US Request - Template

UNICEF Iraq

Programme Summary 2007

1. UNICEF Iraq - Overview

Although Iraq was not officially an “emergency” country according to UNICEF global definitions in 2006, many of UNICEF’s programmes were already responding to the humanitarian needs of displaced and vulnerable communities. The highly complex nature of Iraq’s situation, which mixes displaced families and settled families within the same communities, affects basic services in a range of different ways.

Therefore, UNICEF’s programmes have been neither purely humanitarian nor purely focused on development. Programme strategies have adapted to fit Iraq’s unique reality, attempting to boost local basic services while at the same time reach out with special initiatives for vulnerable children, to improve the living environment and opportunities across entire communities.

Increasingly UNICEF has initiated a local approach, starting to build a package of essential care around children living in a particular area. This balance between providing humanitarian relief and finding sustainable solutions for families will be maintained as the best strategy for Iraq in 2007.

As of February 2007 UNICEF has included Iraq officially on the list of emergency countries, and continues to balance humanitarian response provided to recently displaced populations and their host communities with its regular support of basic social services for the population of Iraq.

UNICEF co-ordinates all its programmes with other United Nations Agencies, keeping children’s issues a key focus of international support to Iraq, and enhancing the scale and reach of integrated actions to produce sustained results for children.

UNICEF is a prominent member of the UNCT and takes a leading role within the Iraq Trust Fund (ITF) Cluster system, as the lead co-ordinator for two ITF Clusters (Education and Infrastructure), deputy co-ordinator the Health Cluster and a key actor in Cluster F (Refugees, IDPs and Durable Solutions).

A summary of UNICEF’s overall programme context for 2007-2010, and intended programme activities in 2007, follows:
2. UNICEF Programmes

2.1. Survival & Growth

The Survival and Growth programme aims to ensure the best start to life, reducing the Maternal Mortality Ratio (MMR), Infant Mortality Rate (IMR) and Under Five Mortality Rate (U5MR), and improving the health and nutritional status of children and women. The main planned results were: a) increased quantity and quality of health care services, leading to reductions in mortality rates of infants, children and women, and in malnutrition rates; b) increased immunization coverage; and c) development of a more protective environment for children/youth, including access to information on HIV/AIDS. The programme is contributing to the realization of MDGs 4, 5 and 6.

The Survival and Growth programme supports efforts of the Ministry of Health (MoH) to sustain basic health and nutrition services, ensuring effective and equitable coverage to all children under-five years of age and pregnant/lactating women. These combined efforts have resulted in no major disease outbreaks, maintenance of polio-free status, and continued substantial reductions in the number of reported measles, mumps and rubella cases in Iraq. The Survival, Growth and Early Development (SGED) programme comprises of four projects:

Project 1: Maternal Infant and Child Survival and Healthaims to ensure the best start to life by reducing the Maternal Mortality Ratio (MMR), infant mortality rate (IMR) and under-five mortality rate (U5MR) from current levels, and improving the health status of children and women. This project operates through:a) provision of required essential supplies/equipments;b) conducting national immunization days and outreach activities;c) strengthen routine immunization activities, d) development of national policies/strategies;e) advocacy & social mobilization, f) capacity building of health workers; and g) rehabilitation/construction of health facilities.

Project 2: Maternal and Child Nutrition aims to build upon infant and child survival, ensuring optimal growth and development up to age of entry into primary school. This project operates through: a) provision of required essential supplies/equipments/ therapeutic foods;b) development of national policies/strategies; advocacy & social mobilization;c) institutional and legislative reforms; andd) capacity building of health workers and rehabilitation/construction of health facilities.

Project 3: HIV/AIDS aims to support the protection of children, youth and women from HIV/AIDS by advocating with and building the capacities of key duty-bearers to enable them to play their effective role towards halting and beginning to reverse the spread of HIV/ AIDS. This project operates through: a) development of national healthcare capacity at all levels in formulation of policies, strategies, protocols and plans related to prevention of mother to child transmission (PMTCT);b) provision of essential components of services delivery;c) advocacy and social mobilization.

