UNICEF Pakistan 2010 Annual Report - Low Res

ANNUAL REPORT 2010
PAKISTAN
Text: Fatima Raja Editing: Loa Magnusdottir & Pamela Ledbetter Coordination: Margaretha Francia & Ban Dhayi Design: Muhammad Ali Hashmi Photography: Marta Ramoneda, A. Sami Malik, Shehzad Noorani, Zafar Ahmad Khan & Asad Zaidi All photographs UNICEF/Pakistan
ANNUAL REPORT 2010
PAKISTAN
ContentS
FOREWORD......................................................................................................................... 1 2010: YEAR IN REVIEW ..................................................................................................... 5 MATERNAL AND CHILD HEALTH CARE ............................................................................ 9 g Action .......................................................................................................................11 g Emergency Response ............................................................................................. 13 g Plans for 2011 .......................................................................................................... 14 g Partnerships............................................................................................................. 15 g Case study: UNICEF supports efforts to fight malnutrition in Pakistans floodaffected Sindh province ........................................................................................... 16 WATER, ENVIRONMENT AND SANITATION................................................................... 19 g Action ...................................................................................................................... 20 g Emergency Response ............................................................................................. 23 g Plans for 2011 .......................................................................................................... 23 g Partnerships............................................................................................................. 24 g Case study: In tribal Bajaur, school sanitation and hygiene brings girls back to school.......................................................................................................... 25 PRIMARY EDUCATION ..................................................................................................... 29 g Action ...................................................................................................................... 30 g Emergency Response ............................................................................................. 32 g Plans for 2011 .......................................................................................................... 33 g Partnerships............................................................................................................. 33 g Case study: Temporary learning centres offer opportunities for children in Pakistan camps ....................................................................................................... 34 CHILD PROTECTION ......................................................................................................... 37 g Action ...................................................................................................................... 38. g Emergency Response ............................................................................................ 40 g Plans for 2011 .......................................................................................................... 40 g Partnerships............................................................................................................. 41 g Case study: Flash floods carry landmines from conflict zone.................................. 42 INNOVATIONS .................................................................................................................. 45 g Third party monitoring in humanitarian situations.................................................... 45 g GAVI support for strengthening civil society organizations ..................................... 47 CHILDREN OF THE FLOODS............................................................................................. 48 g Sobias story ............................................................................................................ 49 g Umairs story ........................................................................................................... 51 RESOURCE MOBILISATION ............................................................................................. 55 g Financial Resources ................................................................................................. 55 g Supplies ................................................................................................................... 56 g Human Resources ................................................................................................... 56 ACRONYMS ...................................................................................................................... 62
FoReWoRD
UNICEF Pakistan faced unprecedented challenges in 2010, as did the government and people of my country. These challenges, however, also brought opportunities to reach women and children who had previously not been reached with key services, such as health care, water and sanitation, education and protection. In 2010, a natural disaster and the lasting effects of insecurity dominated UNICEFs work with children in Pakistan. The massive floods during the monsoon season in July-September 2010 proved to be the greatest humanitarian disaster in the countrys history. The floods followed ongoing activities to assist the thousands of families affected by conflict in the countrys north-west, and came in the midst of efforts to improve Pakistans progress in fulfilling its commitments to children and women under the Millennium Development Goals (MDGs). The devastating flooding of 2010 covered, at its height, one-fifth of the country, affecting 20 million people, and caused massive damage to key infrastructure. Relief efforts immediately became UNICEFs top priority. The sheer number and geographical spread of the population affected by the flooding was a major challenge to humanitarian efforts, as was the preexisting poverty, lack of coping mechanisms, and the limited capacity of partners. Insecurity and lack of access also posed challenges. Even in the face of these daunting problems, UNICEF Pakistan responded quickly and effectively when the floods began to make their way down the length of the country. UNICEF Pakistan nearly doubled its staff temporarily in 2010, established emergency field offices in Multan, Sukkur and Hyderabad, and procured supplies worth nearly US$ 90 million, including local procurements worth US$ 41 million. By positioning staff members at the new emergency field offices, UNICEF was able to identify and act upon needs and gaps in services with urgently needed speed and efficiency. Major accomplishments included the vaccination of 9.2 million children against polio and 8..2 million against measles. Safe drinking water was provided to 3.2 million people and sanitation facilities to 1.5 million. Another 1.9 million received hygiene messages to help protect themselves and their families against waterborne diseases. About 354,000 children and 111,000 women were screened for malnutrition. To minimise disruption to schooling, 208.,000 children received school supplies, and 2,790 temporary learning centres were set up for 164,500 children. Over 223,000 children received psychosocial support and a safe environment for learning and recreation at 926 childfriendly spaces. In a joint effort to alleviate the impact of emergencies on children and meet long-term development challenges, 2010 was a year in which UNICEF built new partnerships and strengthened old ones. Key collaborative partnerships continued with government, and also within the humanitarian system. In responding to the floods, UNICEF was the lead agency for the Water, Sanitation and Hygiene Cluster, the Nutrition Cluster and the Child Protection sub-Cluster, and UNICEF co-led the Education Cluster with Save the Children. UNICEF also supported the Health Cluster and the Gender sub-Cluster. UNICEF deployed over 60 Cluster coordinators and information management staff to improve coordination during what turned out to be one of UNICEFs largest humanitarian efforts in history. UNICEF initiated the Cross-Cluster Survival Strategy with the World Health Organisation (WHO) and the World Food Program (WFP), to strengthen the joint response to health, water
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and sanitation, and nutrition issues. This interagency Survival Strategy enabled UNICEF and partner agencies to identify high-risk communities, specific health risks and service gaps and ensure that life-saving assistance delivery was delivered. In addition to the flood relief and recovery efforts, UNICEF continued to respond to the aftermath of earlier emergencies, including the displacement crisis of 2008.2009 and reconstruction following the devastating earthquake of 2005. In addition, UNICEF responded to development challenges by supporting the national, provincial and district government on strengthening policies and standards, and filling urgent needs and capacity gaps by providing services to children and women through both government and civil society. Pakistan is one of the eight countries piloting the One UN Programme, which seeks to provide development assistance more effectively through improved coordination between the UN sister agencies. UNICEF participated actively in the programme, co-chairing the joint programmes on education and environment, and contributing to two other joint programmes. UNICEF participated regularly in media briefings as a credible source of information on the ground in 2010. In addition, hundreds of media interviews and human interest stories were produced as part of UNICEFs advocacy efforts. The country offices website proved an important resource, receiving 26,000 hits in a single day. A presence on social networking sites was developed at the end of 2010. Advocacy initiatives and campaigns to support the UNICEF Country Programme over the course of the year included the Healthy Hat Trick initiative, which conveyed key messages on good nutrition, improved sanitation and girls education with the engagement of the Pakistani cricket team. UNICEF advocated for a national sanitation programme targeting 48. million
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people, with 18. million flood affectees as the first priority. Freeing Pakistan from the scourge of polio remains a major challenge. In line with the agreed division of labour among polio partners, UNICEF took the lead on public advocacy, social communication and vaccine supply management. A notable success was achieved in advocacy when a gathering of religious leaders committed to polio immunisation. The Multiple Indicator Cluster Survey (MICS) report for Khyber Pakhtunkhwa province was published, and the Balochistan MICS is nearing completion, while those for Punjab and Sindh were delayed by the flood emergency but are now under way. The UNICEF-supported Multi-Cluster Rapid Assessment Mechanism (McRAM) enabled rapid assessments to be made of the situation of the flood affected population, and the results were used to prepare response plans, flash appeals and other donor proposals. It demonstrated, for example, that due to restricted mobility and lower literacy rates, women had less information than men on the floods and on the resources available to them, and limited access to aid. An important field monitoring initiative was introduced to strengthen monitoring the emergency response and early recovery in terms of UNICEFs Core Commitments to Children in Emergencies, especially in accessconstrained areas. Nutrition surveys in flood-affected areas were conducted during the last quarter. They revealed emergency level global acute malnutrition (GAM) rates in Sindh and South Punjab, leading to intensified response in 2011. Pakistans progress in achieving the MDGs by the target year of 2015 has been further jeopardised by the immense setbacks caused by the floods. According to World Bank estimates, the floods caused damage worth US$ 9.7 billion.1
1 World Bank. 2010. Press release 2011/134/SAR, 14 October 2010, ADB-WB Estimate Pakistan Flood Damage at $9.7 Billion .
About 1.9 million homes were damaged, and it is estimated that child mortality in the affected areas may rise by 10 per cent in the coming year.2 Primary school enrolment and completion were already low in many affected areas, and these will suffer further with 10,000 schools damaged in the floods, the interruptions in the academic year, and losses of livelihood, which may cause many families to withdraw their children from school. Protection issues of concern in the coming months include trafficking, early marriage and child labour, as well as violence and exploitation. In areas affected by the conflict, children also require protection from unexploded ordnance and child recruitment. A major constitutional development, which UNICEF is adapting to in 2011, is the passage of the 18.th Amendment to the Constitution of Pakistan, which significantly decentralised revenue and service delivery responsibilities to provincial governments. This will require policy work at the provincial level, to mirror achievements at the national level, and new modes of planning to mitigate the risk of inequality due to diverse resource distribution between provinces.
At UNICEF Pakistan, we are turning the many challenges that we faced in 2010 into opportunities. During relief work following the floods and the displacement crisis, we were able to reach many children who had not previously attended school or had access to health care, immunisation services or nutrition support. When insecurity and lack of access cut off people, we developed innovative new means of reaching the unreached, using cars, boats, helicopters, planes, donkeys and our own feet to bring services where they were most needed. My colleagues and I at UNICEF Pakistan are committed to working closely with our partners; government, civil society, donors, and, most importantly, the people and communities, to fulfil all rights of all Pakistani children.
Dan Rohrmann Representative UNICEF Pakistan
2 United Nations Pakistan. 2010. The Human Cost of the Floods in Pakistan .
2010: YeAR In ReVIeW
he year 2010 brought new challenges and achievements for UNICEFs mandate in Pakistan. The worst natural disaster in the countrys history called for a coordinated and strategic response by UNICEF government , counterparts and local and international partners to respond immediately and at scale to the flood that affected nearly 18. million people. While some communities still required relief assistance, early recovery and rebuilding can be prioritised in many flood affected areas in 2011. Prior to the July-September floods, UNICEFs ongoing work to improve the lives of children and women included two Mother and Child Weeks held in cooperation with government partners, community health workers and local civil society organisations and reaching 3.5 million children and a million pregnant women with low cost yet potentially lifesaving interventions and information. National guidelines were developed to help support children affected by HIV, and UNICEF supported the endorsement of an ordinance to promote better nutrition and feeding practices for children. Successful advocacy and technical assistance helped develop government policies and action plans on sanitation and water quality. School sanitation and child-centred education were prioritised through the endorsement of national standards for child-friendly schools. During 2010, legislation, policies and services were put in place to create a structure that helps protect children from exploitation, violence and abuse at the federal and provincial levels. These included the Khyber Pakhtunkhwa and Pakistan Administered Kashmir Child Protection Policies and Child Complaint Offices established through the Childrens Ombudsmans Office. The passage of the 18.th Amendment to the Constitution in March increased provincial
Map showing the extent of the damage brought by the floods. Source: OCHA, 16 August 2010
autonomy in sectors such as health, education, water and sanitation, and child protection. As provincial governments take up new responsibilities with new authority, UNICEF is restructuring its staff and budgets to ensure even stronger support to provincial governments. UNICEFs work in 2010 was dominated by the torrential monsoon rains that began in July 2010 resulting in six weeks of massive flooding. Over 18. million people, more than half of them children, were affected in a vast swathe
of the country. At the height of the flooding, the water covered one fifth of the country, an area the size of Austria, Switzerland and Belgium combined. According to government estimates, 1.9 million homes were damaged or destroyed. Key services, such as water, sanitation, health care and education, suffered serious damage and may take months or years to restore. A disaster needs assessment, focusing primarily on infrastructure, estimated that building back would cost US$ 7 billion, but building back with better designs and materials that would be resistant to flooding and earthquakes would cost at least US$ 10 billion. As with most natural disasters, women and children suffered disproportionately. Prior to the floods, women had limited access to education and health care and limited means of generating income in the flood affected areas. The difficult conditions increased the risk of domestic abuse and gender-based violence. As families struggle to rebuild their livelihoods, children are at heightened risk of early marriage, removal from school to work or exploitative abuse. Even before the floods, many areas were extremely fragile due to prior humanitarian crises and long-term development challenges. An estimated 36 per cent of the population of Pakistan, or 62 million people, live below the poverty line. Many others live just above the poverty line, and are extremely vulnerable to shocks. In particular, many of the flood affected areas suffer from entrenched inequalities in access to education and health care, and scant livelihood opportunities. The damage caused by the floods requires significant effort from every sector to address both immediate and longerterm needs. When the floods struck, Pakistan was still struggling with a pre-existing humanitarian crisis. In addition to hosting about 1.6 million Afghan
3 Formerly known as the North-West Frontier Province (NWFP).
refugees, more than three million people have been displaced over the past two years due to insecurity in north-western Pakistan, particularly in the Federally Administered Tribal Areas (FATA) and in Khyber Pakhtunkhwa3 province. While some families and individuals have returned to stabilised areas, over 1.3 million people remained displaced at the end of 2010. Pakistan faces significant challenges in achieving the Millennium Development Goals (MDGs) by 2015, especially those relating to education, poverty reduction and the health of mothers and children. Nearly one out of every ten Pakistani children does not live to see his or her fifth birthday. Of these, half do not complete even a single month of life. Malnutrition is widespread, particularly in remote areas, contributing to this high mortality rate.
View of the flooded town of Ghari Khairoo in interior Sindh. UNICEF Pakistan/2010/Ramoneda
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Pakistan reported a total of 140 wild poliovirus cases in 2010, higher than any other endemic country or country with re-established polio transmission. Challenges in polio eradication due to restricted access from the ongoing insecurity in Federally Administered Tribal Areas (FATA) and Khyber Pakhtunkhwa, and limitations in the quality of management and supervision of immunisation activities in Sindh and parts of Balochistan were also greatly exacerbated by the devastation and large-scale population displacement following the floods in 2010. The 2010 floods are likely to increase poverty, keep more children out of school, reduce access to safe water, increase the spread of diseases, and reverse the advances in gender equality. It is estimated that in affected areas, child mortality may increase by 10 per cent following the floods. Nutrition surveys of flood affected areas in late 2010 showed shockingly high levels of stunting and emergency levels of moderate and acute malnutrition. It is likely that a large proportion of the population were already malnourished prior to the floods, and the concomitant shortages of food, clean water, and the prevalence of disease in the aftermath of the floods aggravated the nutrition situation. A grim reality is that over 2.8. million children under the age of five were affected by the floods. Expectations are that newborns, children and mothers will now be even more vulnerable to disease and malnutrition than they were before the floods. At present, about 276 women are estimated to die from pregnancy-related causes for every 100,000 live births. This high maternal mortality rate could be lowered if women have access to skilled birth attendants as well as antenatal and postnatal care. The flood impact is expected to
reduce the pre-flood rate of skilled birth attendance from 39 per cent to 36 per cent, potentially increasing the maternal mortality rate. Although Pakistan has made modest gains in improving the supply of clean drinking water and sanitation coverage in recent years, the setbacks caused by the floods makes it unlikely that the country will achieve its water and sanitation-related MDG targets by 2015. Before the floods, only 75 per cent of the population had access to safe drinking water. In flood affected areas, this figure fell to only 55 per cent, greatly increasing childrens risk of contracting waterborne diseases, including diarrhoea, hepatitis and polio. Almost half (43 per cent) of Pakistani children are out of school. With 10,000 schools damaged by the floods, and displacement affecting students and teachers alike, the education system is under severe strain. School enrolment and completion are likely to fall, especially for girls, as families keep their daughters at home due to economic reasons, lack of women teachers and inadequate sanitation facilities at schools. Less than a third of children in Pakistan are registered at birth, which may exclude them from vital services, such as access to health care, education, and protection from child labour and trafficking. Many children are involved in child labour, and a third of girls are married before reaching 18. years of age. The floods increased the risk of exploitation, especially for children who are out of school. Major risks include gender-based violence, child labour, early marriage, sexual exploitation, trafficking, and psychosocial issues.
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MAteRnAL AnD CHILD HeALtH CARe

