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Tunisia study explores effect of intervention packages on childhood stunting

(19 October 2017) A new UNICEF Innocenti Working Paper: Child Undernourishment, WASH and Policy Synergies in Tunisia, establishes an econometric strategy for implementing UNICEF’s conceptual framework on nutrition by analysing the effects of water, sanitation, and hygiene (WASH) investments on child stunting. Looking at evidence from different populations and locations in Tunisia – a country with uneven progress in child nutrition – the paper asserts that successful mitigation of child stunting cannot rely on one universal approach, but instead requires mapping and application of the most effective intervention packages by residence and socioeconomic status to meet the varied needs of children in different contexts.A family in their kitchen in an urban low income area of Tunis, the capital city of Tunisia. Many families in the neighborhood arrived from rural areas in search of jobs, but most are now unemployed. The paper, co-authored by UNICEF Innocenti’s Jose Cuesta and the World Bank’s Laura Maratou-Kolias, demonstrates how improvements in stunting come from successful integration of interventions from nutrition and WASH sectors. While UNICEF’s strategy has long recognized that WASH interventions can improve nutrition, this paper intends to enable policy makers and programme managers to implement more effective intervention packages to improve nutrition outcomes specific to targeted population groups.“Typically, economists will tell you which intervention has the largest impact, but we wanted to look at which packages of interventions correlate with the best outcomes,” Cuesta, author and Social Policy Chief with UNICEF Innocenti, said. “Indicators are just one part of how to improve programing – in this paper, we’re trying to provide a bigger strategy to inform policy interventions, linking UNICEF’s conceptual framework with multidimensional indicators to follow over time.”In the case of Tunisia, the study analysed which investments had the largest impact on improving child nutrition using data from the 2012 Multiple Indicator Cluster Survey. The estimates indicated that multi-sectoral invention packages varied in how they correlated with better nutrition outcomes depending on socioeconomic status and residence.  Among rural poor groups in Tunisia, for example, packages combining WASH, care, food security and health interventions did not show significant effects on child nutrition, whereas this combination was effective in Tunisian urban settings. Among rural poor groups, integration of care and food security interventions alone correlated with better nutritional outcomes for children. Integrated multi-sectoral interventions for appropriate child nutrition. Adapted from UNICEF policy review 1990 Intervention packages can be ineffective for several reasons. Lack of sufficient investment and poor efficiency in implemention can explain why some interventions are more effective than others, especially for the most vulnerable rural poor. According to Cuesta, measurement and evaluation need to be improved in order to implement better targeted solutions.“The data from Tunisia shows that single interventions don’t work – or don’t correlate with the best outcomes for nutrition specifically,” said Cuesta. “Only packages work, but not all packages worked for every location, setting, or socioeconomic zone. Packages aren’t going to work the same for everyone.” This research aims to lay the foundation for more effective efforts to mitigate child stunting by improving understanding of how interventions from different sectors should be packaged differentially to address undernourishment by population group and location. The paper stresses that a single intervention will not bring uniform benefits across different types of households and that since investments are limited, interventions need to selectively respond to the specific requirements of different types of households before nutrition can improve evenly for all Tunisian children.Keywords:Nutrition, stunting, WASH, programming, TunisiaRelated publications:UNICEF Strategy for Improved Nutrition of Children and Women in Developing CountriesImproving Child Nutrition: The achievable imperative for global progressThe role of foods as source of nutrients in the prevention of stuntingCash Transfers and Child Nutrition: What We Know and What We Need to Know  
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Child Dignity in a digital world Congress at Vatican City

