UNICEF MADAGASCAR

Newsletter on the Situation of Children and Families in Madagascar

No. 2: May 2010

PROTECTION – Immense needs and no resources

Based on data coming from the ‘Police de Moeurs et Protection des Mineurs’ (PMPM) and the
‘Syndicats des Professionels du Travail Social’ (SPDTS), the number of children being kidnapped or
disappearing in Antananarivo continues to be high. The main reason for children disappearing is
considered to be mistreatment and violence at home (often a sign of increasing family breakdown)
combined with high poverty levels. In 2009 a total of 1,026 children have been reported as missing.
Out of these, a total of 444 cases still require further investigation. The 2009 level has been
particularly worrying as the political crisis precipitated the disappearance of children beyond
previously known levels for the city of Antananarivo. Between January 1 and May 1 2010, a total of
238 children have been reported missing out of which 138 were reunified with their families and 100
cases are still under investigation.

The number of cases of sexual violence that have been received by the Befelatanana Maternity
Hospital in Antananarivo alone is even more disturbing. In 2009, a total of 479 cases were registered
of which only 27 were cases concerning persons over the age of 18, while 345 were cases
concerning children aged 10-18 years and 107 cases concerning children aged 10 years old and
younger. Young girls appear to be particularly vulnerable. As of May 1, 2010, a total of 228 cases of
sexual violence have been reported by the same institution.

Table: Sexual Violence – Cases received by the Befelatanana Maternity Hospital – Antananarivo

Age 2009 2010

Under the age of 10 107 46
Aged between 10 and 18 345 172
Over the age of 18 27 10
TOTAL 479 228

Weak institutions, a failure of officials to adequately respond to reported crimes, and the lack of
resources to address cases of disappearance, abuse, exploitation and sexual violence all result in
many of children not receiving adequate response, treatment and protective measures. This situation
is further compounded by the fact that government officials at the municipal (commune) levels have
not been – or only irregularly - receiving their salaries for several months and have reduced the
amount of work they have carried out. This affects the child protection networks that UNICEF has
facilitated in 761 municipalities as a means of local follow-up to cases of child abuse.

The municipalities are receiving a lump sum amount of 8 million Ariary per year of government
funding for the purpose of social protection interventions. In the absence of development resources
being disbursed since the onset of the crisis, and given the delay in payments for local government
staff, this amount is increasingly being used to fill the fiscal gaps for any other budgetary items, thus
even further decreasing the little amount available for social protection measures including child
protection.

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 Street clashes in Diego on April 26 and 28 between
students protesting against the non-payment of
scholarships since the beginning of 2010 and police
forces led to violent use of force by the police resulting
in one student being killed and six students being
severely injured by gunshots.. Out of the injured, one
has been confirmed by UNICEF to be 17 years old. As
has been the case during the violent events at the
beginning of 2009 in Antananarivo, children continue
being drawn into violent public events thus are being
Diego University students hospitalised in Diego exposed to and falling victim to physical violence.
Hospital following clashes with police

UNICEF is working on establishing, expanding and strengthening child protection networks

throughout the country to prevent, and respond to, violence and abuse against children. These
mechanisms/networks composed of child protection key actors are operating at district and
community levels to facilitate interaction between law enforcement authorities, service providers
and communities themselves to address identified cases of violation of child protection rules and
to refer cases to appropriate services in a timely manner. Child protection networks are
responsible for monitoring and reporting on child protection cases. To date there are networks
operating in 761 ‘communes’ with different degrees of efficiency.

Besides this, UNICEF is advocating for 1) the recognition of the social workers’ role, 2) supporting
the training of social workers to reinforce family structures and facilitate reintegration of children
into their families and communities, and 3) training law enforcement officers to ensure that child
rights are applied in the justice system. To date 80 per cent of judges have participated in
awareness raising and orientation sessions on international standards to protect the rights of
children in contact with the justice system, including in the context of the crisis and political unrest.
More than 492 stakeholders benefited from training in the new child protection legislation, and
3,500 copies of the penal code have been printed and distributed since January 2009.

At community level volunteers were identified by the community and mobilized to address child
protection issues and to reduce exposure of children to violence and abuse. They contribute to
identification and referral of child protection cases to appropriate services. They played a
significant role in mobilizing the research of missing children. In the Analamanga region there are
471 volunteers /FIANTSO engaged in 127 Fokontanys (out of 192).