Expenditure 2010 (US$) 69.50 million 9.01 million 19.88 million 40.61 million Total Core UNICEF Resources Resources from donors for development work Resources from donors for emergency and recovery work Even before the floods, a major underlying cause of deaths amongst children under five years of age was poor nutrition, which is estimated to contribute to a third of child deaths worldwide. Chronic malnutrition is widespread in Pakistan, and the worst affected are children in remote and insecure areas where access is difficult and education levels are low, particularly amongst women. In Sindh and Punjab provinces, 18. per cent and 12 per cent of children suffer from wasting respectively, and about 6 per cent suffer from severe acute malnutrition, the most serious form of malnutrition. A major contributor to malnutrition among young children is the low rate of exclusive breastfeeding. Only 37 per cent of children are fed exclusively on breast milk for the first six months of life. Many mothers are simply unaware of the importance of this prac-
early one out of every ten children born in Pakistan dies before his or her fifth birthday; half of these children die before completing their first month of life. Though Pakistan experienced a decrease in infant mortality (deaths of children under one year of age) between 2002 and 2007 the , rate of decrease is not enough to achieve the Millennium Development Goal of reducing child mortality by two thirds by 2015. More than 2.8. million children under five years of age were affected by the floods in 2010. It is estimated that the flood devastation in some of Pakistans most deprived districts may cause child mortality in affected areas to rise by 10 per cent in the next year. The effects of this emergency are added to those caused by population displacement and ongoing insecurity in various areas in recent years.
Opposite: Mir Dadi, 22, sits with her twin babies in her tent in Bypass Camp for people displaced by flood on the outskirts of the city of Dera Allah Yar in Jaffarabad district of Balochistan province. The twins were delivered four days before her village was hit by floods. UNICEF Pakistan/2010/Noorani
A mother breastfeeds her baby at a breastfeeding corner located inside a UNICEF-supported Basic Health Unit in Basti Shahdu Khan village in Layyah district of Punjab province. UNICEF Pakistan/2010/Marta Ramoneda
tice or do not receive the support they need to breastfeed their babies. Aside from the high rates of malnutrition amongst Pakistani children, iodine deficiency is common in many parts of the country. In children, iodine deficiency can result in impaired mental growth and development as well as learning difficulties. This can, however, be easily prevented if families use iodised salt. Other contributors to Pakistans high child mortality rate include poor hygiene and sanitation, which can lead to infections and diseases. Vaccination rates are low, and children are vulnerable to preventable childhood diseases such as measles. Pakistan remains one of the four countries where polio is still endemic; indeed, the number of reported cases increased between 2009 and 2010. One reason for this is often lack of awareness among parents of the importance of taking preventive steps for their children. Weak local health care and immunisation management, preventing vaccination campaigns from reaching vulnerable children has also contributed to the problem.
A high proportion of Pakistani women die due to causes related to pregnancy and childbirth, with a maternal mortality ratio of 276 deaths per 100,000 live births. This figure, as well as the rates of child mortality, varies dramatically by residence, socioeconomic status and education. According to the Pakistan Demographic and Health Survey, Balochistan province has the highest maternal mortality in the country, with 78.5 deaths per 100,000 live births. Maternal and newborn mortality rates fall dramatically if women receive regular antenatal care from trained health workers who can monitor the progress of the pregnancy and give guidance on infant care. Yet only a third of pregnant women receive regular antenatal care, and 61 per cent give birth with the assistance of unskilled attendants (family members or traditional birth attendants) who are not trained in clean delivery practices and cannot recognise serious complications or know where to refer women for facility-based care. At present, HIV is concentrated amongst highrisk groups comprising those using intravenous
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drugs and sex workers. Unfortunately, there is little understanding of the disease in Pakistan, necessitating awareness raising on HIV transmission and prevention.
ACTION
UNICEFs Maternal and Child Health Care Programme aims to ensure that Pakistani mothers and children are informed about, and can easily access, health care, nutrition and immunisation services. The 2010 floods had a catastrophic effect on already weak local health systems, and on the health status of children living in some of the countrys most impoverished areas. During the floods, UNICEFs emergency health and nutri-
tion response was activated around its Core Commitments for Children, in partnership with the member agencies of the Health and Nutrition Humanitarian Clusters. UNICEF reached nearly eight million children with measles vaccinations and 500,000 children under five and their parents with treated mosquito nets. UNICEF also continued strengthening routine immunisation services, distributed one million mosquito nets and 47 ,000 health kits. Basic services provided by lady health workers were severely interrupted by the flood crisis. Lady health workers are a cadre of communitybased health professionals who provide health care services and information on preventing and treating diarrhoea, malnutrition and pneumonia to mothers at their doorstep. To maintain a continuum of care, UNICEF directly supported over 10,000 of these vital community workers. In addition, the health and nutrition programme supported training for over 60,000 lady health workers.
MOTHERS AND NEWBORNS

