut. The households with children made the most significant reductions in food consumption (and in other areas), resources being reallocated mainly to education (and less in health, dwelling maintenance, communication and others). In times of crisis, the couples with children allot 0.9% of the total household budget on education. The share spent on education varies greatly between 0.1-0.2% in low-income households, which concentrate families with many children, and 1.5% in the richest households. Single-parent families allocate less on education (0.4%). Households from rural areas spend from their budget a share three times lower than do household located in towns and seven times lower than those from cities (0.2% compared to 0.6% and 1.4% respectively).182 Roma children face multiple obstacles in accessing compulsory education. There are significant differences in school attendance between Roma and non-Roma children. Of the 7-15-year age group, 43% of Roma do not attend school in comparison to 6% of non-Roma.183 An UNDP study from 2007 shows that the drop in school enrollment of Roma children begins already in primary school, as enrollment in secondary education is only 45% (compared to 94% for non-Roma children) while upper secondary 180 This is partially the eﬀect of the practice of combining two years into one, common to both cycles, primary and secondary, which results into decreased values of the indicator on general compulsory education. Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010: 32. 181 Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010; UNICEF, Ministry of Education and Youth of the Republic of Moldova, Mid-Term Review of the 2007-2011 Program of Cooperation between the Moldovan Government and UNICEF, Equitable Access to Quality Education, 2009; Institutul de Politici Publice, Plăţile informale în învăţământul preuniversitar și accesul egal la educaţie, 2007. 182 UN, The World Bank, Impact of the Economic Crisis on Poverty and Social Exclusion in the Republic of Moldova, 2009: 39-45. Ministry of Economy, Raport privind saracia si impactul politicilor 2009, 2010: 22-23. 183 UNICEF, The Situation of Roma Children in Moldova, 2010: 23. Data for 2005-2006.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

education is no more than 20%. School dropout is thus very high. The main reasons for dropout among Roma children include the high costs of the studies (34%), illness (7%) and long distance to school (5%). The subjective motivations refer to parents’ attitudes (the necessary level of education is considered at a low scale by many parents), early marriages, migration abroad of the entire family and perceived discrimination in schools. The latter one is considered to be the main reason by the Roma leaders.184 Children with disabilities have a very low participation to the mainstream education. In 2010/2011, only 3,148 children are enrolled in school, out of a total number of 15,321 children with disabilities.185 Those enrolled study in specialized schools or at home. There is no systematic information about the other approximately 11,000186 children, which indicate the clear need for additional studies on this subpopulation of children in Moldova. The legal provisions stipulate that in case the child is not able to attend mainstream school, a teacher should teach him/her at home. However, a recent qualitative assessment shows that this is not really happening in most cases.187 In case the teacher comes at home, it does not last for long. In addition, they lack the appropriate skills and methodologies to work with children with disabilities. Other subpopulation groups which require data collection with regards to education are teenage mothers and injecting drug users. They have been mentioned as vulnerable groups in the chapter on Health. However, for a comprehensive identification of root causes of child vulnerabilities, education should also be considered. Lack of physical facilities (including in schools), shortage of professionals trained in inclusive education as well as deficiency of methodologies, equipments and tools ‘force’ parents of children with disabilities to choose residential institution.188 A study189 on the teachers and pupils from Moldova unravels the attitudes that dominate the national education system from the inclusive education perspective. Part of the teachers thinks that the integration of children with special educational needs would mean 184 UNDP, Roma in the Republic of Moldova, 2007: 61-62, 66. Data for 2005-2006. 185 National Bureau of Statistics, Situaţia copiilor din Republica Moldova în anul 2010, 2011. 186 About 1,100 children with disabilities (0-18 years) are in special residential care institutions, under the Ministry of Health or the Ministry of Labour, Social Protection and Family. (see also section 5.3 on Children in residential care) 187 Oxford Policy Management, Support to the National Development Strategy. Needs Assessment of Persons with Severe Disabilities and Their Families, 2011: 12-13. 188 UNICEF, Assessment and Recommendation on Child Disability Prevention and Care System in Moldova, 2009. 189 UNICEF, Ministry of Education and Youth of the Republic of Moldova, Studiu Educaţia de bază în Republica Moldova din perspectiva școlii prietenoase copilului, 2009: 30, 35.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

a change of focus in attention and therefore, other children would be at disadvantage. Other teachers consider that integrating them would pose budgetary constraints for the educational institutions. Another part signals that children with disabilities would be marginalized and excluded in the mainstream institutions, while some invoke the general population’s intolerant attitudes towards children with disabilities. However, they selfevaluate as poor their level of knowledge on the pedagogical strategies of working with children with disabilities. In teachers’ opinion, for including children with disabilities in the mainstream education the following would be needed: a curriculum change (differentiated and adapted); updating the textbooks; training for teachers; physical facilities for access; changes in the evaluation system. Unlike teachers, children are more likely to accept children with disabilities as colleagues (40% of children fully agree, 30% partially agree and 28% don’t agree at all). Nonetheless, even in this case, the level of acceptance is rather for children with physical disabilities than for those with intellectual disabilities. Similar to the case of children with disabilities, children are more open to the educational inclusion of children with HIV/AIDS than teachers are. The higher their levels of information about transmission mechanisms and protection methods, the more tolerant are pupils towards children with HIV. Nonetheless, children from rural area are less tolerant and although children accept them more than adults do (teachers and parents of healthy children), pupils declared that they would be more cautious with HIV/ AIDS-infected children, even trying to avoid them. In this sense, children with HIV/AIDS may be marginalized.190 In this prejudiced environment, parents living with HIV developed survival strategies. They avoid informing the school that their child belongs to a family affected by HIV, in order to minimize the risk of negative reactions on the part of staff or other children.191 The share of school-age children with parents working abroad in the total number of pupils increased from 18.2% in 2006 to 24% in 2008. Largest shares are in Basarabeasca, Cimislia, Falesti and Floresti districts.192 On this topic, the available studies agree on the following characteristics and 190 Ibid., 2009: 36. 191 Scutelniciuc et al., 2008: 10. 192 National Bureau of Statistics, Approaches to Social Exclusion in the Republic of Moldova, 2010: 126.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

tendencies.193 Migration of parents for work abroad, on the one hand, improves the living conditions of the children left behind, as long as remittances are sent home. On the other hand, the lack of supervision makes children more vulnerable to various risks related to substance abuse (drugs, alcohol), precocious sexual relationships, socially undesirable behaviors or school dropout. After parents left, most children experience sadness, loneliness, and emotional insecurity. Relationships with caretakers are not always close enough so that to fulfill children’s need of moral support. In many cases, relationships with caregivers and family left at home are tensioned. Most caregivers tend to neglect the educational area. Children’s academic performance may change in both directions. However, in most cases, school performances decrease. Lack of supervision and support results in school absenteeism, lose of interest in school, or even school dropout. Teachers have various attitudes towards children left without parental care. Some of them envy the children’s better conditions. Other teachers offer emotional support or sympathy. The family-school relationship is very weak. Schools have the obligation to register them at the beginning of every school year, but schools neither monitor their situation nor offer counseling services. Neither does the community institutions as children of migrants are seen rather a privileged than a vulnerable category. Nonetheless, during the crisis, the remittances were diminished or even ceased so that at least a part of them has experienced in 2010-2011 a sudden and sharp income drop. Regarding children from Transnistria, there are two types of problems in accessing compulsory education.194 Firstly, Transnistria region, education in the mother tongue is a challenge for Moldovan children. In only 20% of the schools in the region children can study in the Romanian language. Secondly, Transnistria is not integrated in the Bologna process of creating a unique European higher education space. Therefore, Moldovan pupils, with a diploma from educational institutions from Transnistria, have difficulties when try to access the right-bank schools.

193 In Moldova, studies on children left without parental care due to migration are based on qualitative methods or on opinion surveys, and not on indicators of educational outcomes. UNICEF and CRIC, Situation of children left behind by migrating parents, 2006; Survey carried out in 128 communities in Moldova by the Institute of Educational Sciences, 2007; UNICEF, The impact of parental deprivation on the development of children left behind by Moldovan migrants, 2008; National Bureau of Statistics, Approaches to Social Exclusion in the Republic of Moldova, 2010; Ministry of Labor, Social Protection and Family, Necesităţile specifice ale copiilor și vârstnicilor lăsaţi fără îngrijirea membrilor de familie plecaţi la muncă peste hotare, 2011. 194 Tiron, 2009: 10; UNDP, National Human Development Report, From Social Exclusion towards Inclusive Human Development, 2010: 77.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

4.3.2 Quality of Education The available information on quality of education in Moldova dates from 2006 (PIRLS) and 2003 (TIMSS). Results at TIMSS and PIRLS International Study Center tests195 indicate rather a poor quality of education. Only 3% of pupils in Moldova have an advanced reading level, 20% have a high level, while 41% are on intermediary level and 24% on a low one. Pupils below the low level represent 9% in reading, 23% of pupils in mathematics and 17% in sciences. Overall, Moldova is close to the international average score. Table 4. Student achievements in mathematics, science and reading (average scores) Mathematics achievement (grade 8) 467

Science achievement (grade 8) 474

Reading achievement (grade 4) 500

Moldova

460

472

500

Latvia

508

512

541

Russian Federation

508

514

565

Lithuania

502

519

537

Romania

476

470

489

Bulgaria

475

479

547

International average

Data: TIMSS and PIRLS results in European Training Foundation, Overview of the Relationship between Human Capital Development and Equity in the Republic of Moldova (2010), p. 28

Other indicators for quality of education are to be found in the statistical data regarding repetition or survival rates. Repetition rates, with data available only for 2007/2008,196 indicate decreasing trends. However, intrepretation of data should consider the changes made in legislation which allows promotion in the next grade even if the pupil has underpassing marks.197 In addition, important consideration regarding quality of education should be devoted to youth entry into the labor market. A recent study on human capital development in Moldova198 concludes that the quality of specialized 195 TIMSS (Trends in International Mathematics and Science Study) and PIRLS (Progress in International Reading Literacy Study). 196 Available in UNICEFâ&#x20AC;&#x2122;s TransMONEE 2011 database. 197 European Training Foundation, Overview of the Relationship between Human Capital Development and Equity in the Republic of Moldova, 2010: 23. 198 European Training Foundation, Overview of the Relationship between Human Capital Development and Equity in the Republic of Moldova, 2010.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

education (vocational, post-secondary non-tertiary and higher education) is decreasing. The finding is based on employers’ and employees’ perceptions on the preparedness of entering the labor market. Same study explains dissatisfaction with the education provided especially in vocational schools by an outdated curriculum and material basis together with a low interest of teachers, which leads to acquiring knowledge irrelevant for the labor market. Many of the students of vocational schools are future migrants. Official data of the National Bureau of Statistics show that, in the last 20 years, the share of youth (15-34 years old) who succeeds, after leaving the educational system, in finding a significant job is decreasing, especially for men.199 Key determinants explaining the quality of education have been attributed to teacher and curriculum quality. Although specialists consider that after the reform, the curriculum has been rarefied, the subjective perceptions of parents, pupils and teachers still consider it overloaded.200 A curriculum evaluation conducted in 2009 by the Institute of Educational Sciences concludes that the current version of the curriculum places little attention on a ‘wise management of personal life’.201 Recommendations for improvement include, among other, a larger focus on competence development, increased share of curriculum left for school decision, ensuring education for private life, promoting a child-friendly school and democracy values, respect for individual rights and responsibilities towards community and society. In this context, placing greater emphasis on Life Skills could bring results under various areas, including the ones already identified under chapter on Health and Nutrition, in particular on sexual education and substance use.

4.4 Capacity and Policy Gaps 4.4.1 Institutional Capacity Financing The education system in Moldova sets the general compulsory education up to the ninth grade. The pre-primary education starts at three years old. Children’s education up to three years old is the responsibility of parents. Compulsory education is free-of-charge for all children 7-16 years. 199 National Bureau of Statistics, Intrarea tinerilor pe piaţa muncii, 2010. 200 UNICEF, Ministry of Education and Youth at the Republic of Moldova, Mid-Term Review of the 2007-2011 Program of Cooperation between the Moldovan Government and UNICEF, Equitable Access to Quality Education, 2009: 17-18. 201 Institutul de Știinţe ale Educaţiei, Evaluarea curriculumului școlar – perspectiva de modernizare, 2009: 653.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

The system is financed from the state budget and internationally-funded programs dedicated to specific issues. State Budget allocations to education have been constantly increased from a low 4.5% in 2000 to 9.5% of GDP in 2009.202 The share of GDP allotted to education ranks Moldova first in comparison with the European Union member states (EU-27 average of 5.6% with a high 8% in Denmark and a low 4.1% in Romania, in 2009).203 However, in absolute terms, the public spending on education is still low in Moldova, although increased considerably in the last years. The share of GDP distributed to education in Moldova, on the one hand, reflects the administrative responsibilities of the Ministry of Education, which is still in charge with a large number of residential institutions. On the other hand, the second MDG report for Moldova points out that this significant budget allocation has not led yet to an improvement in the quality of education.204 The efficiency of public spending in education is rather low due to a series of causes,205 including: (i) financing per institution instead on per pupil; (ii) low wages and strongly influenced by seniority instead of performance, which makes young professionals to leave or not enter the system; (iii) high share of administrative budget and personnel (not linked to the educational process); (iv) decreasing number of pupils per teacher and per administrative staff. Organizational structure and human resources Ministry of Education is the central public administration responsible with the design of educational policies and has under its subordination Education Departments, which are organized at the level of districts and municipalities. The Education Departments, together with the local public authorities, ensure mandatory school enrolment up to 16 years old. Local authorities should organize school transport as well as health care and nutrition of pupils. Previous reports draw attention to certain flaws of the legislative provisions, which conduct to an excessive centralization and an insufficient representation of parents and local communities in decisions regarding children’s education.206 However, the new Consolidated Strategy 202 General government expenditures on education represented 7.2% of GDP in 2005, 8.1% in 2006, 8.0% in 2007, and 8.2% in 2008. Data source: IMF Country Report No. 10/232, July 2010: 11. 203 Eurostat database (General Government Expenditure by function – COFOG) at August 13, 2011. 204 Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010: 31. 205 UNICEF, Ministry of Education and Youth of the Republic of Moldova, Studiu Educaţia de bază în Republica Moldova din perspectiva școlii prietenoase copilului, 2009: 22. 206 UNICEF, Ministry of Education and Youth of the Republic of Moldova, Mid-Term Review of the 2007-2011, Program of Cooperation between the Moldovan Government and UNICEF, Equitable Access to Quality Education, 2009.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

for Education Development for the period 2011-2015 announces various directions for action that are likely to contribute to positive developments. On the infrastructure part, the network of educational institutions has been enlarged for kindergartens, but reduced for schools. In the period 2000-2010, 84 schools were closed down due to a low number of children. Additionally, many schools are in poor conditions. In the rural areas, 29% of schools do not have a heating system and 49% have no water and sewage system.207 (see also section 3.4) Figure 20. Educational institutions in Moldova (number) 2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

Change 2010-2000

Pre-primary

1135

1128

1192

1246

1269

1295

1305

1334

1349

1362

1381

246

Primary and secondary

1573

1584

1587

1583

1577

1558

1546

1541

1526

1512

1489

-84

Source: National Bureau of Statistics. Data for primary and secondary education include institutions subordinated to the Ministry of Education from the left bank of Nistru River. Note: The other institutions from Transnistria include 176 pre-primary institutions with 21,359 children, 192 of general education with 92,352 pupils and 2 institutions of tertiary education. Source: Tiron (2009), p. 5.

The educational system is negatively affected by demographic and economic factors. The low birth rate results in decreasing cohorts of children entering the system. The households’ small incomes (and decreasing during the crisis) and high incidence of consumption-poverty further diminishes the school population. In this context, a reform of school network optimization is implemented, which envisages to contribute to a more efficient use of funds through the following key actions: (i) creation of circumscription schools, so-called ‘hub’ schools; 208 (ii) development of the school transport system; (iii) introduction of per-student financing formula; and (iv)financial decentralization at the level of education institution.209 In Moldova, in 2010, the education sector employed more than 119 thousands persons. Employment in education is highly concentrated in the public sector (98%), is feminized (74%), and has had a continuous declining trend since 2006.210 207 UNICEF, Ministry of Education and Youth of the Republic of Moldova, Studiu Educaţia de bază în Republica Moldova din perspectiva școlii prietenoase copilului, 2009: 80. 208 The circumscription schools will group children from several communities. The selected schools which will be regrouped at district level will be selected from communities with a low number of children, where running costs are increasingly higher. Transport solutions are identified, as mentioned under component (ii). 209 Government of the Republic of Moldova, Rethink Moldova, Medium Term Development Priorities, 2010: 31. 210 National Bureau of Statistics, http://statbank.statistica.md. Data refers to the average monthly average of employees. Transnistria is not included.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

The management of human resources in the education system is shaped by several aspects. As in the case of health sector, first aspect is the mass migration of professionals. Official statistics indicate that over 12,000 teachers, unofficial estimates amounts to more than 20,000 teachers, left the education system between 1995 and 1999, especially from rural areas.211 Other relevant aspects in Moldova refer to wages, job attractiveness, and pronounced aging tendency of the system workforce. Wages, although have increased, are low in the education system, much lower than in the health system. Table 5. Gross wages in Moldova in the social sectors by sector 2004

2005

2006

2007

2008

2009

2010

1103,1

1318,7

1697,1

2065,0

2529,7

2747,6

2971,7

- nominal, MDL

710,7

881,8

1209,3

1351,2

1670,5

2135,6

2361,0

- % national average monthly wage

64,4

66,9

71,3

65,4

66,0

77,7

79,4

- nominal, MDL

844,7

1016,7

1333,5

1703,2

2265,5

2718,2

2886,3

- % national average monthly wage

76,6

77,1

78,6

82,5

89,6

98,9

97,1

Average monthly wage on economy (nominal, MDL) Education

Health and social assistance

Data: National Bureau of Statistics, http://statbank.statistica.md Notes: Indicators based on data collected in all enterprises with 19 or more employees. Transnistria is not included.

Job attractiveness is low, especially in the rural areas. In order to increase attractiveness, a governmental program on the provision in rural settlements of free housing for young specialists with tertiary and postgraduate studies distributed in public institutions was enacted in 2008. However, the impact of this program has not yet been assessed. The education sector workforce has a marked aging tendency. The share of teachers of retirement age in the total number of staff has constantly increased from 6.6% in 2000/2001 to 19.6% in 2010/2011 school year.212 As less and less fresh graduates applied or were recruited for a teaching position,213 retired teachers were employed to fill in vacancies in schools. The results, however, have been positive, according to the school directors 211 UNDP, National Human Development Report, Republic of Moldova, From Social Exclusion towards Inclusive Human Development, 2011: 68. 212 National Bureau of Statistics, Education in the Republic of Moldova 2010/2011, 2011: 57. 213 European Training Foundation, Overview of the Relationship between Human Capital Development and Equity in the Republic of Moldova, 2010: 30.

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

and the representatives of the Ministry of Education. 214 The retired teachers who re-entered the system are experienced and well-qualified, so the quality of education has been maintained in spite of the low wages. Furthermore, the retired teachers are legally allowed to accumulate the (low) pension with the (low) wage, so the living conditions of teaching staff has been preserved at an acceptable level. In the education sector, the workload is high. This, nevertheless, is the effect of low wages also. Allowing more than one teaching-norm per teacher has been used as a salary incentive in Moldova. Thus, most teachers have up to 1.5 norms, but a considerable share has over 1.5 workloads, in both urban and rural areas, primary and secondary schools.215 Considering all the above, the main policy recommendations on teacher quality and working conditions are directed primarily to ensuring recruitment and retention of young teachers, accompanied by developing a comprehensive system of salary incentives and bonuses based on performance.216 Factors that hinder access to education services There are no educational services available, neither for children nor for their parents, for two categories, namely children aged 0-3 years and children with medium or severe mental disabilities. Geographic access to kindergartens is problematic for about 3.8% of families with pre-school children (in 2008), especially in the south and center parts of the country. In Chisinau as in other cities, on the other side, over-crowded traffic limits access of children to kindergarten.217 Lack of geographic access to general compulsory education institutions, due to large distances and underdeveloped transportation, is more frequent in the north and south parts of the country, regarding secondary schools, especially. This holds also for the 50-60 rural remote communities of Roma.218 Teachers’ negative attitudes and poor skills represent another factor that hinders access of children to school. Part of the teachers is reported to have hostile attitudes towards children with learning difficulties or disabilities. 214 UNICEF, Teacher Quality and Teacher Work Conditions in the Republic of Moldova, 2010: 43. 215 Ibid., 2010: 42-43. 216 UNICEF, Teacher Quality and Teacher Work Conditions in the Republic of Moldova, 2010: 52-54. 217 IDIS Viitorul, Educaţia preșcolară în Republica Moldova din perspectiva incluziunii și a echităţii sociale, 2008: 30. 218 UNDP, National Human Development Report, From Social Exclusion towards Inclusive Human Development, 2010: 72; UNICEF, The Situation of Roma Children in Moldova, 2010: 24.

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Actually, most teachers self-evaluate as poor their knowledge on the pedagogical strategies of working with children with disabilities. In the same time, some are not supportive with children who return to school or with those left behind by migrant parents, increasing in this way their chances of school dropout. One in ten children does not attend classes because she/he has not done homework. Other children do not attend classes for fear of teacher or conflicting relations with colleagues. In 2008, some 16% of pupils declared that they received corporal punishment from teachers, whereas only 2% of teachers reported to do so. 219 Poverty impedes access to education, also in relation to the needed informal payments. Particularly in rural areas, families dependent on agriculture, take their children from kindergarten during winter in order to reduce household expenditures. Others do not take their children to kindergarten due to lack of proper clothing and shoes, especially when it rains or it is cold. Some others, including Roma parents, particularly from localities with insufficient places in pre-school institutions, report restricted access because children whose parents have a certain social and/or financial position are received with preference. However, in many localities, the local authorities provide financial support to low-income families for the attendance of kindergarten.220 So, ultimately , parents’ attitudes influence enrollment of children in pre-school education. In addition, it may represent a barrier to the inclusion of children with disabilities in the mainstream education, be it pre-school, primary or secondary levels. Finally, the declining trends of enrollment in compulsory education in rural areas and the increasing urban-rural gap in school access show the clear need for tackling the accumulated disadvantages of children from rural areas: poor school infrastructure, large distances, higher rates of poverty, and migrating parents. 4.4.2 Policy Gaps and Solutions Universal access to quality education, especially access to pre-school education, preparation of students for life, improving efficiency of public spending in education and promotion of inclusive education are among the country priorities in the pre-university education acknowledged within the Government’s Activity Program for 2011-2014.221 219 UNICEF, Ministry of Education and Youth of the Republic of Moldova, Educaţia de bază în Republica Moldova din perspectiva școlii prietenoase copilului, 2009: 30. 220 UNICEF, Impact of public transfer payments on poverty and well being of the most vulnerable families in the Republic of Moldova, in the context of transition from category-based to means-testing social assistance, 2011: 12. 221 Programul de activitate al Guvernului ‘Integrarea Europeană: Libertate, Democraţie, Bunăstare’ pentru anii 2011-2014, 2011: 67. SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

Statistics and studies An important problem related to monitoring access to education is the quality of statistics. In this respect, the Republic of Moldova should make significant progress in supplying in a coherent and continuous manner the statistical indicators used at the international level, such as school drop-out rate, share of children who successfully completed compulsory education or rate of early school leavers222 (which is now computed only at request). In the same time, data and studies from the education of view are missing regarding the situation of children with disabilities, children without parental care, but also of Roma. Around 11,000 children with disabilities are neither enrolled in school, nor in residential care, and no data are available. Children left behind migrants represent almost a quarter of the school population, but there are no data regarding their school performance, school absenteeism, dropout, etc. The same is true for teenage mothers and young injecting drug users. The most recent empirical study on Roma was carried out in 2005-2006, more than five years ago. As the National Bureau for Statistics does not collect data on ethnicity, the situation of Roma children is practically unknown. Pre-primary education At the pre-primary education level, policy response223 includes a more flexible work schedule of kindergartens, differentiating the number of working hours on parents’ requests, enhancement of technology oriented technology approaches, together with introducing new educational services (psychological, physical development, etc.). In small villages deprived of the opportunity to open and sustain kindergartens, community educational centers for vulnerable children have been established, where children can benefit from pre-training for school.224 A program of individualized early-education targeting children from vulnerable families (in 20 kindergartens) has already been implemented with the support of international donors. Based on the technical assistance from UNICEF a new curriculum has been developed, together with standards for early development of children under 7-year old and professional standards for educators. 222 Eurostat definition: Percentage of the population aged 18-24 with the lowest level of secondary education at most (ISCED 0-3c) and not receiving any education or training. Data from the Labour Force Survey. 223 Ministry of Education, Strategia consolidată de dezvoltare a învăţământului pentru anii 2011-2015, 2010. 224 Community centers, unlike kindergartens, have 4-hour program.

