Annual Report 2015 - UNICEF · ANNUAL REPORT 2015 1 FOREWORD from the Country Representative ......

Annual Report2015

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NIC

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ADVOCACY, CHILD RIGHTS, PARTNERSHIPS

FLOODS: HUMANITARIAN ACTION NUTRITION HEALTH, HIV/AIDS

MALAWI IN 2015

ANNUAL REPORT 2015 1

FOREWORD from the Country Representative

UNICEF MALAWI ANNUAL REPORT 2015

CONTENTS

04

12 16 22

06 08

2 ANNUAL REPORT 2015

WASH

EARLY CHILDHOOD DEVELOPMENT, BASIC EDUCATION & YOUTH

26 30

12

PROTECTION

FINANCIAL REPORT

36

40


C4D Communication for Development

EMIS Education Management Information System

FAO Food & Agriculture Organization

HMIS Health Management Information System

ILO International Labour Organization

IMF International Monetary Fund

MBC Malawi Broadcasting Corporation

MDG Millennium Development Goal

MSF Médecins sans Frontières

MTL Malawi Telecommunications Limited

ABBREVIATIONS

PACHI Parent & Child Health Initiative

RTM Real Time MonitoringSADC Southern African Development Com-munity

SRH Sexual & Reproductive Health

UNCDF UN Capital Development Fund

UNDP UN Development Programme

UNFPA UN Family Planning Association

UNV UN Volunteers

WFP World Food Programme

WHO World Health Organization

The start of the year 2015 coincided with catastrophic flooding, which disrupted the lives of thousands of Malawians, especially in the Southern Region. UNICEF Malawi shifted focus swiftly to dealing with the emergency, working in close cooperation with other UN agencies, Government structures and various donor-funded interventions. Displaced families were assisted with shelter, basic sanitation and nutritional support; children at special risk were identified and offered protection and psychosocial support. The food security crisis during and following the disaster called for improved surveillance systems, and the success of RTM (Real Time Monitoring) mechanisms used in the emergency response were integrated into the health, nutrition, protection and education programme activities for the remainder of the year. Persisting food insecurity prompted UNICEF to join with partners in building resilience in communities over the longer term, and in strengthening the capacity of Government structures.

2015 was a milestone year for UN development goals, as the Millennium Development Goals made way for the sustainable development agenda. As progress achieved in the MDGs was assessed, the perspective turned towards the 17 new Sustainable Development Goals, which were adopted globally in September 2015. These goals aspire to end poverty, protect the planet, and ensure prosperity for all over the next 15 years.

UNICEF support has contributed to the decline in under-five mortality in recent years, and in 2015 attention turned to areas where progress has been slow, notably neonatal mortality and its correlated factors, such as pregnancy in younger adolescents, pre-term births, HIV and poor nutritional status of mothers.

2015 saw great advances in institutionalising Early Childhood Development activities. These focus on the holistic care of young

children from birth to age eight, and include components on parenting skills. Upstream efforts resulted in the development of an ECD policy supported by a budget allocation to the sector for the first time. The strategy to increase the proportion of children made ready for school through ECD programmes led to initiatives to further professionalise the sector, and reach into the teaching and learning opportunities in Lower Primary classes.

With the enforcement of the National Registration Act (2010) a vital step was taken towards the safeguarding of human rights and sustainable development. UNICEF and its partners continued to support the National Registration Bureau, which has piloted electronic birth registration in 4 hospitals, and mechanisms for recording hospital and health facility births are already in place in 17 districts.

Malawi registered impressive gains in

FOREWORD FROM THE COUNTRY REPRESENTATIVE


© UNICEF

HIV treatment and prevention through the Prevention of Mother to Child Transmission programme, which is reaching more and more HIV-infected pregnant women with ART, prolonging their lives and protecting their children. Efforts were placed into Early Infant Diagnosis of HIV and innovations to reduce the turn-around time between testing and informing the caregivers of the results.

In all programmes UNICEF has used its comparative advantage in gathering evidence, data analysis and information systems management.

Malawi is characterised by a host of disparate initiatives in social development, and in 2015 UNICEF supported a range of innovative measures to transmit grassroots data to Government offices (education, health, HIV), streamline services for quick referrals (child protection), and consolidate records (youth services).

We look forward to a greater year to come as the SDG’s agenda gets into action.

“2015 saw great advances in institutionalising Early Childhood Development activities. These focus on the holistic care of young children from birth to age eight, and include components on parenting skills.”


Johannes WedenigCountry Representative


The WASH (Water, Sanitation and Hygiene) Programme made critically important achievements in disease prevention during the floods and in the recovery phase. Under UNICEF leadership, the Education cluster succeeded in applying a range of measures that enabled almost 200,000 learners from schools affected by flooding to resume their education. Child protection measures introduced by UNICEF brought safety and care for nearly 9,000 children in Community Based Childcare Centres (CBCCs), and about 11,500 vulnerable children in Children’s Corners.

Continued advocacy for legislation to support women and children’s rights came to fruition with the enactment of the Marriage, Divorce and Family Relations Act (2015) and the Trafficking in Persons Act (2015), and the enforcement of the National

Chikhwawa and Nsanje districts. Following on from the floods the country is experiencing the worst food insecurity crisis in over a decade, affecting about 2.8 million people. UNICEF Malawi provided US$3 million of emergency supplies in response to this natural disaster, and strategically coordinated life-saving interventions, working speedily with a range of partners and with district councils as far as possible.

As a result of UNICEF Malawi support, nearly 21,000 children with severe acute malnutrition received treatment through the Outpatient Therapeutic Programme and in the Nutritional Rehabilitation Units at health facilities. With 47% of Malawi’s children already undernourished, increased malnutrition rates and likelihood of water-borne diseases have a long-term negative effect on the health and survival of children.

In the last 25 years Malawi’s population has almost doubled, to about 17.3 million in 2015. This trend provides the context for all development achievements and poses particular challenges in social development.

90% of Malawians live on less than US$2 a day. The proportion of people living in dire poverty has not improved in recent years, and an estimated 74% of the population live below the income poverty line of US$1.25 a day. The country continued to face serious economic challenges in 2015, partly due to the loss of budget support after the misappropriation of funds (Cashgate in 2013) and soaring inflation, reaching over 24%.

Malawi experienced devastating flooding in January 2015, which affected 1.1 million people especially in Phalombe, Zomba, Blantyre,

MALAWI IN 2015

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The Open Defecation Free (ODF) strategy continued to make progress, promoting locally appropriate hygiene practices and engaging community leaders.

In 2014, 4,670,279 children were enrolled in primary education, a million more than five years before (EMIS 2014).The system is overwhelmed by the pace of the increase in numbers of children entitled to exercise their right to education. Though the qualified teacher to pupil ratio registered some progress and dropped to 1:75, the target of 1:70 was not attained. UNICEF developed strategic partnerships with development partners in education in order to develop a common funding mechanism to support the Education Sector Investment Plan II, and leverage funding for Malawi from the Global Partnership for Education amounting to US$45 million. The new Teacher Training College at Chiradzulu was completed, supported by UNICEF through a partnership with Roche, helping to address the shortage of qualified teachers. Other private sector partnerships were developed in the year, to benefit girls’ education, child protection, etc.

UNICEF Malawi in partnership with WFP and UNFPA continued to run the UN Joint Programme on Girls’ Education. The multi-sectoral, school-based approach brings together programmes in quality education, child protection, social norms, and sexual and reproductive health into one comprehensive intervention that aims to overcome barriers to girls’ attainment of quality education.

Registration Act (2010). The completion of the first study of violence against children led to the development of a National Plan of Action for Vulnerable Children (2015-2019) and 27 district plans.