Mother and Child Weeks are large-scale campaigns that reach thousands of families in focus districts with information and low-cost, high-impact interventions. In 2010, Mother and Child Weeks were scaled up to cover 136 districts across the country with information on better care for children. During the summer campaign, messages on basic diarrhoea treatment were emphasised, while management services for pneumonia were highlighted in the winter campaign. About 3.5 million children and a million pregnant women were reached in each campaign. These campaigns increased the use of clean delivery kits for hygienic childbirth from 53 per cent to 65 per cent. Coverage of the BCG tuberculosis vaccine and mothers understanding of the use of oral rehydration salts also improved.
Amna Khatun holds her 11 month old daughter, Laila Allahdatta, as she speaks with Lady Health Worker Taslim Kausar in Basti Nowshera in Layyah district, Punjab province. Laila suffers from severe acute malnutrition and anaemia. She is being referred to a rural health clinic for treatment. UNICEF Pakistan/2010/Noorani
NUTRITION
In 2010, UNICEF supported the endorsement of the Rules on Child Nutrition and Breast Milk
children aged between 659 months in floodaffected areas of Northern Sindh and 21.2 per cent in Southern Sindh. This rate is well above the World Health Organizations (WHO) 15 per cent emergency threshold level which triggers a humanitarian response. The Global Acute Malnutrition (GAM) rate of flood affected areas of Punjab was found to be 13.9 per cent, indicating a serious situation. To respond to the findings, UNICEF and other nutrition partners are working with the provincial governments to carry out robust response plans. A total of 55 master trainers and 1,230 health care providers were trained in infant and young child feeding, a strategy to ensure that children receive adequate nutrition, including exclusive breastfeeding during their first six months of life.
A baby is screened for malnutrition at a UNICEFsupported Basic Health Unit near a camp for people affected by the floods in Nowshera district, Khyber Pakhtunkhwa province. UNICEF Pakistan/2010/ Ramoneda
Vitamin A, which increases childrens resistance to disease, was provided as a supplement during national immunisation days to 8.0 per cent of the 30 million children in Pakistan aged 659 months.
IMMUNISATION
Ordinance to protect breastfeeding practices. UNICEF also supported the endorsement of a legislation to help address iodine deficiency. Nearly half a million children now benefit from the programme for community management of acute malnutrition, which seeks to treat severely malnourished children at home by providing families with highly nutritious therapeutic foods, reducing the burden on health facilities. Following the 2010 floods, nutrition surveys were carried out in flood affected areas in four provinces, and a national nutrition survey is planned for 2011. The Flood Affected Nutrition Survey (FANS) data released by the Sindh and Punjab Departments of Health indicates a nutrition crisis. Sindh recorded a Global Acute Malnutrition (GAM) rate of 23.1 per cent in
In 2010, 144 cases of polio were reported, of which over half were from FATA, where insecurity and violence render access extremely difficult for technical and managerial support and oversight. Polio is now increasing in Sindh province due both to in-migration from worse affected areas and low rates of immunisation. Government, with WHO and UNICEF support launched a polio immunisation campaign seeking to reach children in the most vulnerable areas. More than 90 per cent coverage was achieved in 8.2 per cent of the districts targeted for supplemental polio immunisation. Locally appropriate public advocacy to eradicate polio was a major area of work. To help navigate the complex political, cultural and religious issues facing vaccination campaigns in FATA and Khyber Pakhtunkhwa, UNICEF pioneered partnerships for social mobilisation with religious
leaders in these areas. A notable success was a convention of religious leaders who endorsed vaccination against polio in Khyber Pakhtunkhwa and FATA. Nevertheless, in light of the rising number of polio cases in 2010, the programme is now revising its communication strategy for future campaigns.
Coverage of Penta III (which combines protection against hepatitis B, Hib [haemophilus influenzae type b], diphtheria, pertussis and tetanus, for children aged 14 weeks) reached 92 per cent of the targeted population. Measles vaccination achieved 8.2 per cent coverage and tetanus toxoid II achieved 72 per cent of the targeted population.
HIV AND AIDS

During 2010, UNICEF entered into a new partnership with the National Association of People Living with HIV and AIDS and also helped ensure that children in over 500 families living with HIV received care and support. The first national anti-retroviral treatment adherence training and paediatric clinical management training were completed in 2010. UNICEF also supported the revision of the national guidelines for anti-retroviral treatment and prevention of parent-to-child transmission (PPTCT) of HIV, with consensus reached on early breastfeeding. The Guidelines for the Care and Support of Children Affected by HIV and AIDS in Pakistan were developed, and UNICEF also supported the development of a national training curriculum on the prevention of parent to child transmission of HIV for district hospitals.
EMERGENCY RESPONSE
UNICEF delivered health and nutrition services to populations affected by crises in Khyber Pakhtunkhwa and FATA. A total of 1.2 million children were vaccinated against measles and provided Vitamin A supplementation while an additional 272,000 children were vaccinated against polio. UNICEF also supported the establishment of 11 Mother and Child Health Centres, and equipped 36 health facilities with Expanded Programme on Immunisation (EPI) equipment benefitting 316,000 children. UNICEF interventions supported the screening of 520,165 children and mothers, of whom
A health worker vaccinates an infant against polio during Polio National Immunisation Day in Sherpow in Landhi town, Karachi. UNICEF Pakistan/2010/Zaidi
A mother plays with her child in Haji Jan Mohammad Shoro village of Jamshoro district in Sindh province. Most homes in this village were made with mud that collapsed when the village went underwater during the flood. UNICEF Pakistan/2010/Noorani
32,400 moderate and severely malnourished children and mothers were referred for further treatment. Additionally, UNICEF provided nutrition supplies for 76,200 children and 26,000 mothers and de-worming tablets for 53,000 children between two to five years of age. Furthermore, 34,000 mothers and caretakers in the IDP camps, host districts and areas affected by instability received information about the importance of breastfeeding and child feeding best practices. The 2010 floods caused extensive damage to Pakistans rural health care infrastructure in all four provinces, not only damaging health facilities, but also displacing frontline staff, including lady health workers and vaccinators. In many areas, capacity and number of implementing partners were lacking. To support health and nutrition initiatives in flood affected areas between August 2010 and July 2011, UNICEF requested a sum of US$ 78..4 million. By the end of 2010, 8.3 per cent (US$ 65.2 million) had been received. As part of UNICEFs emergency response, 8..2 million children were vaccinated against
measles and 9.2 million against polio. To bring health workers back to work, UNICEF equipped about 10,600 lady health workers and supported them with financial incentives. UNICEF supported malnutrition screening of 399,000 children between six months and five years of age and 140,000 mothers. Of these, 23,8.00 severely malnourished children, 47 ,700 moderately malnourished children and 43,300 pregnant and lactating women considered at risk were enrolled in feeding programmes. UNICEF also supported the establishment of 337 nutrition centres, 306 outpatient therapeutic feeding programmes and 31 inpatient stabilisation centres for malnourished children suffering from complications. UNICEF worked in partnership with the World Food Program to support 167 supplementary feeding programmes.
PLANS FOR 2011

In 2011, UNICEF and its partners will concentrate on: g Promoting innovative approaches to reaching all children with immunisation and health care services, with a special emphasis on polio eradication.
Advocating that nutrition be a government priority at both the national and the provincial levels. UNICEF WFP FAO and , , WHO are jointly supporting the Pakistan Integrated Nutrition Strategy to simultaneously address the proximate underlying and root causes of undernutrition. For UNICEF , this will include a sustained emergency response until acute malnutrition levels fall significantly, expanding education and training, expanding community management of acute malnutrition, and conducting a national nutrition survey. Supporting lady health workers and community midwives in order to scale up community integrated management of neonatal and childhood illnesses. Strengthening capacity of local CBOs and Departments of Health for behaviour change communication. Sustaining programming for at-risk populations living with HIV, and scaling up the PPTCT Continuum of Care.
Center for Disease Control (CDC), Consolidated Funds from National Committees, the Netherlands National Committee for UNICEF , the United Kingdom National Committee for UNICEF the United States Fund for UNICEF , , Bill and Melinda Gates Foundation, Micronutrient Initiative (formerly IDRC), Red Crescent Society UAE, Rotary International, GAVI Fund, United Nations Foundation, Global Immunisation Plus, Global Thematic Humanitarian Response, HIV-AIDS and Children, Young Child Survival and Development, UNAIDS, UNDP (Joint Programme), UN-OCHA, WHO. Donors who contributed to Thematic Funding: Global Humanitarian Response: Andorran National Committee for UNICEF Australian , National Committee for UNICEF Austrian , National Committee for UNICEF Belgian Nation, al Committee for UNICEF Canadian National , Committee for UNICEF Czech National Commit, tee for UNICEF Danish National Commit, tee for UNICEF Finnish National Committee , for UNICEF French National Committee for , UNICEF German National Committee for , UNICEF Hellenic National Committee for , UNICEF Hong Kong National Committee for , UNICEF Icelandic National Committee for , UNICEF Italian National Committee for UNICEF , , Japan National Committee for UNICEF Korean , National Committee for UNICEF Luxembourg , National Committee for UNICEF Netherlands , National Committee for UNICEF New Zealand , National Committee for UNICEF Norwegian , National Committee for UNICEF Portuguese , National Committee for UNICEF Spanish , National Committee for UNICEF Swedish , National Committee for UNICEF Swiss Nation, al Committee for UNICEF Turkish National , Committee for UNICEF United Kingdom Nation, al Committee for UNICEF United States Fund , for UNICEF .
PARTNERSHIPS
UNICEFs main partner in implementing the Maternal Health and Child Care programme in Pakistan is the Ministry of Health. UNICEF also works closely with the Inter-Religious Council for Health; parliamentarians; media; traffic police; civil society organisations and NGOs; salt producers; other UN organisations, such as WHO, UNESCO, WFP FAO , and UNFPA; and several implementing and research organisations. Key donors to UNICEFs maternal and child health care programme include: Canada (CIDA), Japan, Netherlands, New Zealand, Saudi Arabia, Sweden (SIDA), United Kingdom of Great Britain and Northern Ireland (DFID), United States of America (USAID),
Case Study: UNICEF supports efforts to fight malnutrition in Pakistans flood-affected Sindh province
The devastating monsoon floods that recently affected more than 20 million people in Pakistan including 2.8. million children under the age of five have brought many underlying problems to the surface. In a country that already had alarmingly high rates of malnutrition, the floods have made the situation worse. Even before this crisis, about a third of Pakistans children were born with low birth weight. The challenge now is not just to scale up nutrition interventions but, in some areas, to establish them for the first time. Children in Sindh province, for example, are particularly vulnerable to malnutrition. Even before the floods, stunting rates in Sindh were higher than the national average. A recent survey of the flood-affected population revealed that Sindhs Global Acute Malnutrition (GAM) rate is 23.1 per cent in children aged between 659 months in flood-affected areas
of Northern Sindh and 21.2 per cent in Southern Sindh. This rate is well above the World Health Organizations (WHO) 15 per cent emergency threshold level which triggers a humanitarian response. The Sindh government estimates about 90,000 children aged 659 months are malnourished. To combat the problems of malnutrition and stunting, UNICEF and its partners screen children through outpatient therapeutic feeding programmes, where their weight, height and mid-upper arm circumference (a key indicator of growth and development) are measured. When necessary, children are referred to mobile units or stabilisation centres.
Mobile units and stabilisation centres