To improve services provided to victims of sexual violence reported by the Befelatananana

Maternity Hospital in Antananarivo, an integrated unit is in the process of being set up in the
building to facilitate access to psycho-social and legal counseling and medical assistance for
victims.

UNICEF and its partners from the Child Protection Networks initiated a series of consultations
with youths on the problematic of violence. Regional discussions were realized in Antananarivo,
Toliara (Tulear) and Fianarantsoa involving youths from different districts on their perception on
violence, juvenile delinquency and criminal responsibility. At the end of each consultation a set of
interventions were identified on how to prevent and respond to violence at the local level.

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EDUCATION – a halt to Madagascar’s primary school enrolment success

An assessment carried out by UNICEF of the situation in

65 public primary and lower secondary schools across
twelve regions1 provides a mixed picture and some
worrying trends in performance during the 2009/10
school year compared to 2007/2008 and 2008/2009. The
study, carried out in rural and urban schools along three
axes (central/ east, north and south), confirms results
from the McRAM 20092: Parents in Madagascar are
increasingly stretched to ensure the education of their
children. This has become more difficult as government
A fifth grade student in Morondava Public
Primary School contributions designed to help decrease direct education
expenses for families through school kits and school
capitation grants has so far not been provided for the 2009/2010 school year. At the same time,
household budgets, particularly in urban areas, are increasingly distressed.

While primary school enrolment rates in the 65 assessed schools (using a non-representative but
indicative sample) increased by 6.5 per cent in urban areas between the 2007/08 and 2008/09 school
years, it decreased by 4.6 per cent between 2008/9 and 2009/10.3 For rural areas, on the other hand,
there was a minimal increase for the same period (0.1 per cent), but the previous level of increase in
enrolment (3.3 per cent between 2007/08 and 2008/09) was not maintained. According to parents and
teachers, the reasons for this negative development are primarily economic: the inability of parents to
cover the education expenses for their children combined with the increase in fees requested by
schools. According to information from 175 parents interviewed, direct primary school expenses to
families increased on average by about 21,400 Ariary (about 11 USD) per student from the school
year 2008/09 to 2009/2010 – an increase of 30 per cent: The total cost to families per student was on
average 67,400 Ariary (USD 34) in 2008/2009; in 2009/2010 it has increased to 87,500 (USD 44).
This cost is difficult to bear for many families.

For the first time in many years the exceptionally strong upward trend in Madagascar’s primary school
enrolment has been arrested and reversed. Madagascar’s net enrolment rate increased with
breathtaking speed between 2001 and 2007 with rates jumping from 65 per cent to 87 per cent. The
drop in enrolment in urban areas in 2009 is even more worrying when taking into account results from
the McRAM study, indicating that there is a shift from private to public schools in urban areas. Since
the study did not take into account private school enrolment, it can be inferred that the overall
enrolment has decreased even more than revealed by the study data, since some of the enrolment
registered can be presumed to result from children previously enrolled in private schools.

Of serious concern is also the significant reduction in inscription rates for the end of primary school
exams, which enable students to proceed to the secondary level. The study shows a 17.7 per cent
decrease in registration for the CEPE in 2009/2010 compared to 2008/2009. Inscription rates for the
secondary level examinations (BEPC) required for proceeding to upper secondary school have
decreased by 4.6 per cent. These reductions in exam inscriptions risk translating into reduced
transition rates between primary and lower secondary, and between lower and upper secondary
schools, in turn threatening the progress towards universal basic education and a general lift in the
level of education of the population—a lift which is deemed essential for economic growth and poverty
reduction.

1
Evaluation de la situation des écoles primaires et collèges en période de crise, 2009/10. UNICEF, May 2010.
2
McRAM III. Evolution de la situation socio-economique des ménages de la ville d’Antananarivo durant la crise sociopolitique.
United Nations Madagascar, November 2009
3
Data based on local school registers
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A positive development highlighted in the study is the increased achievement in final examinations at
the end of the 2008/09 school year compared to the previous year. Primary school examinations
(CEPE) were successfully mastered by 75.6 per cent of students at the end of school year 2008/09
compared to only 62.7 per cent of students at the end of school year 2007/08. This could at least in
part be due to a change in the examination, since a new competency based examination (supported
by UNICEF) was in place for the first time in 2008/094.