UNICEF engaged communities by promoting the efforts of selected Civil Society Organisations (CSO)s. These CSOs were supported to be fully active in establishing constructive relationships with the district councils. The management challenge for district government was to coordinate multiple initiatives from CSOs and Non-Governmental Organisations, notably in the health sector. To facilitate this, UNICEF supported the strengthening of district health systems, focusing on five districts.

While Malawi has achieved the fourth Millennium Development Goal of reducing mortality in children under five to 85 deaths per 1,000 live births, and infant mortality to 53 per 1,000 live births, newborn mortality remains unacceptably high at 29 per 1,000 live births. The incidence of pre-term births in Malawi is the highest in the world. Neonatal mortality reduction will need to receive priority attention in the coming years.

In 2015, 85% of an estimated 13,317 HIV-infected pregnant women in Malawi were on treatment, compared to 73% in 2014; an additional 1,584 women initiated antiretroviral therapy during breastfeeding, a period when HIV transmission to infants can be high. 95% of HIV exposed infants received antiretroviral prophylaxis, prolonging lives and further decreasing the risk of HIV infection.

UNICEF Malawi’s support in WASH resulted in 187,370 people realizing their right to access to water, with the construction of 750 new water points and rehabilitation of existing non-functional water points. Water supply was provided to 80 schools, health facilities and CBCCs.

“In the last 25 years Malawi’s population has almost doubled, to about 17.3 million in 2015. This trend provides the context for all development achievements and poses particular challenges in social development.”

“While Malawi has achieved the fourth Millennium Development Goal of reducing mortality in children under five to 85 deaths per 1,000 live births, and infant mortality to 53 per 1,000 live births, newborn mortality remains unacceptably high at 29 per 1,000 live births. The incidence of pre-term births in Malawi is the highest in the world. Neonatal mortality reduction will need to receive priority attention in the coming years. ”

“Though the qualified teacher to pupil ratio registered some progress and dropped to 1:75, the target of 1:70 was not attained.”


ADVOCACY, CHILD RIGHTS, PARTNERSHIPS

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UNICEF mobilised US$6.5 million from KfW, the German Development Bank, to strengthen routine immunization in Malawi.

UNICEF ensured that the best interests of children and adolescents were well represented in the Joint TB/HIV concept note to Global Fund and the revised HIV Testing and Counselling (HTC) Guidelines. The Global Fund grant was signed for

and Child Health Trust Fund awarded Malawi resources amounting to nearly US$7 million, to be implemented up until 2016. UNICEF leveraged resources from the Global Fund for Vaccines Initiative (GAVI) for the community based health system and received US$7.2 million for 2016-2018. An additional US$1 million was mobilised as vaccine introduction grants for IPV (polio) and MSD (measles) for 2015. Also,

A notable achievement in 2015, through well-informed advocacy, was the first separate allocation for Early Childhood Development (ECD) within the Ministry of Gender’s budget. In 2015 UNICEF Malawi continued to address the gaps in data on which to base interventions for children in Malawi. At the same time, capacities to work with the data were strengthened, at district and national levels.

External communications and public advocacy

UNICEF Malawi’s website informed the general public within and outside the country about events in Malawi and the role UNICEF plays for children. The Country Office increased its investment in social media and doubled its reach through Facebook (over 5,000 friends) and Twitter (over 3,000 followers).

When unprecedented floods affected the country during the first half of the year, UNICEF Malawi’s emergency communication plan ensured that information was disseminated to all stakeholders in a timely and efficient manner. Development partners, national committees and supporters were kept abreast of the situation, recognising how UNICEF Malawi and partners were responding to the emergency.

Leveraging resources for Health

As a result of UNICEF’s sustained, evidence-based advocacy, the Reproductive, Maternal, Newborn

UNICEF Malawi’s strategic commitment is to generate child-focused evidence to influence national policies, programmes, plans and budgets. The goal in 2015 was to use this evidence-based advocacy to address, above all, child equity and social exclusion. Wherever possible, children’s participation was sought.

NATIONAL PLAN OF ACTION FOR VULNERABLE CHILDREN

In line with the UNICEF Malawi communication and advocacy strategy, there was a strong focus in 2015 on promoting the Violence Against Children Survey (VACS), the first ever baseline on the situation of violence against young women and children in Malawi. At the launch of the VACS, the Ministry of Gender, in partnership with CDC (Center for Disease Control), committed itself to a multi-sectoral response plan, the National Plan of Action for Vulnerable

Children (2015-2019), and 27 district plans followed. UNICEF produced a suite of public advocacy products, including a 3-minute infographic video and a video that was broadcast globally (http://www.goodnewsnetwork.org/hard-work-pays-off-malawi-cel-ebrates-dramatic-drop-in-child-mor-tality/).


gaining media space for the Violence Against Children campaign that featured the Malawi Netball team through a partnership with the telecommunication company, Airtel. New partnerships were signed with Standard Bank and MTL - the latter supporting UNICEF’s Innovation Lab. Academic partnerships continued with the Polytechnic (for child rights reporting and Innovation Hub); Mzuzu University (for WASH innovative design and sanitation marketing); and Magomero College (for Social Work training). In 2015 UNICEF Malawi widened its engagement with innovative partners, such as the Lake of Stars, to organise the first ever Children’s Festival and the Lake of Stars youth mobilization event. Communication for Development (C4D) forged new partnerships with Development Communications Trust and MBC Development Broadcasting Unit for a new approach to emergency recovery, strengthening the voices of flood-affected communities.

US$600 million, the largest per capita grant to be made.

Partnerships UNICEF Malawi strengthened existing partnerships and developed new ones with Government, CSOs, academic institutions and the private sector. UNICEF partners with more than 50 CSOs across all programmatic areas. Most partnerships focus on implementation of programme goals, through capacity development and service delivery, but increasingly in 2015, partnerships focused on advocacy and movements for change (e.g. Malawi Economic Justice Network, NGO Coalition on Child Rights). The health section worked through NGO partners, including PACHI, for strengthening civil society engagement on social accountability in health advocacy. Partnerships around adolescent and youth development were strengthened and coordinated with national and local Government, NGOs and the private sector.

UNICEF Malawi continued to develop its highly valuable private sector partnerships, and succeeded in

“My sister died too young. She gave birth prematurely and left behind her beautiful daughter. Girls should be educated on safety and health.”

Towera A. VinkhumboGoal Keeper, Malawi Queens

unite for girls protecting and promoting girls for a stronger Malawi

UNICEF does not endorse any brand or product.Airtel supports UNICEF.

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FLOODS:HUMANITARIANACTION


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out mobile clinics in other parts of the districts. UNICEF brought tents for health service delivery, some of them donated by the government of Japan.

Supply chain management faced some challenges mainly with regard to distribution of supplies to the last mile as District Councils faced logistical and financial challenges.

Treatment was given to 20,830 children suffering from severe acute malnutrition, in health facilities (NRUs) and through the Outpatient Therapeutic Programmes (OTP). The OTPs achieved a recovery rate of 93%, and 82% of children admitted to NRUs recovered. The NRU death rate reached 14% (above the recommended SPHERE of <10% mortality rate), giving rise to a critical analysis of the performance of the Community Management of Acute Malnutrition programme, in order to improve quality and strengthen nutrition screening. UNICEF supplied an additional 4,465 cartons of Ready-to-use Therapeutic Food.

Health Surveillance Assistants in health centres and in community outreach were given intensified supervision and mentorship, which focused on integrating services in reproductive and child health,

The Government’s Flood Response Plan uses the concept of clusters to maximise the power of collaboration. UNICEF Malawi co-led the WASH, Education, Nutrition and Child Protection clusters and contributed to the Health cluster (including HIV/AIDS). Emergency preparedness and readiness measures were in place, enabling UNICEF to respond effectively.

UNICEF Malawi appealed for US$9 million to support the response for an initial three months. Through discussions with donors in country, over US$5 million was re-allocated from existing resources, and the appeal raised a further US$2 million. This left a funding gap of over US$2 million. UNICEF Malawi provided emergency supplies to the value of US3 million.