UNICEF has established the first stabilisation centre in a district civil hospital in Thatta district to treat malnourished children with serious
Above: Nine-year-old Khatidja feeds her 11-month-old sister, Laila Allahdatta, a ready-to-eat therapeutic food at a rural health clinic. Laila is severely malnourished and anemic. UNICEF Pakistan/2010/Noorani
medical complications. The centre was set up as a public-private partnership. With beds for children and their caregivers, the centre receives nutrition supplies and medicines from UNICEF as well as training for staff. Hameed, , 2, was recently admitted to the Thatta centre, suffering from high fever and diarrhoea. We had no idea what was wrong with him. The village doctor gave him drips, which caused swelling all over his body, says his grandmoth er. Today, Hameeds condition is beginning to show marked improvement as a result of therapeutic feeding and medical treatment.
deliver maternal and child health and nutrition messages to pregnant women and lactating mothers. We are telling the lactating mothers that for six months they must breastfeed and nothing else, after which semi-solid and solid food should be given, says health worker Maqbool Ahmed. UNICEF has provided extensive support to this programme, particularly since thousands of Lady Health Workers were themselves affected by the flooding. Meanwhile, UNICEF continues to work closely with the government, WFP and non-governmental and community-based organisations, to deliver life-saving and sustaining nutrition supplies to children and women affected by the flooding.
Demand exceeds capacity

The stabilisation centre in Thatta is the first of its kind, and the demand for its services exceeds capacity. At the moment, we have six children admitted here, and until now we have treated 51 patients in two months, says Shagufta Samoo, a staff nurse at the centre. We have had to refer children to other hospitals because we had no space. Thattas Deputy District Health Officer, Dr. Khaled Navaz, explains that much more work is needed to improve the nutritional status of children especially girls and women. In our society, males are given higher priority than females, so we see many more malnourished girls than boys, he says. More health education sessions are needed as mothers are also malnourished, and we should provide nutrition support in schools. The high percentage of malnourished women and low birth weight babies is evidence that much more attention should be given to womens nutrition. Through the governments extensive Lady Health Worker programme, local women
During a home visit to identify children with moderate or severe malnutrition, Lady Health Worker Taslim Kausar speaks to a young mother who holds her child in her arms. UNICEF Pakistan/2010/Noorani
WAteR, enVIRonMent AnD SAnItAtIon

Expenditure 2010 (US$) 49.85 million 4.37 million 0.98 million 44.5 million Total Core UNICEF Resources Resources from donors for development work Resources from donors for emergency and recovery work of all deaths to children under the age of five, a total of over 40,000 deaths every year. Poor hygiene is also a factor in the high number of deaths of mothers and newborns during or soon after childbirth, and it contributes to the high rate of potentially deadly infections, such as pneumonia. Older children who suffer from illnesses caused by lack of clean water and sanitation are more likely to miss school or drop out. In addition, many sources of drinking water are contaminated with industrial waste, bacteria, or high proportions of arsenic. About 48. million people around the country practice open defecation, and good hygiene practices such as washing hands with soap after defecating is low. According to the 2010 joint report by WHO and UNICEF 4 access , to proper sanitation facilities increased from 28. per cent in 1990 to 45 per cent in 2008., only a 17 per cent increase in almost two
NICEF works with partners and the government of Pakistan to improve water quality, sanitation and hygiene throughout the country. Safe drinking water, adequate sanitation facilities and proper hygiene all have a significant impact on quality of life, particularly for young children, whose health and well-being are affected by these factors. Many diseases, including polio, are related to poor sanitation. The level of water and sanitation services in Pakistan is not acceptable, especially in rural areas, with inappropriate operation and maintenance systems, poor water quality and the absence of safe hygiene practices. These problems are compounded by water scarcity, pollution and environmental damage. As a result, diseases related to hygiene and water quality, such as diarrhoea, contribute to Pakistans high child mortality rate, accounting for 11 per cent
Opposite: A girl drinks from a newly installed hand pump in the village of Jinnah Colony in Muzaffargarh, one of the worst flood-affected districts in Punjab province. UNICEF Pakistan/2010/Noorani
4 WHO and UNICEF 2010. WHO/UNICEF Joint Monitoring Programme on Water and Sanitation. Progress on Sanitation and Drinking Water: 2010 Update. ISBN 978. 92 4 156395 6. Available at: http://www.wssinfo.org/fileadmin/user_upload/resources/1278.061137-JMP_report_2010_en.pdf ANNUAL REPORT 2010 | 19
decades. Contributing factors include rapid population growth, an insufficient enabling environment to promote sanitation, lack of education and poverty. It is estimated that health costs and lost earnings due to preventable diseases related to water and sanitation cost Pakistan over US$ 3.5 million a day.5 Simply improving water and sanitation services and adopting safe hygiene practices could reduce water-related disease by as much as 50 per cent, making it among the most cost-effective health interventions. Depending
on the region and the level of services provided, the economic gains from every Rs 100 invested range from Rs 500 to Rs 2,8.00.6 Poor sanitation has a particular negative impact on girls. To preserve modesty, women and girls may have to wait until after dark in areas where open defecation is the only option, making the process of utilising proper hygiene more difficult and even dangerous. Similarly, in emergencies, women and girls are disproportionately affected by inadequate sanitation and washing facilities, especially when living in camps or other crowded accommodations. When schools lack sanitation facilities, girls are less likely to enrol and less likely to complete their education. At present, 43 per cent of schools in Pakistan do not have an accessible source of clean drinking water, and 48. per cent lack toilet facilities. The 2010 floods caused great damage to the limited water and sanitation infrastructure in affected areas. Before the floods, only 75 per cent of Pakistanis had access to a source of safe drinking water; in flood affected areas, this proportion has fallen to 55 per cent.7 This is likely to result in increased morbidity and deaths in the affected areas.
ACTION
A child washes his face at a water pump built with UNICEF support in a camp for people affected by the floods in Charsadda district, Khyber Pakhtunkhwa province. UNICEF Pakistan/2010/Ramoneda
UNICEFs Water Sanitation and Hygiene (WASH) programme aims to improve water quality and resource management, promote household latrines, sanitation and improved hygiene practices in rural areas, and to contribute to increased enrolment and retention in primary school, especially for girls. In response to the emergencies faced by Pakistan in the last six years, enhanced emergency prepared-
4 WHO and UNICEF 2010. WHO/UNICEF Joint Monitoring Programme on Water and Sanitation. Progress on Sanitation and Drinking . Water: 2010 Update. ISBN 978. 92 4 156395 6. Available at: http://www.wssinfo.org/fileadmin/user_upload/resources/1278.061137JMP_report_2010_en.pdf 5 World Bank, 2006. Pakistan Strategic Country Environmental Assessment. Available at: http://siteresources.worldbank.org/SOUTHASIAEXT/Resources/Publications/448.8.13-118.8.777211460/pakceavolume1.pdf 6 Ibid 7 UNDAC. 2010. Multi-Cluster Rapid Assessment. Available at: http://www.pakresponse.info/LinkClick.aspx?fileticket=7cXrpRTKX8.M%3 d&tabid=8.6&mid=526.
A baby is bathed under a water point at the relief camp for people displaced by the floods in Sukkur. UNICEF Pakistan/ 2010/Ramoneda
ness and response and disaster risk reduction have been integrated into all three areas of the WASH programme. UNICEF is co-chair of the One UN Environment Programme, which includes water and sanitation. In 2010, UNICEF completed a study on how the WASH programme could be adapted to deal with the impacts of climate change. In 2010, in response to multiple emergencies, UNICEF provided safe drinking water to 4.75 million people, including 2.63 million children. About 1.34 million people, including 720,000 children, received access to adequate sanitation, and hygiene messages were disseminated to 2.95 million people of whom 1.76 million were children. A national communication strategy was formulated to promote better hygiene and sanitation messages. The Global Hand Washing Day, celebrated on 15 October 2010, reached over 2.4 million people (including 1.24 million children) with messages on better hygiene behaviour. Messages on sanitation were also conveyed through the regional Healthy Hat Trick initiative, which promotes good nutrition and girls education along with improved sanitation, with the
involvement of the Pakistani cricket team. UNICEF supported the formulation of the National Sanitation Action Plan, as well as the official approval of the National Drinking Water Quality Standards and the National School WES Design Standards. UNICEF also supported training for 2,770 government officials and community members (969 of them women and 1,8.01 men). In addition to a management information initiative implemented across Pakistan, UNICEF advocated successfully with the government of Punjab province to contribute its management information system to all other provinces so that the software, worth US$ 1.5 million, could be utilised nationally. Thanks to UNICEF advocacy, a national sanitation programme to address the sanitation crisis is ready to be launched; the programme will target 48. million people, with 18. million flood affected people targeted during the first phase. This community-led total sanitation programme aims to improve sanitation for entire communities at a time. UNICEFs support has already enabled 8.6,500 people (of whom nearly 45,000 are children) to benefit from living in communities free of open defecation.
7 UNDAC. 2010. Multi-Cluster Rapid Assessment. Available at: http://www.pakresponse.info/LinkClick.aspx?fileticket= 7cXrpRTKX8.M%3d&tabid=8.6&mid=526.
Carrying pots of water collected from an underground water supply pipeline, children walk home in the village of Sadra Sharif in Dera Ismail Khan district of Khyber Pakhtunkhwa province. UNICEF Pakistan/2010/Noorani
UNICEF participated in a major project to monitor and improve water quality in areas of Khyber Pakhtunkhwa province and Pakistan Administered Kashmir, which were affected by the October 2005 earthquake. Out of the 94 water supply schemes targeted by the project, 8.5 were rehabilitated providing 118.,000 people, including 61,400 women, with access to improved drinking water. In total, 3,500 water schemes are to be mapped for water quality and sanitation. Of these, 1,600 have been completed, with 1,300 still underway. Following the mapping exercise, which identified water schemes supplying poor quality water, government agencies are preparing plans to improve 1,200 water schemes. There have been some delays in this project, due to the slow release of government funds. UNICEF also led support for the establishment of 305 water supply schemes, which were completed by June 2010. Along with these initiatives, seven UNICEF-supported partners provide training and awareness in the 1,700 villages where the water supply schemes are located. To date, over 3,200 water management committees have been formed, with 9,900 community members, including 1,400 women, trained to manage, operate and maintain village water supply systems. Over 48.,100 people, including 15,600 women and 13,545 children, have attended a total of 1,732 information sessions on community and school hygiene. Radio broadcasts were also used to disseminate hygiene messages and to reach communities in Shangla and Kohistan districts of Khyber Pakhtunkhwa province, where access was restricted due to insecurity. In Pakistan Administered Kashmir, UNICEF provided equipment for nine water quality laboratories in order to make them fully functional. Government agencies developed action plans to strengthen water quality monitoring, surveillance and improvement in focus districts of Pakistan Administered Kashmir and Khyber Pakhtunkhwa, and a management information system is being tested in Pakistan Administered Kashmir.
The school WASH programme, which aims to provide safe drinking water, adequate gendersensitive sanitation facilities and hygiene education to primary schools, had to be temporarily suspended midway through the year because of the flood emergency. Prior to this, UNICEF had successfully completed work on renovating water and sanitation facilities in 240 of the 1,500 target schools, benefiting about 25,200 children, of whom 14,8.00 are girls. A total of 48.0 teachers had been trained to provide hygiene education to their pupils as part of life skills training, and the members of 600 school management committees, comprising of parents and local influentials, had been trained to operate and manage the schools renovated water and sanitation facilities. In partnership with the Earthquake Reconstruction and Rehabilitation Authority (ERRA),
the floods. UNICEF promoted improved
Sitting outside her tent, a woman assists her young child to wash hands in a temporary camp in the village of Kharbella in Charsadda district in Khyber-Pakhtunkhwa province. UNICEF Pakistan/2010/ Noorani
EMERGENCY RESPONSE
During the conflict in Khyber Pakhtunkhwa and FATA, UNICEF supplied over two million individuals with clean drinking water, exceeding the initial target of 1.2 million, through the installation and rehabilitation of infrastructure including tube wells, water systems and hand pumps, as well as through water trucking. In addition, hygiene kits were distributed to over 1.6 million individuals. Over 2 million people affected by instability received hygiene messages, and over 300,000 individuals benefited from latrine installation. WASH facilities were provided for health units in IDP camps to serve 165,000 individuals. The floods left 14 million people urgently needing access to safe drinking water and sanitation. To support water, sanitation and hygiene initiatives for a 12-month period, UNICEF required US$ 123.8. million, of which 65 per cent, or US$ 8.0.5 million, had been received by the end of 2010. In 2010 UNICEF provided safe drinking water to nearly 3.2 million people and sanitation facilities to nearly 1.5 million people affected by
hygiene through hygiene promotion messages, which reached 1.9 million people (including 970,000 women), and hygiene kits, which were provided to 1.6 million people (including 8.20,000 women). About 30 million water purification tablets and sachets sufficient to provide 300 million litres of safe drinking water were distributed. UNICEF also assisted local governments to clean reservoirs and conduct chlorination campaigns in order to control disease outbreaks. UNICEFs emergency response was challenged by the lack of capacity among the implementing partners to respond to such a large-scale emergency, suggesting the need to broaden the range of partners in the future. Because adequate baseline statistics did not exist for many areas, accurately assessing damage and needs was a challenge.
PLANS FOR 2011