Project 4: Early Childhood Development (ECD) aims at strengthening the survival, growth, development, protection and participation opportunities for children from birth to 6 years of age in an integrated and holistic manner. This project operates through: a) national capacity development at all levels in formulation of policies, strategies, protocols and plans related to ECD and Better Parenting Initiative (BPI);b) development/adaptation of training modules; and c) development of IECD package for non-governmental organizations (NGOs), parents/care takers & community leaders via the implementation of the BPI.

2.1.1. Key Results

Key expected four-year results include: (a) enhanced health and nutrition services in selected programme areas, with increased access and improved quality; (b) enhanced safe motherhood practices in the same areas, including antenatal care and Emergency Obstetric Care (EmOC), contributing to a reduction in MMR of at least by 30% from 2006 levels which is determined by the Family Health Survey (FHS); (c) sustained immunization-plus coverage of 90% in all districts, linked with diarrhoeal disease/acute respiratory infection (ARI) control, resulting in at least 10% reductions in diarrhoea/ ARI incidence and polio-free status maintained; (d) all pregnant women with access to voluntary counselling, care and testing, 80% of HIV-positive women/children receiving anti-retroviral (ARV) treatment and all young people with access to information on HIV prevention and user-friendly services; (e) strengthened convergence of health/nutrition activities, and their improved correlation with other sectoral interventions; (f) expanded interventions to address Low Birth Weight (LBW), wasting, stunting and micronutrient deficiencies, reducing these by at least 10% from 2006 values; (g) capacity of the MoH is augmented for policy development/prioritization and programme management; (h) optimal infant and young child feeding and care practices, including an extended Baby-Friendly Hospital Initiative (BFHI), promoting baby-friendliness at the community and household levels; (i) strengthened support for more effective growth monitoring, common disease prevention, good hygiene and early care-seeking; and (j) as an integral part of ECD, improved parenting practices to stimulate children’s cognitive and psychosocial development; and (k) minimizing the spread of Avian Influenza in close collaboration with the communication component of the country programme.

The Survival and Growth programme will be developed, planned and implemented within a national vision for the whole country covering the North, Centre and South zones of Iraq. However, special strategies will be developed and piloted targeting specifically hard to reach areas and most vulnerable population groups, and regional programmes will be explored based on the situation of women and children in specific regions.

2.1.2. UNICEF’s Distinctive Role

The cluster approach adopted within the UNCT in 2004 has fostered close cooperation with other Agencies, in particular WHO, WFP, IOM, UNFPA, UNIDO and FAO, as well as NGOs. UNICEF is deputizing WHO in the Health and Nutrition cluster (Cluster D) and actively participates in the work of this body. UNICEF is the lead agency in the UNCT on nutrition in emergencies, and actively participates in the Cluster D working group on HIV/AIDS, Avian Influenza, Emergency Obstetric Care as well as the Health Sector Working Group (SWG) lead by the MoH, with participation of the Ministry of Planning and Development Cooperation, UN agencies, and donors. The Health SWG provides a forum for close government dialogue with partners on issues such as policy development, priority setting, project implementation and monitoring. It is enhancing the government’s ownership of projects for which assistance from the international community is requested, and it is fostering transparency among all stakeholders.