Health care and nutrition

The Health cluster’s efforts were focused on sustaining vital curative and preventive services and on early detection of any unusual increased incidence of diseases. Mobile clinics were set up to sustain basic health services. MSF set up mobile clinics in camps for displaced people, and WHO and UNICEF supported teams from the District Health Offices to carry

The devastating flooding of over 64,000 hectares of land in 15 districts in the south and central regions directly affected more than a million people. Over 100 died and 230,000 sought refuge in displacement camps; in six districts, 145,000 people were still in temporary camps five months later. Many of the 202 displacement sites were in school buildings, depriving thousands of children from regular education for some months.

15,000 Insecticide Treated Nets distributed to displaced people at and around Bangula camp in Nsanje district.

72,753 children immunised across the flood-affected areas (90% coverage).

Vitamin A supplementation and deworming campaigns achieved similar high coverage.

860 HIV positive pregnant women continued receiving antiretroviral treatment for the prevention of mother to child transmission of HIV.

HIV prevention information provided to well over 200,000 people.


flood-affected districts, and UNICEF supported the reconstruction of community police structures.

Communications in the emergency

Real time monitoring mechanisms were set up in early 2015 to respond to the emergency across the country. Teachers in affected schools provided rapid feedback via SMS to several situation rooms which captured the data and conducted analysis, thus enabling government, UNICEF Malawi and other partners to respond quickly.

Public advocacy

UNICEF Malawi’s emergency communication plan ensured that information was speedily disseminated to all stakeholders in local and international media. Online platforms, notably social media (Twitter, Facebook), were used to highlight the impact of the flooding, give real-time information on the response and acknowledge donor support. Analysis revealed that UNICEF Malawi extended mass media coverage by five weeks after the initial media attention ended.

The recovery phase and building resilience

Four districts in particular remained food-insecure in the drought that followed the floods (Nsanje, Chikwawa, Phalombe, Zomba), and remained the focus of social protection measures by concerned partners and government. UNICEF and partners conducted a mass-scale nutritional screening of children 6-59 months in 25 districts.

UNICEF supported the installation of sustainable and safe solar pump systems in flood-affected schools. The work continues with partners to develop various other long-term measures that build resilience to cope with external shocks, and especially to break the cycle of annual droughts that increase vulnerability.

HIV/AIDS and nutrition. Key health promotion messages were disseminated with our partners, through roadshows, interpersonal communication sessions, community mobilisation through chiefs, quizzes with soap as prizes, traditional dances and theatre for development.

Water, sanitation and hygiene

UNICEF provided emergency assistance in water and sanitation to vulnerable and displaced people affected by flooding. To prevent a major cholera outbreak, cholera kits were provided, sanitary facilities constructed, and 12 Cholera Treatment Units set up. These measures and a C4D campaign contributed to containing the outbreak within 8 districts, and limiting the number of cases to 693, with 11 deaths. None of the camps for displaced people experienced an outbreak of cholera or major diarrhoea outbreaks. Education

Education activities for 350,000 pupils were interrupted by the floods. Under UNICEF leadership, the Education cluster made it possible for children to return to their play and learning. A training manual on resuming learning in emergencies was developed, and adopted by the Ministry of Education.

Child protection and protection for women

UNICEF led on holding community meetings to increase awareness of protection issues. UNICEF Malawi’s partners made it possible for over 26,000 children to benefit from psychosocial support services through CBCCs and Children’s Corners that were specially mobilised for them. RTM mechanisms assisted in identifying and directing children to their nearby services, and case management training ensured that social welfare officers, child protection workers and volunteers were capable of responding to individual needs. The Malawi Police set up satellite police units in displacement sites in

235,000 people were given safe water supply280,240 people were given access to safe water.

212,060 were provided with sanitation facilities, including temporary latrines.

913,100 people (almost all the flood-affected population) were reached with hygiene messages, in communities and institutions.

342,383 people were reached with promotional messages on hygiene and cholera prevention.


393,923 children provided with school supplies, including ‘School in a Box’ sets and recreation kits

150 schools rebuilt and 341 tents provided as classrooms, shelters and CBCCs.

450 teachers from affected schools trained in emergency preparedness, child rights, psychosocial support, hygiene and sanitation promotion, climate change and tree planting.

176 stand-by teachers recruited, trained and deployed.

267 volunteer teachers trained to resume quality teaching.

14 district officials trained in monitoring and management.

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HEALTH,HIV / AIDS


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within districts the support is not equitably distributed. In 2015, the supply of essential commodities was inconsistent, and partly as a result of this, a number of donors moved their financial support away from the Ministry of Health supply chain, where performance issues were so serious that commodities might not have been used in lifesaving interventions at all, or they were used inconsistently. Certain donors moved to fund parallel systems managed by partners.

Despite task-shifting and the increase in Health Surveillance Assistants (HSAs) and other staff over recent years, severe staffing gaps persisted into 2015. An assessment of obstetric facilities in 2014 showed that only 23% of health centres had the recommended 2 midwives and 2 medical assistants. Retention of community-based health staff was a problem in rural areas, and especially those hard to reach. HSAs often did not live in the communities that they served, or they were not present at their village clinics at designated times, resulting in serious gaps in coverage.

Efforts towards government decentralization offered an opportunity to strengthen district-level health systems and promote local accountability. However, in 2015 this did not translate into empowered communities or improved health care; districts struggled to develop systems and plans and to find resources.

Despite the significant reduction in under-5 mortality, maternal and newborn health outcomes were still poor. Access to antenatal care and to delivery at health facilities increased dramatically in recent years. In 2015, emphasis needed to be placed on the quality of health services: clinical practice in facilities and the community, and better governance and use of resources as the decentralization process continued. Communities were mobilised to seek accountability from their health services, with the aim to stimulate improvements in quality across the spectrum of care. Funding in the health system is inequitably distributed across districts, such that districts with the highest disease burden may not receive commensurate funding, and

Under-five & neonatal mortality rates

0 20 40 60 80 100

(2005-2009)

per 1,000 live births

(2010-2014)

NeonatalUnder-five

100

30

29

85

574 per 100,000 births.

Maternal mortality rate 2007-2014 was

60%

80%

100%

Skilled attendant at birth rates

2010 2014

87%

71%

Reproductive, maternal, newborn and child health (RMNCH)

Prevention, care and treatment of HIV among children, adolescents, pregnant and lactating women

OVERVIEW OF PROGRESS IN 2015

SOCIAL MOBILISATION FOR GREATER ACCOUNTABILITY

In 5 districts, UNICEF and its partners supported CSOs to engage with Village Health Advisory Committees and help them to advocate for and sup-port women to access services at community and health facility levels. Around 130,000 women sought timely antenatal and birth care as a result. The CSOs developed ‘data dashboards’ which record key evidence of how well services are function-ing.

The supported Health Advisory Committees participated in data review meetings in their health facility, monitored supplies of drugs, and mobilized communi-ties to utilize SRH/HIV services. Committee members joined health workers and district HIV coordinators at special meet-ings to review health facility data on PMTCT.


Integrated Community Case Management UNICEF procured drugs to treat malaria, pneumonia and diarrhoea, and trained HSAs. Over 600,000 cases in under-five children were treated for various ailments, mostly malaria.

Immunisation programme UNICEF supported immunisation campaigns in hard-to-reach areas in 9 districts. Across the country, refrigerators were provided, health workers were trained in data and stock management, and cold chain technicians trained on repair and maintenance.

HEALTH

UNICEF Malawi sought to improve the quality of health care by adopting a comprehensive approach with high-impact interventions, working in three areas - Community awareness, Clinical service delivery and Management systems.

Building capacity in clinical practice

Neonatal intensive care units In 10 district hospitals, UNICEF supported the establishment of these specialist units, with training for health workers in the care of sick newborns.