In 2011, UNICEF and its partners will concentrate on:
Implementing the Flood Work Plan to reach 3.69 million flood affected people in the relief phase, and 5 million flood affected people in the early recovery phase. Addressing the needs of approximately 100,000 IDPs still living in camps and other persons returning or displaced in Khyber Pakhtunkhwa and FATA. Strengthening partner capacity and leading the transition of partners from relief to early recovery work in the sector. Maximising efforts to ensure that policies and strategies relevant to water, sanitation and hygiene are approved. Scaling up rural sanitation following the total sanitation strategy. Strengthening water quality monitoring and surveillance systems. Strengthening and operationalising management information systems in all provinces. Scaling up school water, sanitation and hygiene facilities.
Australia (AusAID), European Commission/ ECHO, Ireland, Japan, Luxembourg, Netherlands, New Zealand, Republic of Korea, Saudi Arabia, Sweden (SIDA), Spain, United Kingdom of Great Britain and Northern Ireland, United States of America (USAID), the French National Committee for UNICEF the Netherlands Nation, al Committee for UNICEF Global Thematic , Humanitarian Response funds, UNDP (Joint Programme), UN-OCHA. Donors who contributed to Thematic Funding: Global Humanitarian Response: Andorran National Committee for UNICEF Australian , National Committee for UNICEF Austrian , National Committee for UNICEF Belgian Nation, al Committee for UNICEF Canadian National , Committee for UNICEF Czech National Commit, tee for UNICEF Danish National Committee , for UNICEF Finnish National Committee for , UNICEF French National Committee for UNICEF , , German National Committee for UNICEF , Hellenic National Committee for UNICEF Hong , Kong National Committee for UNICEF Icelandic , National Committee for UNICEF Italian National , Committee for UNICEF Japan National Commit, tee for UNICEF Korean National Committee , for UNICEF Luxembourg National Committee , for UNICEF Netherlands National Committee , for UNICEF New Zealand National Committee , for UNICEF Norwegian National Committee , for UNICEF Portuguese National Commit, tee for UNICEF Spanish National Committee , for UNICEF Swedish National Committee for , UNICEF Swiss National Committee for UNICEF , , Turkish National Committee for UNICEF United , Kingdom National Committee for UNICEF , United States Fund for UNICEF .
PARTNERSHIPS
UNICEFs main WASH partners in Pakistan at the federal level are the Ministry of Environment, Ministry of Science and Technology, Ministry of Education, and the Ministry of Health at provincial and district levels. UNICEF works with other partners, including UN organisations, in particular the World Health Organisation, as well as rural development departments, public health engineering and health departments, directorates of education, tehsil management administrations, local and international NGOs, civil service organisations, and the private sector. Key donors to UNICEFs water, environment and sanitation programme include:
Case Study: In tribal Bajaur, school sanitation and hygiene brings girls back to school
Amna left school for what she thought then would be the very last time. That was in 2008., when she was a Grade 2 student and only 11 years of age. She started working at home, cleaning the house, taking care of her younger siblings, and helping tend the familys crops. Amna lives in Jan Kili, a farming village of 1,400 inhabitants located in Bajaur Agency of the Federally Administered Tribal Areas (FATA) of Pakistan. FATA is amongst Pakistans least developed areas, and education levels are very low. A 2007 study showed that only 22 per cent of people over 15, and 7 per cent of women, were literate. Only 28. per cent of children were enrolled in primary school, including 17 per cent of girls. Since the survey was completed, FATA has experienced increasing uncertainty and violence in which schools, especially for girls, have been targeted by militants. Bringing children to school, and keep-
ing them there, is thus doubly challenged by poverty and violence.
When my friend Aisha told me that water and latrines are now available at the school I was delighted, says Amna. I was fed up of working at home, and I wanted to continue my schooling. Here, she could learn, play and grow with other children her age instead of spending all her time working at home.
In these areas, we have to work with parents to convince them that their children should
Above: While a young boy helps pump, a girl washes her hands with water from a hand pump in a village in Shado Khan Union Council of Layyah district in Punjab province. UNICEF Pakistan/2010/Noorani
have a full course of primary education, says Ishaq Israr of Just Peace International, a UNICEF local partner working in Bajaur Agency. But an essential prerequisite is to ensure that schools have basic facilities. This includes trained teachers, school equipment and a functional structure, including a lavatory. Through the help of partners, UNICEF offers children, women and their families in crisis affected areas greater access to safe water and sanitation facilities. Under this partnership, early recovery Water, Sanitation and Hygiene Promotion (WASH) interventions in conflict affected districts of Malakand Division and Bajaur and Mohmand Agencies of FATA hopes to benefit nearly 1.5 million individuals, including 8.2,500 school children. Amnas school was one of those that lacked a latrine, and pupils were forced to use the open fields instead. As I was then a grown girl, I felt uncomfortable going outside into the open when I needed to use a latrine, she says. Her parents were also uncomfortable. We live in a Pashtun culture where the privacy of women and girls is of primary importance, says her father, Jan Bahadar. I could not tolerate my daughter having to visit the open fields to attend to the call of nature. Then, in 2010, Just Peace International came to Jan Kili. While, as a village elder explained, the girls school had been eagerly attended since its establishment, recently numbers had dwindled. A major reason was the lack of sanitation infrastructure: many children like Amna had dropped out. The Jan Kili Government Girls Primary School thus became a key focus in a project to support education in remote Bajaur Agency by ensuring that 50 primary schools had functioning water and sanitation facilities, and students, teachers and parents were informed about good hygiene practices and their importance. Amna and her parents were delighted.
A girl drinks from a pump in in a village in Shado Khan Union Council of Layyah district in Punjab province. UNICEF Pakistan/2010/Noorani
When my friend Aisha told me that water and latrines are now available at the school I was delighted, says Amna. I was fed up of working at home, and I wanted to continue my schooling. Here, she could learn, play and grow with other children her age instead of spending all her time working at home. Mr Bahadar, Amnas father, was also delighted. I am a poor man and want to educate my children, he says. I am very pleased that Amna can go back to school. Project schools have hygiene sessions in which children and school staff learn about good hygiene and how to maintain a healthy school environment. Children are encouraged to take their newfound knowledge home, thus contributing towards greater awareness in the community. In Ganji Kali Village, this aspect of the project has gained the support of the prayer leader, Maulvi Abdullah.
The reason, Mr Abdullah says, is that he had seen a change in the village children. He noticed that they were cleaning their teeth regularly, and keeping a bar of soap at the mosque to wash their hands. They would even ask adults to use the soap. When he asked the children how they had adopted such high standards of cleanliness, which were in full accordance with religious teachings, they told him about the hygiene education at school. This is the Islamic message of hygiene, says Mr Abdullah.
Good school sanitation and hygiene help every aspect of a childs growth and development, says UNICEF WASH Officer, Moham mad Shakaib Jan. They prevent diseases such as diarrhoea and pneumonia which cause 40 per of all child deaths. They help prevent children, especially girls, from dropping out of school, especially in these areas where insecurity has already taken a toll on education. By developing school sanitation infrastructure and hygiene education, we invest in the future of children like Amna.
A facilitator uses a flipchart to teach health and hygiene messages to a group of women in the village of Jinnah Colony in Muzaffargarh, one of the worst flood-affected districts in Punjab Province. UNICEF Pakistan/2010/Noorani
PRIMARY eDUCAtIon
Expenditure 2010 (US$) 21.69 million 2.65 million 9.45 million 9.59 million Total Core UNICEF Resources Resources from donors for development work Resources from donors for emergency and recovery work tic labour in the home, lack of female teachers and separate sanitation facilities in schools. The impact of these issues can be most clearly seen in the Federally Administered Tribal Areas (FATA), where it is estimated that only 13 per cent of primary school-aged girls are enrolled in primary school. The passage of the 18.th Amendment to the Constitution of Pakistan in 2010 led to a redefinition of the role of the federal Ministry of Education, as most of its responsibilities were devolved to the provincial governments. This, along with frequent changes in political leadership, a high turnover in the public sector, and the security situation created complications for project planning and implementation. In recent years, Pakistan has weathered a series of tremendous challenges for primary education. These have included the 2005
akistan faces a difficult challenge in achieving universal primary education by 2015, as per Pakistans commitment to the Millennium Development Goals. Even before the displacement of millions of people as a result of flooding and insecurity in 2010, only about half of Pakistani children attended school. Many factors contribute to low enrolment and completion of primary school for boys and girls; these low educational attainment and income of parents, and school-related issues, such as the use of corporal punishment, lack of trained teachers and learning materials, and inadequate water and sanitation facilities. The problems, however, are most acute for girls who have traditionally faced serious barriers to completing a full course of primary education, such as societal pressures against educating girls, low awareness amongst parents of the benefits of educating girls, demand for domes-
Opposite: Sitting on floor in a UNICEF-supported Temporary Learning Centre (TLC), an older girl assists a younger girl child to write on a wooden board, in the village of Basti Bhaya in Rajanpur, amongst one of the worst affected district in Punjab province. UNICEF Pakistan/2010/Noorani ANNUAL REPORT 2010 | 29
A girl practices her letters at a camp for flood affected families. Accessing education has been especially difficult for girls. UNICEF Pakistan/2010/ Ramoneda
earthquake, which damaged 6,000 schools in Pakistan Administered Kashmir and Khyber Pakhtunkhwa province, and increasing insecurity in these two areas, preventing many children from attending school. The floods of 2010 negatively affected education in all four of Pakistans provinces and put immense strain on an already fragmented education system. With more than 10,000 schools damaged or destroyed, the devastation is likely to lead to a decline in school enrolment and in the rate of primary and secondary school completion, especially for girls.
dren are able to fulfil their rights to education. UNICEF is supporting primary school education in 30 focus districts in four provinces. During 2010, primary school enrolment increased in these districts from 350,000 to 530,000 children. UNICEF has pioneered child-friendly schools that involve parents, teachers and communities in a holistic and child-centred approach to providing quality education. In Punjab province, this approach contributed to a 64 per cent increase in enrolment. UNICEF established 501 new child-friendly schools, bringing the total to 2,8.10 schools with 399,000 students in grades 1 to 5; nearly 254,000 of these students were girls. In addition, these schools serve 97 ,700 pre-school students; nearly 62,000 of these students are girls. About 5,670 primary school teachers were also trained in child-friendly methods and early childhood education. UNICEF also supported mass enrolment campaigns in Punjab and Sindh provinces that led to the enrolment of 1.4 million primary school aged children in Punjab and an additional 120,000 girls in Sindh. In Balochistan, 3,000 girls primary schools were opened through the
ACTION
UNICEFs Primary Education programme in Pakistan seeks to:
g
g g
Expand girls and boys enrolment and retention in primary and middle school. Improve the quality of primary education. Strengthen the education system at the national level and at provincial levels.
UNICEF also seeks to integrate education into emergency response and disaster risk reduction activities to help ensure that affected chil-
Community Support Process, which helped reduce gender disparity in access to primary schooling and employed thousands of female teachers. In 71 remote public girls primary schools, middle schooling for girls (grades 6 and 7) was initiated, giving 2,200 girls the opportunity to receive this level of education for the first time. Childrens health and well-being is at the centre of the child-friendly school approach. To ensure that schools have adequate sanitation and water facilities for children, UNICEF supported the finalisation of the National Standards on Water and Sanitation. Supported by evidencebased best practices in all provinces and areas, and with strong advocacy at the federal level, the National Child-Friendly School Standards
were developed and endorsed as the standards for quality education by the federal minister and secretaries for education in all provinces and areas. The Ministries of Health and Education developed and agreed on a school health framework, which is due to roll-out at the provincial level. In order to strengthen pre-primary education and reduce the number of children who drop out at the pre-primary level, UNICEF partnered with UNESCO to develop an early childhood education toolkit and national standards on the development of pre-school children. UNICEF also provided training to master trainers in Punjab and established 33 resource centres for early childhood education. In Balochistan and Khyber Pakhtunkhwa provinces, UNICEF supported surveys to establish a learning achievement baseline for grades 4 and 8.. This will help future efforts to improve learning assessments and quality of education. In Punjab province, two million students sat for annual examinations, based on learning achievement standards. To improve the collection of education data, UNICEF supported the development of a national-level education management information system (EMIS) prototype. The integrated EMIS will enable all provinces and districts to receive regular analytical reports to aid in planning and monitoring activities. Recovery efforts following the 2005 earthquake continued in 2010, with 410 permanent earthquake-safe school structures built to child-friendly standards. Of these, 214 were in Khyber Pakhtunkhwa province and 196 in Pakistan Administered Kashmir. In addition, 28.1 transitional schools were constructed, bringing the total number of beneficiaries to 65,130 children. Ambassadors and diplomats from the European Union were given a tour of these sites to examine the quality of construction and the child-friendly approach.
A girl smiles as she solves a maths problem in a centre in Ghaniabad village of Dera Ismail Khan district, Khyber Pakhtunkhwa province. UNICEF Pakistan/2010/Noorani
The floods brought new challenges, such as rapid and unpredictable population movements, damage to infrastructure, and the difficulty of tracking children and ensuring they continued their education. Yet the floods also created an opportunity for many marginalised children, especially girls, to attend school for the first time. While responding to the emergency needs of flood affected children, UNICEF was able to promote the value of girls education. In total, 2,790 temporary learning centres, including 120 dedicated to early childhood education, were established, benefiting 165,000 children in flood affected districts. Education supplies were distributed to centres benefiting 208.,000 children, and 3,700 teachers were trained on the use of emergency educational supplies and on teaching methods tailored to emergency situations.
A child writes in her textbook in the flood affected village of Musarraf Khan Khoso in Jaffarabad District, Balochistan Province. There are no schools within walking distance of this village. For many children, this is the first time in their lives that they are able to go to school. UNICEF Pakistan/2010/ Noorani
EMERGENCY RESPONSE
The emergency situation faced by Pakistan in 2010 required substantial support for education. UNICEF is presently supporting 32 primary schools attended by a total of 28.,500 children displaced by conflict; these include schools/ students in IDP camps and those in host communities in conflict affected areas, which provide second-shift education for IDP children. In addition, eight secondary schools for 28.9 students in IDP camps receive support. To increase parents involvement in their childrens education, 48.6 Parent-Teacher Committees were re-activated and 18. Mother Support Groups were established. Members of both were trained on improving links between schools and the community.
Many people displaced by the floods took shelter in school buildings, making these facilities vulnerable to damage. UNICEF supported the Ministry of Education and the National Disaster Management Authority in the production and distribution of 50,000 posters with illustrated messages for IDPs on how they should care for the school buildings where they were sheltered. Meena storybooks and films were developed by UNICEF to help children learn about child rights, health, hygiene and other issues through the entertaining and appealing character of a young South Asian girl. Fourteen different Meena storybooks and films, translated into local languages, were produced for early recovery education activities and a comprehensive social mobilisation initiative, including interactive sessions with school children, is planned to continue as part of the flood response in 2011. In the flood emergency, survival and protection aspects of the response commanded greater government priority than education and education was not initially included in the national appeal. To support education for 12 months in the aftermath of the floods, UNICEF required
US$ 36.4 million, and received 8.9 per cent, or US$ 32.5 million, by the end of 2010. UNICEF served as the co-lead of the Education Cluster with Save the Children, and as such supported effective coordination mechanisms in the emergency response throughout the country.
and WFP within the framework of the One UN , Programme, as well as national and international NGOs and the private sector. Key donors to UNICEFs primary education programme include: Australia (AusAid), Canada (CIDA), Czech Republic, Denmark, European Commission (EC), Ireland, Italy, Netherlands, New Zealand, Norway, Saudi Arabia, Sweden (SIDA), United Kingdom of Great Britain and Northern Ireland (DFID), Thematic Funding Basic Education and Gender Equality, Thematic Funding Global Girls Education, Thematic Global Funding Humanitarian Response, and Joint Programme UNDP . Donors who contributed to Thematic Funding: Global Humanitarian Response include: Andorran National Committee for UNICEF , Australian National Committee for UNICEF , Austrian National Committee for UNICEF , Belgian National Committee for UNICEF , Canadian National Committee for UNICEF , Czech National Committee for UNICEF , Danish National Committee for UNICEF Finn, ish National Committee for UNICEF French , National Committee for UNICEF German , National Committee for UNICEF Hellenic , National Committee for UNICEF Hong Kong , National Committee for UNICEF Icelandic , National Committee for UNICEF Italian National , Committee for UNICEF Japan National Commit, tee for UNICEF Korean National Committee , for UNICEF Luxembourg National Committee , for UNICEF Netherlands National Committee , for UNICEF New Zealand National Committee , for UNICEF Norwegian National Committee , for UNICEF Portuguese National Commit, tee for UNICEF Spanish National Committee , for UNICEF Swedish National Committee for , UNICEF Swiss National Committee for UNICEF , , Turkish National Committee for UNICEF United , Kingdom National Committee for UNICEF , United States Fund for UNICEF .
PLANS FOR 2011

