- 22.1 million people live in poverty and substandard conditions
- Infrastructure in ruins from 21 years of war
- Systemic gender discrimination against women and girls
- Widespread human rights abuses based on ethnicity, religion and language
- 309,000 children under five years of age die each year; under-five mortality rate ranks fourth worldwide
- Only 17 per cent of population has access to safe water, and only 10 per cent to adequate sanitation
- Adult literacy rate is 27 per cent for men and 5.6 per cent for women
- Primary school enrolment for both girls and boys is low
- Girls have access to formal education in only one province, Badakhshan
- An entire generation of children has grown up amidst armed conflict
- Increase access to education for girls;
- Improve teacher competencies in newly developed gender-sensitive lessons;
- Increase the quality of education for all children, particularly internally displaced persons (IDP) returnees who received foreign culture indoctrination in camps in neighbouring countries;
- Rebuild local capacity for preventive primary health care following exodus of health care professionals;
- Arrest the spread of infectious diseases that cause nearly one half of childhood deaths;
- Address Water and Environmental Sanitation (WES) needs of IDPs.
TOTAL FUNDING REQUEST: $3,890,000
|Expanded Programme of Immunization (EPI)||
|Water and Environmental Sanitation (WES||
|Integrated primary health care (PHC)||
Afghanistan is suffering the effects of 21 years of war. Infrastructure is largely destroyed. Government agencies - short of human and financial capital - function at minimum capacity. Most professionals have left the country because of the war, the Taliban or the pervasive poverty. Human rights violations are widespread and affect every segment of the population: women and children, ethnic, religious, political and regional groups, as well as educated Afghans.
Health conditions are marked by very high rates of infant, under-five and maternal mortality and morbidity from diarrhoea, acute respiratory infections, malaria, tuberculosis and vaccine-preventable diseases. The infant mortality rate measures 165 per 1,000 live births, while the under-five mortality rate is 257 per 1,000 live births. Diarrhoeal diseases and acute respiratory infections cause an estimated 42 per cent of childhood deaths. Poor access to obstetric care and a lack of reproductive health and family planning services contribute to the declining health status of women and children. One in five children present signs of acute malnutrition; more than one half of women of reproductive age have never received tetanus toxoid (TT).
The quality of education is poor, and school enrolment countrywide is low. The education of girls is banned in over 90 per cent of the country. However, non-discriminatory, non-formal basic childhood education programmes continue with external support, and are expanding to serve both girls and boys in contravention of official restrictions.
It is estimated that only 20 per cent of rural dwellers have access to clean water. Efforts to re-establish water supplies in urban areas are difficult to sustain because authorities are unable to maintain supply systems. Considerable progress has been made in recent years in improving access and water quality in rural areas; yet, inadequate supplies of safe drinking water remain a problem.
UNICEF PROGRAMMATIC INTERVENTIONS IN 1999
Funding for 1999 programmes fell far short of the Appeal, forcing cuts in the programme. UNICEF targeted regions that were previously inaccessible due to insecurity. The 'rights-based' approach in Afghanistan is linked to three broad thematic areas: Survival, Development and Promotion/Protection of Rights.
Immunizations resumed in six provinces in the northern region, where an estimated 160,000 children under one year of age have been without services for over one year.
Progress was realized in transforming centralized health care systems promoting curative medicine into regional systems emphasizing preventive/primary health care.
Although donors funded less than one half of the 1999 appeal for health programmes, there are more basic health centres (BHCs) today than existed before the war.
Afghanistan is one of the five countries in conflict that is targeted for extra polio eradication efforts:
- A National Immunization Day (NID) was conducted in opposition-held provinces that had not been accessed since 1996. Vitamin A supplements for 2.7 million children under the age of five were provided during the NID, thereby optimizing EPI coverage of women and children;
- EPI coverage was expanded to newly accessible regions and is now operational nationally;
- There have been fewer recorded incidents of night blindness and mortality caused by diarrhoea and measles in those regions.
- Internal displacement is expected to continue - the fallout from political unrest and civil disorder. Special activities are under way to vaccinate against measles and polio. Displaced children will receive vitamin A supplementation to reduce mortality from measles, diarrhoea and respiratory infection.
Some 25,000 people will have safe drinking water after completion of the project in 2000. Since 1993, UNICEF has provided safe water to over 2 million people, sanitation facilities for half a million people and knowledge on hygiene, sanitation and safe water practices to 3 million people in Afghanistan.
Acute Respiratory Infections (ARI)/Control of Diarrhoeal Disease (CDD) campaigns in urban and peri-urban areas were successful in raising awareness of childhood mortality. It was decided to incorporate ARI/CDD campaigns into larger health interventions on an ongoing basis. The safe motherhood programme received no funds in 1999, disrupting non-governmental organization (NGO) operations and forcing UNICEF to forgo the planned expansion to four additional provinces.
UNICEF provided bridge funding to two NGOs, enabling them to maintain minimum emergency obstetric care (EOC) services in two provincial hospitals for six months.
An interagency initiative to improve the quality of primary education was launched in 1999.
Although our education programme received zero donor funds in 1999, UNICEF, in partnership with Save the Children, USA, was able to sustain activities towards development of basic math and language competencies. This activity met the strategic objective of "improved quality of services and agreement on minimum standards."
UNICEF will continue and expand an ongoing project supporting the formal education sector (primary and secondary education) in Badakhshan province, which started in 1998. Badakhshan is one of very few areas where girls still have access to formal education, and girls' participation is substantial, especially in Faizabad city where 46 per cent of all students are girls. Overall, 27 per cent of all students in Badakhshan are girls.
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