Integrated Maternal and Newborn Health Health workers in 11 low-performing districts were trained in this package, with follow-up supervision and mentoring. UNICEF backed this up with ambulances, obstetric surgical kits (for Caesarean sections), vacuum extractors and midwifery kits.

REPRODUCTIVE, MATERNAL, NEWBORN AND CHILD

In 2015 UNICEF supported 11 districts to implement the District Health Performance Improvement (DHPI) approach, which analyses local HMIS data to identify bottlenecks to assist in developing the District Imple-mentation Plans (DIP).

DHPI involves stakeholders in monitoring programme or DIP reviews and developing District Performance Progress Report cards. Peer review sessions on DHPI at zonal level ensure that the Ministry of Health is fully informed and can participate productively in decentralization efforts.

EVIDENCE-BASED PLANNING IN THE DISTRICTS

MAPPING HEALTH FACILITIES AS KEY EVIDENCE FOR PLANNING

While health infrastructure such as hospitals have been mapped using the Geographic Information System, the more numerous and accessible facilities like outreach services, Health Posts and Village Clinics has never been mapped in Malawi. Therefore information on geographical accessibility of health services for most of the population is missing. The mapping has so far shown that 80% of communities are still more than 8 km far away from a health facility. Ten of the 29 districts were mapped in 2015 and the remaining districts will be covered in 2016. The map-ping includes facilities that are not functional.

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HIV teams in the Health Management Information System (HMIS) in order to build their capacity to manage data for evidence-based planning, advocacy and reporting. Apart from learning more about data extraction and such tasks as ART survival analysis, they reviewed how to increase the value of supervisory visits.

Extending the ‘Option B+’ programme for HIV infected pregnant and breastfeeding women

Malawi pioneered the initiation of HIV positive pregnant and breastfeeding women on to ART, and now ‘Option B+’ is a global guideline. As of March 2015, 85% of an estimated 13,317 HIV infected pregnant women in Malawi were on ART, compared to 73% in 2014. Of these, 6,266 (59%) were already on ART when getting pregnant, a reflection of Malawi’s high fertility rate and the maturity of the Option B+ programme, while 4,317 (41%) started ART during pregnancy/delivery. An additional 1,584 women initiated ART during breastfeeding, a period when HIV transmission to infants can be high.

However, retention rates of women initiated on ART under Option B+ indicate a decline following the breastfeeding period, especially among adolescent mothers. Mentor mothers address this issue. Through interactions with over 36,000 women, mentor mothers enrolled almost 7,000 HIV-positive pregnant women. Support group sessions were conducted with over 42,000 women, and 80% of the women who missed appointments returned to care.

PREVENTION, CARE AND TREATMENT OF HIV AMONG CHILDREN, ADOLESCENTS, PREGNANT AND LACTATING WOMEN

The Government of Malawi has an ambitious plan of reaching the ‘90:90:90’ goals by 2020:

• 90% of the population living with HIV (PLHIV) will know their HIV status

• 90% of PLHIV will be on antiretroviral therapy (ART)

• 90% of people on ART will have viral load suppression. (This is particularly important for maintaining a healthy life and preventing further transmission.)

In 2015, Malawi made steady gains across all HIV indicators, although the gains were not distributed equally. UNICEF continued to contribute to the National HIV Response by working closely with the Ministry of Health at national and district levels and with civil society organizations. UNICEF focused on PMTCT uptake and retention and promoting early infant diagnosis. By March 2015, 714 health facilities were providing ART, and 620 facilities were providing PMTCT.

Treatment for children, while increasing, remained far behind the target. ART coverage for children aged below 14 years increased from 42% (Oct-Dec 2014) to 48% (Jan-Mar 2015).

Building district capacity in data management and its use in supervision

With UNICEF support, the Ministry of Health trained district health and

HIV infected pregnant women in Malawi who were on treatmentof an estimated 13,317 HIV infected pregnant women

0% 20% 40% 60% 80% 100%

2014

2015

73%

85%

Besides these 11,319 women an additional

1,584 women initiated ART during breastfeeding.

Intensive training and task shifting resulted in 361 targeted health facilities in 8 districts offering HTC as part of antenatal care, and providing ARVs to HIV positive pregnant women.

475 health care workers trained in HIV service delivery and tracing defaulters.

BUILDING CAPACITY AMONG HEALTH WORKERS IN HIV PREVENTION, CARE AND TREATMENT


services, facilitating opportunities for interpersonal and community dialogue on social and cultural issues that influence vulnerability to HIV. Adolescents living with HIV need more support

UNICEF’s HIV section focused on service delivery, particularly enrolling and retaining adolescents living with HIV (ALHIV) in care and treatment, providing youth-friendly services, and addressing adolescent key populations. Community structures in selected districts were oriented on the equitable use of HIV services, and on referral to child protection and social protection services. Stigma remains a significant issue, and will continue to be addressed through schools and community dialogue in 2016.

Expanding Early Infant Diagnosis of HIV (EID)

Nearly half of HIV positive children will die before their second birthday if not on treatment. It is therefore imperative to test children early, preferably by two months. Between January and September 2015, over 35,000 HIV exposed children aged below 12 months (approximately 50% for each sex) were tested for HIV using DNA PCR, representing an EID coverage of 66%.

Rapid SMS for getting test results back to caregivers quickly

One of the problems with initiating children on to treatment is the long turnaround time between DNA PCR testing and giving the results to caregivers. In order to reduce that period, UNICEF continued to support the national rapidSMS system, which reduced the turnaround from laboratories from 63 to 31 days.

Point of Care (PoC) testing for Early Infant Diagnosis, CD4 count and viral load UNICEF, in partnership with CHAI (Clinton Health Access Initiative), continued to support the Ministry of Health’s Diagnostic Department. Six PoC machines were deployed to health facilities as a pilot study to test for DNA PCR in HIV exposed children, using different models to ascertain optimal placement of PoC machines. Healthcare workers and HIV testing counsellors were trained in using the machine, and to date, 197 children have been tested; of the 11 HIV infected children, 91% were initiated on ART the same day. The turnaround time was thus reduced to 52 minutes - a significant achievement in advancing paediatric treatment.

Community dialogue on HIV

UNICEF’s Youth Development Office included HIV in its nationwide approach to providing adolescents with a range of information/

New Teen Clubs for ALHIV in 3 districts reached 177 adoles-cents (half boys, half girls) with psychosocial/adherence support, SRH information and services.

30 teachers trained on decreas-ing stigma in schools.

45 facility-level mentors trained to increase support to ALHIV.

Over 106 caregivers attend-ed sessions on SRH, mental health, disclosure, care and treatment.

Camp Hope sessions conduct-ed for 200 ALHIV, supported by 18 Leaders in Training.

5,280 adolescents accessed free HTC; 4,275 received family planning services; 1,763 ado-lescents reached with HIV/SRH information; 174,409 condoms distributed to adolescents.

Analysis of the National Help-line indicated a need for better counselling on SRH, includ-ing sexual orientation; peer educators for adolescent men who have sex with men (MSM) identified.

A post-disaster assessment of adolescents in 4 flood-affected districts showed high rates of transactional sex; response plan drafted.

IMPROVING SERVICE DELIVERY FOR TEENS

NUTRITION


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Scaling Up Nutrition (SUN)

The programme registered progress in rolling out the Nutrition Education and Communication Strategy in four districts where Community Leaders Action for Nutrition (CLAN) and community care groups were established. CLAN groups tackle behaviour change in practices to improve maternal, infant and young child nutrition. Close to 8,000 CLAN groups and over 150,000 households were equipped with skills and knowledge on the SUN intervention package.

Integrating CMAM data into the District Health Information System (DHIS2)

UNICEF provided technical support in integrating CMAM report forms into the DHIS2 to ensure ownership and sustainability of the programme data. The subsequent training and mentoring will entail appropriate utilization of nutrition surveillance data at health facility, district and national levels.