In 2011, UNICEF and its partners will concentrate on: g Promoting universal primary education and focusing on enrolling the most disadvantaged children, especially girls. g Increasing access to education for flood affected children aged 412 years by establishing transitional school structures and temporary learning centres. g Promoting and implementing disaster risk management and school-based emergency preparedness activities at the federal, provincial and district levels. g Preparing guidelines and manuals on childfriendly schools for provincial and districtlevel education authorities. g Enhancing school readiness for primary school children by strengthening early childhood education and development centres. g Supporting a national survey to assess the learning achievements of primary school students. g Evaluating experiences in community involvement, especially the involvement of mothers support groups. g Lead the transition from flood relief to early recovery in the education sector. g Strengthening Cluster coordination to effectively respond to humanitarian needs in Khyber Pakhtunkhwa and FATA. g Completing the schools under reconstruction following the 2005 earthquake.
PARTNERSHIPS
UNICEFs main partner is the Ministry of Education at the national and provincial levels. UNICEF also collaborates with other UN bodies, including UNDP UN-Habitat, UNESCO, UNHCR ,
Case Study: Temporary learning centres offer opportunities for children in Pakistan camps
Sitting in her familys tent, Reshma, 8., proudly shows her mother a textbook she received from the temporary learning centre or TLC here in a relief camp located at the Jaffarabad Flour Mill.
children and flee. Fortunately, the Jaffarabad Flour Mill camp had been set up only 3 km west of their village. Here, they were registered and allocated a tent.
Reshma had no exposure to formal education prior to her arrival at this camp for people affected by recent flooding in Pakistan. Now, she is one of the regular students at the TLC.
Before the floods, Reshmas parents lived in Mala Bagan Baba village, near the city of Jhatpat in Jaffarabad district. When the flood waters came, they had to pack up their five
Window of opportunity for education

In the midst of the crisis, Reshmas parents scarcely could have imagined that this hardship would open a window of opportunity for their children an opportunity for education. Our house, village and all belongings have been lost in the floods, says her mother. We have come to this camp and our children are happily studying here. The rest we can withstand. UNICEF started supporting the 7 ,000 displaced soon after the camp was commissioned in early August. Through its partners, UNICEF is providing safe drinking water and
Above: Reshma, 8., is a student at the temporary learning centre in the Jaffarabad Flour Mill flood-relief camp, Balochistan Province, Pakistan. UNICEF Pakistan/2010/Sami
sanitation facilities, child-friendly spaces for recreation and learning activities, and the TLCs for providing basic education. The TLCs are supplied with School-in-a-Box kits, emergency education and recreation kits, water coolers and school furniture.
learning for the first time in their lives. Some of them were not going to school in their native village or city, but they are studying here and with a lot of eagerness. UNICEF Education Specialist Sanaullah Panezai explains that the TLCs provide benefits that transcend schooling. Besides catering to the needs of children whose education was disrupted by the floods, he says, TLCs are designed to promote diversity and uphold inclusiveness. Mr. Panezai adds that the centres provide opportunities for learning, socialising and recreation including opportunities for children who were earlier excluded from the education system.
Students eager to learn