2.1.3.Key Achievements in 2005/06

• Successful national immunization programmes have effectively protected children against major disease outbreaks. Iraq’s polio-free status has been maintained. There have also been remarkable reductions in the number of reported measles, mumps and rubella cases in Iraq.
• UNICEF has rehabilitated and constructed 25 Primary Health Care (PHC) centres, Maternal and Child Health (MCH) units and delivery rooms throughout the country and provided supplies and basic equipment to these facilities, improving basic health care for over 500,000 people in remote and underserved areas.
• UNICEF has been supporting Wheat Flour Fortification (WFF) with Iron/Folic acid since August 2006, covering 106 mills in Baghdad and 76 mills across other governorates.
• 72 Nutrition Rehabilitation Centres (NRC) and 2700 Community Child Care Units (CCCU) have received therapeutic milk and anthropometric tools as part of the Targeted Nutrition Programme.
• Oral Rehydration Salts(ORS) and other basic essential drugs have been supplied through the Ministry of Health to PHCs, benefiting 4.8 million U5 children.
• UNICEF has trained local health workers and paramedics PHC and maternity and pediatric hospitals across the country on basic child survival healthcare
• UNICEF continues to deliver essential supplies to help children survive and thrive, including ferro-folic acid tablets, potassium iodate, midwifery kits, and premix for salt iodization.

2.1.4. Key Programmes & Projects for 2007

The programme is continuing its assistance to the Ministry of Health (MoH) in meeting basic health and nutrition needs, achieved through a combination of the following strategic elements: a) humanitarian assistance to extremely vulnerable groups, including displaced families and host communities; b) support to service delivery and capacity building of the MoH - expanding access to, and usage of, existing quality basic health and nutrition services, including some rehabilitation where needed; c) community empowerment - ensuring community participation and involvement in the planning and management of community health and nutrition programmes and activities; d) strengthening the integration and convergence of health and nutrition services as well as linkages with other programmes, mainly Learning and Development and Water and Environmental Sanitation; e) sustaining the existing strong partnerships with the MoH, Ministry of Transport, United Nations Country Team (UNCT), donors, international and national NGOs, private and public sectors, to ensure required support, including sustainable financing of health and nutrition programmes; f) continuing to influence within and contribute to the Iraq Trust Fund (ITF) Cluster approach as deputy co-ordinator for the Health Cluster and SWG; and g) concerted policy development, monitoring and evaluation in health and nutrition issues leading to IMR/U5MR reductions.

Specific programme interventions include:

• Immunization Plus,a two week longnational Measles, Mumps & Rubella (MMR )campaignwill start in April 2007 toprovide 3.8 million children from 12-59 months of age with MMR vaccinations.This project will address the risk of a rising level of susceptible children,which may reach 1 million in 2007/8,as part of emergency preparedness measures. Following UNICEF’ssuccessfully advocacy forthe procurement of the required quantity of MMR vaccines and syringes/needles, the Government of Iraq procures all required vaccinations in 2007. UNICEF will support the transport of 2,036 mobile teams for a period of 2 weeks, the provision of safety boxes for collection and incineration/disposal of used syringes/needles, as well as planning and monitoring and social mobilization, with special emphasis on hard to reach areas.This project will also support Polio National Immunization Days (PNID)planned for November and December 2007 with 10 million doses of OPV, transportfor more then 5,300 mobile teams, registersand social mobilization. In addition UNICEF will continue to support routine immunization targeting 56 districts in Iraqwith coverage ofDiptheria, Pertussis and Tetanus 3 (DPT3) vaccination of less then 80%. This will be complemented by the decentralization of the National Vaccine Store and the rehabilitation/construction ofthree sub-regional stores in Erbil, Basra and Babil, and will also include provision of required cold chain equipment. UNICEF will support training of EPI staff at various levels in microplanning, cold chain management and a communication campaign to mobilize communities.

• Disease Management: UNICEF will support the MoH to provide for the availability of ORS and Zincfor at least 3 million cases of childrenless than 5 yearsfor the Control of Diarrhea Diseases (CCD). This is scheduledfor the summer months, whenIraq faces and increased risk of outbreak of diarrhoeal diseases, and complemented with training for concerned PHC staff to refresh their knowledge on diarrhea case management and hygiene promotion. UNICEF will also supportcapacity buildingfor case management of ARI, conductcommunication campaigns to increase community participation, provideessential medicines and IEC materials, as well as support supervision and monitoring.