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Another program, Education for All – Fast Track Initiative has made important contributions to improving the material basis and making more accessible pre-school institutions, including rehabilitation centers for children with disabilities. Continuing and extending this kind of projects is crucial for ensuring improved access to quality pre-primary education in the Republic of Moldova. For the next years, the draft project of Strategic Development Program of the Ministry of Education for 2012-2014 mentions that the services of earlychildhood care and development will be extended, within the ‘Education for all’ project. The actions are mainly aimed at meeting the corresponding MDG goals. The 0-3 age group is not addressed under this plan. Primary and secondary education with focus on rural Moldova The Government has started since 2006 a reform of the pre-university education with a special focus on rural areas.225 Curriculum for grades 10-12 was upgraded, training courses for teachers of grades 10-12 were provided, and a center for examinations and quality assurance was established, for improving quality of education. Grants were made available to rural schools, for increasing access and equity. In 2010, perstudent funding formula as well as optimization of the school network was piloted in two districts (Causeni and Riscani), for increasing efficiency of the education budgeting. Follow-up operations, which scale the mentioned activities, are planned for the next years.226 Optimization of the school network will continue, schools with low enrollment being gradually closed but securing transportation of students to nearby ‘hub’ schools. Per-student funding formula will be rolled out, with nationwide implementation from 2013. Class size will be increased to 30-35 students, in the large schools, and 25-30, in the other schools, which will result in the reduction of 1,736 teaching positions, in the 2011/2012 school year. Vacant and non-teaching positions will be also reduced.227 In addition, fixed-term work contract will become mandatory for teachers beyond retirement age and school managers’ decisions of dismissal, based on business need and performance rather than tenure.

225 With the support of the World Bank, Quality Education in Rural Moldova, Project Information Document, 2006. 226 International Monetary Fund, Moldova: Letter of Intent, Memorandum of Economic and Financial Policies, and Technical Memorandum of Understanding, March 24, 2011; WB, Quality Education in the Rural Areas of Moldova, Implementation Status and Results, 2011. 227 It will be reduced 2,400 vacant positions and, in the academic year 2011/2012, all districts will reduce education personnel by 5% from the 2010 level.

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Furthermore, a review of all social expenditure included in the education budget will be carried out. The goal of such review would be to improve targeting of spending related to scholarships, dormitory assistance and school meals. All previous directions for action have a cost-estimation of savings that would most probably improve the efficient use of resources in the system. However, successful implementation of the reform requires that access, quality and equity in education to be considered equally important as efficiency. Cost efficiency is only one of the country priorities. Specifically, the draft project of Strategic Development Program of the Ministry of Education for 2012-2014 integrates the above-mentioned initiatives into a larger reform program that addresses multiple challenges, including the extension of the school transportation system, creation of â&#x20AC;&#x2DC;hubâ&#x20AC;&#x2122; schools and editing methodological guide for modernized curriculum.228 A distinct direction of action aims the promotion of inclusive education and development of educational alternatives. The main objective refers to the family reintegration of children with disabilities. A Program for development of inclusive education for 2012-2020 was approved by Government in 2011.229 Only one initiative sets a specific target for mainstream education integration: the number of schools accepting children with special educational needs should increase annually with 10 schools. Many other issues remain to be addressed. For example, the multi-sectoral coordination between education and health systems for children with learning difficulties has not been established, either for data collection or for referral mechanisms. Furthermore, the plan does not include specific actions for other groups of vulnerable children than children with disabilities. The Government implemented a series of measures to reduce the burden of expenses for school attendance, especially among poor families. The state provides free food for all children from primary schools (I-IV grades). They also receive free of charge manuals. Students in gymnasium (V-VIII grades) from poor families are exempted of the book rental fee. In higher and professional education, the mechanism for granting scholarships to children from poor families and orphans has been improved.230 The number of scholarships has increased from 2,231 in 2008 to 2,352 in 228 At the level of professional/ vocational training, technical and material endowment of schools as well as training for teachers will continue. Other areas for reform tackle higher education and life-long learning systems, international collaboration, evaluation procedures and implementing information and communication technology in education. 229 Government Decision no. 523/11.07.2011. 230 Government Decision no. 1009/ 01.09.20.

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2009 and 2,510 in 2010 respectively. At the same time, the quantum of temporary norms related to expenditures in money for orphan and under guardianship or fosterage students has been risen by three times in 2010 compared to 2008.231 Lack of parental care does not necessarily lead to poor school performance, school absenteeism or school dropout. However, children left behind by migrant parents are at risk in these respects. Given, their large share in the total school population, specific measures should be designed for them. The most recent study on the needs of migrants’ children232 recommends: (i) the development of a national system of evidence and monitoring through schools; (ii) the elaboration of a Plan of Action for improvement of the educational activities devoted to this category; and (iii) establishing the position of psychologist in all schools with clear responsibilities on monitoring, counseling and therapy of children without parental care. Another policy gap relates to the life skills contain of the curriculum. As shown in the Health and Nutrition chapter, youth has rather poor knowledge and unsafe practices regarding reproductive health and substance misuse. Considering also the large share of children without parental care, the need for effective life skills and health education in schools becomes evident. At present, neither the coverage nor the quality of life-skills and healthy lifestyle courses has been monitored and evaluated. The unemployment rate in youth continues to be high. The Report on the Evaluation of the National Development Strategy Implementation During the Period 2009-2010 (p. 66-67) lists the Government actions that aimed enhancement of the professional level of the labor force for a more competitive economy. In this sense, the school curricula were improved, training courses for teachers were organized, 46 manuals were republished, and a national committee included among its responsibilities the adaptation of curricula to the labor market demands. For the moment, however, there is a discrepancy between the supply of qualifications/ specialization available in schools (including universities) and the market demand. Services of counseling or career orientation are not developed, which ultimately contributes to increasing youth migration.

231 Government of the Republic of Moldova, Report on the Evaluation of the National Development Strategy Implementation During the Period 2009-2010, 2010: 68. 232 Ministry of Labor, Social Protection and Family, Necesităţile specifice ale copiilor și vârstnicilor lăsaţi fără îngrijirea membrilor de familie plecaţi la muncă peste hotare, 2011: 12.

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4.5 Recommendations To improve statistics by adopting the international methodologies and outcome indicators (e.g. school dropout, early school leaving) and by conducting detailed studies in the areas were data are missing from the education point of view (e.g. children with disabilities, children without parental care, teenage mothers, etc.). Also, for evidence-based programming, the national statistics should also be available disaggregated by age, gender, ethnic group, social criteria and geographic distribution (including Transnistria). The best interest of the child should be the guiding principle of optimization of school network or class size. There is a clear need for increased efficiency in education public expenditure, which covers an important share of GDP. Budgetary constraints make even more stringent the need for reform. However, the recent developments in education bring equity agenda in the front run. To set up an adequate monitoring mechanism of the situation of children based on key performance indicators so that to ensure that the structural reform in education does not result in an increase of children vulnerability. To provide financing and implementing mechanisms for promoting inclusive education and extending the vulnerable groups of children to cover most-at-risk categories (e.g. Roma, children left without parental care, teenage mothers, injecting drug users, children with HIV/AIDS, etc.). To continue the initiatives aimed at extending the kindergartens network, through flexible arrangements such as changing the number of working hours, establishing community centers, together with curricula reform, educators training and improved material basis. To introduce parental education services, particularly for parents of children aged 0-3 years. To develop a national referral mechanism between the

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education and health systems both in terms of the data collection and referral system for children and adolescents with mental and behavior disorders. To develop a national system of evidence and monitoring through schools of children left without parental care as well as other categories of children most-at-risk. To introduce a coherent and nation-wide educational policy for compulsory health education curricula contributing to increased knowledge on HIV/AIDS but also on effective life skills. To establish position of psychologist within all schools, with clear responsibilities on monitoring, counseling and therapy of children left without parental care as well as other categories of children most-at-risk. To develop services of counseling and career orientation for helping young people, particularly from rural area to continue education or to enter labor market. To ensure the recruitment and retention of young teachers, accompanied by developing a comprehensive system of salary incentives and bonuses based on performance. To train professionals in contact with children and young (medical staff, social workers, education professionals, particularly in rural areas), together with updated curriculum and specialized training programs for specific pedagogical approaches. To develop transport infrastructure for improved geographical access to education. To improve access to safe water sources, sewerage and sanitation in the schools from rural areas. To work with media to promote healthy lifestyle and to reduce the discriminatory attitudes towards vulnerable groups of children (e.g. Roma, people living with HIV, etc.).

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5. CHILD PROTECTION

Convention of the Rights of the Child Articles This chapter addresses child’s right to be protected ‘from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s) or any other person who has the care of the child’ (Article 19 of the Convention on the Rights of the Child).233 ‘Child protection’ term is used by UNICEF to refer to preventing and responding to violence, exploitation and abuse against children, including commercial sexual exploitation, trafficking, child labor and harmful traditional practices, such as female genital mutilation/cutting and child marriage. Children who are victims of violence, exploitation, abuse and neglect are at risk of death, poor physical and mental health, HIV/AIDS infection, poor educational outcomes, displacement, homelessness, vagrancy and poor parenting skills later in life.234 In this respect, all Millennium Development Goals relate to child protection issues. UNICEF mentions only a few examples: (i) child labor directly affects goals directed towards eradicating extreme poverty; (ii) education for all is negatively influenced by child marriage and armed conflict; (iii) child mortality is higher for children separated from their mothers, particularly if they are institutionalized; (iv) maternal health is severely affected 233 Articles 16 and 20 of CRC are also relevant. 234 UNICEF, Child Protection Information Sheets, 2006: 1.

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by female genital mutilation; (v) sexual exploitation and abuse impede actions taken to combat HIV infection and (vi) environmental disasters make children vulnerable to exploitation and abuse. Complexity of the term is straightforward. Strengthening child protection system requires an overarching approach across all social sectors: social welfare, education, health, security and justice, in line with UNICEF Child Protection Strategy, adopted in 2008. However, a systemic approach of all implications for child welfare exceeds the scope of this work. In order to ensure a focused situation analysis, it will address topics selected as most relevant by UNICEF Moldova, meaning violence and exploitation, separation and children in contact with law. In line with the Child Protection Systems, Mapping and Assessment Toolkit (UNICEF, 2010), these corresponds to breaking the child protection subject into the following themes: (i) separation and children without parental care (including children in residential care, children with disabilities in institutions, children left behind by migrant parents and street children); (ii) violence and exploitation (physically, sexually and psychologically abused and neglected children, child trafficking, child labor); (iii) children in contact with law.

5.1 Key Data What are the key issues making children vulnerable: situation and trends? The Republic of Moldova has had significant achievements in reducing the number of children in residential care in the last years. Nevertheless, the rate of institutionalized children has remained high. On the integration part, for the institutions under the Ministry of Education, in the period 2007-2011, only 518 children were re-integrated in the extended biologic family, and other 82 were placed in alternative family services. Most of children leaving residential care are graduates. No mechanism has been put in place for them. Reform of the child residential care system has had a rather low impact on children with disabilities. Information about the ones

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which are not integrated in the school system is virtually nonexistent. Every fifth household with children had at least one member left abroad, in 2010. Separation from parents influences the moral and psycho-social development and causes anxiety. Various forms of violence against children such as domestic neglect, domestic emotional/ psychological abuse, domestic physical abuse (beating), commercial sexual exploitation and child trafficking or child labor are still persistent in Moldova. Juvenile delinquency in Moldova has had a decreasing trend in recent years, if considering the share of juvenile crimes in the total number of crimes. However, in absolute numbers, the number of crimes committed by minors increased in 2010 compared to 2009.

5.2 Separation and children without parental care Children in residential care The Republic of Moldova has had significant achievements in reducing the number of children in residential care in the last years. Nevertheless, the rate of institutionalized children has remained high. Figure 21 shows a similar â&#x20AC;&#x2DC;startâ&#x20AC;&#x2122; situation for Romania and Moldova in 2000. In 2009, Moldova still has one of the highest rates in the region, whereas other countries, such as Romania or Bulgaria, have reduced considerable more the number of institutionalized children. This comparison is limited to the number of children in residential care for every 100 thousand population aged 0-7 years, which, nonetheless, does not account for the quality of the process, as the length, pace and intensity of reforms have been specific to each country.

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Figure 21. Rate of children in residential care235 (per 100,000 population aged 0-17 years) 1.500 1.400

Rus s i a n Fe de ra ti on; 1.330,3

1.300 1.200

Mol dova ; 1.099,4 Ukra i ne ; 1.099,1 Be l a rus ; 1.043,1

1.100 1.000 900 800 700

Roma ni a ; 600,4 Bul ga ri a ; 549,5

600 500 400 2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Data: TransMONEE 2011 database Notes: Bulgaria – data include children accommodated in specialized institutions under the regulations of the Law for Child Protection; Romania – data include children 18 years or older; Belarus and Russian Federation - data include children living in general boarding schools; Moldova - data include boarding schools for orphans and children without parental care; data do not include Transnistria; Ukraine - data include children living in general boarding schools (only public institutions).

A National Strategy236 for Reforming Child Residential Care System was elaborated for the period 2007-2012 with two main objectives: (i) to reduce by 50% the number of children in residential institutions and (ii) to reorganize the residential institutions according to a general action plan of transformation. The numerical objective is likely to be achieved by 2012, as the number of children in residential institutions subordinated to the Ministry of Education has declined from 10,500 children in 63 institutions, in 2007 (the beginning of the reform), to 5,813 children in 53 institutions, at the end of 2010. Accordingly, the overall reduction in institutionalized children was of almost 45% in 2010 compared with 2007.237 However, on the integration part, in the period 2007-2011, only 518 children were re-integrated in the extended biologic family, and other 82 235 Children in residential care include children in infant homes, in orphanages, in boarding homes and schools for children without parental care or poor children, disabled children in boarding schools and homes, family-type homes, SOS villages, etc. Children in punitive institutions are normally excluded. Definitions may diﬀer among countries. Source: UNICEF, TransMONEE 2011 database, May 2011. 236 Government Decision no. 784/09.07.2007, National Strategy and Action Plan for reforming the residential child care system in the course of 2007-2012, www.edu.md. The Ministry of Education in collaboration with the Ministry of Labour, Social Protection and Family, Ministry of Health, Ministry of Finance, with the support of UNICEF, in partnership with local authorities and three NGOs with experience in the field, Every Child, CCF Moldova and A.O. LUMOS, implement the National Strategy and the corresponding Action Plan for reforming the residential child care system. 237 Ministry of Education, Monitoring implementation of the Strategy for Reforming Child Residential Care System, www. edu.md. At October 10, 2011. Data refer to 10 residential institutions, out of which 1 residential institution in process of liquidation, 8 closed down in 2009/2010 and 1 transformed in 2010. As part of the reform, four institutions were turned over to local authorities, so that to optimize the system and to increase ownership.

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were placed in alternative family services.238 The NGOs working under this area follow various approaches and procedures. Common standards for re-integration are not yet available, policy developments in this area being only at an early stage.239 Additionally, the monitoring capacity of the responsible public institutions is weak. These aspects are considered to be the main risks related to the quality of reform by representatives of all parts involved, ministries, donors and NGOs. Other risk-factors are placed at the community level. Family support services to endorse deinstitutionalization and prevent separation are underdeveloped at the community level. Early intervention and inclusive education services have been established only in 4 and 8 districts respectively (figure 8). 240 Most mainstream community schools do not have inclusive education services and lack trained teaching staff and capacity to integrate former students of boarding or auxiliary schools. Most community social workers are overloaded and have poor skills to monitor and offer family support services. On the one side, re-integration of children is difficult and may be unsustainable in the absence (or insufficiency) of appropriate services at the community level, particularly after the NGOs conclude their intervention. Many biological families of children from boarding or auxiliary schools live in very poor conditions, are incomplete or have many children, and face various problems such as violence or alcohol abuse. The evaluation of pilot projects on Prevention of Family Separation241 showed that in one auxiliary school (from Falesti) with 103 children, 43% of children with siblings had their sisters and brothers institutionalized in the same school. Actually, there is a tendency of large families to place their children into the same institution. In 85 cases (or 82%), poverty was the reason for sending children in residential care. In 30 cases (29%), parentsâ&#x20AC;&#x2122; alcohol abuse was the main reason. Mental retardation of the child was the motive in only 24% of all children in that auxiliary school.242

238 Ibid. 239 Every Child, Oxford Policy Management, UNICEF, Assessment of the childcare system in Moldova and technical assistance to the government of Moldova to host the sub-regional consultation on child care reform countries in ENP countries, 2009: 84. Similar positions were expressed by the representatives of the Ministry of Labor, Social Protection and Family during the interviews conducted in April 2011. 240 Data from 2008. 241 Pilot project Prevention of family separation, violence, abuse, neglect and exploitation implemented in Ungheni and Falesti, in partnership with EveryChild and local authorities, with the support of UNICEF. 242 Ministry of Labour, Social Protection and Family, USAID, Buletin Informativ. Protectie sociala. Familie puternica â&#x20AC;&#x201C; stat prosper, No. 4/mai 2011, 2011: 8.

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On the other side, the introduction of the gate-keeping system243 together with the prevention mechanisms of child abandonment has lowered the rate of entries into the residential care system.244 However, those communities (and districts) that have a residential institution on their territory require special attention. It is documented245 that in these areas, parents tend to place their child into residential care, simply for convenience reasons: ‘even after the moratorium was imposed, a lot of mothers came to us and said: <<Please, it has to be a way to leave him here (i.e. in a boarding school). I need to get rid of him, to have some rest>>’246 The number of the re-integrated children represents just 13% of all deinstitutionalized children, as we have already mentioned. The others more than 85% (that is about 4,580 children between 2007 and 2010)247 were graduates of residential institutions. So, they left ‘naturally’ the system. No mechanism has been put in place for them. Some returned to their families. Others have broken relationships with family long ago. For this reason, some specialists consider the young graduates of boarding schools to be a vulnerable group for which social services is scarce. They are socially vulnerable on multiple dimensions, including weak links with the family, underdeveloped life skills, and high unemployment risk.248 A qualitative study249 reveals the dominant practice of teaching staff and school directors of residential institutions, who ‘bring down to earth’ 243 Commissions for the protection of children in diﬃculty with the role of prevention of family separation by ensuring that residential institutionalization is the last solution. They were instituted in all administrative-territorial units. For example, in 2009, were examined 1,568 cases of which 835 cases of institutionalization were prevented and 255 cases were institutionalized. Government of the Republic of Moldova, Report on the Evaluation of the National Development Strategy Implementation During the Period 2009-2010, 2010: 82. 244 A comparative analysis on family separation of small children showed that the phenomenon of children entering institutional care did not change significantly between 2002-2003 and 2007-2008. In each day at least one Moldovan small child (0-6 years) was placed in a health or residential institution because of lack of family care. In 2007-2008, nearly all of them were ‘social orphans’, only 1.1% being biological orphans. Almost 35% were abandoned children. The majority were coming from single-mother families, particularly from urban areas. Children aged 0-3 years had a disproportionately higher risk of institutionalization or abandonment. As response, the Government has implemented since 2004 a number of interventions with the support of UNICEF in order to reduce the number of small children separated from family environment. The most important interventions include: creation of a nationwide network of community based social workers, setting-up of a number of maternal centers, training of health professionals all over the country on how to identify and to refer vulnerable mothers to services they need, how to partner with local authorities in order to prevent family separation, a number of communication materials targeting professionals, families, young people have been produced and distributed. UNICEF, Separation of Small Children From Family Environment. Comparative Analysis 2002-2003/ 2007-2008, 2009. 245 Every Child, Oxford Policy Management, UNICEF, Assessment of the childcare system in Moldova and technical assistance to the government of Moldova to host the sub-regional consultation on child care reform countries in ENP countries, 2009: 63. 246 Every Child, IMAS, USAID, Protection of rights of the children without parental care or of children at-risk-of separation from their families, 2009: 27. Excerpt from an interview with a jurist and a child protection specialist, which was conducted in Chisinau in April 2011. 247 Ministry of Labour, Social Protection and Family, USAID, Buletin Informativ. Protectie sociala. Familie puternica – stat prosper, No. 4/mai 2011, 2011: 6. 248 The Foundation for Social and Economic Research – CASE Moldova, UNICEF, REPORT on evaluating the cost of nonaction in the implementation of the National Strategy Action Plan on Reforming the Residential Child Care System for the years of 2007-2012, 2010: 50. 249 Every Child, IMAS, USAID, Protection of rights of the children without parental care or of children at-risk-of separation from their families, 2009: 12.

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those students aspiring to higher-education professions such as lawyer, physician, etc. and direct them to vocational education. As a result, most of them have continued education in vocational schools, which in turn offer poor employment chances. In 2009, only 7.5% of the young graduates of residential institutions followed higher-education institutions.250 Children with disabilities in residential care Children with disabilities represent a large part of children in residential care, and they are vulnerable in many ways, as we have already presented in the previous chapters on health and education. A part of residential care institutions subordinated to the Ministry of Education are special schools for children with disabilities. In the 2010/2011 school year, 3,148 children251 have been enrolled in the existent special schools. Besides, in the Republic of Moldova, the residential care institutions comprise two institutions252 for young children (0-3 years), under the Ministry of Health, and five centers253 for children aged 4-18 years, under the Ministry of Labour, Social Protection and Family. Overall, about 1,200 children are in these institutions, of which approximately 1,100 are children with disabilities. Thus, of the total number of 15,321 children with disabilities,254 no data are available regarding around 11,000 children. Up to now, the reform of the child residential care system has had a rather low impact on children with disabilities. The main issue in this respect refers to the coordination mechanisms between health, education and social services sectors. For example, in the two centers for children with mental disabilities, out of more than 600 children, only 10 children were reintegrated in their biological family and one child in the service of professional parental assistance.255 The main issue in this respect refers to the coordination mechanisms between health, education and social services sectors. The reform of 250 The Foundation for Social and Economic Research – CASE Moldova, UNICEF, REPORT on evaluating the cost of nonaction in the implementation of the National Strategy Action Plan on Reforming the Residential Child Care System for the years of 2007-2012, 2010: 50. 251 National Bureau of Statistics, Situaţia copiilor din Republica Moldova în anul 2010, 2011. 252 Centru de plasament si reabilitare pentru copii de varsta frageda, mun. Chisinau; centru de plasament temporar si reabilitare pentru copii, mun. Balti. 253 Two centers for children with mental disabilities with 343 places for girls (Hincesti) and 332 places for boys (Orhei). Three family-type centers for disadvantaged children, which provide residential care for less than one year, with 30 places in Soroca, 40 places in Taraclia, and 40 places for children with special needs in Criuleni. www.mpsfc.gov.md At October 10, 2011. 254 National Bureau of Statistics, Situaţia copiilor din Republica Moldova în anul 2010, 2011. 255 Ministry of Labor, Social Protection and Family, Annual Social Report 2010, 2011: 123. SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

residential care cannot succeed in the absence of effective mechanisms of inclusive education or of community services of family support. At the policy level, the Government has defined inclusive education as a priority and elaborated a national plan for 2011-2020.256 The main focus of this document is the re-integration of deinstitutionalized children and the inclusion of children with special needs into the mainstream education. More, in August 2011, the Ministry of Education approved257 the extension of the inclusive education services in two more districts, Floresti and Ialoveni (besides the four pilot districts from figure 8). However, for now, available assessments258 conclude that the existing system of children rights protection and common practice do not properly represent the interests of children with disabilities. Due to lack of coordination, gaps and delays affect (a) further intervention, (b) waiting lists (overloaded services or teams) and (iii) lack of continuity of support when children are moving from one institution to another. There are 30 day-care centres for children with disabilities, but seven districts have no service provider at all. Moreover, inclusive education does not work, as only 2.7% of school-aged children with disabilities where using such services in 2008. 259 As mentioned in the chapter on Education, capacity of schools to work with children with special educational needs is rather limited and, as a result, many parents are ‘forced’ to choose residential institutions. Besides coordination between sectors (ministries and community professionals), the coordination between international donors poses an additional challenge. The best example to illustrate this is the multitude of community centers. The centers have different names and provide a range of diverse services according to various standards and methodologies, whereas the monitoring capacity of the public institution is rather weak. The Donors’ Coordination Council in the field of labor and social protection is already functioning under the coordination of the Ministry of Labour, Social Protection and Family. Nonetheless, strengthening the coordination efforts is vital for more comprehensive and effective actions at the local and national levels.

256 In line with the policy recommendation advanced by UN Committee on Economic, Social and Cultural Rights to focus the reform on the re-integration of children with disabilities. UN, Committee Consideration of reports submitted by States parties under Articles 16 and 17 of the Covenant, 2011. 257 Decision of the Ministry of Education No. 739/15.08.2011. 258 UNICEF, Assessment and Recommendation on Child Disability Prevention and Care System in Moldova, 2009. 259 Ibid., 2009: 18.

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Street children ‘Street children’ in Moldova are at least 1,799 (in 2010). 260 They are recorded in official statistics in relation to the topic of juvenile delinquency. As is the case with other countries, their exact number is not known. The identified 1,799 cases have been sent to The Center for Temporary Placement of Minors, under the Ministry of Internal Affairs. Two thirds of them are of school age and every third child is repeatedly placed in this centre. Children left without parental care due to migration We have already presented the situation of the children with migrant parents under the previous chapters. However, few other aspects are worthwhile mentioning. Separation from parents influences the moral and psycho-social development and causes anxiety. The emotional life of the children left behind is marked by disappointment and feeling of being lied and betrayed, particularly in the period following immediately the parent’s departure. Children experience emotional difficulties, including sadness, loneliness and a feeling of insecurity.261 Mother’s leaving causes the deepest emotional distress.262 As time goes by, the emotional distance between children and parents is widening, while attachment to caregivers does not always develop into relations close enough to fulfill their need of moral support. Particularly, when the mother left for work, the father does not succeed in ensuring the necessary care and grandparents are often the ones taking care of children. However, in many cases, relationships with caregivers and family left at home are tensioned and characterized by violence. In addition, they tend to feel ‘different’ from children with parents in Moldova. As a solution, most children left behind isolate or turn to peers, who share the separation situation, to whom they confess, ask for advices, enjoyed together daily activities, life joys and sorrows, or seek for empathy and moral support. The lack of parental support and emotional deprivation combined with excessive money at their disposal cause the adoption of behaviors such as irrational use of money, orientation to consume, and tendency to refuse any domestic work, which expose them further to aggressiveness, precocious sexual relationships, alcohol or drug abuse, and socially undesirable behavior.263 260 National Bureau of Statistics, Situaţia copiilor din Republica Moldova în anul 2010, 2011, http://80.97.56.163/newsview.php?l=ro&id=3418&idc=168 261 Child Rights Information Center, UNICEF, The situation of children left behind by migrating partners, 2006: 7. 262 UNICEF, The impact of migration and remittances on communities, families and children in Moldova, 2008: ii. 263 Child Rights Information Center, UNICEF, The impact of parental deprivation on the development of children left behind by Moldovan migrants, 2008. Ministry of Labor, Social Protection and Family, Necesităţile specifice ale copiilor și vârstnicilor lăsaţi fără îngrijirea membrilor de familie plecaţi la muncă peste hotare, 2011: 9, 50-54, 60-65, 72-77.