Nadia, one of the teachers, was herself displaced when the floods hit. I have 103 students here. These girls are studying Urdu, English and Mathematics. They are eager to learn, she says. By seeing other children study, more are becoming attracted to
A teacher and students inside a temporary learning centre at the Jaffarabad Flour Mill relief camp in Pakistans floodaffected Balochistan Province. UNICEF Pakistan/2010/Sami
CHILD PRoteCtIon
Expenditure 2010 (US$) 14.08 million 1.89 million 1.86 million 10.33 million Total Core UNICEF Resources Resources from donors for development work Resources from donors for emergency and recovery work Many children are driven to work in order to supplement family incomes, or because of lack of awareness of the importance of education. These children, especially those working in hazardous occupations, rarely attend school and engage in long hours of difficult work in dangerous conditions. Lack of access to schools and the need to contribute to meagre family incomes makes it very difficult to break the inter-generational cycle of poverty and lack of education. Finding ways to address issues surrounding child labour and increase childrens opportunities to pursue an education (e.g., through legislative initiatives or raising awareness of childrens issues) is of significant concern to the UNICEF Child Protection section. At present there is no universal birth registration system in Pakistan. Nationwide, the birth registration rate is less than 30 per cent. When a child is deprived of their right to an identity,
here are nearly 79 million children under the age of 18. in Pakistan, and 24 million of them are under the age of five. Because of widespread poverty and instability in Pakistan, many of these children face protection issues, such as hazardous child labour, trafficking, child marriage, displacement, and institutionalisation. For children living in areas affected by conflict, child recruitment, conflict and unexploded ordnance are also major areas of concern. The precarious situation of children in Pakistan was negatively impacted by natural disaster and insecurity in 2010. Displacements caused by the widespread flooding and by instability in some regions of the country affected millions of children, further increasing UNICEFs concern for their safety and well-being. Even before the floods, 36 per cent of Pakistans population was living below the poverty line.8.
Opposite: Children participate in a physical exercise activity in a UNICEF supported Child Friendly Space in Charsada Station Camp in Charsada district of Khyber-Pakhtunkhwa province. UNICEF Pakistan/2010/Noorani
8. State Bank of Pakistan. 2010 Annual Report.
the consequences last a lifetime, making it difficult for children and in adulthood, women, to claim important services and protection.
regular contact with children, about childrens rights and the need for, and benefits of, a protective environment for children. In 2010, a major achievement in this area was the approval of the Khyber Pakhtunkhwa Child Protection Act and the Pakistan Administered Kashmir Child Protection Policy. In Gilgit Baltistan, a Social and Child Protection Reform Unit was established as the first step towards an integrated and comprehensive approach to child protection and social services. In addition to these legislative achievements, Child Complaint Offices were supported under the Childrens Ombudsmans Office to strengthen governmental accountability at federal and provincial levels. About 40,000 children benefited from protection and referral services supported by UNICEF . At the national level, UNICEF supported the establishment of a Gender and Child Unit in the National Disaster Management Authority. At the provincial level, UNICEF supported five Child Protection Units that identify, refer and support unaccompanied and vulnerable children through the provision of a wide range of protective services. At the district level, UNICEF supported 11 Child Protection Units. Five child-friendly help desks were established in Balochistan police stations, and helplines were set up in Sindh and Khyber Pakhtunkhwa provinces to provide information and referral services to children and families. These units were in addition to five Child Protection Centres established under Pakistans Federal Investigation Agency. Child Protection Centres are an important cornerstone in the provision of child protection services for the children of Pakistan. In UNICEFsupported Child Protection Centres children and adolescents have the opportunity to take part in learning activities and are encouraged to join the mainstream educational and vocational learning systems. Child Protection Centres
ACTION
UNICEFs Child Protection section works towards the ideal of ensuring that all Pakistani children live in a protective environment, free from violence, abuse, exploitation and neglect. Creating a protective environment is not just about protecting children in immediate danger, but is also about seeking to ensure that all aspects of child protection, from policies and
Mubeen Ashraf and Aqsa Yaseen with their puppets in the Education Counseling Center of UNICEF-supported Hayat Foundation in Rashidabad, Faisalabad of Punjab province. UNICEF Pakistan/2010/Zaidi
legislation to services and resources, are in place to protect children at the national, provincial and district levels. This includes educating parents, teachers, community members, health care professionals, and others who come in
Children play in a UNICEF-supported Child Protection Centre in Taru Jabba of Nowshera district in Khyber Pakhtunkhwa province. UNICEF Pakistan /2010/Noorani
provide a range of services through staff trained in protection and child-friendly skills. In Khyber Pakhtunkhwa and Punjab provinces, about 4,8.00 children working in brick kilns received formal or non-formal education and life skills training through 36 Child Protection Centres. Also, 1,8.70 children living and working on the streets were provided with non-formal education, life skills training and counselling through Child Protection Centres in Khyber Pakhtunkhwa, Balochistan and Sindh provinces. In areas of Khyber Pakhtunkhwa affected by armed conflict, about 96,400 children (including 42,400 girls) and 11,400 women received services from 238. Child Protection Centres. In addition, 28. victims of unexploded ordnance (UXO) were identified and linked with services. UXO risk education was provided to 94,900 children (including 25,500 girls). Some 5,000 women and 19,000 men were also educated on the dangers of UXOs and to how to live more safely with the threat. One hundred and fifty children who had formerly been associated with militant armed groups received residential rehabilitation and support services at Sabaoon Academy through the provision of educational, recreational, psychological, vocational and health-focused services and referrals.
Two critical priorities in 2010 were the development of child protection service standards and improving government planning and oversight. UNICEF supported the development of standard operating procedures and terms of reference for the governments Child Protection Units and for service providers in Child Protection Centres, Transit Centres and Child Friendly Spaces. UNICEF also supported training for 1,150 child protection professionals from government departments and other stakeholders; 300 more were trained on child protection in emergencies. UNICEF supported the Government of Pakistan in reviewing and addressing the elements of legislation that were incompatible with the Optional Protocols to the Convention on the Rights of the Child. This is an important step that will support the ratification and implementation of legislation and programmes that promote childrens rights. During the course of the year, more than 150,000 children were registered at birth through district authorities, in parallel with UNICEFs ongoing advocacy at all levels to achieve universal birth registration.
The child protection programme faced constraints that included the lack of capacity and continuity in the governance of federal and provincial bodies mandated to protect childrens rights. This added to the low awareness of child protection issues in the public sector. Challenges were also posed by inconsistent legal provisions, low budget allocations and delays in approving child protection policies, and establishing the structures needed to implement them.
and flood emergencies. By the end of 2010, 47 per cent of this funding (US$ 12.5 million) had been received.
PLANS FOR 2011

In 2011, UNICEF and its partners will concentrate on: g Strengthening the capacity of provincial and district authorities to protect children as services and administrative structures become increasingly decentralised under the 18.th Amendment to the Constitution of Pakistan. g Advocating for institutional reform and the creation of a National Authority for Childrens Rights. g Accelerating the legislative reform process and advocating for the inclusion of childrens rights on the agenda of the national and provincial assemblies. g Advocating for the adoption of the Optional Protocols to the Convention on the Rights of the Child. g Assisting the Government of Pakistan to set up a child protection information management system for data collection, analysis and reporting. g Assisting authorities to accredit child protection service providers. g Continuing advocacy and support to increase birth registration. g Advocating for budgeting initiatives for social and child protection, such as conditional cash transfers to provide an incentive for working children and children living on the street to attend school. g Providing protective services for flood affected children during the early recovery phase and relief services for displaced children, especially in Khyber Pakhtunkhwa and FATA. g Assisting government institutions at all levels in preparing to meet future emergencies. This is a key focus as the challenges posed by successive emergencies over the course of recent years threaten to undermine development gains.
EMERGENCY RESPONSE
The 2010 floods exposed millions of children to increased risks of exploitation, abuse, trafficking, separation, and other forms of violence, livelihoods, schools and social services were swept away or inundated. As part of the flood response, UNICEF established 926 static and mobile Child Friendly Spaces and Child Protection Centres, where 223,000 children, 40 per cent of them girls, came to a safe place to play and learn. Almost 18.0,000 children received psychosocial support or were referred to other services. Some 250,000 children and their families were provided with clothes, blankets and other nonfood items. Some 550 separated and unaccompanied children were identified and registered through UNICEF supported facilities and services, and 354 of these children were reunited with their families. UNICEF also supported the establishment of 12 help lines and 369 communitybased child protection committees to ensure that vulnerable children could be identified, referred and monitored at the community level. UNICEF led the Child Protection sub-Cluster of organisations working to provide protective environments for children after the flood emergency. It also co-led the Gender-Based Violence sub-Cluster (with UNFPA) until November 2010. US$ 26.5 million was required in order to provide child protection support for the conflict
PARTNERSHIPS
UNICEFs main partners include the Ministry and Provincial Departments of Social Welfare, the National and Provincial Commissions for Child Welfare and Development, the Ministry of Human Rights, Pakistan Bait-ul-Maal, the Law and Justice Commission, the National Police Bureau, the Federal Investigation Agency, the National Database and Registration Authority, the Planning Commission, Provincial and Federal Childrens Ombudsmans Offices, the National and Provincial Disaster Management Agencies, UNHCR and international and national NGOs. Key donors to UNICEFs child and adolescent protection programme include: Belgium, Canada (CIDA), European Commission (EC), Italy, Japan, Norway, Sweden (SIDA), Spain, Switzerland (Swiss Agency for Development), United Arab Emirates, United States of America (USAID), Consolidated Funds from UNICEF National Committees, Thematic Global Funding Humanitarian Response, Joint Programme UNDP UNMAS UN OCHA. , Donors who contributed to Thematic Funding: Global Humanitarian Response include: Andorran National Committee for UNICEF , Australian National Committee for UNICEF , Austrian National Committee for UNICEF , Belgian National Committee for UNICEF , Canadian National Committee for UNICEF , Czech National Committee for UNICEF , Danish National Committee for UNICEF Finn, ish National Committee for UNICEF French , National Committee for UNICEF German , National Committee for UNICEF Hellenic , National Committee for UNICEF Hong Kong , National Committee for UNICEF Icelandic , National Committee for UNICEF Italian National , Committee for UNICEF Japan National Commit,
tee for UNICEF Korean National Committee , for UNICEF Luxembourg National Committee , for UNICEF Netherlands National Committee , for UNICEF New Zealand National Committee , for UNICEF Norwegian National Committee , for UNICEF Portuguese National Commit, tee for UNICEF Spanish National Committee , for UNICEF Swedish National Committee for , UNICEF Swiss National Committee for UNICEF , , Turkish National Committee for UNICEF United , Kingdom National Committee for UNICEF and , United States Fund for UNICEF .
Seven year old Javid takes a mobile picture of the social worker at the Rahbar Child Help Line in Peshawar. The helpline provides protection for children from all forms of abuse and help separated, missing and unaccompanied children during emergencies in Pakistan. UNICEF Pakistan/2010/ZAK
Case Study: Flash floods carry landmines from conflict zone
Catastrophic flash floods scarred the lives of Tayyab, 4, and his family in more than one horrific way. His father, Mohammad Aslam, is a small farmer in the remote village of Sadra Sharif, located in north-western Pakistans Khyber Pakhtunkhwa Province. In early August, as floodwaters receded in the village, Mr. Aslam went to the fields to assess the damage to his crops. I saw this thing stuck in the field and I brought it home out of curiosity, he remembers. Not even for a moment did it cross my mind that I was bringing destruction to my family. Mr. Aslam had mistakenly brought home an anti-personnel landmine. His son and daughter were badly wounded when the landmine exploded as they were playing with it. I want to play, but it hurts, says Tayyab, whose foot had to be amputated as a result of his injuries. He cries all the time. He has lost a lot of weight and has become aggressive, says
Tayyabs mother, Naseem Bibi. He is totally dependent and has to be carried everywhere.
Lurking menace
The receding waters have unearthed a lurking menace of unexploded ordnance and landmines in Pakistan. The floods carried the explosives into Khyber Pakhtunkhwa from the mountains in neighbouring, conflict-stricken South Waziristan, one of the countrys Federally Administered Tribal Areas. Sixteen cases have been reported during the last two months in flood-affected areas, says UNICEF Child Protection Officer Farman Ali. Seven victims, including women and children, have been injured leading to amputation. In response to the danger, UNICEF and its non-governmental partner, the Sustainable Peace and Development Organization, have expanded their mine-risk education (MRE) programme to flood-affected areas.
Above: Tayyab with his sister, Sadia and parents, Mohammad Aslam and Naseem Bibi, at their home UNICEF Pakistan/2010/Shandana
An effective response
UNICEF initiated and has been leading an MRE Working Group in north-western Pakistan to develop a concerted, effective landmine response at the community level for two years. Today, UNICEF and its partners are now promoting precautionary measures among the flood-affected population in hazardous areas. An important component of the programme is selection and training of volunteers, who also receive first-aid kits for the provision of immediate medical assistance in case of an explosion. If I had information and awareness, this would not have happened to my family says , Mr. Aslam, Tayyabs father. Because he wants to make sure that no one else in his village suffers the pain that his family has endured, Mr. Aslam now assists in organising local MRE sessions taught by a team of social mobilisers.
Floodwaters have contaminated vast areas, says Inayat Ulah, a bomb squad official. MRE training and awareness at the community level is very important, as we do not have the financial and human resources to comprehensively sweep these areas. Due to identification and timely reporting by community members, many lives have been saved.
Volunteers save lives