Also on the positive side, the study indicates that repetition rates in primary schools dropped slightly
in the transition between 2008/09 and 2009/10 (21.2 per cent) compared to the previous transition
2007/08 and 2008/09 where the repetition rate was 24.2 per cent.

The above positive trends could be interpreted as the results of efforts to improve the quality of
education over the past years. However, the overall implications of the study are that there is
significantly high risk of losing these achievements unless urgent action is taken to reverse current
trends in enrolment and costs to parents. At the policy level, the local education partners have taken
the initiative to organize an external study of the state of implementation of the endorsed education
sector plan covering primary and lower secondary education. It is hoped that the results will be a good
basis for dialogue to re-establish progress and the inflow of resources to the sector.

Access to safe WATER AND SANITATION: a deteriorating trend

The recently released Joint Monitoring Progress (JMP) report of March 2010 documents a recent
downward trend in access to water and sanitation. In 2008, 47 per cent of households had access to
improved water facilities whereby in 2010 it is only 41 per cent. Access to improved sanitation
decreased from 12 to 11 per cent over the same period.

In an attempt to address the shortage of urban water capacity, UNICEF negotiated with JIRAMA
to have NGOs involved in the construction and management of water points in urban areas. Over
the past two years a total of 174 urban water connections were put in place – still short of the
target of 450 per year required to achieve the MDGs.

A significant regression in the access to safe water has been diagnosed in urban areas where no
investment is being made in the expansion of respective infrastructure, yet urban populations are
growing by an estimated 2.5 per cent annually. UNICEF, together with the World Bank, is currently
engaged in a study on the situation of urban water and sanitation that is expected to shed more light
on critical issues to be addressed and how.

NUTRITION – a situation mitigated in the South but grave deficiencies for treatment of severely
malnourished children elsewhere

In April 2009 the acute malnutrition situation in the South reached alarming levels due to a failure of
the 2009 harvest, due to inappropriate rainfall and also compounded by poor access to clean water,
inadequate sanitation and inadequate care seeking behaviour. In response, the national and
international communities launched a multi-sectoral emergency intervention with the local
communities and health structures. The successful intervention resulted in a halving of acute
malnutrition rates between April 2009 and November 2009.

The latest survey carried out in Androy and Anosy in April 2010 showed a slight increase due to the
lean season with, global malnutrition rates were 7.2 per cent in Androy and 8.7 per cent in Anosy,

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A separate evaluation of the 2009 CEPE examination results is being conducted by the Ministry of Education with support
from UNICEF
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significantly lower than the levels seen in April 2009.
For severe acute malnutrition the levels were 1 per cent
in Anosy and 1.7 per cent in Androy resulting in 3,593
children still in-treatment at the end of April in the 145
UNICEF-supported ‘Centres de Récupération
Nutritionnelle Ambulatoire pour Sévères’ (CRENAS)
and roughly 1,500 new admissions are seen every
month.

In order to effectively identify all children with severe

acute malnutrition, active mass screening of acute Malnutrition screening in the Beloha Basic Health
malnutrition was integrated in the April 2010 Mother and Centre, Beloha District, Androy region
Child Health week. This successfully integration
resulted in a total of 208,427 children under 5 screened equating to 97% coverage.

A recent assessment exercise by UNICEF with partners of the ‘Centres de Récuperation et

Education Nutritionel le Intensifs’ (CRENIs) in Antananarivo and elsewhere has found a serious
deterioration in their capacity to adequately treat severe acute malnutrition. The CRENI provides
intensive in-patient treatment of severe acute malnutrition and are located within the public hospital
structures.

In 2003 the Malagasy Government declared fee-free the package of treatment for severe acute
malnutrition (SAM) within the CRENI. The free package of treatment includes; therapeutic food (F100
milk), first and second line systematic drugs, hospital consultation fees as well as the nutritional meals
for the child and their carer. This commendable policy resulted in a reduction in case fatalities in
CRENIs to less than 10% across Madagascar and was supposed to be financed by the Office
Nationale de Nutrition (ONN), via its decentralized structures Office Regional de nutrition (ORN), in all
45 CRENI of Madagascar.