• Emerging Diseases: UNICEF will supportthe MoH in communication and social mobilization of Iraqi communities on Avian Influenza in the following specific areas: planning, strategy development, support to develop IEC materials, capacity building in communication skills and outreach campaigns.

• Safe Motherhood and New Born Health:UNICEF will support a master training of trainers for the MoH and the Minister of Higher Education staff. By January 2007, 36 master trainers have completed their training. Cascade trainings will be carried out in 2007 in all of Iraq, resulting in 500 experts being trained in this field in 2007. UNICEF will alsoprovide teaching/training materials and essential supplies for safe motherhood and newborn care as well as related IEC materials, supervision and monitoring.

• Maternal and Child Nutrition:will be supported through a series of key interventions, such as:a) anemia prevention and control throughprocurement and distribution of iron and folic acid supplementation tablets/capsules; b) WWF through procurement of premix, feeders and spares, lab equipments and reagent for quality assurance and control, IEC materials, capacity building, social mobilization and advocacy for sustainability; c) Universal Salt Iodization (USI) through procurement and distribution of potassium iodate, testing kits, training of staff from the Ministry of Health and Ministry of Transport, monitoring and supervision of USI implementation as well as advocacy for sustainability of the USI interventions; d) Vitamin A supplementation throughprocurement of Vitamin A capsules and provision of the requiredtechnical support and IEC materials. A Micronutrient Surveywill be supported by UNICEFto establish the baseline data on micronutrient levels in Iraq. UNICEF inputs to the survey will include training, recruitment of consultants, procurement of required supplies including laboratory equipments and reagents.NRCs will be provided with training to manage severely malnourished children through procurement of supplementary and therapeutic feeds as well as anthropometric tools and training of staff on the management of severe acute malnutrition. UNICEF also supports Community Child Care Units (CCCUs)through training of community volunteers on the assessment of the nutritional status of children and strengthening the referral system to the PHCs and NRCs with focus on 36 food insecure districts. UNICEF supports the MoH in the area of Infant Young Child Feeding (IYCF) by developing the national IYCF strategy. In 2007 UNICEF will support a series of workshops to disseminate the strategy. UNICEF will continue to provide support to Ministry and Departments of Healthwith procurement of essential supplies for BFHI hospitals. Social mobilization will be carried out through provision of IEC materials and media campaigns on breast feeding promotion and an advocacy campaign to discourage distribution of infant formula within the public distribution system (PDS).

• HIV/AIDS:UNICEF will support the MoH in developing the capacity of national healthcare staff at all levels to enhance their skills in the formulation of policies, strategies, protocols and plans related to PMTCT and Youth Friendly Service Interventions.

• Early Childhood Development (ECD): to provide basis for future programming, 2007 UNICEF will conduct a home and community based pilotproject on early childhood care for children between 0-3 years in selected districts in the Kurdistan Region. Support will be provided in developing and adapting training modules for parents and care givers, health workers and community leaders through the implementation of the BPI.

• Humanitarian Assistance: UNICEF’s support will include three main components addressing the emergencies in Iraq: (a) mitigation of possible outbreaks of measles, diarrhoea and avian influenza and sustained polio eradication efforts;(b) support to areas affected by internally displaced people (IDPs) to strengthen and increase existing capacity for services; c) support selected district hospitals to deal with injuries from violence including procurement of first aid kits, antiseptics, essential medicines and disposable medical supplies.

2.1.5. Budget

Planned Budget for 2007:US$: 15 million

Funding Shortfall by end May 2007: US$ 1.4 million

2.2.Quality Learning and Development

The Quality Learning and Development Programme (QLD) promotes increased participation of children and youth in quality education programmes at early childhood, primary and intermediate levels, through both formal and alternative channels. This component falls within the UN-Iraq Joint Strategic Plan supporting the MDGs, in particular goals 2 and 3. The quality learning and development programme comprises thefollowing four projects: