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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 https://www.unicef-irc.org/research/270/ and www.globalkidsonline.net. 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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New Expert Report Uncovers the Massive Global Burden of Childhood Violence

(27 September 2017) Violence in childhood is a preventable but nearly universal phenomenon that affects 1.7 billion children, nearly 3 out of 4 worldwide, each year, with catastrophic but often hidden impacts on individuals, communities and societies.It affects children in every country, rich and poor, north and south.Ending violence in childhood and freeing children from fear is the world’s single largest investment opportunity to enhance children’s capabilities and build peaceful societies. The annual financial costs of physical, sexual and psychological violence against children are estimated to range between 2 and 5 percent of global GDP, or about US $7 trillion.Two siblings in their home in Omoa, Honduras. They have tried to flee intense gang related violence through migration numerous times.Violence in childhood is also inextricably linked with violence against women.Children who witness the abuse of their mothers are more likely to become victims or perpetrators of abuse when they grow up.These are among the key findings of the new Global Report 2017 Ending Violence in Childhood, issued today by the international learning collaborative Know Violence in Childhood: A Global Learning Initiative (or Know Violence). The report is one of the most comprehensive analyses of childhood violence ever undertaken, an almost three year long effort documenting the scale of violence experienced by millions of the world’s children. The new report highlights both the enormous scale of this global crisis, and the integrated prevention strategies that can end childhood violence, thereby unlocking opportunities for economic progress, enhanced human development, and expanded freedoms.“From severe physical punishment to sexual abuse to homicide, childhood violence damages individuals, families and communities in both rich countries and poor, with a cost in the trillions of dollars a year,” said Know Violence Global Co-Chair A.K. Shiva Kumar. “But violence in childhood is not inevitable. Political leaders must help us implement what we already know works and break the silence around this critical issue.”Childhood violence includes a broad range of experiences, from corporal punishment to physical, sexual and emotional abuse, to the effect of witnessing violence against others.Beyond the immediate physical damage it causes, exposure to violence can traumatize children, harm school performance, lead to depression and other illnesses, and increase the chances that young people will become the victims or perpetrators of violence in the future.“Growing up free from violence is a fundamental human right, and ensuring safe childhoods is a key component of sustainable human development,” said Baroness Vivien Stern, Know Violence Global Co-Chair. “The UN Sustainable Development Goals will require all governments to strengthen their data gathering systems on violence.Know Violence has synthesized the best evidence from thousands of sources worldwide on how to make these global goals a reality.”Over the course of Know Violence’s work, the research team uncovered significant gaps in the availably of nationally representative data on key indicators of violence against women and children.According to Know Violence Steering Group Chair and President of the China Medical Board Dr. Lincoln Chen, “The Know Violence Learning Initiative has made a significant contribution by compiling what we know, but also identifying what we do not know.”Dr. Chen continued, “This is particularly true with violence against boys, with data on physical violence only available for six countries, and sexual violence for only four countries. Surely we can find the will and resources to ensure that we understand the extent to which our children are impacted by violence and how to stop it.”In an effort to better track and compare available data, the Know Violence report also presents a unique new matrix, the global Violence in Childhood (VIC) Index. This new tool enables comparisons to be made between countries and regions of the world.The report is informed by input from 44 research papers exploring the causes and impact of, and responses to, childhood violence, that were commissioned from over one hundred authors. These papers drew on over 3,100 articles, books, and reports, including over 170 systematic reviews of evidence on preventing childhood violence.Know Violence also organized a series of regional meetings around the world in order to directly engage with researchers, practitioners, and policy makers.While the challenges in ending violence in childhood are significant, solutions exist and the opportunities are substantial.Governments everywhere