(10 October 2017) UNICEF Innocenti was invited to present the results of a survey launched by Global Kids Online (GKO), an international research project co-sponsored with the London School of Economics, at the “Child Dignity in the Digital World” congress organized by the Pontifical Gregorian University in Rome and the WeProtect Global Alliance, 3-6 October. The Congress brought together outstanding experts, leaders and government representatives from around the world to discuss international efforts to protect children from online sexual abuse and other issues related to child protection in the digital age.In his remarks Pope Francis recognized the great advantages offered by the digital revolution, but exhorted social media businesses to invest “a fair portion of their great profits” to protect “impressionable minds” and to guide the processes set in motion by growth of technology, rejecting any “ideological and mythical vision of the net as a realm of unlimited freedom”.An adolescent girl reading a text at the Pontifical Gregorian University in Rome first congress on Child Dignity Congress on protecting children from online sexual abuse. The final “Declaration of Rome” called on politicians, religious leaders, and stakeholder organizations to help build a global awareness to protect children from online exploitation. Jasmina Byrne, child protection specialist at UNICEF Innocenti, introduced the GKO project and shared insights from 5 countries that have already made their results public: Argentina, Bulgaria, South Africa, Chile and Montenegro Between 32 and 68 per cent of children have seen sexual images online, and between 11 and 27 per cent have felt upset by the images. Moreover, between 7 and 26 per cent of interviewed children were targeted by sexual images with up to 39 per cent feeling upset about it. Both experiences were more common among the older children. Between 20 and 41 per cent of children accepted contact with people they were familiar with but had not met in person, while in the 12 months prior to the surveys between 8 and 32 per cent of children met a “stranger” and of those up to 40 per cent fell into the 15-17 age range. “Although only between 1 and 8 per cent were upset by meeting those they did not know before” said Jasmina Byrne, “… we should not neglect the number of those who felt bothered about this experience and we need to know more about these children.”Byrne also highlighted some of the implications for policy that have resulted from the survey, including: the close connection between offline and online risks and the need to understand more about the children who are most vulnerable to online harm. She also highlighted the importance of adopting a child-centered approach to online risks, giving full recognition of diversity in children’s lives, age and gender. Early educational interventions, especially for younger children, to support the development of children’s digital skills, literacies and safety practices are among the most critical recommendations coming out of the GKO research to date. Byrne emphasized the importance of promoting digital citizenship and child safety online through a multi-stakeholder, multi-sectoral approach, and with engagement from parents and children themselves. Jasmina Byrne, child protection specialist with UNICEF Innocenti shaking hands with Pope Francis at the Pontifical Gregorian University Congress on Child Dignity in the Digital World. The random household surveys undertaken by GKO research partner countries did not specifically target children or groups of children who are vulnerable to sexual abuse online, but instead looked at the whole range of children’s experiences online. As of 2017 it has collected data from 10 countries and some 10,000 children and 5,000 parents. More information available about country reports, comparative analysis and other resources at and Also presenting at the Congress was Cornelius Williams, Global Chief of Child Protection based at UNICEF headquarters in New York. Williams explained how the Sustainable Development Goals for 2030 provide an important global commitment endorsed by the world’s governments to advocate for improved multi-sectoral efforts to protect children from violence and exploitation online.Prof. Hans Zollner SJ, President of the Centre for Child Protection said “The congress provides an outstanding opportunity to exchange knowledge and good practice on risks and prevention as children navigate this new digital world.”Baroness Shields OBE, UK Minister for Internet Safety and Security said: “Our increasingly connected society greatly empowers children, but also exposes them to risks that compromise their safety and wellbeing. To address these escalating global threats we need a broad coalition of government, faith leaders, academia and industry, all committed to protecting the dignity of children in this digital age.” The Pontifical Gregorian University conference in Rome provided an opportunity to reflect on the magnitude of a rapidly growing global phenomenon which involves children from all ages and in all countries, and to discuss online bullying, pornography and paedophilia at the presence of representatives from the main social media business companies, including Facebook and Microsoft.The international research project GKO developed by UNICEF Innocenti, London School of Economics, EU Kids Online is a first step in that direction. GKO provides a methodology and a research framework to carry out comparative research worldwide with children from 9-17 and their parents, and to build evidence that can be used to help policy makers and practitioners develop approaches to protect children’s rights in the digital age; maximizing their opportunities to benefit from the internet while minimizing risk of harm. 
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Global workshop raises capacity on Public Finance for Children

(28 Sept 2017) Nearly 100 UNICEF staff, managers and specialists from 62 countries recently gathered at UNICEF Innocenti in Florence for two one-week workshops on public finance for children.
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International Conference on Social Protection in the contexts of fragility and forced displacement

(27 September 2017) Evidence demonstrates that a set of protective policies – known as social protection – can help reduce poverty, inequality, and childhood deprivation and has long-term positive impacts on human capital development. Social protection can unlock the productive potential of the poorest, increase local economic growth and micro-economic activity and even stimulate aggregate growth.
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How to halve poverty in all its dimensions by 2030

by Yekaterina Chzhen, Lucia Ferrone
(2017-10-19) The way countries define poverty is going to matter for their probability of achieving Sustainable Development Goal 1, Target 1.2. It calls for reducing at least by ...

Are randomized control trials bad for children?

by Tia Palermo
(2017-10-18) There was a time when UNICEF was known in development circles as the agency that “does everything but knows nothing.” Indeed, UNICEF is known for getting thin ...