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Estimating the magnitude of this problem is a difficult task, but there is a general agreement that it is quite high for Moldova. During the economic crisis, the migration for work abroad decreased. Accordingly, the number of children left without parental care was lower in 2009 compared to 2008. In 2009, the National Bureau for Statistics reported a number of 157,000 children which represented 19.5% of all children in the country, of which 2% have both parents left abroad, 5.9% the mother, and 11.6% the father.264 In 2010, 17.1% of all children below 18 years old (or around 133 thousands) had one or both parents left for work abroad: 10.4% the mother, 5.2% the father, and 1.5% both parents. Most children left behind live in villages, in multigenerational extended families with one or two children.265 Official data266 indicate that every fifth household with children had at least one member left abroad, in 2010. In the rural area, this share was 26.2% compared with 15.5% in the urban one. In fact, 69% of households with children and migrants were located in rural communities. As response, a project on the Negative Effects of Migration Over Minors and Families Left Behind, with the support of the European Commission, was launched in May 2011.

5.3 Violence and Exploitation Forms of violence against children include neglect, physical, psychological, sexual violence as well as exploitation for commercial purposes. Domestic Neglect Pre-school children are rather often left unsupervised at home, particularly in rural areas.267 More than 11% of parents with children aged 0-7 years reported in 2009 that left unsupervised at home their child. The proportion varies between 4% of parents with children under 1 year old and 16% of those with 5-6-year olds. This is not a casual behavior, but a systematic one. It is not influenced by parentsâ&#x20AC;&#x2122; level of education or social strata, but it is more common in rural than in urban areas. Actually, in rural areas, many children of 6-9 years old are not only unsupervised, but often left in charge over their younger siblings. 264 Ministry of Economy, Raport privind saracia si impactul politicilor 2009, 2010: 34. 265 Of households with children and migrants 52% have one child, 38% have two children and only 10% have three children or more. In addition, 61% are multigenerational extended families, 38% are nuclear families, and less than 1% are single-parent families. Data for 2010. 266 Ministry of Labor, Social Protection and Family, Annual Social Report 2010, 2011. 267 UNICEF, Government of the Republic of Moldova, National Study on Knowledge, Attitudes and Practices of Families in the field of early childhood development and care, 2010: 40-41. Data from 2009.

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The neglect of school-age child is rather spread, especially among the poor.268 In the Republic of Moldova, one in every ten children aged 1018 years did consider themselves neglected, with nobody taking care of them, in 2006. The share increases to three in every ten children who self-identified as being ‘very poor’. This type of abuse is associated with difficulties in adapting in school. Physical Abuse/Beating Official statistics based on reported cases of domestic violence are unreliable in any country. Where it is socially defined as undesirable, the cases are concealed. Where it is ‘normal’, the cases are ‘invisible’, being taken for granted. Moldova appears to be in this second category. For example, only 5% of parents with school-age children would make a report to the police if they saw another parent beating a child. Physical violence against small children (0-7 years) is widespread too.269 As ‘the punishment is torn from heaven’ and ‘where the mother is beating, (the child) is growing’,270 almost 42% of parents (50% of mothers and 33% of fathers) report using physical punishments as a disciplinary method. The share is higher among parents from rural areas (57% of mothers and 37% of fathers). Even infants below 1 year old are beaten (report 16% of parents), while among children of 6-7 years, the abusive punishment methods are dominant (57% of them). Beating is more spread than neglect among school-age children, particularly in poor families.271 As much as 25% of children aged 10-18 years declared in 2006 that their own parents beat them if they do not listen to them. Children from households self-assessed as ‘very poor’ were more likely to report physical abuse from parents. ‘Reasons’ for physical abuse include smoking, alcohol consumption or school absenteeism. Children victims of physical abuse are more vulnerable to becoming victims of sexual abuse, have difficulties in adapting in school, and have a higher risk of suffering physical abuse from teachers also. 268 IMAS, Ministry of Education and Youth of the Republic of Moldova, Ministry of Social Protection, Family and Child of the Republic of Moldova, UNICEF, Violence against children in the Republic of Moldova, 2007: 13. More recent data are not available. 269 UNICEF, Government of the Republic of Moldova, National Study on Knowledge, Attitudes and Practices of Families in the field of early childhood development and care, 2010: 39-40. Data from 2009. 270 ‘Pedeapsa e rupta din rai’, ‘Unde bate mama, creste’, http://www.moldovacrestina.net/social/proverbe-popularedespre-disciplinarea-copiilor/ 271 IMAS, Ministry of Education and Youth of the Republic of Moldova, Ministry of Social Protection, Family and Child of the Republic of Moldova, UNICEF, Violence against children in the Republic of Moldova, 2007:14-15, 26-27.

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Besides parents, teachers also use beating as a disciplinary method at school. In 2008, some 16% of pupils declared that they received corporal punishment from teachers, whereas only 2% of teachers reported to do so.272 Violence against women is associated with violence against children.273 Latest data, from the Demographic and Health Survey 2005, found that 33% of women experienced violence by 30 years old (with most of the cases attributed to husbands or ex-husbands). The UN Committee on Economic, Social and Cultural Rights (2011) declares that there is a widespread violence against women in Moldova, including domestic violence, with a still inadequate policy response. Domestic Emotional/Psychological Abuse Children of 0-7 years are witnessing arguments between parents often.274 Half of parents with small children have frequently family arguments, and they do this in front of their children. This behavior characterizes 59% of parents from rural areas and 50% of parents from urban areas. Associated, four of every five children have fear of parents. According to teachers, emotional violence represents the form of abuse with the highest prevalence among children in Moldova.275 The IMAS survey confirms teachers’ assessment.276 On the school-age (10-18 years) children’s part, 30% felt too much control by parents, 22% reported verbal violence (usually from fathers), 19% declared being threatened by parents (2% with death), 12% felt lack of support and trust, while 52% perceived emotional pressure by imposing excessive expectations. On parents’ part, one in every ten declared in 2006 to use emotionally or psychologically abusive ways towards their children (threatening, prohibiting activities, etc.). There are significant correlations between psychological and physical abuse and between neglect and emotional abuse.

272 UNICEF, Ministry of Education and Youth of the Republic of Moldova, Educaţia de bază în Republica Moldova din perspectiva școlii prietenoase copilului, 2009: 30. 273 UN, Committee Consideration of reports submitted by States parties under Articles 16 and 17 of the Covenant, 2011. 274 UNICEF, Government of the Republic of Moldova, National Study on Knowledge, Attitudes and Practices of Families in the field of early childhood development and care, 2010: 39-40. Data from 2009. 275 National Center of Child Abuse Prevention, Nobody’s Children Foundation, Professionals’ attitudes towards child abuse in Moldova, 2005: 4. 276 IMAS, Ministry of Education and Youth of the Republic of Moldova, Ministry of Social Protection, Family and Child of the Republic of Moldova, UNICEF, Violence against children in the Republic of Moldova, 2007: 14, 23-24.

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Commercial Sexual Exploitation and Child Trafficking Data on sexual exploitation are rather scarce. However, a part of the interviewed specialists mentioned commercial sexual exploitation as a major future risk for the children from Moldova, particularly given the high migration abroad combined with the high poverty in the country. One in every ten children aged 10-18 years did declare in 2006 to have been sexually abused. The same proportion did report being involved by adults in watching pornographic films.277 Moldova is considered to be a source-country for women and girls subject to sex trafficking.278 Moldovan girls and women from the rural area have been identified among victims of forced prostitution. Children and youth living in residential institutions represent also a vulnerable group to sexual exploitation and trafficking. At the same time, the region of Transnistria remains a source for victims of forced labor and forced prostitution. Most of the child-victims have no professional training, with some of them never attending school. The share of mentally retarded children in this situation has significantly increased. The most exposed child-victims, both to child trafficking and child sextourism, belong to poor, large and incomplete families, with problems of alcohol abuse and violence.279 Latest report of the International Centre ‘La Strada’ gives an Overview of the child trafficking phenomenon in the Republic of Moldova (2010). The report highlights the problem of statistical data at national and transnational levels. Due to data inconsistencies, it’s difficult to estimate the current trends in this phenomenon. However, available data indicates a decrease in the number of victims of transnational child trafficking and a slight increase in the number of victims of child trafficking inside the country. Data provided by CAP,280 on the other hand, show that in 2010, the share of children among victims of trafficking increased (9.6% of total, compared to 5.3% in 2009) as well as the share male victims (adults and children). 277 Ibid., 2007: 15. 278 United States Department of State, Trafficking in Persons Report - Moldova, 27 June 2011, http://www.unhcr.org/refworld/docid/4e12ee5e3c.html. 279 International Centre ‘La Strada’, Overview of the child trafficking phenomenon in the Republic of Moldova, 2010. 280 CAP - Centre for assistance and protection of victims and potential victims of human trafficking, Source: Ministry of Labor, Social Protection and Family Report on monitoring implementation Strategy for the National Refferral System for protection and assistance to the victims and potential victims of human trafficking for 2010, 2011:25.

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When exploitation of children occurs in another country, proofs are difficult to be collected. This is why the report ‘La Strada’281 emphasizes that proficiently organized crimes of transnational child trafficking can remain uncovered specifically due to lack of necessary resources. Child labor The official estimations show a number of 109,000 child laborers in Moldova,282 which equals 18.3% of children aged 5-17 years in 2009. Child labor in Moldova is mainly associated with working in hazardous conditions. Major economic activity is agriculture. Most vulnerable groups of children include adolescents, rural children and those from households that cultivate kitchen gardens. In their case, school attendance is not influenced by child labor. The worst forms of child labor which were found in Moldova include children working on the streets, in factories or carpentry.283

5.4 Children in contact with law Juvenile delinquency Article 40 of the UN Convention on the Rights of the Child ensures children’s right to legal treatment in their best interests and proportionally with committed crimes or situations in which they have been involved. In Moldova as in other countries, juvenile delinquency is associated with school drop-out and school absenteeism. Most minors that committed crimes in 2010 (85.7%) are not enrolled in school. After a steep decline between 2005 and 2009, the juvenile delinquency in Moldova increased in 2010 to 1,586 minors who committed crimes, with 17.2% more than in 2009. However, the share of crimes committed by minors in the total number of crimes has decreased from 9.2% in 2005 to 4.1% in 2010. 284 281 International Centre ‘La Strada’, Overview of the child traﬃcking phenomenon in the Republic of Moldova, 2010 282 National definition of child labor includes children in Moldova involved in both System of National Accounts and nonSystem of National Accounts. The first group includes children who work in hazardous economic activities or occupations, children employed for hours considered to be excessively long for their age, and children who work under hazardous conditions. The second group considers children engaged in hazardous unpaid household services, defined as domestic chores carried out by children for other household members for more than 27 hours per week. Source: National Bureau of Statistics, International Labour of Organization, Working Children in the Republic of Moldova: The Results of the 2009 Children’s Activities Survey, 2010. 283 UN, Findings on the worst forms of child labor, Country Profiles: Moldova, 2009. 284 Registered juvenile crime rate in 2009 in Moldova is of 508 per 100,000 population aged 14-17 (decreasing trend). The rate is much lower than in the neighboring Romania (1,419) or Russian Federation (1,529). Source: TransMONEE 2011

database.

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Several trends have been identified in the latest statistical data regarding juvenile delinquency.285 Most of the children involved in crimes are aged 16-17 years old. In the past years, there is a diversification of crimes committed by children. Lately, most frequent crimes relate to stealing transport vehicles. There is also an increase in crimes addressing personal life and health. In 2010, 30 adolescents have been arrested for rape. In the same time, in the last years, minors committed an increasing share of group crimes (19%, in 2010). Crimes related to drugs need special attention. The study286 on young Injecting Drug Users (IDUs) from 2008 brought into the light that almost a half (48.5%) of them were detained or harassed by police during the last year, more males than females. Of IDUs, nearly 9% (mostly of 18-24 years old) were convicted and served a sentence, and more than four of every ten of those used injecting drugs even during the period of detention in the penitentiary institution. Compared to Chisinau, police harassment is more frequent in Balti and incarceration within a penitentiary in Tiraspol. The same study287 brought evidence that one in every four adolescents in detention was in child protection centers or orphanages, during the lifetime. Most of them were detained in pre-sentencing facilities before final sentence delivery. The majority had court-appointed lawyers who did not grant ‘sufficient’ time to the case,288 as the family support was low or inexistent. During the entire process, 44% of them were beaten by police or employees of the penitentiary service in the last year. Both categories of young people, injected drug users and juveniles in detention, are included among the groups of most-at-risk adolescents as regards to HIV/AIDS infection, as shown in the chapter on Health. Considering all the above, the experiences of most-at-risk adolescents with law-enforcement bodies hinder their proper identification and referral to services, increasing thus their vulnerability. On the policy side,289 positive developments have been initiated by the Moldovan Government in 2006. The maximum detention term allowed as 285 National Bureau of Statistics, Situaţia copiilor din Republica Moldova în anul 2010, 2011. 286 Ministry of Health, Assessment of Risk of HIV Infection among Most at Risk Adolescents (MARA), 2009: 53-54. An IDU was considered to be someone aged 12-24 years who has injected drugs at least once during the 12 months prior to the interview. The study covered the district centers and rural communities neighboring Chisinau, Balti and Tiraspol municipalities. 287 Ministry of Health, Assessment of Risk of HIV Infection among Most at Risk Adolescents (MARA), 2009: 66-67. Data from 2008. Adolescents 14-18 years old in pre-sentencing facilities or serving their sentence in penitentiary institutions of the Ministry of Justice of the Republic of Moldova (right bank of the Nistru River). 288 Subjective assessment of the detainees. 289 UNICEF, Growing up in the Republic of Moldova, 2008.

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well as the period of time during which children can be detained before sentence delivery was reduced. Other improvements were registered also on the nature of sentences and in the way the children cases are treated, as the Convention of the Rights of the Child recommends. Other legislative achievements under this field include the introduction of unpaid community work as an alternative to detention and a new law on probation, approved in 2008. These developments have succeeded in getting Moldova closer to the concept of ‘child friendly’ courts and to the international standards. Nonetheless, there are multiple areas which still need support:290 focus on community-based secondary prevention; elimination of the use of isolated cells; institutional reaction against to violation of the rights of children by public officials; program addressing juveniles released from correctional facilities; improvement of statistical indicators on juvenile justice, etc. Also, the decreasing budgetary resources allocated for the Ministry of Justice are seen as an impediment to the continuation of projects.291 Children victims of crimes The number of crimes against children substantially increased in 2010. Out of a total number of 653 crimes, 13.3% are rapes, 7.5% robberies and 2.3% are murders. Table 6. Crimes against children 2005

2006

2007

2008

2009

2010

Total number of crimes against children

418

415

436

515

475

653

Of which, Rapes (%)

14.4

13.0

9.9

11.3

10.9

13.3

Source: National Bureau of Statistics, Situaţia copiilor din Republica Moldova în anul 2010, 2011, http://80.97.56.163/ newsview.php?l=ro&id=3418&idc=168

The increased number of crimes against children advocates once more for the need of appropriate measures in the field of justice for child victims and witnesses of crime. It should address investigation, trial and post-trial phases.

290 UNICEF, Assessment of Juvenile Justice Reform Achievements in Moldova, 2010. 291 SIDA, Joint Evaluation of Impacts of Assistance to Social Sector Reforms in Moldova, 2011.

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5.5 Capacity and Policy Gaps 5.5.1 Institutional Capacity Financing The main goals of the childcare reform refer to the move from residential care to family-based services and the development of a network of community social assistants. As in the neighboring Romania, the reform of the residential system in Moldova has been strongly advocated and supported by international donors. A great part of external funding has been allocated to social protection projects, estimated to 15% of all bilateral and multilateral donor funds in 2006.292 Data on detailed classification of state budget allocations for child protection is not available. Large part of the budget is under education, social protection or justice. Organizational structure and human resources Consistent with the child protection reform, the number of residential care institutions has decreased, whereas the network of community assistants has increased. Nine293 residential child care institutions under the Ministry of Education were closed down and one was transformed. Four institutions were turned over local authorities so that to optimize the system and to increase ownership. Still, 53 institutions are functioning, of which 26 auxiliary schools, 15 boarding schools, 7 special schools, 3 sanatorium schools, and 2 orphanages.294 Reorganization of an institution means job loss for staff. The reorganization of eight institutions from 2009-2010 has affected 509 employees (out of which 131 pensioners).295 Even if job security has been ensured, a fall of wage has been almost certain, as the transfer of teaching staff from a residential care institution to a mainstream secondary school has translated 292 Every Child, Oxford Policy Management, UNICEF, Assessment of the childcare system in Moldova and technical assistance to the government of Moldova to host the sub-regional consultation on child care reform countries in ENP countries, 2009: vi. 293 One institution is in the process of liquidation, while eight were reorganized during 2009-2010. 294 Ministry of Labour, Social Protection and Family, USAID, Buletin Informativ. Protectie sociala. Familie puternica â&#x20AC;&#x201C; stat prosper, No. 4/mai 2011, 2011: 6. 295 Ministry of Education, Monitoring implementation of the Strategy for Reforming Child Residential Care System, www. edu.md. At October 10, 2011.

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in a drop by 30% of the wage.296 Consequently, although professional counseling and training have been delivered to the affected personnel, resistance to reform among staff of residential institutions has been quite high and has caused delays and distortions. Until 2009, ‘there has been much greater success in recruiting staff to the newly created social assistant posts than in reducing the numbers of people working in residential institutions.’297 The network of community social assistants has been expanded from less than 100 at the beginning of the reform to more than 1,100 in 2010.298 In qualitative terms, most part of social assistants benefited from training even more necessary considering that only a small part of them is graduates of a social assistance faculty. A major problem has, however, remained unsolved, the low pay. The wages of social assistants are very low, lower than in education, which in turn are lower than in health. There are cases in which the wage of a social assistant is below the social aid level. 299 By this we do not want in any way to say either that wages in education or health should be cut or that social aid should be reduced. Instead, we remark that wages of social assistants are so low that represent an obstacle to maintaining and recruiting specialized workforce. On the one side, the high personnel turnover endangers the activities of the system and creates additional costs for training of new staff. On the other hand, as the number of specialized workforce was insufficient at the beginning of the reform, many posts were occupied by people with average education, ‘the mayor’s wife, someone’s daughter or so. For this reason, the system is blocked. There is no space left for the fresh graduates of the social assistance faculty willing to accept the low wage for the sake of a gain in experience’.300 The change in the referral mechanisms from the district to the community level, through the social assistants, is considered a positive development, 296 Foundation for Social and Economic Research – CASE Moldova, UNICEF, Report on evaluating the cost of non-action in the implementation of the National Strategy Action Plan on Reforming the Residential Child Care System for the years of 2007-2012, 2010: 52. Interviews with representatives of ministries and experts carried out in April 2011. 297 Every Child, Oxford Policy Management, UNICEF, Assessment of the childcare system in Moldova and technical assistance to the government of Moldova to host the sub-regional consultation on child care reform countries in ENP countries, 2009: ix. 298 More precisely to 1,159 units of social assistance. One social assistant can work on less than one unit. Source: Ministry of Labor, Social Protection and Family, Annual Social Report 2009, 2010: 105. 299 Interviews conducted in April 2011, in Chisinau, with various experts. UNICEF, Impact of public transfer payments on poverty and well being of the most vulnerable families in the Republic of Moldova, in the context of transition from categorybased to means-testing social assistance, 2011: 27. Some of the interviewed social workers mentioned that, considering the low wage reported to high workload and responsibility, they themselves had the temptation to resign for a period of time to benefit the social aid. 300 Interview with the Dean of the Faculty of Social Assistance, State University of Moldova, held in Chisinau, April 2011.

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even though implementation of the mechanism is not uniform across districts. The social assistant identifies the children in difficulty, conducts their initial assessment and general support. The guardianship authority (Department of Social Assistance and Family Protection) makes the final decision concerning the form of protection. Individual needs assessment and referral to specialized services are still not equally distributed among groups of vulnerable children, as children from residential institutions have fewer chances to benefit from them.301 Several drawbacks of the current organizational settings were identified by previous assessments,302 which mainly come from shared distribution of responsibilities, insufficiently clarified or distinctive. There is an overlap of responsibilities between: (i) the Ministry of Labor, Social Protection and Family and the Ministry of Education; (ii) the community (‘primaria’) and district levels; and (iii) the gate keeping system303 and the Medico-PsychoPedagogical Commissions (MPPCs).304 In 2009, a UNICEF study revealed that only 20% of MPPCs was actually functioning. Their evaluations were not based on a social assessment of the family and child, a prerequisite of inclusive education. Their recommendations for placing children with special needs into education residential institutions were not accompanied by alternative plans. This is, however, motivated based on the low level of physical facilities, lack of training methodologies and tools in mainstream education, as the section on Education shows. At the community level, although the number of social services delivered by NGOs has increased, there are some vulnerable groups poorly addressed as is the case of detainees, drug addicts or alcoholics, homeless, or HIV-AIDS infected people. Further development of community social services is hampered, among other, by lack of financial resources at the local level, which results on rather ‘moral’ participation of local public authorities, as viewed by NGOs.305 In the field of violence against children, the number of services for care and protection of child-victims is limited.306 At the community level, the 301 Every Child, Oxford Policy Management, UNICEF, Assessment of the childcare system in Moldova and technical assistance to the government of Moldova to host the sub-regional consultation on child care reform countries in ENP countries, 2009. 302 Ibid., 2009: vii. 303 Committees for the protection of children in diﬃculty with the role of prevention of family separation by ensuring that residential institutionalization is the last solution. They were instituted in all administrative-territorial units. 304 Commissions expected to evaluate entry into auxiliary schools for children with mild disabilities. 305 Information dated 2007. The social services delivered by NGOs address various vulnerable groups of children: (i) disabled people - 44%, (ii) orphans - 39%, (iii) victims of domestic violence - 22 %, (iv) victims of abuse – 18%, (v) victims of human traﬃcking - 17%, etc. UN, National Human Development Report 2010/2011, 2011: 98-99. Data from EU TACIS, Database of social NGOs providing services, 2007. 306 UNICEF, State Responsiveness to Violence against Children, 2006. This is the most recent comprehensive assessment of state responsiveness to violence against children in Moldova.

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referral systems work only partially because the inter-sectoral cooperation and services targeting victims are limited. There are no coordination mechanisms between responsible ministries. The prevailing social attitudes and practices, as described in section 5.3, prevent further the identification and referral of child-victims of violence. In the field of combating human trafficking and protection of victims, based on the Strategy for the National Referral System (NRS) for protection and assistance to the victims and potential victims of human trafficking, multidisciplinary teams are active in 28 districts (out of 35), two municipalities (Chișinău and Bălți) and one town (Otaci).307 In most of the cases, the teams are coordinated by the representative of the Social Assistance and Family Protection Department at the district level. Other represented institutions are: Police, Employment Agencies, health and education institutions, NGOs, departments for persons’ legal status, prosecution, departments for population registration. Members of the multi-disciplinary teams benefited from specialized training, including a module on child labour.308 In addition, some NGOs brought a significant contribution to identification of victims of human trafficking. For example, the International Centre ‘La Strada’ established a hotline supporting potential victims and a mobile multidisciplinary team specialized in identification. Still, the specialized personnel at the local level, such as jurists, is insufficient. In general, the decentralized services at the local level are underdeveloped, counting those supplied by NGOs, centre for protection and assistance of victims and potential victims of human trafficking, including victims of domestic violence. At the central level, the National Committee on Combating Trafficking of Human Beings, including representatives of different Ministries, needs enhanced capacity (a stronger commitment and full staffing of its Permanent Secretariat). Funding is also problematic, as international donors and NGOs represent the primary source. Financial problems affect not only continuation, but also quality of services. The specialists, especially from the National Centre for Assistance and Protection of Victims and Potential Victims (CAP), might leave for the private sector if included in the current payment scheme for public sector.309 307 Ministry of Labor, Social Protection and Family, Report on monitoring implementation Strategy for the National Referral System for protection and assistance to the victims and potential victims of human traﬃcking for 2010, www.mpfsc.gov.md 308 International Labour Organization, Activities for preventing and combating child labour in Moldova 2003-2010, 2011, http://www.un.md/un_ag_mol/ILO/Fact_sheet_ILO-IPEC-Moldova_EN.pdf 309 Ibid.

