For Every Child • Survival & Development
Comprehensive efforts in health, nutrition and water, sanitation and hygiene (WASH) have been made in the last decade to reduce under-5 and maternal mortality in Djibouti. The progress is undeniable. Between 2002 and 2012 under-5 mortality decreased from 127 to 68 per 1,000 live births; and maternal mortality from 546 to 383 per 100,000 live births. Yet these rates remain amongst the highest in the Middle East and North of Africa region.
Immunisation is one of UNICEF’s main strategies to promote child survival. In 2016 the percentage of children fully immunised for diphtheria, pertussis and tetanus (DPT3) stood at 90 per cent, the same rate achieved the year before.
However, the DPT3 coverage in the regions (outside of Djibouti-city) decreased from 72 to 65 per cent in this period, a reduction explained by deficient cold chain equipment at rural healthcare centres.
The programme of Integrated Management of Childhood Illnesses continued to be implemented at community level to provide low-cost and high-impact interventions to the most hard-to-reach children. The percentage of children with pneumonia receiving antibiotic treatment has increased slightly from 80 to 82 per cent between 2015 and 2016; while the proportion of children suffering from acute diarrhoea treated with oral rehydration salts increased from 75 to 80 per cent. This is a result of the improvement of healthcare workers’ skills along with the provision of the necessary essential drugs (antibiotics and oral rehydration salts).
Following the trend of the past three years, the proportion of HIV + pregnant women enrolled in the Programme of Prevention of Mother-To-Child Transmission (PMTCT) of HIV and receiving antiretroviral treatment continued to increase, rising from 75 to 85 per cent between 2015 and 2016.
In 2017, UNICEF will focus on health system strengthening at community level through the development of targeted interventions by identifying barriers to access and utilisation of health services.
Malnutrition remains one of the main child-killers and a major public health concern: over one in four children under 5 years of age (29.7 per cent) is stunted and one in six (17.8 per cent) is wasted. This explains why nutrition is considered a critical component of the 2013–2017 National Health Development Plan, and why the Government together with UNICEF and other partners is investing on malnutrition prevention and expanding children’s access to quality treatment.
In 2016, nine out of 10 children suffering from severe acute malnutrition (93.1 per cent) were admitted and treated in health facilities. Among these children who accessed quality treatment, 96.9 per cent recovered and 2.9 per cent defaulted, while the death rate stood below 0.1 per cent.
UNICEF in collaboration with partners will continue to advocate for the development of a strategy document on Infant and Young Child Feeding, the establishment of a steering committee on the reduction of stunting, and for Djibouti’s adhesion to the Scaling-Up of Nutrition movement.
In refugee camps, UNICEF, WFP, UNHCR and African Humanitarian Action pursued its partnership, with the nutrition humanitarian response being guided by a single and harmonised logical framework that enhances the coordination, allowing each organisation to intervene within its area of comparative advantage and preventing duplication of efforts.
Djibouti has met the Millennium Development Goal related to improved water. However, disparities of access between urban (97 per cent) and rural areas (65 per cent) are still a challenge. In 2016, the Government launched the development of a Water Point Management Strategy as a result of UNICEF advocacy. This document is a breakthrough for the sustainability of water points as it will regulate the participation of communities in its management. In rural areas, over 84 per cent of those with access to improved water are using shared facilities; therefore it is of the utmost importance that communities take the lead in their maintenance.
In 2016, a further 12,020 people regained access to drinking water through the rehabilitation of wells and extension of the water distribution network. These people had lost access to improved water due to the degradation
and consequent breakdown of the facilities. To help prevent similar situations in these areas, UNICEF and its partners supported the Government to establish and train 15 local Water Management Committees (60 people) on water point management.
In pastoralist and nomadic regions, 1,146 children and families were given access to sanitation through shared facilities and are abandoning open defection practices.
Lack of access to water and sanitation contribute to disease and malnutrition, which is why UNICEF is promoting an integrated WASH and Nutrition approach. In malnutrition- affected rural areas, 1,860 people gained access to safe water for the first time in 2016 thanks to the extension of existing boreholes supported by the Government and UNICEF.
UNICEF co-leads with the government the WASH sector working group for humanitarian preparedness and response, and thanks to the continuous technical support, government’s leadership and analytical thinking have widely improved as revealed during the coordination of the development of the 2017 Humanitarian Need Overview and Human Response Plan.
The overall vision of the UNICEF programme 2018–22 is to ensure that children’s rights to survival and development are realised through access to quality social services and through the adoption of healthy and protective behaviours as well as positive parenting practices by families and communities, with an emphasis on the rst 1,000 days of life spanning
from conception until the end of the second year of a child’s life, thus contributing to reductions in maternal and child mortality. The programme will focus particularly on vulnerable children living in areas identified as the most deprived.