Integration of HIV with nutrition

UNICEF Malawi continued to support HIV and Nutrition integration, including screening and testing children for HIV within the CMAM, Supplementary

Support to the coordination mechanisms for nutrition

The move of the Department of Nutrition, HIV and AIDS (DNHA) to the Ministry of Health posed a challenge to policy-making and coordination in Nutrition. Slow progress was registered in strengthening capacity under the Ministry of Health. UNICEF facilitated the participation of DNHA in global and national advocacy for Scaling-Up Nutrition (SUN), and an agreement was reached on the coordination of SUN.

Supporting policy development

UNICEF supported the development of the National Nutrition Policy, and a gender strategy in the Community-based Management of Acute Malnutrition (CMAM) programme. A study on CMAM supply chain management informed the CMAM Operational Plan 2015-2020. Additionally, through UNICEF’s advocacy and support, the micronutrient surveys (previously conducted separately) were included in the Demographic & Health Survey 2015. Furthermore, as a result of persistent advocacy on maternal nutrition as a factor in reducing stunting, Malawi is now ready to prepare a policy on Anaemia Control.

The year was very challenging for the nutrition sector. Over a million people were hit by flooding, and food insecurity affected three times as many. In the ensuing drought, children in the most deprived communities all over the country continued to need nutrition interventions.

The CMAM programme is implemented in all 29 dis-tricts. There are 100 Nutrition Rehabilitation Units (NRUs), and the Out-patient Therapeutic Programme (OTP) operates in 89% (562 out of 632) of health facilities.

At least 20,283 lives were saved out of the 23,040 severe-ly acute malnourished (SAM) children who were treated in the UNICEF-supported NRUs and OTPs during the year. Cure rates for SAM were maintained at both facility and community level within WHO SPHERE standards in all the 29 dis-tricts: 88% cured, 4.1% died, 5.4% defaulted and 2% no-re-sponse (referred for further clinical management).

With active case-finding and referrals, the whole CMAM programme treated about half of the expected burden of SAM children; priority now is to improve case-finding and man-agement of SAM children.

COMMUNITY-BASED MANAGEMENT OF ACUTE MALNUTRITION (CMAM)


Sugar fortified with vitamin A

Two Illovo factories incorporated vitamin A into sugar production, using their resources, while UNICEF provided technical support for quality assurance and quality control. Illovo supplied 90% of local market sugar with access to all markets in the country; however, a joint assessment revealed that less than half of sugar being sold was adequately fortified. Increasing nutritional resilience

Behaviour and social change activities in nutrition mostly focused on engaging communities in the flood-affected districts as part of the emergency response and recovery process. Key messages on infant and young child feeding were aired on national and community radios, reaching households in both displaced and surrounding communities. A comprehensive C4D initiative in partnership with NGOs and district councils meant that an estimated 650,000 men, women and children were engaged through such interventions as social dialogue, theatre for development and peer education.

and Outpatient Feeding programmes, and NRUs. Field assessment was conducted and early initiation of breastfeeding was promoted for hospital-based deliveries to improve newborn care and survival.

Policy dialogue on micronutrient powders (MNP)

UNICEF’s advocacy on how MNP can be used to improve the quality, quantity and frequency of complementary food for children aged 6-59 months was endorsed at Government level in the fight to reduce stunting.

Vitamin A and de-worming tablets

Under-five children immunity was boosted with vitamin A supplementation during the first round of Child Health Days, held in June 2015. In 2015, the total coverage of vitamin A supplementation reached about 90% of children aged 6 to 59 months. Deworming tablets were given to about 92% of children aged 12 to 59 months. Well over a million children were reached with nutrition information messages.

Partners in selected districts trained in promoting appropri-ate household behaviours for maternal nutrition, infant and young child feeding and care.

District Nutrition Coordination Committee members and front-line staff trained on how to use counselling cards in communi-cation interventions to families.

BUILDING CAPACITY TO PROMOTE GOOD PRACTICE IN INFANT AND YOUNG CHILD FEEDING AND CARE

59 of the 100 NRUs in Malawi required repairs and more than half lacked equipment.

59%

ANNUAL REPORT 2015 25© UNICEF

WASH


© UNICEF


because of difficulties in making their expected contributions in logistics and related costs. The progress towards a Sector Wide Approach (SWAp) for WASH stalled, and UNICEF took a leading role in seeking workable solutions to these budgetary issues.

The main challenge during the year was the effect of the floods, which diverted resources and staff to life-saving flood emergency responses. Programme activities were stalled from January to around May. The floods destroyed some sanitation facilities, thus the programme lost some of the gains realised before the floods, including the programme for handwashing promotion in about half of the UNICEF’s target districts. As soon as the floods were over UNICEF and partners embarked on the recovery programme.

90% of the population had access to clean water in 2015 (from 42% in 1990), although some water points served huge numbers of people, and might be at some distance from home. Only 41% accessed improved sanitation (from 29% in 1990), and about 5% of the rural population (1% of urban) practised open defecation.

UNICEF remained a key player in the WASH sector in the country, actively engaging in strategic dialogue with Government and donor partners to win sustained support for the WASH programme. UNICEF supplied technical and financial support to Joint Sector Reviews and to the Sector Working Group in 2015, and was an active member of the Donor Coordination Group. With the withdrawal of donor budgetary support, government structures found it hard to be effective at field level

In 2015 Malawi was declared to have met the MDG target on access to safe drinking water, and to have made moderate progress towards achieving the MDG target in sanitation. 187,370 people in rural

areas gained access to safe water supply (750 new water points constructed and non-functional water points rehabilitated).

Water supply provided to 80 schools, health facilities and CBCCs; 179 schools were reached with School Led Total Sanitation. 39,000 children got access to safe water supply; 29,800 got access to sanitation facilities, and 93,350 were reached with hygiene messages.

259,250 gained access to basic sanitation.

1,037 villages achieved Open Defecation Free (ODF) status.

About 350,000 people in communities targeted for ODF received hygiene messages (handwashing with soap, safe handling of water, proper latrine use, etc.).

Hygiene activations were performed in 1,889 villages.

2015 – ACHIEVEMENTS OF UNICEF’S REGULAR WASH PROGRAMME IN 15 DISTRICTS

© UNICEF


Social marketing activities need to be complemented by working directly with beneficiaries to come up with ideas for hygiene behaviour changes, such as handwashing with soap at critical times.

Service delivery in institutions

UNICEF’s approach was cross-sectoral, covering primary schools, CBCCs, health facilities and NRUs. UNICEF supported district council implementation of WASH in institutions, engaging the support of WASH NGOs through Programme Cooperation agreements. Through UNICEF support in 2015, targets were met in the water supply component and in hygiene promotion. Slower progress was made in giving children access to improved sanitation; here, the main challenge was the lack of capacity of district partners to contract out and manage the construction of school sanitation facilities.

Partnership for innovation and sanitation marketing

In 2015 the success of Mzuzu University’s SMART Centre was built upon in refining designs for sustainably constructed latrines, and in training sanitation entrepreneurs. Fifty sanitation entrepreneurs were trained in the maintenance of low cost toilets.

Community Led Total Sanitation (CLTS)

UNICEF is an active member of the National ODF and Hand Washing Taskforce, and in 2015 supported the review of the ODF Malawi 2015 Strategy. UNICEF played a critical role to ensure that the coordination role of the Ministry of Health over CLTS continued despite a major staff turnover in the ministry. The National ODF Taskforce proved key to implementing the CLTS, to verifying ODF status at national level and compiling national statistics for progress.

Partnerships for social marketing

UNICEF seized opportunities for partnerships to deliver social marketing campaigns on hygiene and sanitation at district level. District councils, WASH NGOs and agencies that specialize in social marketing all worked together during the emergency and into the recovery period, reaching all 15 WASH districts with, for instance, hygiene activations.