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On the institutional setup for juvenile justice, there are also positive developments. The Superior Council of Magistracy introduced in 2004 the obligation of president of each court to appoint one or more judges to handle cases of juveniles. Similar, the General Prosecutor asked each district to designate a prosecutor to handle cases of juveniles. These measures have been assessed with limited impact, but a positive one. In addition, Ministry of Justice is in charge with supervising juveniles with non-custodial sentences (such as probation and community service). Coordination problems are still important and might be addressed through setting up of an inter-ministerial body responsible for policies on juvenile justice.310 Several factors negatively affect children in contact with law, of which the most important include:311 (1) strategic planning: poor legislative and policy coverage of children under the minimum age of criminal responsibility; (2) process and management: (i) lack of specialised services at the community level and poor capacity of local public administration, education, health systems and police to early identify, refer and provide services for children at risk of offending, (ii) lack of diversion312 and relevant support mechanisms/services for children and their families, (iii) non-efficient use of resources in the justice sector, (iv) limited accountability of state authorities in cases of children right violations, (v) double stigma, which hinders rehabilitation and social reintegration, (vi) low access to justice of vulnerable children and their families, (vii) long deprivation of liberty for children both during the trial and regarding sentences, (viii) heavy reliance on deprivation of liberty in Transnistria; (3) monitoring and evaluation: 310 UNICEF, Assessment of Juvenile Justice Reform Achievements in Moldova, 2010. 311 UNICEF Moldova, Capacity Gap Analysis, Justice for children, preparation to new 2013-2017 Country Programme of Cooperation, 2011. 312 Channelling of young people from the criminal justice system into programs that make them accountable for their actions. Examples include placement under a supervision and guidance order such as a mentor or peer role model, compulsory school attendance, positive peer association, compulsory attendance at a specified centre for vocational or educational purpose, etc. UNICEF, Malawi Fact Sheet, Diversion of children in conflict with the law, http://www.unicef.org/tdad/Malawifactsheetdiversion.pdf

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weak and fragmented system of data collection, analysis, and use for policy development; (4) community/ parents’ role: (i) migration, poverty, substance abuse by parents and adolescents exposes children to risk-behaviours, (ii) weak parental skills, (iii) low level of participation of the community, family and children, (iv) stereotypes perpetuated by media. Other important institutions for child protection system are Child Rights Protection Agency (only in Chisinau, with one specialist in the Social Protection department at the district level) and Child Ombudsman. Nevertheless, both institutions have still limited resources to tackle efficiently the complex problems from the child protection field.313 Factors that hinder access to child protection services Several factors impede the development at the community level of the services of identification and referral in cases of child abuse and neglect, violence, exploitation or other risks and violation of rights. Besides the institutional ones, discussed above, the dominant social attitudes and practices are particularly critical for the child protection reform. The most relevant ones include: 314 (i) violence as a disciplinary measure is widespread and accepted both in family and school; (ii) both parents/ caregivers and teaching staff have limited knowledge on positive educational approaches or rights and entitlements, do not provide children with the appropriate communication and conflict resolution skills; (iii) abused children often come from families with incomplete families, with problems of alcohol abuse or from poor families, which makes them more vulnerable to neglect and especially to economic (including sexual) exploitation; (iv) gender inequalities and stereotypes are supported by media. 5.5.2 Policy Gaps and Solutions Eradicating human trafficking and domestic violence, free access to justice and the right to a fair trial and securing rights for disabled people are among the priorities in the Government’s Activity Program for 2011-2014.315 313 Many NGOs are critical towards the latter institution, including selection of personnel. SIDA, Joint Evaluation of Impacts of Assistance to Social Sector Reforms in Moldova, 2011. 314 As summarized in UNICEF Moldova, Capacity Gap Analysis, Violence, neglect and exploitation of children, preparation to new 2013-2017 Country Programme of Cooperation, 2011. 315 Programul de activitate al Guvernului ‘Integrarea Europeană: Libertate, Democraţie, Bunăstare’ pentru anii 2011-2014,

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Statistics and studies Data and studies are missing or obsolete, particularly in the field of violence against children and child trafficking. The most recent comprehensive assessment of state responsiveness to violence against children in Moldova dates in 2006.316 Latest data come from a research carried out also in 2006.317 Regarding the child trafficking phenomenon in the Republic of Moldova, the latest report of the International Centre ‘La Strada’ (2010) points to the problem of statistical data at national and transnational levels, partially attributed to the data collection methods used by NGOs active in this field. State response envisages the creation of an Automatic Informatics System in Social Assistance, which will also serve the referral, monitoring and evaluation purposes of cases or potential cases of human trafficking, including exploitation. Separation and children without parental care The official start of the child care reform in Moldova is considered to be the year 2006.318 The reform has placed as the frontrunner the Ministry of Labor, Social Protection and Family (former Ministry of Social Protection, Family and Child). This institutional setting has been considered to be an important step forward as it assumed coordination of responsibilities for child rights protection. Main programmatic documents for childcare reform are represented by the: (i) Law on social assistance (2003); (ii) National Strategy and Action Plan for Deinstitutionalization, 2007-2012, (iii) National Programme on the Development of an Integrated System of Social Services, 2008-2012, (iv) Strategy of Social Inclusion of People with Disabilities (2010-2013), (v) Law on social services (2010) and (vi) Adoption Law (2010). Children’s right to be raised by their family is approached in a comprehensive way in the National Strategy and National Action Plan in order to reform the system of residential child care over the years 2007– 2012. Accordingly, in addition to other strategies, family-type homes are being created, social worker units introduced, and conditions created to 2011: 76. 316 UNICEF, State Responsiveness to Violence against Children, 2006. 317 IMAS, Ministry of Education and Youth of the Republic of Moldova, Ministry of Social Protection, Family and Child of the Republic of Moldova, UNICEF, Violence against children in the Republic of Moldova, 2007. 318 Some reports place the start of the reform in 2007. UNDP, National Human Development Report, From Social Exclusion towards Inclusive Human Development, 2010; UN, Country Analysis- UN Moldova, 2010, 2011.

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enable children from residential homes to attend school in the community. The Ministry of Labor, Social Protection and Family is responsible for coordinating activities, but the Ministry of Education (former Ministry of Education and Youth) has under its subordination most of the residential institutions for children. The policy document, the National Strategy for Reforming Child Residential Care System has had two main objectives for the period 2007-2012: (i) to reduce by 50% the number of children in residential institutions and (ii) to reorganize the residential institutions according to a general plan of transformation.319 As we have already shown, the numerical objective is likely to be achieved by 2012. For the second objective, an Action Plan has been developed and revised in October 2009. The plan establishes seven directions for action, including several Ministries, along these lines: (i) legal and Institutional framework; (ii) development of family and community type social services; (iii) increased professional level of human resources; (iv) reorganizing residential institutions; (v) redirecting financial resources from the residential institutions in the community services; (vi) monitoring and evaluation and (vii) communication, advocacy and social mobilization. On a general level, the available evaluations of implementation of the National Strategy and Action Plan on Reforming the Residential Child Care System320 conclude that major progresses were achieved in 20072008, whereas in 2009, the reform lost its impetus. On the other hand, a key factor in implementing the reform resides with the residential institution managers and their capacity and openness to contribute to a successful implementation of the reform. Development of standards as well as of an integrated system of monitoring and evaluation has lagged behind. Ensuring the necessary financing is another challenge, as lack of resources is one of the most important problems in implementation. In addition, as previously mentioned, the reform needs to reconsider the problem of children with disabilities and graduates of residential institutions. Besides, common standards for re-integration, family support services at the community level, the monitoring capacity of the guardianship authority (Department of Social Assistance and Family 319 Government Decision no. 784/2007, National Strategy and Action Plan for reforming the residential child care system in the course of 2007-2012, www.edu.md 320 Every Child, Oxford Policy Management, UNICEF, Assessment of the childcare system in Moldova and technical assistance to the government of Moldova to host the sub-regional consultation on child care reform countries in ENP countries, 2009; The Foundation for Social and Economic Research â&#x20AC;&#x201C; CASE Moldova, UNICEF, Report on evaluating the cost of non-action in the implementation of the National Strategy Action Plan on Reforming the Residential Child Care System for the years of 2007-2012, 2010: 15.

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Protection) as well as coordination between various Ministries needs serious improvements for ensuring the interventions sustainability. On the issue of children left behind by migrant parents, there is a National Plan regarding protection of children without parental care for 2010-2011.321 It includes generous directions for action at multiple levels: legal, institutional, human resources (training for professionals in the field of social protection), raising awareness, prevention activities, including directed towards preventing juvenile delinquency, and monitoring statistics at the community level on children without parental care. However, ensuring financing, realistic sequence of activities and coordination with other social protection fields has remained crucial issues. The assessment of plan’s stage of implementation conducted by the Ministry of Labor, Social Protection and Family in 2010 mentions several achievements, but the overall accomplishment in terms of impact for children well-being is difficult to be evaluated at this moment. Violence and exploitation In the field of violence against children, the state response is still weak. There is a lack of monitoring system and of enforcement mechanisms of existing policies. At the local level, services for care and protection of child victims are limited. Social attitudes count substantially in cases of violence against children. Major mass media campaigns are required for changing the dominant tolerant attitudes towards violence. 322

At the central level,323 there are not a common understanding and definition on what cases of violence represent. The coordination mechanisms between responsible ministries need to be improved. Although at the level of programming documents substantial progress has been made, in implementation the process is still at an early stage and needs stronger commitment. Reintegration and assistance for victims and development collaboration with the NGO sector are seen as priority areas.324

321 Government of the Republic of Moldova, Planul Naţional de acţiuni cu privire la protecţia copiilor rămași fără îngrijirea părinţilor pentru anii 2010-2011, www.mpsfc.gov.md 322 UNICEF Moldova, Capacity Gap Analysis, Violence, neglect and exploitation of children, preparation to new 2013-2017 Country Programme of Cooperation, 2011. 323 UNICEF, State Responsiveness to Violence against Children, 2006. 324 EC, Implementation of the European Neighbourhood Policy in 2010, Country report: Republic of Moldova, 2011.

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In the field of combating human trafficking and protection of victims, the legislative framework includes: (i) Law on prevention and combating the trafficking of human beings (2005); (ii) National Plan of Action to Prevent and Combat Trafficking in Human Beings during 20082009; (ii) Framework/Regulations on the Organization and Functioning of the Centres to Protect and Assist Victims of Trafficking in Human Beings (2006), (iii) Law on labour force migration (2008); (iv) Law on prevention on combating domestic violence (2007) and (v) Strategy for the National Refferral System (NRS) for protection and assistance to the victims and potential victims of human trafficking (2008) and a corresponding Action Plan during 2009-2011. The law on accreditation of services, which would allow subcontracting of services to NGOs, is currently under discussion. On the policy side, the Memorandum of Understanding signed in 2009 by the Government of the Republic of Moldova with the International Labor Organization325 for the elimination of child labor is considered an important progress. The action plan focuses on targeting young girls, children in hidden work situations, and other groups of children with special vulnerabilities and needs. Children in contact with law In the field of juvenile justice, the National Strategy for Strengthening the Judicial System (2007) includes provisions on ‘streamlining the system of justice for minors’ with four objectives: needs assessment (staff and infrastructure); legislative changes to increase due process and simplify legal proceedings; training for judges and staff; establishing the infrastructure for the efficient functioning of the system of juvenile justice. The National Development Strategy (2008-2011) also sets strengthening of juvenile justice as one of its goals, although the formulation of specific objectives/actions lacks concreteness. Relevant legislation includes: (i) Code of Criminal Procedure (2003); (ii) Law on probation (2007) and (iii) Law on mediation (2008). Positive legislative changes326 relate to the length of pre-trial detention for children (cannot exceed four months), length of time a juvenile detained by the police may remain 325 Memorandum of Understanding between the International Labour Oﬃce and the Government of the Republic of Moldova, 2009, available at: http://www.un.md/un_ag_mol/ILO/Memorandum_ILO_GRM_Aug-2009_en.pdf 326 For an extensive list of legislative changes, see UNICEF, Assessment of Juvenile Justice Reform Achievements in Moldova, 2010.

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in police custody (reduced from 72 hours to 24 hours), responsibility for investigating offences by juveniles transferred from the police to the prosecutor, taking into full account childâ&#x20AC;&#x2122;s background and circumstances of the offence, maximum sentence for a juvenile (may not exceed half of the sentence for an adult convicted of the same offence), and developing alternatives to detention for children such as mediation and probation. Cross-sectoral approaches between the juvenile justice system and child care field (reforming residential institutions system) or social protection (prevention activities directed towards at-risk children as children left without parental care or children being in vulnerable families without support) are key for ensuring sustainable reform for children in contact with law.327

5.6 Recommendations To improve statistics by conducting detailed studies in the areas were data are missing or obsolete (e.g. children with disabilities, graduates of residential institutions, violence against children, victims and potential victims of human trafficking and exploitation, children in contact with law, etc.). Also, for evidence-based programming, the national statistics should also be available disaggregated by age, gender, ethnic group, social criteria and geographic distribution (including Transnistria). To continue the residential child care reform with a focus on the quality of the deinstitutionalization process, for ensuring the sustainability of interventions. Major areas for improvement are: (i) financing, including redirecting financial resources from residential institutions to community services; (ii) common standards for re-integration; (iii) integrated monitoring system and improvement of the monitoring capacity of the guardianship authority (Department of Social Assistance and Family Protection); and (iv) coordination between ministries but also between donors. To put more emphasize on the prevention side the residential child care reform by prevention of institutionalization of children bellow age 3 years, family support services at the community 327 Every Child, Oxford Policy Management, UNICEF, Assessment of the childcare system in Moldova and technical assistance to the government of Moldova to host the sub-regional consultation on child care reform countries in ENP countries, 2009: 74.

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level, and the provision of targeted support for families at risk of placing children in institutional care (such as poor households, families with many children, etc.). Effective deinstitutionalization process should be accompanied by reforms promoting inclusive education. Financing and implementing mechanisms for extending the vulnerable groups of children to cover most-at-risk categories (e.g. victims of abuse and trafficking, street children, juveniles released from detention, etc.). To provide financing and implementing mechanisms for promoting the National Plan regarding protection of children without parental care for 2010-2011. To improve the links, coordination and operationalization of the existing strategies and action plans in order to ensure detection and responses in cases of child abuse and neglect, family violence, sexual exploitation of children, child labor and other risks and violations of rights. Long-term interventions are needed to tackle the family and community tolerance of violence against children, considered as a disciplinary measure, which adds to the limited knowledge of parents/ caregivers and teaching staff on positive educational approaches. To develop community services, including prevention, to improve the institutional capacity at the local level from the systems of education, health, social assistance and police, as well as to consolidate monitoring and evaluation are common for the issues of children-victims of different forms of violence and abuse and children in contact with law. To develop and strengthen the national network of social assistants through continuous training but also through improving the recruitment mechanism accompanied by developing a comprehensive system of salary incentives and bonuses based on performance.

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To continue the support for the reform in juvenile justice. Major areas for improvement include: (i) focus on communitybased secondary prevention; (ii) elimination of the use of isolated cells; (iii) institutional reaction against to violation of the rights of children by public officials; and (iv) program addressing juveniles released from correctional facilities. To develop and implement a diversion model328 for children in conflict with the law (from the legal process and deprivation of liberty) as well as services for children who are in contact with the law as witnesses and victims. To work with media for reducing tolerance towards violence against children and women as well as the gender inequalities and stereotypes.

328 Diversion can be defined as the channeling of young people from the criminal justice system into programs that make them accountable for their actions. Diversion focuses on the child and not the oďŹ&#x20AC;ence. Diversion options include: Placement under a supervision and guidance order such as a mentor or peer role model, compulsory school attendance, positive peer association, compulsory attendance at a specified centre for vocational or educational purpose, etc. UNICEF, Malawi Fact Sheet, Diversion of children in conflict with the law, http://www.unicef.org/tdad/Malawifactsheetdiversion.pdf.

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6. SOCIAL POLICY AND POVERTY

Convention of the Rights of the Child Articles This chapter addresses the child’s right ‘to benefit from social security, including social insurance,’ (Article 26 of the Convention on the Rights of the Child) or ‘the right of every child to a standard of living adequate for the child’s physical, mental, spiritual, moral and social development’ (Article 27 of the Convention on the Rights of the Child).

6.1 Key Data What are the key issues making children vulnerable: situation and trends? Absolute and extreme poverty rates considerably decreased. Impact of the economic crisis was concentrated in the rural areas. Absolute poverty increased in these areas in 2008-2009. However, in 2010, it dropped in both areas of residence, and the urban-rural gap started to diminish. Households with children have been more vulnerable to the effects of the crisis than households without children. Children’s risk of poverty has remained higher than that of the overall population. One in every four children was experiencing absolute poverty. Besides the urban-rural gap, wide discrepancies exist between larger cities and small towns as well as between large, central and developed villages close to city and small, peripheral, remote,

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aged and poor villages. Incidence of absolute poverty among children has remained three times larger in villages compared with cities and towns. Groups highly exposed to the risk of poverty include children from rural areas, especially from households of farmers, those who belong to households with many children, those living in multigenerational extended families, or in poor households with migrants. Few other categories of children should be mentioned, although their situation is not well documented: children with disabilities, Roma children, graduates of residential institutions, young released from prison, and ‘street children’. Overall, the social protection system has offered support to the poorer households with children, although some benefits had a deficit of targeting. Child allowances and social aid have had a smaller but positive impact, while nominative compensations have been less efficient in protecting children against poverty. The current reform places the means-tested social aid at the core of the system. In relation to the social aid, several categories of children have limited access: children with both parents employed in agriculture, children from young families that live together with one of the parents’ family, children from households with many children who represent certain religious groups, children left behind by migrant parents in households in poverty, Roma children, children with severe disabilities who live in households. Socially excluded groups of children include graduates of residential institutions, especially those that broke relations with their family, young released from prison, or ‘street children’.

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6.2 The international crisis and poverty in Moldova329 The Republic of Moldova has significant achievements in reducing poverty. At the country level, the absolute poverty has considerably decreased since 2006, reaching 21.9% of population in 2010. The extreme poverty has also reduced from 4.5% to 1.4% of population during the same period. The poverty-related intermediary MDG targets for 2010 were achieved.330 Figure 22. Trends of absolute poverty at population level and the structure of poor population in 2010 by residence area (%) 40 35 30 25 20 15 10 5 0

34,6 31,4

36,3

31,3

Urba n ; 20

Rura l ; 30,3

30,2 24,8

25,8

26,3 Tota l ; 21,9

18,4

2006

26,4

2007

15,2

2008

12,6

2009

Urba n ; 10,4 2010

Rura l ; 80

Data: Ministry of Economy (2011), p. 11. Notes: HBS data. Consumption-based concept of poverty.

In every five poor people, four come from rural areas and only one from cities or small towns. Out of the 735 thousands poor people in the country, 588 thousands are from rural areas. The rural areas were hardly hit by the economic crisis in 2008-2009. As a result, the absolute poverty increased considerably, whereas in urban areas, it continued to decline during the crisis. The peak was reached in the first quarter of 2009, when the absolute poverty in rural areas recorded a high 45%.331 However, in 2010, the absolute poverty dropped in both areas of residence, and the urban-rural gap started to diminish. 329 This chapter is based on the methodology of poverty measurement, which is currently used by the Government of the Republic of Moldova for designing, monitoring and evaluation of social policies and social inclusion programmes. In 2006 the methodology for computing poverty has been subject to change, not allowing for comparisons with previous years. The welfare function used for estimating poverty is based on total household consumption aggregate, which consists of

consumption of food (including consumption out of own food production), purchases of non-food and services, and the use value for a small number of selected durables. Data come from the Household Budget Survey. 330 The targets for extreme poverty (of 4% in 2010 and 3.5% in 2015) were achieved already in 2007. Two sets of targets were agreed in relation to absolute poverty. First set of targets refer to the decrease of absolute poverty from 30.2% in 2006 to 25% in 2010 and 20% in 2015. Figure 22 shows that the intermediary target for 2010 was achieved. The second set of targets relates to the reduction of income poverty according to the $ 4.3 (PPP) per person a day poverty line from 34.5% in 2006 to 29% in 2010 and 23% in 2015. Data regarding the value of this indicator in 2010 is not available, but in 2009, the value was 29.5% of population. Considering the sharp decline of poverty in 2010, the target is likely to being also attained. 331 Ministry of Economy, Raport privind saracia si impactul politicilor 2009, 2010: 17.

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The impact of the crisis was concentrated in rural areas and was transmitted through two main channels: the agriculture and remittances. In 2009, the fall of domestic demand resulted in lower prices for agricultural products, which in turn caused a considerable drop in incomes from agriculture. Consequently, the rural households were severely affected, while the loss was insignificant for the urban ones. At the same time, remittances decreased substantially. As most migrants have been from rural areas, the drop in remittances had a much more disturbing effect over rural households compared to the urban ones.332 On the other side, during the crisis, wages registered a slight increase, which protected urban households against the negative effects of the crisis, but it was less effective in rural areas. In 2010, all types of incomes increased, wages, remittances, incomes from agriculture as well as social transfers, both in rural and in urban areas. The poverty declined accordingly. The poor people were the most affected by the crisis. The contraction in demand for labor in both formal and informal sectors of the economy has affected much strongly the poor. They experienced reduced working hours, unpaid overtime, compulsory day-offs and, therefore, decreased wages. At the same time, cessation or reduction of remittances from members working abroad was significantly higher among poor households. Although in 2009, incomes from social benefits registered a significant increase, they could not compensate for the loss in incomes from work and from remittances. Consequently, the consumption inequality333 rose during the crisis. These trends have somewhat calmed down in 2010. Yet, the average consumption of the richest 10% has remained 6.3 times higher than the poorest 10% of population. The inequality is even more accentuated in monetary terms. In-kind incomes (home grown products) account for 21-23% of total budget of the poorest and only 3% for the richest. Thus, once the self-consumption is not taken into account, the inequality would be considerably higher.

332 In 2009, out of the total household disposable income of rural households, wages accounted for 31%, revenues from agriculture 18%, remittances 22%, and social benefits (including pensions) 21%. In urban households, the corresponding shares were 58%, 1%, 13% and 15% respectively. Ministry of Economy, Raport privind saracia si impactul politicilor 2009, 2010: 13-14. 333 The Gini coeďŹ&#x192;cient of consumption inequality rose between 0.292 in 2008 to 0.309 in 2009. In 2010, it decreased to 0.305. Ministry of Economy, Saracia in Republica Moldova 2010, 2011: 3. Unlike Moldova, the EU member states report the Gini coeďŹ&#x192;cient of income inequality. The two indicators are not comparable. Only for information, the EU-27 average was 0.304 in 2009.

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Table 7. Structure of disposable income per person by deciles of consumption expenditures, 2010 (%) The poorest 20%

The richest 20%

All

Decile 1

Decile 2

Decile 9

Decile 10

Total disposable income

100

b. Counter-value of home grown products

9.8

21.3

22.8

4.7

3.0

a. Monetary incomes, of which:

90.2

78.7

77.2

95.3

97.0

- wages

42.6

35.5

30.4

53.6

49.5

- social transfers

18.7

26.5

27.7

13.8

9.0

- remittances

16.8

8.4

10.0

14.0

21.3

- other monetary sources of income

12.1

8.4

9.2

14.0

17.2

Data: Ministry of Economy (2011), p.13. Notes: HBS data. Consumption-based concept of poverty. Deciles are groups of 10% of population ranked according to the consumption expenditures per person.

The informal incomes are widespread. In 2008, the National Bureau of Statistics reported that 10.9% of all employed in the economy, including those in subsistence agriculture, worked in the informal sector and 31.1% had an informal job. Another survey revealed that one in every four employees worked on the basis of a verbal agreement, without a labor contract.334 As in other countries, as survival strategy, a consistent share of households combines subsistence agriculture with casual informal jobs (most often, day laborer in agriculture). However, the cash informal earnings deepen the inequality so that in the informal sector the rich becomes richer, while the poor manage only to obtain the bare necessities.335 Poverty in Moldova is rather ‘shallow’, with a clear tendency of polarization between the few rich households with very high consumption and the large majority crowding in the immediate vicinity of the absolute poverty line. Both the absolute poverty gap and severity have decreased between 2006 and 2010. The average consumption of the poor has fallen short of the poverty lines (by 4.5% of the absolute poverty line and by 0.3% of the extreme poverty line, in 2010). Not only that the consumption of poor is smaller but it differs significantly of that of the non-poor households. On average, a household from Moldova spends 41% of total budget on food and another 18% on the dwelling maintenance, which makes a total of 59%. The poorest 10% households 334 Survey carried out by the Labor Institute, with the support of the International Labor Organization. Institute for Development and Social Initiatives ‘Viitorul’, Study on Social Protection and Social Inclusion in Moldova, 2009: 34. 335 E.g. Stănculescu, M., Ilie, S. (2001); Neef, R., Stănculescu, M. (eds.) (2002); Neef and Adair (2004); Stănculescu, M., Pop, L. (2009).

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allocate for food and dwelling more than 74% of total consumption expenditures (59% and 15% respectively), whereas the richest 10% cover these expenses with 46% of their budget. Consequently, the poor have to spend less on health, education, clothes or other goods. For example, on average, the poorest allot 17 times less per month/ person for health and medical services than the richest (15 MDL compared to 265 MDL). Similar for education, the poorest spend 36 times less (1.5 MDL compared to 52 MDL per person, per month).336 The profile of poor is highly stable.337 The absolute poverty headcount has been disproportionately high among households with five or more members, headed by elderly (65 years or more), with a low level of education (incomplete secondary education at most), and employed in agriculture or pensioners. Households with three or more children have a high poverty rate, 39.1% compared to the national average of 21.9%.338 However, people from households with three or more children represent only 12% of all poor. By contrast, households without children have a low risk of poverty (19.7%), but account for 44% of poor. Most childless households belong to retired persons (with 28.1% risk of poverty and 35.7% share of the poor). Although pensions have increased, the average pension339 has not yet overcome the poverty threshold. Considering also the demographic trend of continuous increase of the proportion of the elderly over 60 years old in the population, it is expected that the state policies will focus on this vulnerable segment of population. Consequently, the proponents of child care reform need to enhance their efforts for advocating that children are not left aside. Children in Moldova are recognized as one of the most vulnerable categories, at risk of social exclusion, as they have higher rates of poverty than other groups. Along with poor children, the following vulnerable groups have been identified in Moldova: (i) victims of trafficking, (ii) youth, (iii) low-income groups, (iv) people with tuberculosis, (vi) elderly, (vii) rural population, and (viii) women.340 336 Data for 2010, comparison between deciles 1 (the poorest 10%) and 10 (the richest 10%) according to the total consumption expenditures per person. Ministry of Economy, Saracia si Republica Moldova 2010, 2011: 12. 337 Ministry of Economy, Saracia in Republica Moldova 2010, 2011: 11. The national rate of absolute poverty was 21.9% in 2010. By comparison, the rate was 35% for households with five or more members, 30.2% for those headed by elderly (65 years or more), 39.1% of households headed by graduates of primary or incomplete secondary education, 53.5% for those headed by illiterate persons, 44.9% for employees in agriculture, 36.5% for self-employed in agriculture, and 28.1% of households headed by pensioners. Gender diďŹ&#x20AC;erences are not significant. 338 Ministry of Economy, Saracia in Republica Moldova 2010, 2011: 11. Households with children under 16 years old. 339 The average pension for old age was 836.6 MDL at the end of 2010 (www.statistica.md ), while the 2010 absolute poverty threshold was 1015.9 MDL. 340 Toritsyn, A., Ex-ante policy assessment vis-Ă -vis vulnerable groups in SEE: Guide for Practitioners, Local Reform and Public Service Reform Initiative, UNDP, 2009: 7.

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Ethnicity is a strong correlate of poverty in countries such as Romania, Bulgaria or Hungary,341 where both the incidence and the depth of poverty of the Roma population are significantly higher than among the other ethnic groups. In Moldova, an UNDP study342 confirmed that in 2005, Roma faced a risk of poverty two times higher than the non-Roma (59% of Roma in absolute poverty and 50% in extreme poverty compared to the national averages of 24% and 19% respectively, at that time). Recent data on Roma are not available. Poverty is a multidimensional phenomenon. Besides incomes and consumption, the level of deprivation in various assets and services should be considered for understanding the living conditions of the population. In Moldova, about 59% of the population lives in rural areas.343 Table 8 shows significant levels of material deprivation (in goods and services) particularly among rural households, even among those that are not classified as poor according to their consumption expenditures. Table 8. Material deprivation of households from Moldova, 2010 (%) Residence

Quintiles according to consumption

All

Urban

Rural

Tap water

62.5

91.4

39.8

16.1

29.6

44.7

60.4

79.4

Hot water from public network

9.4

21.3

0.1

1.9

6.8

13.2

17.9

Sewage disposal system

32.5

71.9

1.6

15.6

40.2

59.7

Central heating or steam-generating station

34.7

71.8

5.5

7.2

16.4

28.4

43.5

63.2

Gas provisioning

52.4

81.6

29.4

23.5

38.1

49.9

61.3

75.5

In-door bathroom

42.6

76.9

15.6

12.8

22.2

37.3

52.3

72.8

In-door toilet

35.5

73.3

5.8

8.5

17.2

29.9

43.5

Telephone

70.6

81.6

87.6

92.6

94.3

Computer

23.1

38.9

10.7

3.8

10.2

18.3

27.6

45.1

Automobile

18.9

21.4

16.9

8.1

16.5

20.6

32.2

Data: National Bureau of Statistics. www.statistics.md Notes: HBS data. Quintiles Q1-Q5 are groups of 20% of population ranked according to the consumption expenditures per adult equivalent. Q1 – the poorest 20%, Q5 – the richest 20% of population. Data do not include population situated on the left bank of Nistru and Bender municipality. * Not available.

Besides the urban-rural gap, wide discrepancies exist between larger cities and small towns as well as between large, central and developed villages close to city and small, peripheral, remote, aged and poor villages. In 2010, the absolute poverty rate was 30.3% in villages compared to 14.2% in small towns and only 7.3% in larger cities, on average. 341 E.g. Stănculescu and Stanovnik (2009). 342 UNDP, Roma in the Republic of Moldova, 2007. 343 www.statistica.md . The share of rural population represented 58.6% in 2010, decreasing to 58.4% in 2011.

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Sizeable regional gaps have constantly been registered between the wealthy capital, Chisinau, where consumption poverty is only 5.3% of population, and the other three regions of the country, which all have a poverty incidence higher than the national average.344 Deprivation is also considerable at the aggregate level of districts and regions. The Small Area Deprivation Index (SADI) indicates the most deprived territories of the country. By definition, a deprived administrative unit is characterized by larger rural population, low infrastructure development, a decreased access to jobs (underdeveloped local economy) as well as to education and health services, and poor living conditions. According to SADI,345 in 2009, the most developed rural communities (on most dimensions) were the villages located in the vicinity of Chisinau municipality, followed by the territorial administrative unit of Gagauzia. Most villages from the other three regions of the country were deprived on one or more dimension, with a small advantage for the North region. Furthermore, the districts that include small and remote villages are considerably poorer. The most disadvantaged districts from Moldova in 2009 were Rezina and Ungheni from the Center region, Leova and Causeni from the South, as well as Sangerei from the North region.

6.3 Child Poverty346 In the Republic of Moldova, in 2010, households with children accounted for 37.8% of all households, that is about 428 thousands, of which the largest part (57.2% or 245 thousands) were residing in rural areas. In urban areas, one-child households predominate by far, whereas in rural areas, households with two or more children prevail. In the country live around 746 thousands children below the age of 18 years.347 Most of them belong to complete nuclear families (48% of households with children) or in multigenerational households, which include grandparents and/or other relatives, with or without parents (46%). The others belong to single-parent families, which vary between 8% of households with children in urban areas and only 3.4% in rural areas.

344 The North region has stayed on the best position with an absolute poverty rate of 23.7% in 2010. The other two regions have changed positions during time, but in 2010, the South was on the second position (27.7%) and the Center was the last with the highest rate among regions (29.6%). 345 DevInfo database, www.devinfo.md. 346 This section draws heavily on the Ministry of Labor, Social Protection and Family, Annual Social Report 2010, 2011. Data included in the text come from this report, if not otherwise mentioned. 347 National Bureau of Statistics, Situatia copiilor in Republica Moldova, 2011.

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Figure 23. Bars: Distribution of households by number of children and by residence area (number); Pies: Structure of households with children by number of children in each area of residence (%) 1.200.000

5,7 30

1.000.000

45 64

800.000 600.000

Households with 3 or more children

400.000

Households with 2 children

200.000

Households with 1 child Households without children

0 Total

Urban

Rural

Data: National Bureau of Statistics, www.statistica.md Notes: Estimations based on the number of households from the 2004 Census and the shares provided by the Ministry of Labor, Social Protection and Family (2011) based on the HBS 2010, children under 18 years old.

Previous researches348 show that the child poverty is more sensitive to unfavorable economic changes than that of adults. Households with children have been more vulnerable to the effects of the crisis than households without children. After the outbreak of the financial crisis, households with children, particularly in rural areas, suffered income losses compared to households without children. Their consumption fell accordingly during the crisis. The households with children headed by farmers, elderly (aged 65 years or more), and people with primary or secondary education were in 2009 in proportions of 38-44% among the poorest households in the country.349 Consequently, the poverty rate of households with children increased, arriving at a high 50.8% among households with three or more children.350 In 2010, both absolute and extreme poverty followed the same declining curves, which were registered at the level of population. Still, children risk of poverty has remained higher than that of the overall population (figure 24). One in every four children was experiencing absolute poverty, which amounted to 188.6 thousand children below the age of 18 years, of which 14.8 thousands were living in extreme poverty. Thus, 188.6 thousands children belonged to households with monthly consumption expenditures below the absolute poverty threshold (of 1015.9 MDL per person), of which 14.8 thousands were in households that hardly could cover food with their spending of less than 550 MDL per person. 348 UN, The World Bank, Impact of the Economic Crisis on Poverty and Social Exclusion in the Republic of Moldova, 2009: 27, 45. 349 First quintile Q1 - the 20% of households with the lowest consumption per adult equivalent in the country. 350 Households with children under 16 years old. SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

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Figure 24. Trends of child poverty, absolute and extreme poverty rates (%) 35

32,8 27,3

28,2

27,2

Absolute poverty Children; 24,2

25 Absolute poverty Population; 21,9

20 15 10

5,4

3,7

3,2

Extreme poverty Children; 1,9

2,9

0 2006

2007

2008

2009

2010

Extreme poverty Population; 1,4

Data: Ministry of Labor, Social Protection and Family (2011), p. 115 and the National Bureau of Statistics. Notes: HBS data. Consumption-based concept of poverty, children under 18 years old.

The child well-being strongly depends on the welfare of the household in which the child lives. In Moldova, in the best situation are children from households with one child and from complete nuclear families,351 which concentrate in the urban areas. The most vulnerable are children that belong to households with three or more children and/or to multigenerational extended families,352 which prevail in rural areas. Table 9 shows that the households with children agglomerate among the better-offs (with the highest consumption), in urban areas, whereas they tend to crowd among the poorest, in rural areas. Table 9. Absolute and extreme poverty rates of children and distribution of households with children by consumption quintiles by residence area, in 2010 (%) Extreme poverty rate (% children)

Absolute poverty rate (% children)

Urban

0.2

9.8

100

8.7

14.5

19.8

26.9

30.2

Rural

2.9

33.0

100

34.8

24.3

20.1

12.5

8.3

All

Quintiles according to consumption (% households with children) Q1 Q2 Q3 Q4

Data: Ministry of Labor, Social Protection and Family (2011), p.111 and the National Bureau of Statistics. Notes: HBS data. Consumption-based concept of poverty, children under 18 years old. Quintiles Q1-Q5 are groups of 20% of population ranked according to the consumption expenditures per adult equivalent. Q1 â&#x20AC;&#x201C; the poorest 20%, Q5 â&#x20AC;&#x201C; the richest 20% of population.

351 In 2010, the absolute poverty rate of children from one-child households was 18.8% and from complete nuclear families was 20.8%. Households with children under 18 years old. 352 The absolute poverty rates of children were 36.8% for households with three or more children and 28.8% for multigenerational extended families, in 2010. Households with children under 18 years old.

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As a result, the incidence of absolute poverty among children has remained three times larger in villages compared with cities and towns, although it declined in both residence areas in 2010. In villages, one in every three children has lived in absolute poverty compared to one in every ten children in cities and small towns. Children from rural areas are even more vulnerable if they belong to households strongly dependent of in-kind incomes from agriculture. For the rural households with children, incomes from agriculture contribute with 30% to the total budget compared to wages, which bring only 20%, on average. However, when both parents are self-employed in agriculture, products from own garden/land represent the crucial income of the household. Depending on the evolution of the prices of agricultural products or depending on weather (drought, floods, etc.) the household income may suddenly drop or be destroyed. In a ‘good year’ such as 2010, the absolute poverty rate of children from such households was as high as 39%. In a ‘worse’ year, such as 2009, the rate was 52%.353 By contrast, children from households of employers or from two-earner households run by employees have a much more stable situation and a significantly lower risk of poverty (4.9% and 14.3% respectively, in 2010). Furthermore, the child is even better protected against poverty in households headed by graduates of a faculty who hold better positions on the labor market and, consequently, higher and more secure wages. Migration for work abroad affects households with children more than those childless. The share of households with children with at least one migrant was 26% in rural areas, 15.5% in urban, with a national average of 22%, in 2010.354 Overall, in 2010, 17.1% of all children below 18 years old (or around 133 thousands) had one or both parents left for work abroad: 10.4% the mother, 5.2% the father, and 1.5% both parents. Most children left behind live in villages, in multigenerational extended families with one or two children.355 In households with children and migrants, remittances contribute with 60% of the total budget.356 Thus, these households strongly depend on 353 Households with children under 18 years old. 354 This represented more than 64 thousands households with children in rural areas and 28 thousands in urban. For comparison, in 2010, the households with one or more migrants accounted for 14% of all households in Moldova. 355 Of households with children and migrants 52% have one child, 38% have two children and only 10% have three children or more. In addition, 61% are multigenerational extended families, 38% are nuclear families, and less than 1% are single-parent families. Data for 2010. 356 On average, remittances contributed with 22% of monthly disposable income of all households with children. SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

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money coming from abroad. Generally, the remittances provide relatively high income so that children with migrant parents have had a significantly lower poverty rate compared to children with parents in Moldova during the entire period 2006-2010. In 2010, the absolute poverty rate of children left behind was 10.5% compared to 27% of children with parents at home. Table 10. Absolute poverty rates of children and distribution of households with children by consumption quintiles by presence of migrants, in 2010 (%) Absolute poverty rate (% children) All Children left behind by migrant parents Children with parents in Moldova

Quintiles according to consumption (% households with children) Q1 Q2 Q3 Q4

10.5

100

14.1

20.6

26.3

19.7

19.2

27.0

100

26.2

19.9

18.2

18.4

17.3

Data: Ministry of Labor, Social Protection and Family (2011), p.112, 117. Notes: HBS data. Consumption-based concept of poverty, children under 18 years old. Quintiles Q1-Q5 are groups of 20% of population ranked according to the consumption expenditures per adult equivalent. Q1 – the poorest 20%, Q5 – the richest 20% of population.

However, children left behind by migrant parents are a highly vulnerable group in many ways. Their economic vulnerability is not determined by higher rates of absolute poverty, but by a high instability of incomes, as remittances might reduce or cease suddenly due to the evolution on the international markets. When the mother is abroad, the remittances sent at home are higher than when the father is left. The poverty rate of children left behind increases from 3.6% when both parents are abroad, to 9.4% when only the mother is working abroad and 14.7% when only the father is overseas. Thus, mother’s leaving protects better the child against poverty. Nonetheless, we should remind here that mother’s leaving causes the deepest emotional distress of the child left behind. 357 So, more than 81 thousands children from Moldova (in 2010) are well protected in economic terms, have pocket money in abundance (compared to their peers), but are under high emotional distress. Therefore, as shown in section 5.2, they are the most exposed to develop a negative image of self, to isolate and to adopt high-risk behavior, particularly if the relationships with caregivers and family left at home (including father) are tensioned and characterized by violence.

357 UNICEF, The impact of migration and remittances on communities, families and children in Moldova, 2008:ii.

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Furthermore, poverty and income insecurity is the usual reason for leaving abroad. Nonetheless, 10.5% of children with a parent working abroad fall under the absolute poverty line. That is almost 14 thousands children aged 0-18 years. Even more, 14.1% of children left behind (19 thousands) live in low-consumption households.358 They are highly vulnerable as they accumulate economic deprivation and emotional deprivation with the lack of parental care. Besides, material deprivation (with respect to goods and services) is most likely added, as most of them are from rural areas. Children from Chisinau have been relatively advantaged compared to the other children in the country during the entire period 2006-2010. The absolute poverty rate of children has declined drastically from 21% in 2006 to 4.7% in 2010. Thus, the incidence of child poverty in the capital city is five times smaller than at the country level. Similar, the extreme poverty of children has decreased from 2.9% to 0.6%.359 Unlike, in the other regions of the country, the incidence of child poverty has remained higher than the national average, although it diminished. In the North region, the situation of children is somewhat better, with an absolute rate of poverty equal to 24.4% of children in 2010. In the Center and South regions the child poverty has fluctuated between 29% and 32%.360 In conclusion, the Household Budget Survey indicates a number of groups of children highly exposed to the risk of poverty. These groups include children from rural areas, especially from households of farmers, those who belong to households with many children, those living in multigenerational extended families, or in poor households with migrants. However, few other categories of children should be mentioned, although data on their welfare are missing, obsolete or weak. The annual reports on child poverty do not refer to children with disabilities, although the National Budget Survey records such data.361 Specific data on poverty of children with disabilities are not available. There are, however, some data coming from various studies,362 which show that disabled people (children and adults) have had a higher rate of poverty than that of the entire 358 The first two quintiles Q1 and Q2 - the 40% households with the lowest consumption expenditures per adult equivalent in the country. 359 National Bureau of Statistics, children under 18 years old. 360 In 2010, the absolute poverty rate of children was 29.3% in the Center and 33.5% in the South region. National Bureau of Statistics, children under 18 years old. 361 In the HBS are recorded persons with (self-declared) invalidity of grade 1, 2 or 3, according to the Law no. 821/24.12.1991 regarding the social protection of invalids. 362 Institute for Development and Social Initiatives â&#x20AC;&#x2DC;Viitorulâ&#x20AC;&#x2122;, Study on Social Protection and Social Inclusion in Moldova, 2009: 107. Data for 2007; Oxford Policy Management, Support to the National Development Strategy. Needs Assessment of Persons with Severe Disabilities and Their Families, 2011: 3-4.

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population. In 2010, 40% of households receiving social care benefits (which include at least a member with severe disabilities and in need of constant care) fell below the official poverty line. The most affected by poverty have been the disabled persons from rural areas. The official statistics do not provide a breakdown on ethnicity and the latest research on the living conditions of Roma is dated in 2005-2006.363 Nonetheless, it is reasonable to think that Roma children have a disproportionately high risk of poverty or even extreme poverty, given the existent poverty estimates for the Roma population and the fact that usually Roma families include a large number of children. About three other groups of children data on poverty are missing. We refer to the graduates of residential institutions, especially those that broke relations with family, young released from prison, and ‘street children’. However, most of them face destitution and social exclusion, so much more than income or consumption poverty. They have to manage on their own with little or no family support and, even worse, under conditions of very limited support to the social protection system.364

6.4 Are the most vulnerable children protected? 6.4.1 The social protection system In the Republic of Moldova, the current system of social protection is a complex one, covering a large range of benefits and beneficiaries. The social protection provides cash benefits as well as social services. Cash social benefits include both social insurance and social assistance schemes, which comprise a large number of benefits addressed to family and child.365 The social assistance system provides 18 types of cash-benefits366 determined on a category-based principle and only few means-tested.367 363 UNDP, Roma in the Republic of Moldova, 2007. 364 Institute for Development and Social Initiatives ‘Viitorul’, Study on Social Protection and Social Inclusion in Moldova, 2009: 70. 365 Social insurance benefits for family and child comprise of: allowance for care of a sick child up to 7 years old or a child with disabilities up to the age of 16 years; one-off allowance on the birth of a child, for insured women; allowance for childcare up to the age of 3 years, for employed women and apprentices, as well as for wives supported by husbands, on the expiry of maternity leave; and maternity leave. Institute for Development and Social Initiatives ‘Viitorul’, Study on Social Protection and Social Inclusion in Moldova, 2009. 366 Nominative compensations for children with disabilities, families with four or more children under 18 years, and other categories of population; State social allocations, including for children with disabilities under 18 years old and children who have lost their breadwinner; Allocation for care, for persons offering home care to uninsured children with disability of grade 1; One-off allowance on the birth of a child, for uninsured women; Allowance for childcare up to the age of 1.5 years, for uninsured women; Allowances for tutorship/guardianship and adoption of children, which are granted to tutors/guardians and adopters of children; Compensations for costs of urban, suburban and long distance transportation, for children with disabilities. Institute for Development and Social Initiatives ‘Viitorul’, Study on Social Protection and Social Inclusion in Moldova, 2009. Ministry of Labor, Social Protection and Family, Annual Social Report 2010, 2011. Government of the Republic of Moldova, The Second Millennium Development Goals Report, 2010: 25. 367 Social aid, targeted to the poor households, using a proxy means testing mechanism; Monthly allowance for child care

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Usually, the cash transfers are grouped in three categories of benefits: (1) social allowances (paid monthly or just one time to persons not entitled to receive a pension), (2) nominative compensations (paid monthly or annually to some categories of population for the amortization of the increase in costs of heating, electricity and facilities), and (3) the means-tested social aid (income gap benefit targeted to vulnerable households with income below the Guaranteed Minimum Income and meeting some other requirements). The means-tested social aid covers a much smaller share of beneficiaries than the category-based benefits (social allowances and nominative compensations). Social services368 for children in difficulty and families with children are underdeveloped in some areas of the country, in particular, those for highly vulnerable categories of children, as presented in the chapter on Child Protection. Social services are classified under three main categories: basic, specialized and highly specialized. The basic social services include information, counseling and family support, day-care services supplied by community multi-functional centers and services for child reintegration in the family.369 The specialized social services include professional parental assistance (105 families with 142 children), family-type houses for children (78 houses with 298 children), protected apartments, assistance in temporary placement centers (23 centers with 1,389 children), maternal centers (6 centers with 256 beneficiaries), adoption (208 adopted children) and tutelage (1,512 children). Overall, the number of beneficiaries of specialized social services is much lower than in the case of community services. The highly specialized social services are provided in residential institutions. (see section 5.2). The Government of the Republic of Moldova has been committed to ensuring welfare reforms to promote sustainable and inclusive growth. In this respect, the national strategic planning framework establishes a set of goals aimed at increasing welfare, which are focused on providing better social protection for disadvantaged people and increasing participation of the poor in social and economic development of the country, besides increasing incomes, creating jobs, and providing guaranteed access to education and health services. between 1.5 and 16 years, for low-income families with children; Material and humanitarian aid, for persons who cannot support themselves, including families with many children, with disabled children, single parent families, families with orphan children in custody, persons who take care of children up to three years and orphans or children without parental care. Institute for Development and Social Initiatives â&#x20AC;&#x2DC;Viitorulâ&#x20AC;&#x2122;, Study on Social Protection and Social Inclusion in Moldova, 2009. 368 Ministry of Labor, Social Protection and Family, Annual Social Report 2010, 2011: 119-123. 369 There are 59 day care centers with 11,924 beneficiaries (in 2010), including mixed day care centers with various categories of beneficiaries. Most centers are for children and youth at risk. The range of services is large: information, sociocultural, counseling, conflict mediation, occupational therapy, feeding, day care, adapted transport, medical and social rehabilitation. This type of services is underdeveloped in several districts: Basarabeasca, Cantemir, Ceadir-Lunga, Cimislia, Comrat, Donduseni, Floresti, Glodeni, Ocnita and Riscani.

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In order to achieve these goals, an increasing part of the general government expenditures (68% of total, in 2009) have been directed to the social sectors - social protection (33.2%), education (20.7%), and health (14.1%) â&#x20AC;&#x201C; in the last years.370 The largest part has been allocated to social protection spending. On the one hand, a part of the budget is inefficiently spent.371 For example, the nominative compensation program, which accounts for more than 40% of the social assistance budget, has been rated as one of the most costly and inefficient program.372 On the other hand, the low level of most social benefits does not allow for a significant impact on social inclusion of vulnerable groups. In order to provide a better social protection for disadvantaged people and to improve system efficiency, the Ministry of Labor, Social Protection and Family has initiated reforms since 2008. There have been several actions aimed at targeting the vulnerable in the last years, such as pension indexation, increased salaries and allowances or social aid introduction in 2008. Current policy proposals envisaged a consolidation of the social assistance system, with an increased coverage of social aid (almost double) accompanied by a withdrawal of nominative compensations and allowances. 6.4.2 Efficiency of social assistance in protecting the children373 In a previous section we have seen that social transfers (including pensions) represent an important source of income for all households in Moldova. They contribute with 18.7% of the total monthly disposable income per person, with a significant variation from 26.5% for the poorest households to 9% for the richest (table 7).374 In this section, we focus on the coverage, targeting and impact of social benefits over the households with children so that to understand to what extent they cushion the most vulnerable children against absolute poverty. Households with children are less dependent on social transfers compared with households without children. On the one hand, only about 19% of all households with children less than 16 years old have benefited from various cash-transfers and, in case of children 3 to 16 years, the coverage 370 The percentage of total social spending in the general government expenditures increased from 61% of total in 2005 to 63% in 2008, and 68% of total in 2009. IMF Country Report No. 10/232, July 2010: 11. 371 Ministry of Economy, Raport privind saracia si impactul politicilor 2009, 2010. 372 UN, National Human Development Report 2010/2011, 2011: 91, 94. 373 This section draws heavily on the Ministry of Labor, Social Protection and Family, Annual Social Report 2010, 2011. Data included in the text come from this report, if not otherwise mentioned. 374 Data refer to the first and the tenth deciles according to the consumption expenditures per person.

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has been even lower, only 7% have received benefits.375 On the other hand, in the households with children, social transfers (all types, including pensions) accounted, on average, for only 9.5% of the monthly disposable income (or 104.7 MDL per person) in 2010. The share, however, was higher for households with many children (13.6%) and for multigenerational extended families (13.9%). More of the households with children receiving social transfers (including pensions) are among the poor than among the rich.376 The trend holds for social insurance transfers (e.g. pensions) as well as for social assistance benefits (e.g. child allowances, compensations, etc.). Noteworthy, the beneficiaries of social assistance benefits distribute almost equally between poor and non-poor households with children. In other words, a half of the households with children that receive cash-transfers of social assistance have an average consumption or better. Cash-transfers contribute more to the welfare of poor households with children than to the richer ones. Thus, in 2010, the share of social transfers in total disposable income decreased monotonously from 17.9% in poorest households to 5.3% in the richest ones.377 However, the largest part of the contribution has come from pensions, as many children (especially the poor) live in multigenerational extended families including pensioners.378 The child allowances had a much smaller impact on the well-being of households with children. Their contribution to the formation of households’ incomes was the highest for the poor, yet only 2.2% of their disposable income compared to 1.8% for the richest.379 375 UN, National Human Development Report 2010/2011, 2011: 94. 376 The households with children that receive any social transfers distribute across consumption quintiles as follows: 29% in Q1, 21.6% in Q2, 19.6% in Q3, 16.2% in Q4, and 13.5% in Q5, where Q1-Q5 are groups of 20% of households ranked according to the consumption expenditures per adult equivalent. Q1 – the poorest 20%, Q5 – the richest 20% of households with children. Data for 2010. 377 The share of total social transfers in total monthly disposable income of households with children was 17.9% in Q1, 12.1% in Q2, 9% in Q3, 7.7% in Q4, and 5.3% in Q5, where Q1-Q5 are groups of 20% of households ranked according to the consumption expenditures per adult equivalent. Q1 – the poorest 20%, Q5 – the richest 20% of households with children. Data for 2010. 378 However, pension is a social insurance transfer, which is not supposed to be directed to the poor, but depends on the previous work experience and earnings. In fact, HBS 2009 showed clearly that only 10% of households benefiting from a pension belong to the poorest (Q1-20% of households) and only 7% of total amount of pensions is directed towards the poorest (Q1). Households with children under 16 years old. Ministry of Economy, Raport privind saracia si impactul politicilor 2009, 2010: 20. 379 According to the 2009 HBS, 34% of households that benefited of child allowances were found in the first quintile (the poorest 20% households in the country). Nonetheless, the targeting of child allowances was rather poor since the total amount granted distributed almost equally between the poor and the non-poor households. Even so, two types of child allowances – for uninsured persons and especially allowances for children aged 3-16 years - had a good targeting of the poor. Households with children under 16 years old. Ministry of Economy, Raport privind saracia si impactul politicilor 2009, 2010: 20.

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The composition of social transfers varies according to the type of household. Single-parent families as well as the multigenerational households rely mainly on pensions, which make up about 78% of all social transfers they receive. By contrast, the nuclear families together with households with three or more children depend on social assistance benefits (allowances, compensations, social aid), which account for more than half of the amount of social transfers they obtain. There are large differences in the performance of the three types of social assistance benefits: social allowances, nominative compensations and social aid.380 Figure 25 shows the situation from 2010. Allowances cover only 8.8% of population in households with children.381 The coverage is better for the poor and especially for the extreme poor, which indicates a moderate pro-poor targeting. By contrast, the nominative compensations cover a double number of people (17.8% of population in households with children), but while succeed to target the poor (with a coverage of 21.3%), perform less well for the extreme poor population.382 Finally, the social aid has a small coverage among households with children (3.4% of population), a very good performance in targeting the poor, but it does not reach the extreme poor people.383 So, at least according to the HBS 2010, the social aid is virtually irrelevant for children living in extreme poor households.

380 Data from UNICEF, Impact of public transfer payments on poverty and well being of the most vulnerable families in the Republic of Moldova, in the context of transition from category-based to means-testing social assistance, 2011: 39-42. Households with children under 18 years old. 381 However, the coverage of allowances reaches almost 90% of people in households with children under 1 year and more than 50% of those from households with five or more children. 382 Compensations have a considerable higher coverage (more than 50%) for households with four children or more. 383 Social aid coverage is considerable higher among people from households with three or more children.

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Figure 25. Coverage of social assistance cash benefits of households with children in 2010 (% population) 25

21,3

17,8

15 10

16,7

Enti re popul a ti on

13,7 8,8

12,4

10,3

Popul a ti on i n a bs ol ute poverty 3,4

Popul a ti on i n extreme poverty

0,0 0 Social allowances

Nominative compensations

Social aid

Data: UNICEF (2011), p. 38-42. Notes: HBS data, households with children under 18 years old. Consumption-based concept of poverty.

Overall, the social protection system has offered support to the poorer households with children, although some benefits had a deficit of targeting. The support, however, has been insufficient since the child poverty rate has remained higher than that of the population (24.2% compared to 21.9%, in 2010). Table 11 shows that pensions have played a major role for the child well-being. In 2010, pensions reduced the child poverty rate by 5.6%. Child allowances and social aid have had a smaller but positive impact, while nominative compensations have been less efficient in protecting children against poverty. Table 11. Impact of social transfers on child poverty, 2010

Before that transfer

After all transfers

Contribution to the reduction of poverty (%) (After-Before)

29.8 25.8 24.6 25.2

24.2 24.2 24.2 24.2

- 5.6 - 1.6 - 0.4 - 1.0

Rates of absolute poverty (%) Social transfer type Pensions Child allowances Nominative compensations Social aid

Data: Ministry of Labor, Social Protection and Family (2011), p. 118. Notes: HBS data. Consumption-based concept of poverty, children under 18 years old.

Regardless the previous considerations on the performance and impact of the various types of social assistance, both beneficiaries and social workers perceive cash-transfers as being â&#x20AC;&#x2DC;very importantâ&#x20AC;&#x2122; for the welfare of households with children.384 The amount of child allowances has been 384 UNICEF, Impact of public transfer payments on poverty and well being of the most vulnerable families in the Republic of Moldova, in the context of transition from category-based to means-testing social assistance, 2011: 14.

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always very small, rather symbolic. Nonetheless, child allowances have been paid regularly, which made them a reliable source of monthly income for the poor. Nominative compensations for the payment of utilities and the one offered to the families with small incomes for heating in the cold period of the year are perceived as being the most useful by families with many children. Social aid is highly appreciated by beneficiaries, but it is criticized by non-beneficiaries and many social workers who perceive this transfer as being offered mainly to people that use alcohol and the ones that lack the initiative to improve their financial situation. 6.4.3 The current reform of the system: welfare effects on children The transition from a category-based to a means-tested social protection system has been initiated since 2008. Between 2009 and 2010, the social aid was expanded, roughly 16,000 additional households with children being covered.385 The objective of the social protection reform is enhancement of the pro-poor targeting of the system. A better targeted system would require the correction of the current flaws, such as the fact that the category-based transfers distribute across entire population, with little focus on the poor. In this sense, from one year to another, the share of beneficiaries should decrease in the superior quintiles (Q4 and Q5) and shift to the inferior ones (Q1 and Q2). Figure 26, however, shows that whatever happened in Moldova in 20092010, the effects have been rather erratic from the pro-poor targeting perspective, at least among households with children. Thus, between 2009 and 2010, the share of beneficiaries of social assistance cash-benefits increased among the poorest (Q1), but also among the average-income households (Q3). The richest 20% households (Q5) have not been affected at all, while the share of beneficiaries decreased among the better-off (Q4), but even more among the poorer (Q2).

385 Ibid., 2011: 41.

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Figure 26. Change between 2009 and 2010 in the social assistance of households with children A (% households with children) B (% population in households with children) 3

0 -1

Entire population

-2

Population in absolute poverty

-5 -10

-3

-15

-4 Share of households that receive any social assistance transfer

Social Nominative Social aid allowances compensations

Population in extreme poverty

Data: (A) Ministry of Labor, Social Protection and Family (2011), p. 114 and (2010), p. 129; (B) UNICEF (2011), p. 38-42. Notes: HBS data. Consumption-based concept of poverty, children under 18 years old. Quintiles Q1-Q5 are groups of 20% of households with children ranked according to the consumption expenditures per adult equivalent. Q1 â&#x20AC;&#x201C; the poorest 20%, Q5 â&#x20AC;&#x201C; the richest 20%.

Furthermore, the poor households with children were less covered with allowances and nominative compensations (even less than the entire population), but the social aid took part of their vulnerability away. The reform had a much more adverse effect on households in extreme poverty. The loss in child allowances and nominative compensations was very pronounced, without being compensated through the inclusion under the coverage of social aid. Therefore, children from households in extreme poverty have become more vulnerable since the support directed to them was lessened between 2009 and 2010. In addition, the households with three or more children as well as those with children under 1 year, which were abundantly covered with allowances and compensations, do not benefit fully of the transition to social aid, but also lose protection.386 Other groups of children appear also to be at risk of being disadvantaged by the current reform, which places the means-tested social aid at the core of the system. The number of these children is not estimated because most information comes from studies based on qualitative methods. Nonetheless, they indicate the main points that should be monitored for making sure that the social protection reform does not result in an increase of children vulnerability. In relation to the social aid, several categories of children have limited access:387 386 Ibid. 387 Ibid., 2011: 22-33.

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- Children with both parents employed in agriculture: As we have shown, children from rural areas have a high risk of poverty. However, the risk is the highest for children with both parents working in agriculture. Their well-being depends strongly on the agricultural land that the family has, as their incomes are formed mainly based on the food produced within household, social transfers and/or the cash incomes from casual work in agriculture. Nonetheless, the agricultural land might be a barrier to access social aid during hardship times. In order to apply for social aid, they should first pay the land tax or the City Hall refuses to release the certificate about family components. Frequently taxes are unpaid, since they have little money, even more so during the difficult periods. In this way, the children from households depending solely on farming have limited access to the protection directed towards the poor. In addition, when these households succeed to fill in the application, either the formula388 for evaluating the income from agricultural land produces a modest amount of social aid or their application is rejected. So, even when they get access, the social aid is insufficient for providing effective support. - Children from young families that live together with one of the parentsâ&#x20AC;&#x2122; family (multigenerational extended families) in the same house: In these cases, social aid is calculated for the complete family group, which frequently does not qualify, since there might be more than one source of monetary income such as wage or pension. Nonetheless, these young families live together with parents precisely because do not afford to run a distinct household. - Children from households with many children who represent certain religious groups: Usually, they work a lot to support their family, including the children who also are helping the parents, receive humanitarian aid and, hence, their applications to social aid are rejected. - Children left behind by migrant parents in households in poverty: We have pointed out previously that among children left behind there were some 10-14% (or 14-19 thousands) in 2010 that lived in poor or extreme poor households. Even if there is no categorical exclusion of households with migrants for receiving the social aid, their situation is rather confused both for beneficiaries as well as for social workers. In their case, receiving social aid is rejected or ceased in two types of situations. First, when the migrant does not go to Labor Force Office every month, as the social aid 388 According to the same UNICEF study (2011), the recent modifications of the law have not solved the problem of the agricultural land owners. These modifications refer to the fact that the agricultural land of the people who are unable to work, for the retired people over 75 years old and the ones that have in their care children till 3 years old is not taken into account, or in case of the existence of the adults able to work their income is partially calculated.

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law stipulates. Second, when the social worker is afraid that the migrant parent can send home remittances, which raise the family income above the guaranteed minimum income and thus, they cannot be certain on the amount of money that the family eventually has. This happens because there is no mechanism of control and monitoring of information either about incomes or regarding the family composition. As a result, households with migrants are treated differently according to the competence and attitudes of the social worker as well as to the level of involvement of the local public administration. Precisely for this reason, the access to social aid of children from poor households with migrants is limited and uneven across the country. - Roma children seem also to have limited access to social aid, according to specialists in social protection as well as to Roma leaders.389 Most Roma people do not comply with the eligibility criteria that the social aid law stipulates. They are neither employed, nor self-employed, pensioner, or registered unemployed. Many of them do not try or do not obtain (at least in some districts) the necessary documents from Labor Force Office, are not aware that the benefit is available, or are unable to fill in the application. There are no studies to confirm or infirm this information. - Children with severe disabilities who live in households: The parents of the severely disabled children, united in an association, claimed higher benefits both for children and for caregivers.390 In response to these complaints, the Ministry of Labor, Social Protection and Family a number of assessments for understanding the best approach to address the concerns of such families. The latest assessment391 points out that the database of applications to the social aid benefit indicates that up to July 2010 only 22% of all recipients of social care benefit applied for social aid and only half of them qualified for the benefit. Those who did not receive the social aid reported various reasons, including: ownership of land, although the care-giving responsibilities prevented them to work the land; lack of awareness that the benefit existed; inability to provide all the required documents; receipt of remittances. However, the main finding of the study is that the needs of persons with severe disabilities and their families (poor or relatively better-off) can be properly addressed only by providing personal and home assistants and quality community services, reducing 389 Interviews carried out in Chisinau in April 2011. 390 Social workers tend to share the parentsâ&#x20AC;&#x2122; opinion that the allowances for the children with disabilities are too small to cover the high costs for the special care they need, particularly the health related costs. UNICEF, Impact of public transfer payments on poverty and well being of the most vulnerable families in the Republic of Moldova, in the context of transition from category-based to means-testing social assistance, 2011: 14-15. 391 Oxford Policy Management, Support to the National Development Strategy. Needs Assessment of Persons with Severe Disabilities and Their Families, 2011: 4, 8.

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health out-of-pocket expenses, ensuring basic and essential goods (such as diapers or wheelchairs), and developing the medical services, besides improving the social aid or increasing the social care benefit. - Furthermore, the social aid, as the existent cash-benefits, does not improve access to better protection of the socially excluded children such as graduates of residential institutions, especially those that broke relations with their family, young released from prison, or ‘street children’. Regarding the current reform, several studies have identified a series of aspects that need to be changed for improving the efficiency of the existent system.392 Reviewing them is out of the scope of this situational analysis. Nonetheless, is helpful to mention the results of a recent impact analysis,393 which signals that: (i) a full withdrawal of allowances or compensations will not be compensated even if the social aid reaches the envisaged coverage (of 71,000 households), thus will result in an increase of poverty of children and their families; (ii) withdrawal of the categorybased transfers for households with children will result not only in more poor children, but also in deeper poverty, which is even more difficult to be addressed through social policies; (iii) targeting of social aid need to be improved for reaching the children in extreme poor households; (iii) the transition from category-based to means-tested benefits should establish households’ eligibility for social aid before the withdrawal of allowances; (iv) an efficient targeting of households with many children is critical. The best and least costly way to do it is to keep paying them a kind of allowance, a fixed amount of money per capita, for example, based on the fact that they have many children and live in the rural area. For addressing the needs of the different groups of vulnerable children, the social assistance system would need to change the focus from cashassistance to social services, and for ensuring a better targeting of these groups, a paradigm shift would be required from the reduction of poverty to social inclusion. Actually, all studies and experts cited in this chapter agree that, for most groups of children, things have to be rearranged not only from the perspective of income, consumption or benefits, but through the development of social services responding to their specific needs, which should represent the main priority of the social protection reform. 392 E.g. UN, The World Bank, Impact of the Economic Crisis on Poverty and Social Exclusion in the Republic of Moldova, 2009. Oxford Policy Management and Every Child, Support to the delivery of eﬀective and sustainable social assistance services, 2010. UNICEF, Impact of public transfer payments on poverty and well being of the most vulnerable families in the Republic of Moldova, in the context of transition from category-based to means-testing social assistance, 2011. 393 UNICEF, Impact of public transfer payments on poverty and well being of the most vulnerable families in the Republic of Moldova, in the context of transition from category-based to means-testing social assistance, 2011.

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6.4.4 The current reform of the system: challenges Financial resources are critical to the success of the reform in the social protection sector. The overall allocations to social protection have increased from 11.3% of GDP in 2005 to 15.3% in 2009,394 which has been constantly below the EU-27 average of 20.1% in 2009, but higher than in countries such as Bulgaria, Slovakia or Romania.395 In order to cover the existing needs, the state budget is heavily dependent on international funding and remittances. The situation will become more difficult as some of the donors (SIDA, DFID) will phase-down their operations in Moldova.396 Within the total donor commitments for child welfare, UNICEF plays an important part, together with the European Commission. World Bank is the most important donor for activities indirectly related to child welfare.397 Financing the investments in the social sector registers similar experience to the neighboring Romania. The centers financed with international support proved to have the running costs too high. In Romania, some of them have been in the responsibility of small communes, with low budgets, covering a much larger area of beneficiaries than that of their locality. In Moldova, although they are financed at the district level, in some cases they amount to more than 75% of the social expenditures of the district budget, which diminishes the expenditures for developing other social services.398 Decentralization brings further challenges to the system. A significant part of the local budgets in the rural area are too small to support financing of communal public services, playing rather a role of representation than that of delivering public services.399 The current draft Law of decentralization assesses the territorialadministrative reform from 2003, replacing ‘judets’ with districts (raion) as a rather negative one. It has been accompanied by a decrease in the local autonomy. Furthermore, the number of mayoralties increased significantly, amounting to 902 in 2008. A quarter of them does not comply with the population criterion of minimum 1,500 inhabitants, which places great fiscal pressure on local budgets. 394 General government expenditures on social protection accounted for 11.5% of GDP in 2006, 12.3% in 2007 and 12.5% in 2008. Data source: IMF Country Report No. 10/232, July 2010: 11. 395 Eurostat database (General Government Expenditure by function – COFOG) at October 7, 2011. 396 SIDA, Joint Evaluation of Impacts of Assistance to Social Sector Reforms in Moldova, 2011. 397 Every Child, Oxford Policy Management, UNICEF, Assessment of the childcare system in Moldova and technical assistance to the government of Moldova to host the sub-regional consultation on child care reform countries in ENP countries, 2009 398 SIDA, Joint Evaluation of Impacts of Assistance to Social Sector Reforms in Moldova, 2011. 399 Government of the Republic of Moldova, National Decentralization Strategy, draft for public discussion, 2011. One solution is the application of ‘inter-municipal cooperation tools’ for joint public service delivery, as promoted by the Joint Integrated Local Development Program, www.descentralizare.gov.md.

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The challenges on decentralization are different from one sector to another. In child care, studies400 identified a tendency of reduced flexibility caused by the design of financial transfers (on estimated number and type of beneficiaries and services) as well as confusion between responsibilities of the mayoralty and that of the district. In health, optimizing solutions within the district area are difficult to be defined in cost-efficiency terms, as the area of beneficiaries is quite small compared to the international standards.401 In education, the introduction of the per-capita financing needs to consider the problem of ensuring inclusion of children with special needs in the mainstream education. Besides financial resources, personnel of the public institutions play a key role at both central and local levels. Currently, the social assistants represent the focal point of identifying vulnerable cases of children. Their low salaries, increased responsibilities and high rate of turnover call for substantial efforts of strengthening the network of social assistants. The workload of social workers with the applications for social aid is estimated somewhere between 40% and 80%,402 which leaves little time for other tasks. The policy efficiency should also consider ensuring a motivating payment level for social workers. (see also section Child Protection) Monitoring capacity at central level is rather low.403 The capacity of the Ministry of Labor, Social Protection and Family to use Moldova Social Assistance System database needs improvement to ensure sustainability of monitoring and evaluation activities. From the organizational point of view, there is still a strong need for inter-sectoral coordination at all levels, between Ministers, local public administration, donors, NGOs as well as media. On the one hand, the extensive funding received by the Republic of Moldova has undoubtedly resulted in significant progress on various areas with impact on child well-being. It has also created services at high standards, which although mostly needed, are not always financially sustainable. On the other hand, the challenge for the Government of the Republic of Moldova is quite high: to succeed in one of the poorest countries in Europe, in making more efficient use of its state budget funds (by measures such as optimization, 400 Every Child, Oxford Policy Management, UNICEF, Assessment of the childcare system in Moldova and technical assistance to the government of Moldova to host the sub-regional consultation on child care reform countries in ENP countries, 2009. 401 Centre for Health Policies and Analysis in Health, Health Monitor, Study of policy on degree of administrative decentralization in health, 2010. 402 UNICEF, Impact of public transfer payments on poverty and well being of the most vulnerable families in the Republic of Moldova, in the context of transition from category-based to means-testing social assistance, 2011. 403 Swedish International Development Agency (SIDA), Joint Evaluation of Impacts of Assistance to Social Sector Reforms in Moldova, 2011.

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deinstitutionalization, improved prevention), coordinate donorsâ&#x20AC;&#x2122; intervention and target the areas left uncovered in a systematic approach, while ensuring fulfillment of the equity agenda. If sustainable progress is achieved, Moldova might become a best practice example for countries in the region.

6.5 Recommendations To improve statistics by adopting the international methodologies on social inclusion and by conducting detailed studies in the areas were data are missing (e.g. children with disabilities, children without parental care, children who left residential care and broke relations with their family, young released from prisons, etc.). Also, the national statistics should also be available disaggregated by age, gender, ethnic group, social criteria and geographic distribution (including Transnistria). To set up an adequate monitoring mechanism of the situation of children based on key performance indicators so that to ensure that the structural reform in social protection does not result in an increase of children vulnerability. To develop community services, including prevention, to improve the institutional capacity at the local level from the systems of education, health, social assistance and police, as well as to consolidate monitoring and evaluation are common for the issues of socially excluded children (graduates of residential care who broke relations with their family, young released from prisons, â&#x20AC;&#x2122;street childrenâ&#x20AC;&#x2122;). To develop and strengthen the national network of social assistants through continuous training but also through improving the recruitment mechanism accompanied by developing a comprehensive system of salary incentives and bonuses based on performance. To improve the links, coordination and operationalization of the existing strategies, action plans and interventions in order to address properly the needs of the vulnerable groups of children. To change the focus of social policies from poverty reduction to social inclusion To streamline the social assistance transfers for better targeting of the extreme poor and other vulnerable groups of children.

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7. MEDIA AND CHILDREN’S VIEWS

This chapter addresses ‘the right to freedom of expression’ (Articles 12 and 13 of the Convention of the Rights of the Child). The same Convention includes provisions to ‘encourage the mass media to disseminate information and material of social and cultural benefit to the child’ (Article 17), in accordance ‘with the development of respect for human rights and fundamental freedoms’ (Article 29).

7.1 Media and children Voice of the children is poorly echoed in media articles, as the child is considered as a ‘rather passive source of information, without rights or power’.404 Positive events involving children or achievements of children are rarely presented in the mass media. Most often, the media focuses on topics related to sensational news, which picture children primarily as victims of different forms of violence, in conflict with law or part of different conflicts or dramatic situations. More worrying is the fact that in some cases of children in difficult situations such as victims of abuse, trafficking or conflict with the law, the child’s personal data have been disclosed. Furthermore, there have been instances when journalists assumed as true accusations against children, although they have not been proved in court. In other cases, the identity of suspects, victims or witnesses has been revealed. Consequently, a change in the editorial policies regarding children, both regarding topics and the approach, together with the full observation of professional and ethical requirements are needed.

404 Association of Independent Press, UNICEF, Media Monitoring Report on Observance of the Rights of the Child, 2010.

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7.2 Children about their rights Traditionally, children and adolescents in Moldova have not been the focus of investment or concern of the public institutions. Sustained efforts to foster their active participation are only few. Also the initiatives of effectively programming with adolescents are rare, and the best practices are insufficiently known or used and, anyhow, not nationally scaled-up. Government policies on youth, education, health and social protection took some of these into account, and further initiatives to work with young people are supported by donor community and civil society.405 There are, however, studies, workshops and consultations with children and adolescents that have brought their opinions and concerns into the light. For this situation analysis, UNICEF Moldova organized focus-groups discussions. There were six focus-group discussions, with 56 children aged between 9 and 19, of which 34 girls and 22 boys. Participants to focusgroups have been recruited based on the projects developed in Calarasi, Tibirica, Ungheni, Comrat, Chisinau and Balti. Based on these materials, we present below a synthesis of how children think about their rights and about how they are respected in the Republic of Moldova. In discussing and describing their day-to-day problems, children and adolescents tend to concentrate on few topics. Irrespective age, gender, social strata or geographical location, the most widespread themes refer to family, school, and leisure activities. Family relations are of major concern, particularly regarding (mis-)communication with parents or caregivers, migration of parents, and domestic violence. School-related issues range from teaching methods, to the grading system, the quality of textbook, teachersâ&#x20AC;&#x2122; attitudes, unfair and/or discriminatory environment or school abandonment. Leisure activities tend to focus on the lack of recreational services and facilities, particularly in rural areas. Adolescents bring also into discussion topics such as tobacco, alcohol or drug abuse. The relevant others for most children refer to the family and the group of peers (friends). Very rarely children know or ask a social worker, a psychologist, or other professionals, except for the teaching staff, for help in solving some problem. They strongly rely instead on parents.

405 UNICEF, Government of the Republic of Moldova, Mid-Term Review. Country Programme of Cooperation 2007-2011. Concept note Leadership Focus Areas, April 2009.

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Right to education406 The right to education represents children’s favorite right and the most violated one, they say. In their view, infringements of the right to education are identified in several areas. School is not always a childfriendly environment. Many schools do not offer proper hygiene, do not offer access to children with special needs, and are poorly endowed with modern equipment (including IT), but impose financial contributions such as school or class funds. School curricula fails to teach ‘useful things’, about relevant life-skills, but is overburden, which results in a school schedule and homework that are perceived as a violation of the right to free time and leisure activities. Some teachers are not well-trained, are passive, and do not take into consideration children’s opinions. Similar to the family environment, in many schools, the freedom of expression is considered by adults as undisciplined behavior, while children participation is viewed only as a way of maintaining cleanliness in schools or as an entertainment activity. The right to non-discrimination of children is often infringed in relation to education, since many children feel discriminated at school based on ethnicity (Roma children), religion, gender, financial situation or special needs. The most disadvantaged children are seen the peers who are forced to work for making a living instead of going to school. Children left behind by migrant parents are also mentioned as a distinctive group but in this case due to their high absenteeism or lack of interest in school. Right to family environment and protection against violence407 Children and adolescents, who were consulted for various studies and reports, frequently identified the family environment as a problem. Family environment does not offer sufficient affection and proper care in poor 406 Child Rights Information Centre Moldova (CRIC), Life through Children’s Eyes, Children’s Report on the Respect of the Convention on the Rights of the Child in the Republic of Moldova, 2008; Child Rights Information Centre Moldova (CRIC), Truth voiced by children, Children’s Report on the respect of the Convention on the Rights of the Child in the Republic of Moldova, 2009: 30-34; UNICEF, Ministry of Health, Mid-Term Review of the 2007-2011, Program of Cooperation between the Moldovan Government and UNICEF, Leadership Area, Adolescent Health and Development, 2009: 42-43; UNICEF, FocusGroup Report, Children’s Consultation regarding the problems in fulfillment of their rights, 2011. 407 Child Rights Information Centre Moldova (CRIC), Life through Children’s Eyes, Children’s Report on the Respect of the Convention on the Rights of the Child in the Republic of Moldova, 2008; Child Rights Information Centre Moldova (CRIC), Truth voiced by children, Children’s Report on the respect of the Convention on the Rights of the Child in the Republic of Moldova, 2009: 49-54; UNICEF, Ministry of Health, Mid-Term Review of the 2007-2011, Program of Cooperation between the Moldovan Government and UNICEF, Leadership Area, Adolescent Health and Development, 2009: 43-48; UNICEF, FocusGroup Report, Children’s Consultation regarding the problems in fulfillment of their rights, 2011.

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households but also when the parents left for work abroad, when a parent deceased or divorced or when parents make alcohol abuse. In these situations, tensions and miscommunication between children are parents are often reported, particularly by adolescents. Given the massive work migration of adults with children from Moldova, children’s right to a family environment can be considered as among the most infringed ones. In children’s opinion, the separation from parents, particularly from the mother leads to: working more, as in taking care of younger brothers and sisters; increased rates of school absenteeism and drop-out; increased rate of juvenile delinquency; substance use; homeless children (besides migration, other causes include alcohol abuse or parents’ decease); physical violence. Children report various forms of violence and abuse in family as well as in school environment, performed by both adults and children: (i) emotional violence, intimidation and teasing (e.g. teachers and children using nicknames, teachers using collective punishments, children making hurtful tricks on their classmates); (ii) neglect (teachers not checking homework, teachers involving only pupils with good performance, parents not attending school meetings); (iii) physical violence (both parents and teachers consider it as a form of education). Other problems related to violence and mentioned by children refer to higher incidence of violence in boarding schools, precocious sexual relations among adolescents, sexual abuse against children and increased number of teenage mothers, abuse cases in families with increased alcohol consumption. Right to life and medical assistance408 The right to life and medical assistance are to a less extent known by children compared to the rights to education, leisure and recreational activities, freedom of expression and family. In children’s view, although they are covered with the health insurance, they often do not receive satisfactory medical care. Schools do not always provide medical services, due to the lack of either personnel or equipment. 408 Child Rights Information Centre Moldova (CRIC), Life through Children’s Eyes, Children’s Report on the Respect of the Convention on the Rights of the Child in the Republic of Moldova, 2008: 29; Child Rights Information Centre Moldova (CRIC), Truth voiced by children, Children’s Report on the respect of the Convention on the Rights of the Child in the Republic of Moldova, 2009: 13; UNICEF, Focus-Group Report, Children’s Consultation regarding the problems in fulfillment of their rights, 2011.

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The medical institutions lack funds, have insufficient technical equipment, under-trained medical personnel, and breach of hygienic norms is frequent in hospitals. Parents or caregivers have scarce financial resources and/or insufficient knowledge. In families with parents left abroad, particularly the mother, the food is less tasty and the nutrition less adequate. The right to health and that to leisure activities are strongly correlated, especially in the case of substance use among children, in children’s opinion. Lack of opportunities for leisure activities is in some cases associated with substance use. The most disadvantaged children with respect to medical assistance are seen the peers from poor families, orphans, Roma children and HIV positive children. Right to leisure and recreational activities409 The right to free time and leisure activities is highly dependent on factors at family and community levels. In poor households but also in households with migrants, especially in rural areas, many children have to help with housework or in agriculture and thus have less time for leisure or homework.410 At the community level, in rural areas, the infrastructure for leisure activities is poor and, in some cases, even harmful to child’s health. There are no facilities for children with special needs. Trained professionals needed for some leisure activities are often missing in rural areas. Actually, the UNICEF study from 2009 confirms the children perceptions. In rural areas, the opportunities for recreational activities are very limited. As a result most rural youth spends time at home, visits friends or just hangs around. The main leisure activity of the vast majority of young (both from rural and urban areas) is going to discos and bars. The right to free time and leisure is strongly correlated with the child’s right to protection against labor exploitation. Concerning child labor, infringements are observed in both family and school environment. There are cases of both parents and teachers who force children to work. Moreover, children with disabilities are more involved in begging, while 409 Child Rights Information Centre Moldova (CRIC), Life through Children’s Eyes, Children’s Report on the Respect of the Convention on the Rights of the Child in the Republic of Moldova, 2008; Child Rights Information Centre Moldova (CRIC), Truth voiced by children, Children’s Report on the respect of the Convention on the Rights of the Child in the Republic of Moldova, 2009: 49-54; UNICEF, Ministry of Health, Mid-Term Review of the 2007-2011, Program of Cooperation between the Moldovan Government and UNICEF, Leadership Area, Adolescent Health and Development, 2009: 49; UNICEF, Focus-Group Report, Children’s Consultation regarding the problems in fulfillment of their rights, 2011. 410 Including child labor as result of poor financial resources or parents’ migration.

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there are also cases of children working in other dangerous conditions such as constructions or restaurants and bars. Child labor is associated with a high rate of school dropout.

7.3 Adolescents’ participation in the community life411 In Moldova there is a lack of tradition of the youth’s participation in the community life. Under conditions of financial constraints, many families give priority to survival and allocate little (if any) time and money for leisure activities. A survey from 2008 showed that only 16% of young people aged 15-24 years were willing to participate in solving their community problems, while 33% said that they are not willing, and 42% said they could not participate, mainly because ‘lack of time’ or ‘do not know how to get involved’.412 On the other side, there is a lack of tradition of the local public administration to adopt a participatory approach, so they are not used to be receptive to the population’s ideas, let alone children’s. In addition, there are very few activities organized at the community level in which the youth can get involved, especially in rural areas. The government has initiated and developed a legal and policy framework, which fosters youth participation, including Youth Law, Youth Strategy for years 2009-2013 and Budgeted Plan of Action for year 2009. In the period 1999-2003, with the UNICEF support, were established 82 Youth Resource Centers, Youth Media network, Local Youth Councils, and Peer educators network. However, at the end of the programme only a part of these initiatives were taken over by local authorities, because of a lack of implementation mechanism and financial support required, although they were recommended and included in the Youth Strategy for years 20032008 and 2009-2013.

411 UNICEF, Ministry of Health, Mid-Term Review of the 2007-2011, Program of Cooperation between the Moldovan Government and UNICEF, Leadership Area, Adolescent Health and Development, 2009: 50-51. 412 The other 9% did not respond the question.

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7.4 Recommendations To work with media for changing the editorial policies and reflecting in an adequate manner the childâ&#x20AC;&#x2122;s image in mass media, with the full observation of professional and ethical requirements. To develop legal mechanism for local public administration to involve adolescents in decision-making and participation at the local level. To include in the Education Code a provisioning that would require schools to involve adolescents in decision-making and participation at the local level. To develop leisure and recreational activities within existent youth services, which are available in all districts but are often outdated or do not correspond to youthâ&#x20AC;&#x2122;s needs.

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8. CONCLUSIONS AND RECOMMENDATIONS The current situation analysis of children in Moldova aims at identifying, based on available data and studies, the key vulnerabilities, progress and remaining challenges for the improvement of the well-being of the most vulnerable children in the Republic of Moldova, with special attention to equity.

CONCLUSIONS What are the key issues making children vulnerable: situation and trends? Health and Nutrition Leading country development indicators, such as infant and maternal mortality are still far from the European average (11.7 compared to 4.3 per thousand live-births). However, infant and under-five mortality rates have been substantially reduced. Vulnerable groups include children from rural areas, boys, children from households within the lowest quintile, Roma children and children from the South region. Immunization rate for children under two years is very high, one of the highest in the world. The proportion has, however, decreased lately, particularly in urban and for children with highly educated mothers. Share of underweight children aged 0-5 years has considerably decreased. Given the coping strategies of households in response to the economic crisis, quality of nutrition might decrease. Morbidity through anemia constantly increased between 2001 and 2010. However, as a better SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

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screening strategy has been put in place, the problem is not necessarily bigger, but it becomes increasingly visible. Number of children with disabilities increased. Mental disorders rate for children has also increased. However, in Moldova the cases of mental retardation are over-estimated while psychiatric disorders are misdiagnosed in the case of some psychological and social issues related to conflict situation. Suicide rate for teenagers (15-19 years) is at an average level in the region. HIV/AIDS rate for the 15-24-year age group increased in 2009-2010. A shift in transmission routes of HIV/AIDS from injecting drug behavior to sexual intercourse has been documented. The left bank of Nistru has a higher incidence than the right bank. People living with HIV have to face discriminatory attitudes from both population and professionals from health and education sectors. This is worsened by the low level of knowledge about HIV transmission, especially in the rural areas and the youthâ&#x20AC;&#x2122;s risk behaviour. Substance use continues to be a major health problem. The prevalence rate of injecting drugs among youth is higher in Moldova than in the EU member states. Alcohol use is increasing, while tobacco use is rather constant. High level of tolerance among youth regarding alcohol consumption needs to be addressed. Factors that hinder access to health services are represented by: lack of medical insurance for about 20% of the population, poor transport, water and sewage infrastructure in rural area, low coverage with family doctors and specialized personnel for rural residents, out-of-pocket money, but also discriminatory attitudes and poor knowledge on health issues of both parents and adolescents. ECD and Education Enrollment rates show positive developments for pre-primary level and decreasing trends for primary and secondary education. Rural area has remained at disadvantage. The declining trends of enrollment in compulsory education in rural areas show the accumulated disadvantages of children from rural areas: poor school infrastructure, large distances, higher rates of poverty, and migrating parents.

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Parents’ knowledge, attitudes and practices play a key role in the earlychildhood development and education. Minor progress is registered in the use of positive childcare practices among families with small children. Moreover, parents’ intolerant attitudes towards children with disabilities hinder the development of inclusive education. It adds to the teachers’ lack of skills and appropriate methodologies for children with special educational needs. Pre-primary education services for children aged 0-3 years are not available, while services for parental education are not developed either. Besides adults’ knowledge and attitudes, geographic access and poverty hinder access of children to school. Child Protection The reform of residential system has as major area of progress the quantitative reduction of the number of children in these institutions. Prevention of institutionalization has also been developed. Still, the rate of institutionalized children continues to be high. Re-integration cases are still few compared to the existing needs. Community services are still underdeveloped. Moreover, most children left ‘naturally’ the system of residential care, as graduates. No system has been put in place for them. Furthermore, the impact of the reform of residential care on children with disabilities is rather low. Number of children left behind by migrant parents is quite impressive. In 2010, 17.1% of all children below 18 years old (or around 133 thousands) had one or both parents left for work abroad. Separation from parents influences the moral and psycho-social development and causes anxiety. Adding to this the excessive money at their disposal, they are likely to adopt behaviors such as irrational use of money, orientation to consume, precocious sexual relationships, alcohol or drug abuse, and socially undesirable behavior. Various forms of violence against children such as domestic neglect, domestic emotional/ psychological abuse, domestic physical abuse (beating), commercial sexual exploitation and child trafficking or child labor are still persistent in Moldova. Physical violence against small children (0-7 years) is widespread. Almost 42% of parents (50% of mothers and 33% of fathers) use physical punishments, with higher shares among parents from rural areas.

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Juvenile delinquency in Moldova has had a decreasing trend in recent years, if considering the share of juvenile crimes in the total number of crimes. However, in absolute numbers, the number of crimes committed by minors increased in 2010 compared to 2009. Focus on communitybased secondary prevention and elimination of the use of isolated cells some of the areas which still need support. Social Policy and Social Protection The impact of the economic crisis was concentrated in the rural areas, leading to increased absolute poverty rates in 2008-2009. Households with children have been more vulnerable to the effects of the crisis than households without children. Absolute and extreme child poverty rates considerably decreased in 2010. Nonetheless, childrenâ&#x20AC;&#x2122;s risk of poverty has remained higher than that of the overall population. One in every four children was experiencing absolute poverty. Incidence of absolute poverty among children has remained three times larger in villages compared with cities and towns. Overall, the social protection system has offered support to the poorer households with children, although some benefits had a deficit of targeting. Child allowances and social aid have had a smaller but positive impact, while nominative compensations have been less efficient in protecting children against poverty. Nevertheless, the effects of the social assistance reforms have been rather erratic from the pro-poor targeting perspective, at least among households with children. Children from households in extreme poverty have become more vulnerable since the support directed to them was lessened between 2009 and 2010. In addition, the households with three or more children as well as those with children under 1 year, which were abundantly covered with allowances and compensations, do not benefit fully of the transition to social aid, but also lose protection.

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CLUSTERS OF VULNERABLE GROUPS The present SitAn investigates key vulnerabilities affecting children on: health and nutrition, early childhood development and education; child protection, social policy and social protection. The Analysis identified several groups of children as vulnerable, most of them on more than two dimensions. For a focused analysis, we have classified them alongside the shared and inter-related vulnerabilities they experience. 413 It does not mean that the groups are mutually exclusive. It only signals the groups to which specific interventions should be addressed, with the only mention that it is difficult to say which are ‘the most vulnerable’ or ‘the least vulnerable’. From the point of view of child well-being, all are equally important and should be addressed in a systematic and comprehensive way. For instance, sustainable improvements in deinstitutionalization cannot be accomplished without developments in inclusive education.

Economically disadvantaged Poor children face restricted access to health and education systems. Social assistance systems do not efficiently protect the extremely poor. Children from households with many children are at a higher risk of poverty. Children from rural areas accumulate multiple disadvantages in both health and education dimensions. The poor infrastructure and coverage with professionals in rural areas, transport costs, and lower quality of services represent root causes. Children with both parents employed in agriculture are particularly vulnerable. Their well-being depends strongly on the agricultural land that the family has. Moreover, children from rural areas are more exposed to being child laborers. Children left behind by migrant parents in households in poverty. Although not traditionally considered as ‘poor’, this specific group has a high vulnerability. In access to social aid, they are highly dependent on the competence and attitudes of the social worker. 1. The invisible children Roma children are practically non-existent in recent official statistics. With the exception of few studies carried out by international donors, 413 We have found very useful the vulnerabilities’ mapping conducted with the study conducted by the Centre for International Education and Research (CIER), School of Education, University of Birmingham, UK and UNICEF Regional Oﬃce for South Asia, Education in emergencies in South Asia, Reducing the risks facing vulnerable children, 2009.

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there is no comprehensive information about them. Still, they hold real vulnerabilities under all dimensions. They face higher risks of infant mortality, school drop-out and poverty than the general population. Children with disabilities are ‘invisible’ in official statistics, as is the case with those not enrolled in school. They are also ‘invisible’ in everyday life, as facilities for their physical access to public institutions/services simply lack. Moreover, they have to face discriminatory attitudes from both professionals and parents of children included in mainstream education. They are exposed to multiple risks under all four dimensions considered. Victims of trafficking or different forms of abuse / violence are hard to track, especially in the case of international trafficking networks. They are exposed to multiple deprivations. For instance, children victims of physical abuse are more vulnerable to becoming victims of sexual abuse, have difficulties in adapting in school, and have a higher risk of suffering physical abuse from teachers also. Physical violence against small children (0-7 years) is widespread. Street children are hard to identify and monitor, especially as they usually do not attend school. They are vulnerable to cases of different forms of violence against children or to becoming offenders. Graduates of residential institutions are left ‘on their own’ by virtually all the systems that should contribute to their well-being. Those that have broken relationships with family are in particular vulnerable. Similar, no monitoring system is put in place for them. Teenage mothers have a significantly higher risk of maternal death and of school drop-out. Also, their babies have a higher risk of death. Children out-of-school are not reported in the official statistics and, hence, tend to become an ‘invisible’ problem. However, they most likely encompass several clusters of vulnerable children whose situation is not documented. Children from Transnistria are part of some health programs, but out of many other social and education programs. Correspondingly, they are captured unsystematically by statistics and their situation remains unclear for important aspects.

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Differently affected This broad category includes children affected mainly by one dimension, which in turn creates deprivations in other areas. This is not to say that the other categories cannot be included under this category, it is used only for synthetic purposes. Children with HIV/AIDS multiply their health vulnerabilities with restricted access to educational services, magnified by discriminatory attitudes of adults (professionals and parents). Children using substance (drug, tobacco or alcohol). Substance usage affects primarily their health and contributes to an anticipatory socialization leading to high-risk behavior. In particular, injecting drugusers are at significant risk of HIV/AIDS infection or drug overdose and are also discriminated by health and education personnel. Children left behind by migrant parents experience emotional difficulties which also impact their results in school system. Children experience emotional difficulties, including sadness, loneliness and a feeling of insecurity. The lack of parental support and emotional deprivation together with considerable amount of money at their disposal leads to adoption of risk behavior. Children in residential institutions are vulnerable especially against education and child protection dimensions. They lack all the benefits of growing up in a family environment, are excluded from mainstream education, do not have necessary basic life skills and find it hard to socially integrate after graduation. Children of 0-3 years are vulnerable mainly because of lack of parental education. Their early childhood development can be affected by the poor knowledge and inappropriate practices of their parents. Children in contact with law are particularly vulnerable from the perspective of the juvenile justice system as part of child protection dimension. They are at risk of being detained in pre-sentencing facilities before final sentence delivery or to be beaten or harassed by police or employees of the penitentiary service. Juveniles in detention are at risk of HIV/AIDS infection. Juveniles released from correctional facilities find it hard to reintegrate within their family or access educational services.

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RECOMMENDATIONS What systems and practices respond to the needs of vulnerable children? 1. Cross-sectoral strategies There is a wide range of vulnerable groups of children identified by the present situation analysis. Moreover, there are a number of reforms carried out simultaneously (child care, social protection, inclusive education, etc.). In order to address them, the following cross-sectoral strategies are considered the main recommendations of this report. In the current multitude of strategies and action plans, there is a strong need to improve the links, coordination and operationalization of interventions in order to adequately address the needs of the vulnerable groups of children. Under increased fiscal budgetary constraints and growing demand of social protection, a change in the focus of social policies from poverty reduction to social inclusion becomes a must. Additionally, efficiency gains in the social sectors could be achieved by developing prevention side at community level. Lastly, the problem of monitoring and evaluation in all sectors contributing to child well-being is key for ensuring that vulnerabilities are properly identified and addressed. The study highlighted the need to set up adequate monitoring mechanisms so that to ensure that the structural reform in education or social protection does not result in an increase of child vulnerability. 2. Data and studies Groups of children which are at present time ‘invisible’ in statistics or studies should become ‘visible’. Documentation about the other clusters of vulnerable groups should be periodically updated. Examples include development of setting up a national system of data collection through schools. The analysis identified as well several policy areas which require

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detailed studies, such as: mental health, suicide, school dropout, early school leaving, etc. Additionally, in the field of social protection, there is a need to improve statistics by adopting the international methodologies on social inclusion. For evidence-based programming, the national statistics should also be available disaggregated by age, gender, ethnic group, social criteria and geographic distribution (including Transnistria). 3. Sectoral strategies Legislation/ Policy development To develop legal mechanisms for public sector to contract NGOs to provide youth-friendly services. To improve the legislation on methodology and practices of working with the family of disabled child and review of Law on social integration of disabled people according to the European standards. To continue the support for the reform in juvenile justice. Major areas for improvement include: (i) focus on community-based secondary prevention; (ii) elimination of the use of isolated cells; (iii) institutional reaction against to violation of the rights of children by public officials; and (iv) program addressing juveniles released from correctional facilities. To develop and implement a diversion model for children in conflict with the law (from the legal process and deprivation of liberty) as well as services for children who are in contact with the law as witnesses and victims. To continue the residential child care reform with a focus on the quality of the deinstitutionalization process, for ensuring the sustainability of interventions. Besides financing, major areas for improvement are common standards for re-integration, integrated monitoring system and improvement of the monitoring capacity and coordination between ministries and donors. To change the focus of social policies from poverty reduction to social inclusion and streamline the social assistance transfers for

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better targeting of the extreme poor and other vulnerable groups of children. Children are among the most vulnerable groups if natural hazards occur. Integrated disaster risk management plan should prioritize interventions towards them. Financing To provide financing from the National Insurance Fund and implementing mechanisms (also through contracting out services to NGOs), especially for preventive and health promotion activities. The best interest of the child should be the guiding principle of optimization of school network or class size. There is a clear need for increased efficiency in education public expenditure, which covers an important share of GDP. Budgetary constraints make even more stringent the need for reform. However, the recent developments in education bring equity agenda in the front run. To provide financing and implementing mechanisms for promoting inclusive education and extending the vulnerable groups of children to cover most-at-risk categories. To redirect financial resources from residential institutions to community services. Services To introduce parental education services, particularly for parents of children aged 0-3 years. To continue the distribution of food to pregnant women, lactating mothers and children under 3 years old during winter time and to extend coverage of the Early Childhood Development program, focusing on young children (0 to 7 years of age), for preventing child malnutrition during the period of crisis. To expand geographic access to youth-friendly services, especially in rural areas, and for most vulnerable ones (including Transnistria region).

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To increase the capacity of youth-friendly services to outreach the most vulnerable and to expand the range of preventive services such as free condoms programs. To develop the specialized services addressing the most-at-risk groups of young people (e.g. harm reduction program including â&#x20AC;&#x2DC;breakthe-circleâ&#x20AC;&#x2122; interventions, drug and alcohol long-term rehabilitation services, smoking-cessation program, etc.). To continue the initiatives aimed at extending the kindergartens network, through flexible arrangements such as changing the number of working hours, establishing community centers, together with curricula reform, educators training and improved material basis. To develop services of counseling and career orientation for helping young people, particularly from rural area to continue education or to enter labor market. To put more emphasize on the prevention side of the residential child care reform by prevention of institutionalization of children bellow age 3 years, family support services at the community level, and the provision of targeted support for families at risk of placing children in institutional care (such as poor households, families with many children, etc.). Human resources To train professionals in contact with children and youth (medical staff, social workers, particularly in rural areas), together with updated curriculum and specialized training programs for specific pedagogical approaches. To establish position of psychologist within all schools, with clear responsibilities on monitoring, counseling and therapy of children left without parental care as well as other categories of children mostat-risk. To ensure the recruitment and retention of young teachers, accompanied by developing a comprehensive system of salary incentives and bonuses based on performance.

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To develop and strengthen the national network of social assistants through continuous training but also through improving the recruitment mechanism accompanied by developing a comprehensive system of salary incentives and bonuses based on performance. Participation and communication To work with media to promote healthy lifestyle and to reduce the discriminatory attitudes towards vulnerable groups of children and tolerance towards violence against children and women as well as the gender inequalities and stereotypes. There is a need of change in the editorial policies in order to reflect adequately the childâ&#x20AC;&#x2122;s image in mass media, observing professional and ethical requirements. To develop legal mechanism for local public administration to involve adolescents in decision-making and participation at the local level. To include in the Education Code a provisioning that would require schools to involve adolescents in decision-making and participation at the local level. To develop leisure and recreational activities within existent youth services, which are available in all districts but are often outdated or do not correspond to youthâ&#x20AC;&#x2122;s needs. Infrastructure To develop transport infrastructure for improved geographical access to medical assistance and education. To improve access to safe water sources, sewerage and sanitation in the schools and households from rural areas.

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9. REFERENCES

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Academy of Science of Moldova (2009), Îmbătrînirea populaţiei în Republica Moldova: consecinţe economice și sociale http://www.unfpa.md/images/stories/ publicati/imbatrinireapopulatieirm_book_color_out.pdf

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Association of Independent Press (2010) Media Monitoring Report on Observance of the Rights of the Child, UNICEF

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BBC News (2007) BBC radio, Julia Rooke, Helping Moldova’s Deserted Children,

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http://news.bbc.co.uk/2/hi/programmes/crossing_continents/6542385.stm

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Bivol, S. (2010) National HIV/AIDS Response Analysis Republic of Moldova, Chisinau

•

Centre for Health Policies and Analysis in Health (2009) Maternal and Child Health Equity Analysis, UNICEF, Chisinau

•

Centre for Health Policies and Analysis in Health (2011) Evaluation of Integrated Management of Childhood Illnesses Initiative in the Republic of Moldova Years 20002010, UNICEF, Chisinau

•

Centre for International Education and Research (CIER), School of Education, University of Birmingham, UK, UNICEF Regional Office for South Asia (2009) Education in emergencies in South Asia, Reducing the risks facing vulnerable children

•

Child Rights Information Center (2006) The situation of children left behind by migrating partners, UNICEF, Chisinau

•

Child Rights Information Center (2008) The impact of parental deprivation on the development of children left behind by Moldovan migrants, UNICEF, Chisinau

•

Child Rights Information Centre Moldova (2008) Life through Children’s Eyes, Children’s Report on the Respect of the Convention on the Rights of the Child in the Republic of Moldova

•

Child Rights Information Centre Moldova (2009) Truth voiced by children, Children’s Report on the respect of the Convention on the Rights of the Child in the Republic of Moldova

•

CIA (2011) The World Factbook, https://www.cia.gov/library/publications/the-worldfactbook/geos/md.html

•

Colliard, C. (2009) Creating a psychosocial component to the Moldovan Emergency Response System, Assessment Report, UNICEF

•

European Commission, European Neighbourhood and Partnership Instrument, Republic of Moldova, Country Strategy Paper 2007-2013

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169

•

European Commission (2011) Implementation of the European Neighbourhood Policy in 2010, Country report: Republic of Moldova

•

European Observatory on Health Systems and Policies (2008) ‘Moldova, Health System Review’, Health Systems in Transition, vol.10, no.5

•

European Monitoring Centre for Drugs and Drug Addiction (2010) The State of Drugs Problem in Europe, Annual Report 2010

•

European Training Foundation (2010) Overview of the Relationship between Human Capital Development and Equity in the Republic of Moldova, Expert Grup

•

EveryChild, Oxford Policy Management (2009) Assessment of the childcare system in Moldova and technical assistance to the government of Moldova to host the sub-regional consultation on child care reform countries in ENP countries, UNICEF, Chisinau

•

Every Child, IMAS, USAID (2009) Protection of rights of the children without parental care or of children at-risk-of separation from their families

•

Expert-Grup (2006) Child Poverty in the Republic of Moldova, UNICEF, Chisinau

•

The Foundation for Social and Economic Research – CASE Moldova (2010) Report on evaluating the cost of non-action in the implementation of the National Strategy Action Plan on Reforming the Residential Child Care System for the years of 20072012, UNICEF, Chisinau

•

Galbur, O. (2010) Report on the assessment of demographic process (by age, gender, environment, trends for the next 10 years) and morbidity analysis in the Republic of Moldova, neighboring countries, and European Union, trends and changes in the last 7 years, Chisinau, http://www.ms.gov.md/_files/8679-Report%2 520on%2520the%2520assessment%2520of%2520demographic%2520process.pdf

•

Government of the Republic of Moldova (2010) Rethink Moldova, Medium Term Development Priorities, www.gov.md

•

Government of the Republic of Moldova (2010) Planul Național de acțiuni cu privire la protecția copiilor rămași fără îngrijirea părinților pentru anii 2010-2011 (National Plan regarding protection of children without parental care for 2010-2011), www. mpsfc.gov.md

•

Government of the Republic of Moldova (2010) Post Disaster Needs Assessment Floods 2010

•

Government of the Republic of Moldova (2010) Moldova’s Report on IADGs Implementation. Annual Ministerial of the ECOSOC

•

Government of the Republic of Moldova (2010) Report on the Evaluation of the National Development Strategy Implementation During the Period 2009-2010

•

Government of the Republic of Moldova (2011) Joint Assessment Report Moldova National Program for HIV/AIDs and STIs Control and Prevention for 2011-2015, www.unaids.md

•

Government of the Republic of Moldova (2010) The Second Millennium Development Goals Report, Republic of Moldova

•

Government Decision no. 523/11.07.2011, Program for development of inclusive education for 2012-2020

•

Government Decision no. 784/2007, National Strategy and Action Plan for reforming the residential child care system in the course of 2007-2012, www.edu.md.

•

Government of the Republic of Moldova (2011) Programul de activitate al Guvernului

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SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

‘Integrarea Europeană: Libertate, Democrație, Bunăstare’ pentru anii 2011-2014 (Activity Program Government of the Republic of Moldova for 2011-2014 European Integration: Freedom, Democracy, Welfare), www.gov.md •

Kids Alive International,

•

http://www.kidsaliveuk.org/Groups/90709/Kids_Alive/Where_We_Work/Europe/ Moldova/Moldova.aspx

•

International Centre ‘La Strada’ (2010) Overview of the child trafficking phenomenon in the Republic of Moldova

•

International Monetary Fund (2010) Country Report No. 10/232

•

International Monetary Fund (2011) Moldova: Letter of Intent, Memorandum of Economic and Financial Policies, and Technical Memorandum of Understanding

•

IDIS Viitorul (2009) Study on Social Protection and Social Inclusion in Moldova

•

IDIS Viitorul (2008) Educația preșcolară în Republica Moldova din perspectiva incluziunii și a echității sociale, (Pre-school Education in the Republic of Moldova from the social inclusion and equity perspective), Chisinau

•

Institutul de Politici Publice (2007) Plățile informale în învățământul preuniversitar și accesul egal la educație

•

Institutul de Științe ale Educației (2009) Evaluarea curriculumului școlar – perspectiva de modernizare

•

International Monetary Fund (2011) Moldova: Letter of Intent, Memorandum of Economic and Financial Policies, and Technical Memorandum of Understanding, March 24, 2011

•

International Monetary Fund (2011) Moldova – Concluding Statement of the IMF Mission, September 22, 2011, www.imf.org

•

IMAS, Ministry of Education and Youth of the Republic of Moldova, Ministry of Social Protection, Family and Child of the Republic of Moldova (2007) Violence against children in the Republic of Moldova, UNICEF, Chisinau

•

International Labour Organization (2011) Activities for preventing and combating child labour in Moldova 2003-2010, http://www.un.md/un_ag_mol/ILO/Fact_sheet_ ILO-IPEC-Moldova_EN.pdf

•

International Labour Organization, Government of the Republic of Moldova (2009) Memorandum of Understanding between the International Labour Office and the Government of the Republic of Moldova, available at: http://www.un.md/un_ag_ mol/ILO/Memorandum_ILO_GRM_Aug-2009_en.pdf

•

Ministry of Economy (2010) Raport privind sărăcia și impactul politicilor 2009 (Report on Poverty and Policy Impact 2009)

•

Ministry of Economy (2011) Saracia in Republica Moldova 2010

•

Ministry of Education, Academy of Sciences, Institute of Educational Sciences (2009) Evaluation of School Curriculum – Modernization Perspective (Evaluarea curriculumului școlar – perspectiva de modernizare), Chisinau, www.ise.md

•

Ministry of Education (2010) Strategia consolidată de dezvoltare a învățământului pentru anii 2011-2015 (Consolidated Strategy for Education Development for 20112015), www.edu.md

•

Ministry of Education (2011) Monitoring implementation of the Strategy for Reforming Child Residential Care System, www.edu.md

•

Ministry of Education (2011) Strategic Development Program of the Ministry of

SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

171

Education for 2012-2014 (draft plan) •

Ministry of Health (2010) Raport Anual în Sănătate 2009 (Annual Report on Health 2009), Chisinau, www.ms.gov.md

•

Ministry of Health (2009) Evaluation of Prevention of HIV Mother to Child Transmission Services in the Republic of Moldova, Chisinau

•

Ministry of Health (2009) Assessment of Risk of HIV Infection among Most at Risk Adolescents (MARA)

•

Ministry of Health (2009) Rezultatele sondajului de opinie privind gradul de satisfacție al pacienților la nivel național pe parcursul anului 2008

•

Ministry of Health (2010) Evaluation Report of National Development Strategy 20082011, for the period of September 2009- September 2010, www.ms.gov.md

•

Ministry of Health (2011) Raport Anual în Sănătate 2010 (Annual Report on Health 2010), Chisinau, www.ms.gov.md

•

Ministry of Health (2010) Informative Note. Situation in HIV/AIDS infection and pregnancies for 2010, National Scientific-Practical Centre of Preventive Medicine

•

Ministry of Labor, Social Protection and Family (2010) Annual Social Report 2009

•

Ministry of Labor, Social Protection and Family (2011) Necesitățile specifice ale copiilor și vârstnicilor lăsați fără îngrijirea membrilor de familie plecați la muncă peste hotare (Specific needs of children and elderly left without care by family members working abroad)

•

Ministry of Labor, Social Protection and Family (2008) Strategy for the National Refferral System for protection and assistance to the victims and potential victims of human trafficking (Strategia Sistemului național de referire pentru protecția și asistența victimelor și potențialelor victime ale traficului de ființe umane pe perioada anului 2010), www.mpfsc.gov.md

•

Ministry of Labor, Social Protection and Family (2011) Report on monitoring implementation Strategy for the National Refferral System for protection and assistance to the victims and potential victims of human trafficking for 2010, www. mpfsc.gov.md

•

Ministry of Labor, Social Protection and Family (2011) USAID, Buletin Informativ. Protectie sociala. Familie puternica – stat prosper (Information Bulletin. Social Protection, strong family – wealthy state), No. 4

•

Ministry of Labor, Social Protection and Family (2011) Annual Social Report 2010

•

National Bureau of Statistics (2008) Children of Moldova, UNICEF, Chisinau

•

National Bureau of Statistics (2009) Women and Men in the Republic of Moldova, Statistical Pocketbook, Chisinau

•

National Bureau of Statistics (2009) Rezultatele studiului privind Sănătatea populației și accesul la serviciile de sănătate în Republica Moldova (Results of the Study on Population’s Health and Access to Health Services) Chișinău

•

National Bureau of Statistics (2010) Youth Entry in the Labor Market (Intrarea tinerilor pe piața muncii), Chisinau

•

National Bureau of Statistics, International Labour of Organization (2010) Working Children in the Republic of Moldova: The Results of the 2009 Children’s Activities Survey, ILO

•

National Bureau of Statistics (2010) Statistical Yearbook of the Republic of Moldova, Chișinau

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SITUATION ANALYSIS OF VULNERABLE, EXCLUDED AND DISCRIMINATED CHILDREN IN MOLDOVA

•

National Bureau of Statistics (2010) Approaches to Social Exclusion in the Republic of Moldova, Chisinau

• National Bureau of Statistics (2011) Situația copiilor din Republica Moldova în anul 2010, http://80.97.56.163/newsview.php?l=ro&id=3418&idc=168 •

National Bureau of Statistics (2011) Education in the Republic of Moldova 2010/2011, Statistical Publication

•

National Bureau of Statistics (2011) Labour force in the Republic of Moldova – employment and unemployment in 2010, www.statistica.md

•

National Commission for Population and Development (2009) Cartea Verde a Populatiei Republicii Moldova, UNFPA, Editura Statistica, Chisinau

•

National Center of Child Abuse Prevention Nobody’s Children Foundation (2005) Professionals’ attitudes towards child abuse in Moldova

•

National Centre of Health Management (2008) Baseline Situation Analysis of Children and Families Affected by HIV and People Living with HIV in the Republic of Moldova, Chisinau

•

Neef, R. and Stănculescu, M.S. (eds.) (2002) The Social Impact of Informal Economies in Eastern Europe, Ashgate, London

•

Nemerenco, Ala (2010) Republic of Moldova: children living in poverty – implications for the health system in World Health Organization, ‘Poverty and Social Exclusion in the WHO European Region: health systems respond’

•

The New York Times (2010) Isabel Castro, Children Heading Households in Moldova, November 29, 2010 http://lens.blogs.nytimes.com/2010/11/29/children-headinghouseholds-in-moldova/

•

Ombudsman Institution (2010) People with special needs access to social infrastructure: reality and necessity, Thematic Report

•

Oxford Policy Management (2011) Support to the National Development Strategy. Needs Assessment of Persons with Severe Disabilities and Their Families

•

Scutelniciuc, O., Condrat, I., Guțu, L. (2006) Youth’s knowledge, attitudes and practices regarding HIV/AIDS

•

Scutelniciuc, O., Condrat, I., Guțu, L. (2008) Youth’s knowledge, attitudes and practices regarding HIV/AIDS

•

Scutelniciuc et al. (2009) Drug Situation in the Republic of Moldova

•

SIDA (2011) Joint Evaluation of Impacts of Assistance to Social Sector Reforms in Moldova

•

Stănculescu, M., Ilie, S. (2001) Informal Sector in Romania, UNDP, Bucharest

•

Neef. R., Adair, P.(eds.) (2004) Shadow Economies and Social Transformation in Romania, LIT Verlag Munster

•

Stănculescu, M., Pop, L. (2009) ‘The transition process and changes in income, income inequality and poverty: the case of Romania’ in Stănculescu, Stanovnik, T. (eds.) Activity, Income and Social Welfare. A comparison across four New Member States, Ashgate, European Centre in Viena

•

Stănculescu, M., Stanovnik, T. (2009) Activity, Income and Social Welfare. A comparison across four New Member States, Ashgate, European Centre in Viena

•

The New York Times (2010) Isabel Castro, Children Heading Households in Moldova http://lens.blogs.nytimes.com/2010/11/29/children-heading-households-inmoldova/

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173

•

Tiron, S. (2009) Education in the Transnistrean region of the Republic of Moldova (Învățământul în regiunea Transnistreană a Republicii Moldova), Institute of Public Policy, Chisinau

•

Toritsyn, A. (2009) Ex-ante policy assessment vis-à-vis vulnerable groups in SEE: Guide for Practitioners, Local Reform and Public Service Reform Initiative, UNDP

•

Transparency International (2009) Perceptions and experiences of household representatives and businessmen regarding corruption in the Republic of Moldova, Chisinau

•

UNAIDS (2011) Data Synthesis on Tendencies of the HIV epidemic and Impact of HIV prevention interventions in the Republic of Moldova 2011

•

UN (1989) Convention on the Rights of the Child

•

UN (2009) Findings on the worst forms of child labor, Country Profiles: Moldova

•

UN, The World Bank (2009) Impact of the Economic Crisis on Poverty and Social Exclusion in the Republic of Moldova

•

UN (2011) Country Analysis – UN Moldova, May 2011

•

UN (2011) Committee Consideration of reports submitted by States parties under Articles 16 and 17 of the Covenant

•

UNDP (2007) Roma in the Republic of Moldova, Chisinau

•

UNDP (2009) National Human Development Report 2009, Social-Economic Impact of Climate Change

•

UNDP (2010) Analysis of the health status of the population of the Republic of Moldova through statistical indicators (Analiza stării de sănătate a populației Republicii Moldova prin prisma indicatorilor statistici)

•

UNDP (2011) National Human Development Report 2010-2011 Republic of Moldova, From Social Exclusion towards Inclusive Human Development, Nova-Imprim SRL, Chisinau

•

UNICEF, Malawi Fact Sheet, Diversion of children in conflict with the law,

•

http://www.unicef.org/tdad/Malawifactsheetdiversion.pdf

•

UNICEF (2006) State Responsiveness to Violence against Children

•

UNICEF (2006) Child Protection Information Sheets

•

UNICEF (2006) Progress for children. A Report Card on Nutrition

•

UNICEF (2008) The impact of parental deprivation on the development of children left behind by Moldovan migrants, Chisinau

•

UNICEF (2008) Growing up in the Republic of Moldova

•

UNICEF (2008) The impact of migration and remittances on communities, families and children in Moldova

•

UNICEF (2008) The impact of migration and remittances on communities, families and children in Moldova, Chisinau

•

UNICEF, Ministry of Education and Youth of the Republic of Moldova (2009) Studiu Educația de bază în Republica Moldova din perspectiva școlii prietenoase copilului (Baseline Study on Basic Education in the Republic of Moldova from the perspective Child-Friendly Schools)

•

UNICEF (2009) Assessment and Recommendation on Child Disability Prevention and Care System in Moldova

•

UNICEF, Ministry of Education and Youth of the Republic of Moldova (2009) Mid-

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Term Review of the 2007-2011, Program of Cooperation between the Moldovan Government and UNICEF, Equitable Access to Quality Education •

UNICEF, Ministry of Health (2009) Mid-Term Review, UNICEF – Government of Moldova Country Programme of Cooperation 2007-2011, Leadership Area, Adolescent Health and Development

•

UNICEF (2009) Needs Assessment Study Prevention of Mother to Child Transmission Programme in the Republic of Moldova

•

UNICEF, Government of the Republic of Moldova (2009) Mid-Term Review. Country Programme of Cooperation 2007-2011. Concept note Leadership Focus Areas

•

UNICEF (2010) Ensuring survival, care and protection of young children in Moldova: extension of the IMCI Initiative in Transnistria

•

UNICEF (2010) Summary Report Study on the Quality of Water, Sanitation and Hygiene Practices in the schools of Moldova

•

UNICEF, Government of the Republic of Moldova (2010) National Study on Knowledge, Attitudes and Practices of Families in the field of early childhood development and care, Summary Report (Studiul national Cunoștințele, atitudinile și practicile familiilor în domeniul îngrijirii și dezvoltării timpurii a copiilor, Raport Sumar), Chisinau

•

UNICEF (2010) Assessment of Juvenile Justice Reform Achievements in Moldova

•

UNICEF (2010) The Situation of Roma Children in Moldova, Chisinau

•

UNICEF (2010) Child Protection Systems, Mapping and Assessment Toolkit, Users Guide

•

UNICEF (2010) Teacher Quality and Teacher Work Conditions in the Republic of Moldova

•

UNICEF (2011) Children’s Consultation regarding the problems in fulfillment of their rights, Focus-Group Report, (Raport de focus grup, Consultarea copiilor cu privire la problemele pe care le întâlnesc în realizarea drepturilor)

•

UNICEF (2011) Impact of public transfer payments on poverty and well being of the most vulnerable families in the Republic of Moldova, in the context of transition from category-based to means-tested social assistance, Quantitative Analysis – Evidence from HBS 2009 and 2010

•

UNICEF Moldova (2011) Capacity Gap Analysis, preparation to new 2013-2017 Country Programme of Cooperation

•

UNICEF, Malawi Fact Sheet, Diversion of children in conflict with the law, http:// www.unicef.org/tdad/Malawifactsheetdiversion.pdf

•

United States Department of State (2011) Trafficking in Persons Report - Moldova, 27 June 2011, http://www.unhcr.org/refworld/docid/4e12ee5e3c.html

•

World Bank (2006) Project Information Document Quality Education in the Rural Areas of Moldova

•

World Bank (2011) Implementation Status and Results, Quality Education in the Rural Areas of Moldova

•

World Health Organization (2008) Adolescent Pregnancy, MPS Notes, Vol. 1

•

World Health Organization Europe (2009) Infant Mortality from Respiratory Diseases, Fact Sheet 3.2,

•

http://www.euro.who.int/__data/assets/pdf_file/0004/96997/3.2-Infant-mortalityfrom-respiratory-disases-EDITED_layouted_V3.pdf

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World Health Organization Suicide Rates, Republic of Moldova,

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http://www.who.int/mental_health/media/repmol.pdf

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Databases

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DevInfo database, www.devinfo.md

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Eurostat database, http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/ search_database

•

National Centre for Health Management, SPD2 2009-2013, http://www.cnms.md/ areas/statistics/indik/

•

National Bureau of Statistics of the Republic of Moldova, http://www.statistica.md/

•

International Human Development Indicators database http://hdrstats.undp.org/en/ tables/default.html

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International Monetary Fund, World Economic Outlook Database, September 2011, www.imf.org

•

UNICEF TransMONEE 2011 DATABASE, http://www.transmonee.org/

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World Bank Development Indicators, World Bank, http://data.worldbank.org/datacatalog/world-development-indicators

•

World Health Organization, www.who.int

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10. ANNEX The progress made by Moldova toward achieving the Millennium Development Goals has not been uniform. Targets in areas such as compulsory education, HIV/AIDS and the access of population to improved water sources and sewerage are problematic. Positive developments on childrenâ&#x20AC;&#x2122;s situation include enrollments rate in pre-primary education, infant and under-five mortality rate, immunization rates, absolute and extreme poverty rates. Figure 27. Health-Related Millennium Development Goals, Current Situation and Targets for Moldova414 Goals

Indicator/ Objective

Goal 1.

Reduce extreme poverty and hunger Incidence of malnutrition in children under 5 years, percent Infant mortality rate, cases per 1000 children born alive Reduce infant mortality from 18.5 (per 1,000 live births) in 2006 to 16.3 in 2010 and 13.3 in 2015 Under 5 mortality rate, cases per 1000 children born alive Reduce the under-5 mortality rate from 20.7 (per 1,000 live births) in 2006 to 18.6 in 2010 and 15.3 in 2015 Share of children aged under 2 years vaccinated against measles*, percent Maintain the proportion of children under 2 years with vaccination against measles at no lower than 96 percent in 2010 and 2015

Goal 4. Reduce child mortality

Goal 5. Improve maternal health

Maternal mortality rate, cases per 100,000 births

Latest data Target 2010

Target 2015

10.6/2009

11.7/2010

16.3

13.3

13.6/2010

18.6

15.3

94.4/2008

>= 96

17.2/2009

15.5

13.3

99.8/2009

Reduce the maternal mortality rate from 16 (per 1,000 live births) in 2006 to 15.5 in 2010 and 13.3 in 2015. Rate of assisted births, percent Maintain the number of births assisted by qualified medical staff during 2010 and 2015 at 99 percent

414 Evaluation of targets attainability in 2010 and 2015 is according to the Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010:113-114. The categories of probably unlikely and unlikely are grouped together.

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177

Goal 6. Combat HIV/AIDS, tuberculosis and other diseases

Goal 7. Ensure a sustainable environment

HIV/AIDS incidence rate*, cases per 100,000 population Stabilize the spread of HIV/AIDS infection by 2015. Reduce HIV/AIDS incidence from 10 cases per 100,000 population in 2006 to 9.6 cases by 2010 and 8 by 2015 HIV/AIDS incidence rate among 15-24 age group*, cases per 100,000 population Reduce HIV/AIDS incidence in the 15-24year age group from 13.3 cases per 100,000 population in 2006 to 11.2 cases by 2010 and 11 cases by 2015 Rate of mortality associated with tuberculosis*, 100,000 population Halt and begin to reverse the spread of tuberculosis by 2015. Reduce the rate of mortality associated with tuberculosis from 15.9 (per 100,000 population) in 2002 down to 15.0 in 2010 and 10.0 in 2015. Share of people with access to improved water sources, percent Increase the share of people with permanent access to safe water sources from 38.5 percent in 2002 up to 59 percent in 2010 and 65 percent in 2015. Share of people with access to improved sewage, percent Increase the proportion of people with permanent access to improved sewerage from 31.3 percent in 2002 to 50.3 percent in 2010 and 65 percent in 2015. Share of people with access to improved sanitation, percent Increase the number of population with access to sanitation systems from 41.7 percent in 2002 to 51.3 percent in 2010 and 71.8 percent in 2015.

17.12/2010

9.6

21.01/2010

11.2

18/2009

55/2009

47.9/2009

50.3

45.9/2008

51.3

71.8

*Data include Transnistria.

Legend

Likely

Probably Likely

(Probably) Unlikely

Data source: Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010. Note: Health-related MDG also include the objective of ensuring access to basic medication, under Goal 8. Create a global partnership for development. The indicator on number of localities with primary medical establishments but without drugstores does not have available data. However, the second MDG report notices positive tendencies on a global level, under the goal of ensuring physical access to basic medication, including the rural area (p. 106).

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Figure 28. Education-Related Millennium Development Goals, Current Situation and Targets415 for Moldova Goals

Indicator/ Objective

Goal 2. Ensure access to general compulsory education (grades I-IX)

Gross enrolment rate in compulsory education system, percent Rate of school dropout, percent Share of children who successfully complete compulsory education, percent Increase the gross enrolment rate for general secondary education from 94.1% in 2002 up to 95% in 2010 and 98% in 2015. Gross enrollment rate in pre-school education, children aged 3-6 years, percent Share of children enrolled in first grade after completing pre-school education, percent Increase the enrolment rate for pre-school programs for 3-6 year old children from 41.3% in 2002 to 75% in 2010 and 78% in 2015, and for 6-7 year-old children from 66.5% in 2002 to 95% in 2010 and 98% in 2015, as well as reduce by less than 5% the discrepancies between rural and urban areas and between disadvantaged and middle-income groups. Literacy rate, percent

Latest data

Target 2010

Target 2015

88.1/2010

77.1/2010

97.7/2010

99.6/2009

99.5

78 -

99.5

Maintain the literacy rate for the 15-24 year-old population at 99.5 percent. Data source: Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010.

415 MDG Targets have been revised in 2007 and the monitoring indicators have been changed from measuring the net enrollment ratio to gross enrollment ratio, as it reflects enrollment regardless of age.

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179

Figure 29. Poverty related Millennium Development Goals Goals

Indicator/ Objective

Goal 1. Reduce extreme poverty and hunger

Share of population living below the threshold of $4.3 at PP (consumer spending per person), percent Share of population living below the threshold of $2.15 at PP (spending per adult equivalent),% Reduce the proportion of people whose consumption is under $4.3 a day/person (in PP terms) from 34.5% in 2006 to 29% in 2010 and 23% in 2015. Share of population living below national absolute poverty line (absolute poverty rate), % Poverty gap index, % Share of poorest quintile in national consumption,% Reduce the proportion of people under the absolute poverty line from 30.2% in 2006 to 25% in 2010 and 20% in 2015 Share of population living below the level of minimum calorific intake (2,282 kcal/per day) (extreme poverty rate), % Reduce the proportion of people under the extreme poverty line from 4.5% in 2006 to 4% in 2010 and 3.5% in 2015

Legend

Likely

Target 2015

Latest data Target 2010

Probably Likely

29.5/2009

13.2/2006

21.9/2010

5.9/2009 7.9/2009

1.4/2010

3.5

(Probably) Unlikely

Data source: Government of the Republic of Moldova, The Second Millennium Development Goals Report, Republic of Moldova, 2010.

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UNICEF MOLDOVA Country Office 131, 31 August 1989 Street, UN House Chisinau, Moldova www.unicef.md SITUATION ANALYSIS OF VULNERABLE, AND DISCRIMINATED CHILDREN 2011 IN MOLDOVA © The United Children’s FundEXCLUDED (UNICEF), November, 182 Nations