However, reports from the field suggested that

The Befelatanana CRENI in Antananarivo, where the the supervision team found a 40% default rates
families of patients with severe acute malnutrition with
complications are now obliged to pay certain costs as part
of their treatment
ONN is no longer in a position to continue
financing the 45 CRENI leaving the families to
bear the cost of treating SAM children.
Surveillance teams found these reports to be
true particularly in the CRENIs of Antananarivo
where out of 33 admissions, 9 children died,
equating to 27% case fatalities. Of the 9
children that died, 8 died within the first 48
hours following admission due to the inability of
the families to pay for the drugs necessary for
SAM children with complications. In addition,
as families are unable to pay for the complete
treatment of the SAM child.

In 2009, 4,143 children were admitted in 40 CRENIs (data from 5 CRENI remains unavailable). If
inappropriate treatment to SAM children continues, case fatality is likely to reach 50-60% resulting in
2,000-2,500 SAM children across Madagascar at risk of dying due to inappropriate care.

To provide some initial relief to the situation, UNICEF has provided 100,000 USD for the basic
functioning of 15 CRENIs in the most vulnerable areas. The amount is sufficient to provide basic
services until October 2010 only. Additional funds are urgently needed to extend the services in the
15 CRENIs until at least May 2011 and to ensure adequate services also in the additional 30 CRENIs

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which are also facing challenges in providing basic essential services to severely malnourished
children.

HEALTH – malaria outbreak, deteriorating maternal health care and shortage of basic drugs

An outbreak of malaria affected Tolagnaro district in the southern Madagascar. A total of 3,391 cases
were confirmed between January and March 2010 of which 64 per cent were of children under the
age of five years. Thirty children have been reported dead due to malaria infections. The peak of the
epidemic was in April, and no mortality cases were so far reported for May. The national impregnated
bed net distribution campaign originally planned for later this year was advanced and 22,000 bed nets
distributed at the beginning of May - complemented by indoor spraying. Between February and
March, community health agents were trained to provide community based advice, mobile clinics for
malaria testing and management were activated and sensitisation campaigns carried out. UNICEF
and partners such as CARE, ASOS and Santenet 2 assisted the government in its response. UNICEF
started preparation activities to address a wave of increased malnutrition among children that is likely
to occur following malaria epidemics.

Currently there are no more than 22 out of 194 required emergency obstetric and newborn care
centres operating in the country.
Out of these, only 19 are able to
provide caesarean sections as
opposed to 39 that should
provide this service. This does
not bode well for maternal health
in cases of birth complications
(on average 10 per cent of all
deliveries encounter some form
of complication).
Mother and Child Health Week completed: The
Mother and Child Health weeks (MCHW) are a free-of –
cost out-reach activity providing high impact
interventions through immunisation (for children under
the age of one year and pregnant women), de-worming
of children under the age of five years and pregnant and
postpartum women and vitamin A supplementation.

According to 2009 data from the
government’s drug monitoring
system there have been
shortages of medical stocks in 2
per cent of basic health centres
(on average lasting between one
and 2 ½ months depending on
the kind of drugs). Drugs for
sexually transmitted diseases
have not been available in 8- 30
per cent of health facilities
depending on the type of drugs
for an average period of 3
months. A total of 20 per cent of
health facilities are not receiving
the ordered amount of drugs
due to blockages/shortages at the level of SALAMA or the district drug distribution system.
The latest campaign started as planned on April 26 in all
111 districts of Madagascar targeting 3,967,300 children
and 56,000 pregnant and postpartum women. Despite a
strike announced by paramedical staff during the
planned period, the campaign received full support from
the Ministry of Health at regional and district levels. A
total of 6,430 health workers, 16,100 health volunteers
and 600 supervisors were involved. At the community
level, 58,000 mobilisers including 13,000 scouts
encouraged women and children’s caretakers to
participate in the campaign. The campaign was
budgeted at 954,000 USD, and was financed by
UNICEF, GAVI, WHO and UNFPA.

CONTACTS
Bruno Maes Valérie TATON
Representative Deputy Representative
Tel: (+261 20) 23 300 92/93/94 Tel: (+261 20) 23 300 92/93/94
Email: bmaes@unicef.org Email: vtaton@unicef.org
UNICEF Madagascar UNICEF Madagascar
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