need to adopt prevention approaches to end violence and stop treating violence in childhood as a series of bad incidents.Solutions should enhance the individual capacities of parents, caregivers, and children to deal with anger and frustration, also to report violence.Violence-prevention must be embedded in institutions – such as schools, health, and social services facilities – so that children are in violence-free spaces as they grow up.Eliminating the root causes of violence – arising from power differences, inequality, and patriarchy – can support the building of more peaceful communities.Ending Violence in Childhood calls for political leaders and policy-makers to advance proven programs to end violence in childhood.Break the silence around violence, encourage discussion of this widespread social problem, and foster movements that can bring about long-lasting change.Strengthen violence-prevention systems and improve knowledge and regular evidence gathering and reporting.Integrate violence-prevention into health, education, and social policies, and make sure violence-prevention is a core dimension of policy reform.Track progress towards ending violence by putting in place appropriate monitoring and tracking systems.Unite the movements combatting violence against women and ending violence against children, by uncovering and focusing on the links between these two pervasive threats.About Know Violence in ChildhoodLaunched in New Delhi in November 2014, Know Violence in Childhood is an international learning initiative dedicated to informing and supporting a global movement to end violence in childhood. Know Violence has analyzed existing data, commissioned new research and synthesized knowledge on the causes and consequences of violence against children worldwide. The work highlights the impact of childhood violence on individuals, families, communities and societies, expands the research base on this global crisis, and promotes evidence-based strategies to help keep children safe. Know Violence is comprised of a diverse, multi-sectoral group of 100 leading researchers and experts. The initiative operates under the leadership of Steering Committee President Lincoln Chen (President, China Medical Board) and of Global Co-Chairs AK Shiva Kumar (economist and policy adviser) and Vivien Stern (UK House of Lords). Partners include the Public Health Foundation of India (PHFI), the University of Delaware, and FXB. Know Violence supporters include an anonymous donor, American Jewish World Service, the Bernard van Leer Foundation, the IKEA Foundation, the NOVO Foundation, OAK Foundation, the Robert Wood Johnson Foundation, the UBS Foundation and UNICEF. Associates of Know Violence include the Global Partnership to End Violence Against Children, Save the Children International, Together for Girls, World Childhood Foundation and Twitter.(The article originally appeared as a press release on www.knowviolenceinchildhood.org) 
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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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Innovative research impact assessment looks at drivers of violence study in Peru

(21 September 2017) Dr. Sarah Morton, of the University of Edinburgh, and fellow researchers, recently completed an impact assessment of a UNICEF Innocenti research programme, the Multi-Country Study on the Drivers of Violence Affecting Children, which generates evidence on best pathways to prevent violence against children in Italy, Peru, Viet Nam and Zimbabwe. The project aims to help governments address violence against children by promoting better understanding of why it occurs – the drivers of violence. The assessment report narrowed its focus on the outcomes of the violence study in Peru, making that country a case study for important lessons learned for other countries involved in the research project and beyond.The assessment addressed the following objectives: understand and evaluate the impact of the Multi-Country Study on the Drivers of Violence Affecting Children in Peru; assist UNICEF in demonstrating the value of research-based projects on children and violence through objective verification; and develop and refine an approach to assessing the impact of research through field testing in a middle income country setting. “The Drivers of Violence project has human-centred design approaches at its core. Findings are intended to feed back into both national programming and the emerging global evidence base on violence prevention on a real-time basis,” said Kerry Albright, Chief of Research Facilitation and Knowledge Management at Innocenti. “Unusually, early indications of outcomes and impact were emerging even before research outputs had been written.  We were keen to better understand and document the value of approaching research in such a way through independent corroboration, as well as to capture tacit knowledge and effects not usually captured by more traditional impact assessment models.”The impact assessment found that the multi-partner, relationships-driven approach of the Multi-Country Study helped to maximise impact in Peru. The assessment also found that national ownership of the research process was important in ensuring that the findings were specific to Peru, a key finding considering the country’s geographic diversity and multi-culturalism, and also helped ensure national ownership and data sovereignty. Dr Morton’s assessment also set out to test the Research Contribution Framework (Morton, 2015), developed to examine how research uptake and use ‘contributes’ to policy and practice change, in a low- and middle-income country. The Research Contribution Framework requires key partners to agree the main mechanisms through which the research might impact on policy or practice, which are then tested, along with key risks and assumptions. [Read an 8 page illustrated data graphics report Cross-Country Snapshot of Findings from the Multi-Country Study on the Drivers of Violence Affecting Children]In describing the Research Contribution Framework, Albright explained the framework has been adapted from contribution analysis, using the idea of ‘contribution’ to help explain the ways research is taken up and used to influence policy and practice as well as to articulate wider benefits. The Framework provides an empirical basis to focus on research users and to better assess the value of the research process as well as the final outcomes, enabling the team to capture more intangible impacts such as empowerment, ownership, trust and the added value of strategic partnerships which had occurred along the way.A husband and wife receive counseling and information on domestic violence from a district social worker in Vinchos, PeruBy using this approach, the Study contributed to a number of policy and programme changes in Peru, including the passage of a law banning corporal punishment in all settings. Through this impact assessment, the Research Contribution Framework was also found to be adaptable and effective in low- and middle-income countries, and could be used to assess research impact in other contexts. Similar to other impact studies (Oliver et al 2014) there are several key factors that helped to unlock impact in this case:Starting out with an intention to make a difference Building a partnership approach to research, acknowledging different roles needed for change (but also creating time lags and other challenges) Assigning knowledge-brokering roles to key staff In-country research and analysis capacity building a core component of the approachNew to this study, the value of it being a multi-country study was also identified as a factor which maximised impact. The fact that the study allowed participants to understand how the drivers of violence affecting children in Peru compare to other countries was important, with one saying they ‘don’t feel alone’. [Read Mary Catherine Maternowska's blog: Bringing data out of the shadows in Peru - A 25 year journey]Key findings from the UNICEF Innocenti study on the drivers of violence affecting children in Peru: The study used a practically-focused, multi-partner approach to generating evidence that was important for subsequent impact. The specific combination of research outputs, awareness-raising, capacity-building and knowledge-brokering activities, built on this partnership approach, and maximised impact. UNICEF took a knowledge brokerage role to connect people with the research and to ensure key actors were aware of and included in the study, its findings and possible actions. Richer connections between research and policy were developed and sustained. Being engaged closely with the study helped local actors to be clearer about the issues of violence in their country, and was seen as a useful way of forwarding the agenda to tackle violence. Partnership kept levels of awareness high during a change of government. The study filled an evidence gap, helping to shift discourse on violence and give it higher political priority. There is now more capacity in Peru for academics, government analysts and policy makers to work together to address this issue and to get the evidence they need to develop policy. The research improved access to high quality information on violence, which in turn contributed to legislative changes, will help to leverage funding and has informed programmes at the ministerial level. It has also improved coordination efforts at the national level regarding violence prevention and has influenced how other countries in the region approach violence issues. Study partners will continue to work on violence issues. Levels of violence against children may have begun to decrease in Peru since the start of the study, but the final impact of the study is not yet known. Read a case study report on the violence affecting children study in Peru (Spanish) and Dr. Morton’s full impact assessment report. This article was adapted from a story in the AESIS September newsletter.
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Children and youth face abuse, exploitation on Mediterranean migration routes – UNICEF, IOM

(13 September 2017) Migrant and refugee children and youth trying to reach Europe face appalling levels of human rights abuses, with 77 per cent of those traveling along the Central Mediterranean route reporting direct experiences of abuse, exploitation, and practices which may amount to human trafficking – UNICEF and IOM, the UN Migration Agency, said today in a new report. (Download at right)Harrowing Journeys shows that while all migrants and refugees are at high risk, children and youth on the move are far more likely to experience exploitation and trafficking than adults aged 25 years and above: nearly twice as likely on the Eastern Mediterranean route and at a rate 13 per cent higher on the Central Mediterranean route.Aimamo, a 16-year-old unaccompanied child from the Gambia interviewed at a shelter in Italy described being forced into months of grueling manual labor by traffickers upon his arrival in Libya. “If you try to run, they shoot you. If you stop working, they beat you. We were just like slaves. At the end of the day, they just lock you inside.”The report is based on the testimonies of some 22,000 migrants and refugees, including some 11,000 children and youth, interviewed by IOM.“The stark reality is that it is now standard practice that children moving through the Mediterranean are abused, trafficked, beaten and discriminated against,” said Afshan Khan, UNICEF Regional Director and Special Coordinator for the Refugee and Migrant Crisis in Europe. “EU leaders should put in place lasting solutions that include safe and legal migration pathways, establishing protection corridors and finding alternatives to the detention of migrant children.”[Explore our Children on the Move edition of Research Watch where global experts discuss evidence gaps on refugee and migrant children]“For people who leave their countries to escape violence, instability or poverty, the factors pushing them to migrate are severe and they make perilous journeys knowing that they may be forced to pay with their dignity, their wellbeing or even their lives,” said Eugenio Ambrosi, IOM’s Regional Director for the EU, Norway and Switzerland.“Without the establishment of more regular migration pathways, other measures will be relatively ineffective. We must also re-invigorate a rights-based approach to migration, improving mechanisms to identify and protect the most vulnerable throughout the migration process, regardless of their legal status.”A child sits on a mattress laid on the floor of the women's section of the Al-Nasr detention centre in Zawiya, Libya.UNICEF Innocenti is ramping up research and evidence activities on children in emergency contexts with recent creation of new streams of research on children and migration and humanitarian response. Work will focus on capturing intricate dynamics of children's experiences not captured in other research efforts.The report also shows that, while all children on the move are at high risk, those originating from sub-Saharan Africa are far more likely to experience exploitation and trafficking than those from other parts of the world: 65 per cent compared to 15 per cent along the Eastern Mediterranean route, and 83 per cent compared to 56 per cent along the Central Mediterranean route. Racism is likely a major underlying factor behind this discrepancy.Children and youth traveling alone or over longer periods, along with those possessing lower levels of education, were also found to be highly vulnerable to exploitation at the hands of traffickers and criminal groups over the course of their journeys. According to the report, the Central Mediterranean route is particularly dangerous, with most of the migrants and refugees passing through Libya which remains riven with lawlessness, militias and criminality. On average young people pay between $1,000-5,000 for the journey and often arrive in Europe in debt, which exposes them to further risks.The report calls on all concerned parties − countries of origin, transit and destination, the African Union, the European Union, international and national organizations with support from the donor community – to prioritize a series of actions.These include establishing safe and regular pathways for children on the move; strengthening services to protect migrant and refugee children whether in countries of origin, transit or destination; finding alternatives to the detention of children on the move; working across borders to combat trafficking and exploitation; and combating xenophobia, racism and discrimination against all migrants and refugees.(The original version of the article appeared on www.unicef.org)
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Philippines conducting national survey of child internet use

(11 September 2017) UNICEF Philippines, in collaboration with researchers at De La Salle University, is currently undertaking a national survey of child internet use based on the ‘Global Kids Online’ cross-national research toolkit methodology. The research follows a successful pilot study in 2016. A total of 144 field researchers are carrying out data collection across the country. In order to ensure young children's engagement, emphasis was placed on hiring young researchers with whom children would find it easier to establish rapport.In some cases, the fieldwork researchers have to undertake great efforts to reach secluded areas. For ensuring their safety, as well as to have a gender balance, there is a buddy-system in place in which one male and one female interviewer work and travel together. In terms of equipment, each team member received a waterproof bag for the tablet and printed surveys as back-up.[Read the Global Kids Online Research Synthesis, 2016]“We are trying to do fieldwork site visits and monitor the progress of the fieldwork and the work of the survey interviewers,” said Maria Margarita Ardivilla, of UNICEF Philippines. “This is important so that we can get an understanding of the perspective on the ground and help to address issues as they arise.”“This provided a space in which the field researchers and the members of the Research Board can process and talk about concerns from the field which proved to be an enriching experience for everyone involved. As some of the enumerators work under hard circumstances trying to reach hard to access places, seeing core members of the Research Board boosted their morale.” Researchers are taking a phased approach to the study: the preparatory phase (then undertaken with the University of the Philippines and the Philippines National Institutes of Health) included working on the research protocol and obtaining ethical approval; the second phase entailed conducting the pilot study in 2016; and the final third phase now includes conducting a nationally representative study with children aged 9-17 and their parents.Considering the sensitivity of some of the questions, particularly related to child sexual exploitation, all researchers received an extensive 4-day training prior to commencing the fieldwork. Training sessions were organized by the De La Salle University’s Social Research Development Centre where the research team, including UNICEF, Council for the Welfare of Children and Stairway Foundation, discussed and practiced utilization of standardized, accurate, sensitive and safe techniques for implementing the survey. The training programme included: 1) children’s rights and child safeguarding principles and protection protocols; 2) development and personality of children; 3) a participatory approach to reviewing the Global Kids Online toolkit, the tablet use and questionnaire application, including interview techniques; 4) discussion of key issues related to children’s internet use; 5) ethical considerations when conducting research with children; 6) role plays; and 7) a mock survey. UNICEF Philippines also required a Research Advisory Board to be created by the academic institution where members are from critical national agencies such as the Departments of Social Welfare and Development, Justice and Information and Communications Technology from government, NGOs, and sectoral representatives from the youth and LGBT organizations.A school girl takes a ‘selfie’ with her smartphone at St. Francis of Assisi School, while other students check their smartphones after classes in the Central Visayas city of Cebu, Philippines. The study aims to cover as many regions as possible, but some ongoing conflicts pose challenges for the team. The declaration of Martial Law in Mindanao initially raised concerns on whether social preparation and the actual survey would be affected, and whether the personal safety of the data collectors could be ensured. Having addressed the challenges, the fieldwork in Mindanao was able to commence but red flags remain in the Autonomous Region in Muslim Mindanao (ARMM). This is a fragile region with pockets of armed conflicts and the team is currently seeking dispensation from the Ethical Review Board of De La Salle University to allow the inclusion of the ARMM as a site for the study. During the time of writing, it was reported to UNICEF Philippines that the De La Salle University continued the field survey in Mindanao with facilitation where some of the randomly selected areas had a 100% response rate. Notably, in Metro Manila, children living in gated communities also proved hard to recruit, despite intensive social preparation.At present, 2,250 child respondents are identified to be surveyed. The quantitative survey will be followed by a qualitative workshop for results validation and to afford children the platform to express in more depth their experiences and thoughts about their opportunities and risks in the digital environment.The Global Kids Online survey in Philippines is made possible through the technical support of UNICEF Innocenti, London School of Economics, and the shared programmatic commitment on child online protection of UNICEF Philippines and Australia’s Department of Foreign Affairs and Trade.(The original version of this article was written by Maria Margarita Ardivilla of UNICEF Philippines and published on 17 August 2017 on www.globalkidsonline.net. It has been edited slightly for re-publication here.)
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‘Cash plus’ interventions have potential for greater impact than cash alone

(5 September 2017) New Innocenti Working Paper: “How to Make ‘Cash Plus’ Work: Linking Cash Transfers to Services and Sectors”, sets out to evaluate what factors contribute to more successful ‘cash plus’ programme outcomes.  The paper asserts that while cash transfers alone have contributed to numerous positive impacts in reducing poverty and promoting well-being, the provision of cash alone falls short in achieving long-term positive impacts on nutrition, learning, and morbidity. ‘Cash plus’ programmes aim to rectify this impact gap by complementing cash transfers with additional inputs, services, and linkages to other services in order to more effectively achieve successful outcomes and ensure long-term sustainability. The new working paper is a collaboration between the Centre for Social protection, Institute for Development Studies, the Transfer Project, the University of Ghana and UNICEF.‘Cash plus’ programming evolved from the theory that while cash transfers can be effective alone in the most ideal circumstances, the effect of cash transfers can be constrained by behavioural mediators, such as financial security, or broader moderators, such as quality or availability of health services.  Cash transfers alone, for example, may not prompt effective behavioural change to ensure successful outcomes for better nutrition, education, or health – these moderators may need their own additional inputs in the form of infrastructure support to improve the quality and availability of services to recipients.  Complementing cash transfers with programmes to improve access and quality of services aims to address these gaps to augment the effects of income.  Complementary inputs for ‘cash plus’ can include the provision of information, such as educational training or nutrition seminars for new mothers on best practices for feeding their children, as well as the provision of support, such as psycho-social counselling, and the facilitation of access to services, such as health insurance, or strengthening the quality of existing services and linkages.[Ghana LEAP 1000 Impact Evaluation: Overview of Study Design]The study aimed to identify criteria for successful ‘cash plus’ initiatives as well as challenges in development and delivery of such programmes, specifically targeting the health, nutrition, and education sectors.  The study reviewed the emerging evidence assessing the impact of ‘cash plus’ versus stand-alone cash and examined case studies in three countries:Livelihoods Empowerment Against Poverty (LEAP) programme in Ghana,Chile Solidario scheme in Chile,Integrated Nutrition Social Cash Transfer (IN-SCT) pilot project in EthiopiaTia Palermo, social policy specialist at UNICEF Innocenti and co-author of the working paper, discussed how ‘cash plus’ programming in Ghana augmented existing transfers to include vulnerable mothers and children. “Innocenti is leading a study evaluating the LEAP programme extension studying pregnant and nursing mothers in Ghana. What we found is that these programs were not reaching households with young children since the previous program targeted the mostly vulnerable elderly population. In order to reach these households, the ‘cash plus’ programme, which included cash transfers ‘plus’ free access to healthcare, was extended to pregnant women and mothers of children under one year old in order to achieve greater impact on child stunting in the first 1000 days,” she said. “This is particularly a problem in Ghana.” One aim of the LEAP ‘cash plus’ programme was to improve basic household consumption and nutrition and access to health care services. A need for complementary health insurance was identified after evidence of LEAP beneficiaries using their cash transfers to pay for high health insurance premiums, and often the cash transfers weren’t enough to cover that. The ‘cash plus’ intervention supplemented the cash benefit with free access to health insurance in Ghana. Previously, this wasn’t something impoverished mothers had access to in Ghana.  The three case studies identified key factors that were likely to contribute to more effective ‘cash plus’ programmes:Policy-level factors: including the importance of political champions in advocating for cash plus programmes and the establishment of formal agreements;Programme-level factors: including the need for awareness and engagement on behalf of all parties involved, such as the availability of a skilled workforce and better resources;Supply-side-level factors: including greater investment in availability and quality of services;Fit-for-purpose interventions: meaning additional components should appropriately match their intended purpose and also take into account local considerations.The paper concludes that the assessment of the three case studies indicates that effective implementation of ‘cash plus’ components has contributed to more successful programme outcomes. Where cash alone fails to address non-financial and structural barriers, ‘cash plus’ has the potential to contribute to greater, more sustainable impacts, overall. Through ‘cash plus’ programmes, the most vulnerable households living in poverty can be targeted beyond financial limitations.While ‘cash plus’ proves to be a promising intervention for social protection, more innovative monitoring and evaluation is called for, especially to understand the impact of the many variations of ‘cash plus’ programming as well as identifying ways to examine the impacts of additional components in isolation from the cash benefit, as well as to gain more insight into how greater impacts can be achieved.Download the working paper here. For more information on cash transfer programmes and ‘cash plus’ studies, please visit our webpage on Social Protection & Cash Transfers and follow our partner project: Transfer Project. 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WHO, UNICEF global estimates for water, sanitation and hygiene for the SDGs

(28 August 2017) Some 3 in 10 people worldwide, or 2.1 billion, lack access to safe, readily available water at home, and 6 in 10, or 4.5 billion, lack safely managed sanitation, according to a new report by the World Health Organization (WHO) and UNICEF.The Joint Monitoring Programme report, Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and Sustainable Development Goal Baselines, released last month, presents the first global assessment of “safely managed” drinking water and sanitation services. The overriding conclusion is that too many people still lack access, particularly in rural areas.[During World Water Week: 29 Aug - 1 Sept, UNICEF will be drawing attention to the importance of water, sanitation and hygiene in emergencies; for more information follow UNICEF coverage here]“Safe water, sanitation and hygiene at home should not be a privilege of only those who are rich or live in urban centres,” says Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organization. “These are some of the most basic requirements for human health, and all countries have a responsibility to ensure that everyone can access them.”Billions of people have gained access to basic drinking water and sanitation services since 2000, but these services do not necessarily provide safe water and sanitation. Many homes, healthcare facilities and schools also still lack soap and water for handwashing.  This puts the health of all people – but especially young children – at risk for diseases, such as diarrhoea.As a result, every year, 361,000 children under 5 years die due to diarrhoea. Poor sanitation and contaminated water are also linked to transmission of diseases such as cholera, dysentery, hepatitis A, and typhoid.“Safe water, effective sanitation and hygiene are critical to the health of every child and every community – and thus are essential to building stronger, healthier, and more equitable societies,” said UNICEF Executive Director Anthony Lake. “As we improve these services in the most disadvantaged communities and for the most disadvantaged children today, we give them a fairer chance at a better tomorrow.”Significant inequalities persistIn order to decrease global inequalities, the new SDGs call for ending open defecation and achieving universal access to basic services by 2030. Of the 2.1 billion people who do not have safely managed water, 844 million do not have even a basic drinking water service. This includes 263 million people who have to spend over 30 minutes per trip collecting water from sources outside the home, and 159 million who still drink untreated water from surface water sources, such as streams or lakes. In 90 countries, progress towards basic sanitation is too slow, meaning they will not reach universal coverage by 2030.A girl pumps water from a borehole provided by UNICEF in Borno State, Nigeria.Of the 4.5 billion people who do not have safely managed sanitation, 2.3 billion still do not have basic sanitation services. This includes 600 million people who share a toilet or latrine with other households, and 892 million people – mostly in rural areas – who defecate in the open. Due to population growth, open defecation is increasing in sub-Saharan Africa and Oceania.Good hygiene is one of the simplest and most effective ways to prevent the spread of disease. For the first time, the SDGs are monitoring the percentage of people who have facilities to wash their hands at home with soap and water.  According to the new report, access to water and soap for handwashing varies immensely in the 70 countries with available data, from 15 per cent of the population in sub-Saharan Africa to 76 per cent in western Asia and northern Africa.Additional key findings from the report include:Many countries lack data on the quality of water and sanitation services. The report includes estimates for 96 countries on safely managed drinking water and 84 countries on safely managed sanitation.In countries experiencing conflict or unrest, children are 4 times less likely to use basic water services, and 2 times less likely to use basic sanitation services than children in other countries.There are big gaps in service between urban and rural areas. Two out of three people with safely managed drinking water and three out of five people with safely managed sanitation services live in urban areas. Of the 161 million people using untreated surface water (from lakes, rivers or irrigation channels), 150 million live in rural areas.(This article originally appeared on www.unicef.org on 12 July 2017) 
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