Social mobilization through traditional leaders

The key lesson during the year was the benefit to be gained from actively involving traditional leaders in WASH interventions, particularly those that have to do with behaviour change in attaining CLTS and ODF status.

10 members from each of 691 WASH committees trained to manage and maintain facilities.

60 area mechanics trained to support the water point committees to handle slightly more complicated repairs which communities could not handle on their own. Each area mechanic was expected to handle up to 50 water points in the surrounding communities.

CAPACITY DEVELOPMENT TO ENSURE SUSTAINABILITY

EARLY CHILDHOOD DEVELOPMENT, BASIC EDUCATION & YOUTH


© UNICEF


for Malawi to investigate its primary education system now that more children are enrolling in school with experience of pre-school education.

and learning materials; to fund an honorarium and training to caregivers; and to support the construction of new ECD centres.

In the face of inadequate data, a national mapping of ECD services was completed in 2015, with a view to establishing a management information system. The National ECD policy was revised during 2015, strengthening the coordination role of MGCDSW and improving the functions of other ministries (Health, Education and Youth), academic institutions and CSOs for an integrated and holistic ECD programme.

Professionalising the ECD sector

Early Learning Development Standards were almost completed, setting a foundation for all major policy and curriculum development in ECD, and informing all caregivers of young children on the stages in child development.

National ECD training strategy was developed, based on evidence that children learn better using the local language and things available in their traditional setting, UNICEF supported the development of a local ECD kit containing traditional songs, games and story books.

Mainstreaming ECD into teacher training There is a pressing need

EARLY CHILDHOOD DEVELOPMENT

More and more young children took part in Early Childhood Development groups in 2015, and UNICEF continued to place a strong focus on the rural areas where most children live in deprivation with no ECD services. Major efforts were placed on creating an enabling community environment for Community Based Childcare Centres or CBCCs, in order to ensure quality and equitable access. A remaining challenge for scaling up services was the persisting low quality of the current ECD infrastructure. Also, caregivers work in the CBCCs on a voluntary basis, making it hard to ensure the knowledge and skills for quality ECD provision.

The policy and legislative environment for ECD in Malawi improved significantly during the period 2014-2015, with better sector coordination and inter-sectoral collaboration. Joint advocacy with key ministries and CSOs resulted in increased budgetary allocations. This was a crucial milestone for the sector which was, for the first time, allocated separate funding within the budget of the Ministry of Gender, Children, Disability and Social Welfare (MGCDSW), receiving US$1,038,000. These funds were designated to improve existing ECD services, partly by providing play

UNICEF Malawi’s education programme focuses on Early learning, care and development (ECD) for 0 - 8 year-old children; Primary education (learning outcomes, completion and transition to post-primary education); and Youth services (quality social services for adolescents and youth, particularly girls).

CCD is an evidence-based in-tervention to support caregiving practices. Local and simple play and communication activities are selected according to the individual child’s age and abili-ties, thus enabling caregivers to be more sensitive and respon-sive to each child’s needs and to stimulate their learning.

In 2015 UNICEF Malawi supported its counterparts (Ministry of Health, Ministry of Gender and World Relief International) to be trained on CCD, and Malawi adopted the global WHO and UNICEF CCD package.

CARE FOR CHILD DEVELOPMENT (CCD)


based financing project based on the National Education Standards and accountability at school level. The project develops the capacity of primary education advisors and inspectors to support schools on improving learning outcomes, school management and accountability, and safety of students.

Child Friendly Schools

During the year, ten schools in two districts were provided with a comprehensive Child Friendly Schools package benefiting approximately 8,000 learners. Another 15 schools in another two districts continued to benefit from activities initiated in 2014 with a particular focus on gender sensitive WASH facilities. In addition, a demonstration school was built in Chiradzulu, which enshrines and promotes that Child Friendly School approach.

Support to teachers

To help to improve on the qualified teacher to pupil ratio, UNICEF supported the construction of a teacher training college in Chiradzulu, which was handed over to the Government in mid-2015.Through UNICEF, the UK-based volunteer programme VSO engaged educational advisors in five public teacher training colleges; and nearly a thousand teachers in ten low-performing districts benefited from in-service training. UNICEF played a key role in facilitating a policy dialogue on linking pre-service and in-service teacher training, through a technical advisor in the Ministry of Education.

BASIC EDUCATION

The Malawi Learning Assessment results in 2014 highlighted the dire state of attainment, and stimulated a national debate on learning outcomes. In 2015 the policy dialogue in the education sector placed emphasis on this challenging area and on completion of primary education, especially in anticipation of Global Partnership for Education (GPE) support, which requires tracking of learning outcomes as a key indicator. Sustained support for minimum standards led to the development of National Education Standards, which were published in early 2015. The standards are aligned to the core elements of the child friendly education framework espoused by UNICEF, and focus on: outcomes for learners; the teaching process; leadership and management.

Following the challenging political, economic and aid environment in 2014 which led to a declining share of the national budget for education, the sector moved to implement reforms nonetheless. UNICEF worked with the ministry and development partners on results based budgeting, in order to inform the GPE programme and leverage additional resources. UNICEF Malawi supported a gender budget analysis of the education sector, and played a pivotal role in seeking to establish a new ‘common funding mechanism’ for the education sector.

Support to the National Primary Schools Improvement Programme

By end-2015 UNICEF had supported the Ministry of Education to engage 250 schools across Malawi in a results

Low primary completion ratebetween 2013/14 and 2015/16

46%Primary completion rate

58%Transitionrate to

secondary

Between 2013/14 and 2015/16 primary completion rates and transition to secondary schools remained static with about 46% primary completion

rate and about 58% transition rate to secondary.(EMIS 2015)

Instead of fired bricks, com-pressed stabilized soil blocks were produced on-site for the construction of Chiradzulu Teacher Training College and 11 child friendly schools, including latrine blocks. Buildings were designed to include rainwater harvesting and solar panels and were oriented to facilitate the use of prevailing winds for cooling.

INNOVATIONS FOR SUSTAINABLE BUILDING

This is a learning exercise for school children using car-bon-neutral, green or recycled building materials. Children design the pavilions to provide a conducive environment for learning, and also redesign schoolyards into landscapes with fruit trees, shading trees and flowers. Rich learning con-tent on environmental issues is to be found in the pavilions.

GREEN LEARNING PAVILIONS

© UNICEF


The Joint UN Working Group on Youth was set up in 2015, which successfully lobbied for around US$750,000 for a Joint Youth Participation project.

The programmes on livelihoods skills, functional literacy and complementary basic education which are directly supported by UNICEF are all now incorporated in the National Youth and Sports Plan. At local level, six district youth networks were revamped and operationalized with UNICEF support, and developed a comprehensive Action Plan for 2016.

Improving information systems

UNICEF mobilized support for improving the EMIS at national and district levels. At district level, the introduction of “Edutrack” and data dashboards hold great promise for improving analysis and action in response to identified bottlenecks. At the same time, UNICEF supported the training of selected teachers in order to roll out the Education RTM system using RapidPro, which will provide timely information on education indicators such as attendance in 154 schools in 10 districts.

Community mobilisation for girls’ education

In the ten low-performing focus districts, C4D initiatives implemented by various NGOs in selected schools succeeded in increasing enrolment and lowering drop-out rates. Girls became actively engaged in promoting their right to education, calling on chiefs and school management committees to fulfil their duties and ensure girls’ rights to education.

YOUTH SERVICES

Overall, in 2015, the youth sector saw a considerable expansion of opportunities provided to young people, girls in particular. Building on the national and sector wide approach to youth services adopted in 2014, UNICEF continued to support policy review and development, national planning and budgeting processes, and collaboration on youth matters. An overall assessment of youth services continued, and fragmentation of activities reduced where possible. UNICEF supported the National Youth Council (NYCOM) for their Annual General Meeting, and in their strategic planning process. UNICEF also initiated a review on the National Sports Policy, which now includes sports in schools. The ‘Let Girls Lead’ initiative is part of the post-2015 development agenda in Malawi.

Two sections within UNICEF (Basic Education & Youth and Child Protection) work with WFP and UNPFA to implement this programme targeting all bottlenecks that impede girls’ education in Malawi. The programme has resulted in collaboration and advocacy for girls’ education at high levels in four key ministries (Education, Youth, Agriculture and Health). Public awareness was raised by high level events, notably a National Girls’ Forum, which brought together 300 school-aged girls from all over Malawi to raise their voices on issues affecting their education; these included child marriage and the lack of bursaries.

A campaign to raise awareness on menstrual hygiene, originally part of the Keeping Girls in School Programme, continued in 2015 under the Joint UN Programme, with a number of activities at community level, including booklets answering key questions that girls might have regarding menstruation and their physical and psycho-logical development.

JOINT UN PROGRAMME ON GIRLS’ EDUCATION

Malawi has one of the highest rates of child marriages in the world. One out of two girls are married before 18 years old. Poverty, social and cultural factors hamper girls’ access to education, making them more vulnerable to harmful cultural practices, child marriage and therefore higher risk of early pregnancies and maternal mor-tality. In a culture of silence, women and girls are not em-powered enough to speak out, and abuse, discrimination and inequality are socially accept-able.

The advocacy interventions of UN Women and UNICEF and their engagement with tradi-tional leaders have contributed to a landmark step undertaken in June 2015 by the female Chief Inkosi Kachindamoto, who annulled 330 child mar-riages in the district of Dedza (Central Region), sending the children back to school. In addition, Chief Kachindamoto suspended the Village Heads that consented to the marriage in order to give a good example and encourage other chiefs to not endorse to child marriages.

PUTTING A STOP TO EARLY MARRIAGES – ENDING THE SILENCE

© UNICEF


Building capacity in the Ministry of Youth & Sports

UNICEF supported the Ministry to develop a capacity development plan for 70 of its district and national staff. Some were trained in youth sports facility management in China, and UNICEF supported training in planning, budgeting and project management skills.

Multi-purpose youth centres

The government adopted this pilot programme in Bangwe and Thyolo. Both centres became fully functional and reach about 10,000 adolescents with alternative and non-formal learning opportunities and life skills training. Additionally, and in under the same line of support from UNICEF, the government secured funding to refurbish the Kamuzu Institute of Sports in Lilongwe, and Youth Centres in Neno and Mzuzu.

An information management system for the youth sector

Tracking progress in the youth sector has been limited by the absence of an effective information management system. A situation analysis was done in 2015, led by the Ministry of Youth. The focus was five areas of young people’s lives (health, education, economic opportunities, protection and participation) and an analytical framework was drafted for tracking and assessing provision of basic services to adolescents and youth by 2017.

This highly effective 9-month literacy and numeracy pro-gramme has been running since 2005, aiming to reduce illiteracy among adolescent girls and boys aged 9-19 years who dropped out of or missed school. There is a direct link to 100 ‘convergence schools’, to pick up school drop-outs. UNICEF continued to support the A4A secretariat in 2015, which is now operational in 15 districts, coordinated by district staff of the Ministry of Youth & Sports. UNICEF’s technical sup-port on resource mobilization led to a 100% budget increase, with investments in core areas. The Ministry of Youth contrib-uted limited funding for the scaling-up of A4A in 11 districts.

A4A (ACTION FOR ADOLESCENTS) LITERACY AND LIFE SKILLS PROGRAMME

YOUTH CONFERENCE: ‘YOUTH AND AGRICULTURE: INVESTMENTS THAT LAST’

Over 350 young people from across the country attended Malawi’s first-ever youth con-ference, with representatives from each district youth net-work, Youth Consultative Forum members, university students’ unions, faith-based institutions, political parties, government and development partners. The conference agreed that advoca-cy at different levels is the key to engaging more young people in agriculture.

INNOVATION HUB The hub was set up in October 2015 in partnership with the Polytechnic of the University of Malawi. It promotes active youth engagement with technological innovations, and gives chances to develop capacities in skills, collaboration and entrepreneurship.

‘GIRLS’ VOICES’ held a workshop for 36 girl leaders from all over the country.

© UNICEF


social norms and traditions that cause discrimination. In 2015, by engaging traditional and religious leaders, C4D tackled deep-seated attitudes around gender and the role of girls and women. The ‘Learning Lab’, organised with government and CSOs, led to the implementation of these C4D strategies.

UNICEF addressed the acute shortage of qualified workers in child protection by supporting professional training. 77 social workers upgraded their qualifications from diploma to degree level through the partnership with Magomero College, and 2,000 police officers were trained in case management. As in other fields, the use of new technology led to significant advances. The mobile case management monitoring system for child protection was used to report 4,632 abuse cases through its coverage of 85 community victim support units in 8 districts. At the same time, ‘D-Tree’ helped develop an e-health solution by converting the One Stop Centre guidelines. Advice is given on mobile phones to guide service providers on the treatment of rape, so that appropriate care/ medication/ procedures are swiftly identified. The application facilitates accurate data collection and allows for real time monitoring and online peer review of cases.

CHILD PROTECTION

Malawi’s Violence Against Children and Young Women Survey (VACS) revealed that a significant number of girls in Malawi are exposed to violence: 1 in 5 are sexually abused before the age of 18. The VACS Priority Responses, published by the Ministry of Gender, allocate functions for the key duty-bearers, outlining a proactive and integrated approach in response to the high levels of violence against children and young women in Malawi. Prevention is the first line of defence against child abuse, and in 2015, with support from the UK’s Department for International Development (DFID) and the Royal Norwegian Embassy, UNICEF partnered with Plan Malawi and ActionAid Malawi to implement the violence prevention programme. These interventions are part of the newly formulated National Plan of Action for Vulnerable Children (2015-2019).

In 2015 multiple interventions in the area of education and protection remained a priority for the UN in Malawi. The UN Joint Programme on Girls’ Education tackled interrelated and multiple threats to girls’ education. Threats such as inadequate protection, violations of girls’ sexual and reproductive rights, cultural practices and gender inequalities can be addressed by a holistic approach to advance the rights of every girl. C4D is an important strategy to address the

From the start of 2015, UNICEF Malawi prioritised the children and women affected by the flooding emergency and the drought that followed. Life-saving interventions in health, HIV and nutrition were coupled with measures that made it possible for children to have decent shelter, resume some kind of schooling, and receive psychosocial support.

Children arrested by Malawi Police referred to diversion programmes

45%

4,000child victims of violence referred to Victim Support Units

Almost

42,000vulnerable children referred to protection services, through case management.


to be given a voice in ensuring the fair delivery of the services. Communities were engaged for this social accountability through CSOs, who engaged constructively with the district councils, and were fully active in district planning and in the coordination of services.

UNICEF Malawi continued to support the Government of Malawi to strengthen the social protection system and in implementation of the national social protection policy with focus on the Social Cash Transfer Programme (SCTP), targeting ultra-poor and labour-constrained households. 18 out of 28 districts were part of this programme in 2015. While in each district 10% of the population is identified as being the most vulnerable, 62% of eligible beneficiaries are children. UNICEF is providing technical support to the SCTP, focus areas are capacity building, evidence creation and advocacy towards an integrated and

Declaration commitments to their school or health clinic, for example. Citizens and officials at national and sub-national level have a right to know how much of the budget is reaching its intended destination. UNICEF, with UNDP, supported the Ministry of Finance to undertake Public Expenditure Tracking Surveys in the health and education sectors. Such analysis can play a vital role in empowering both citizens and officials to demand the highest accountability from government in budget expenditure. UNICEF conducted a 2014/15 mid-term budget analysis and a 2015/16 budget analysis; these helped in advocacy with Government and the IMF to protect social sector funding during public sector reform.

SOCIAL PROTECTION

UNICEF and development partners continued to strive for equitable access by all communities in social services, and for communities

SOCIAL POLICY

UNICEF led the way in championing child rights in international and national policy formulation in Malawi in 2015. UNICEF Malawi supported, wherever possible, the gathering of concrete evidence for policy-makers. Multidonor support enabled the MDG Endline survey 2014 to be finalized, and also the Welfare Monitoring and the Demographic and Health surveys, where UNICEF’s special interest was the inclusion of child related modules.

With technical and financial support from UNICEF Malawi, the Government of Malawi submitted a combined periodic CRC State Party report.

UNICEF Malawi supported the process leading to submis-sion of the initial States Party Progress Report against the African Charter on the Rights and Welfare of the Child.

Preparation of the State Party Report on the Convention on the Rights of People with Disabilities was supported and awaits approval prior to submission.

UNICEF Malawi provided inputs for the Shadow Report on the Convention on the Elimination of all forms of Discrimination against Women (CEDAW) pre-pared by civil society organisa-tions, and tabled with the State Party report.

UNICEF Malawi is supporting the development of shadow and alternative reports for all of these international com-mitments, and will develop its own report to the pre-sessional working group for the UN CRC.

CONVENTION ON THE RIGHTS OF THE CHILD (CRC), AND OTHER STATE PARTY REPORTS

© UNICEF


system aiming at linking and referring SCTP beneficiaries to complementary social services was initiated in two SCTP districts. Moreover, an extensive assessment about possible graduation paths for SCTP beneficiaries into sustainable livelihoods was commissioned, which revealed that complementary support in the areas of provision of access to effective veterinary services for acquired livestock as well as access to sexual and reproductive health services and secondary education would be first starting points to foster graduation from the SCTP.

In the context of regular external shocks through extreme climate conditions, such as regular droughts and floods in Malawi, UNICEF took efforts to integrate an emergency component into the current Social Protection system to align it with seasonal emergency response measures. In this context, UNICEF advocated for an automatic inclusion of SCTP beneficiaries into emergency response measures, e.g. food and cash support in response to existence-threatening droughts or floods.

In addition, UNICEF together with the government worked on strategic future directions of social protection and the SCTP in Malawi and commissioned the development of a strategic document providing possible directions and costings until 2030. This strategic document will be used to advocate for an increased government commitment.

The growth in interest in social protection measures led to a more complex web of stakeholders, and coordination posed a great challenge in 2015, especially in light of the limited capacity of Government to lead and manage the system. Due to inadequate funding, UNICEF Malawi’s planned support to the Social Cash Transfer Programme, which would have helped 350,000 most-vulnerable and labour-constrained families meet their daily basic needs, was not fully realized in 2015.

holistic social protection system in Malawi.

In the area of capacity building, UNICEF developed a comprehensive capacity development plan for the implementing government entity, which will guide capacity building measures in the next three years. In addition, a comprehensive communication strategy was developed and tailored IEC materials for the SCTP designed, which will help various stakeholders to embrace main programme objectives and components.

In the area of knowledge creation, UNICEF Malawi completed a three-year longitudinal Impact Evaluation of the SCTP in 2015. The study revealed that the programme has achieved its primary objective of ensuring food security and improving consumption among the ultra-poor and labor. Positive impacts were observed on the material well-being of children. A proportion of children in program households with a pair of shoes, access to blanket and a change of clothes has risen from just 12% at baseline to 50%. The study further revealed that the SCTP has had impact on ownership of agricultural and non-agricultural assets and strong effects on children’s school participation. Further, the SCTP was also found to have had the effect of delaying the first sexual encounter, reducing the experience of forced sex and decreasing poor health among adolescents. In addition, a two-year process evaluation was initiated by UNICEF Malawi in 2015, aiming at evaluating the core processes of the SCTP as well as measuring the adherence to and relevance of existing manuals and guidelines.

Given the fact that recent studies revealed that the provision of cash alone cannot lift the most vulnerable out of poverty on a long-term perspective, UNICEF further supported the government in the areas of linkages creations, resilience building and possible graduation from ultra-poverty. In this context, an IT-based

The country urgently needs to have alternative and innovative sustainable financing mechanisms, and to improve private sector contributions in order to mobilize additional resources for better health outcomes.

FINANCIAL REPORT



UNICEF Malawi’s largest donors were the European Union, the United Kingdom and Northern Ireland through DFID, the Government of Germany through KfW, and the Government of Norway.

UNICEF Malawi worked closely with donors to raise and re-programme funds to respond effectively to emergency situations in the country. With agreement from donors, over

In 2015 donors to Malawi’s development partners maintained their reluctance to channel resources through Government systems; budget support and sector support were not reinstated. Therefore, the year witnessed large inflows of OR (Other Resources) funding compared to planned results. By November 2015, UNICEF Malawi received US$103,501,349 in OR funding, representing 39% of the OR ceiling.

0 3,000,000 6,000,000 9,000,000 12,000,000 15,000,000

Emergency Response

Programme Support

CS Prog. Support

M&E Systems National Prog.

Partnerships for Child Rights

Social Policy

Social Protection

Child Protection

Youth Friendly Services

Education

ECD 0-8 Yrs

WASH

HIV & AIDS

Nutrition

Health

Expenditure ($)

US$5.1 million was re-programmed from existing grants, contributing to the achievement of most of the planned results. The UNICEF Malawi Humanitarian Action for Children fund (HAC) amounted to US$14,247,441 of which US$5,978,948 was received (42% funded).

UNICEF Malawi continued to champion the National Committee Donor Toolkits in Education, Child and

Social Protection and HIV through the new online reporting platform with a total of 14 grants being channelled through toolkits.

The partnership with Airtel Malawi was rolled out, and is planned to extend into 2016. A new agreement was signed with Standard Bank Malawi, to support the girls’ education campaign, with scholarships and promotion of campaign actions.

SUMMARY OF BUDGET ALLOCATION

42 ANNUAL REPORT 201542 ANNUAL REPORT 2015

6%UNICEF Core Funds$805,660

94%Other donors$13,224,261

HEALTHTotal expenditure$14,029,922



NUTRITIONTotal expenditure

$3,978,364



HIV & AIDSTotal expenditure

$2,912,580



WASHTotal expenditure$12,743,152


68%Other donors$413,404

ECD 0-8 YRS Total expenditure

$609,639



EDUCATIONTotal expenditure$12,167,702



YOUTH FRIENDLY SERVICESTotal expenditure

$1,253,713



CHILD PROTECTION

Total expenditure$5,686,376




SOCIAL PROTECTION



0%Other donors$0

SOCIAL POLICYTotal expenditure

$558,293


0%Other donors$0

PARTNERSHIPS FOR CHILD RIGHTS

Total expenditure$174,382


0%Other donors$0

M&E SYSTEMS NATIONAL PROG.

Total expenditure$618,038

83%UNICEF Core Funds$4,976,063


CS PROG. SUPPORTTotal expenditure

$5,997,807


1%Other donors$16,509

PROGRAMME SUPPORTTotal expenditure

$1,758,221



EMERGENCY RESPONSETotal expenditure

$5,145,632



TOTAL2015


“In 2015 UNICEF supported a range of innovative measures to transmit grassroots data to Government offices (education, health, HIV), streamline services for quick referrals (child protection), and consolidate records (youth services).”

UNICEF Malawi, 2015 Annual Report

Published by UNICEF MalawiPO Box 30375Airtel Complex, Area 40/31Lilongwe 3, Malawi.

[email protected]/malawi

© United Nations Children’s Fund (UNICEF)August 2016

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