UNICEF is also linking survivors like Tayyab with appropriate service providers for medical treatment and rehabilitation. At the same time, school sessions are being conducted to help educate children about the dangers. The impact of these interventions has been felt already, with casualties averted due to community volunteers identification of unexploded ordnance, which local bomb disposal squads have defused immediately.
Shabana Bibi, a social mobilizer from the nongovernmental Sustainable Peace and Development Organization, conducts a mine-risk education session with women and children in Budh village, a hazardous area of north-western Pakistan. UNICEF Pakistan/2010/Shandana
InnoVAtIonS
Expenditure 2010 (US$) 14.08 million 1.89 million 1.86 million 10.33 million Total Core UNICEF Resources Resources from donors for development work Resources from donors for emergency and recovery work
THIRD PARTY MONITORING IN HUMANITARIAN SITUATIONS

Contracting third party field monitors during the flood emergency was an important component in UNICEFs emergency flood response. Emergency flood relief needs required UNICEFs operations in Pakistan to be quickly and radically scaled up as existing systems and staff numbers were not sufficient to respond to the humanitarian relief efforts required to meet such a large-scale crisis. Staff coverage was also affected by Pakistans ongoing security situation, which restricts staff movement in some areas, and by local governments resource constraints. Even with implementing partners reporting regularly, UNICEF Pakistan issued competitive bids for third party field monitors in the four flood affected provinces in order to ensure effective monitoring of activities and to improve transparency and accountability. The field monitoring contracts were awarded to specialist research organisations that are not affiliated with UNICEF government or NGO , partners. These organisations provide monitors who are trained on indicators to measure UNICEFs Core Commitments to Children in Emergencies, and can follow-up on the end use of UNICEF supplies. Field monitors visit two to three sites per day, including schools, health units, water systems and communities supported by UNICEF to , perform qualitative and quantitative assessments of affected populations and UNICEF interventions. They also gather information on the needs of children, so that UNICEF can redirect resources to the areas of greatest need. UNICEFs Planning, Monitoring and Evaluation (PME) units in each of the four provincial offices supervise the deployment of the field monitors, and compile the field monitors reports for use by the programme and supply
Opposite: Children laugh while standing outside a UNICEF supported Child Protection Centre in Taru Juba in Nowshera district, Khyber Pukhtunkhwa province. UNICEF Pakistan/2010/Noorani
A health worker vaccinates a child against polio outside his home during Polio National Immunisation Day (NID) in Bhutto Nagar in Landhi town, Karachi. UNICEF Pakistan/2010/Zaidi
sections. The information the third party monitors collect is shared with UNICEF programme staff weekly. At the national level, the PME unit analyses common themes to share with UNICEF programmes nationally and in other provinces. The information is used to identify successes and to assess the implementation and appropriateness of a particular approach. Supply monitoring is emphasised, as is appropriate to the nature of this emergency. The information is then fed into the decision-making process for planning and managing the overall emergency response. Additional examples of third party monitoring include the following activities: g Confirming the progress reports of implementing partners before payment is authorised. g Field-testing, for example the Child Friendly School Standards to support their adaptation. g Identifying communities that were not reached by supplies, or confirming that supplies that arrived were distributed to targeted people and used appropriately.
Third party monitors are an effective performance and quality assurance mechanism in emergencies when there is a sudden and massive increase in the need for monitoring capacity. The third party monitors constitute an independent tool for UNICEF to validate their partners reports, and they provide regular updates on interventions, as well as the changing situation of the population being assisted. Future uses of research organisations as third party monitors will include: g Supporting regular programme monitoring, especially in high-risk areas. g Supporting monitoring by the Clusters coordinating an emergency response. g Informing ongoing work to develop the global Core Commitments to Children in Humanitarian Action performance monitoring system and toolkit. At the end of 2010, performance assessment of the contracted research organisations was done to inform decisions on improving performance
and continuing the initiative in 2011. Best practices were shared between provinces and will feed into future plans.
GAVI SUPPORT FOR STRENGTHENING CIVIL SOCIETY ORGANISATIONS

The Global Alliance on Vaccines and Immunisation (GAVI) has allocated US$ 4.5 million to Pakistan to strengthen cooperation between government and civil society on health care services. In Pakistan, people who live in remote areas often lack access to health care services, as local governments lack the capacity to provide a full complement of health services. In some areas, the security situation is volatile, and access is limited. In Pakistan as a whole, but particularly in remote and insecure areas, the private sector, including civil society organisations (CSOs), are widely trusted to provide essential health services to mothers and children. UNICEF is providing support to a platform bringing government and civil society organisations together at the policy and implementation level. This takes advantage of the strengths of both parties: the government provides maternal and child health services from the central level, while CSOs have close links with the communities in which they work. CSOs work with communities to increase awareness and improve health care service delivery. CSOs have trained health care workers, provided equipment and established immunisation services in remote areas. With support from UNICEF and GAVI, the Ministry of Healths Expanded Programme for Immunisation (EPI) brought together 15
CSOs working on a range of activities, including immunisation and health services for mothers and children, in four provinces. Each organisation has signed agreements stating its activities, targets and budget. Quarterly reports ensure that issues are quickly tackled, and are supplemented by frequent monitoring visits. In addition, CSO staff also receive training. Coordination meetings are attended by CSO staff, UNICEF and representatives from the , federal, provincial and local governments twice a year. At these meetings, CSOs can discuss their progress, concerns and challenges with government counterparts. The result of the inclusion of CSOs is that, instead of working in isolation, they build on and complement government initiatives. This public-private partnership has had several benefits: g Duplication and gaps in coverage are avoided as intervention areas are chosen in consultation. g Accountability is improved as district advisory committees, consisting of CSOs, government staff and community members, link communities with government departments. g Service delivery is coordinated, especially during mass campaigns, such as national immunisation days and Mother and Child Weeks. UNICEF plays the role of the intermediary: managing and transferring funds, reporting results, and bringing together partners. There is great potential for expansion of this approach within Pakistan and in other countries and areas facing similar challenges.
CHILDREN OF THE FLOODS

Throughout the flood emergency response, UNICEF has told the stories of many children who have suffered as a result of losing their loved ones, their homes and their schools. UNICEF went back to find these children to see how they are doing six months after the floods struck. Here are the stories of Sobia and Umair, children who have been reached with the support of the many UNICEF donors and supporters throughout the world.
Above: Sitting on the rubble of his house, Faizan, 5, plays with his sister Alezba, 6, in Taru Jabba Union Council of Nowshera district in Khyber-Pakhtunkhwa province. UNICEF Pakistan/2010/Noorani
Sobias story
October 2010
January 2011
My beautiful daughter will go to school and have a job, says fourteen year old Sobia, looking down lovingly at 10 week old Haseena. I will make sure that she is not married at an early age. She will not suffer like me.
Sobia, then: Pregnant and suffering from severe anaemia and exhaustion, her eyes were completely devoid of any expression. UNICEF Pakistan/2010/Zaidi
Sobia, 14, lives in a camp in Khyber Pukhtunkhwa with her husband and in-laws. The young expectant mother has never been to school and was married when she was barely thirteen. It is hard to believe that she is nearly eight months pregnant, but that is what her medical reports state. Sobia is living in a tent with her young husband, as well as his widowed father, and younger siblings. Very quiet and withdrawn, she is too shy to speak but the ravages of the floods are evident from her face. Suffering from severe anaemia and exhaustion, her eyes are completely devoid of any expression. Her father-in-law, Noor Uddin tells us, My wife died last year and there was no one to look after my young children. I married off my eldest son, 18. year old Rooh Ullah so that his wife could look after the home and my children. With tears in his eyes he adds I have lost everything. Whatever I had made for my sons wedding was also lost. Many families have gone back and are rebuilding their homes but I am a poor man and have no resources to restart my life. I dont know how I will look after my family .
Sobia, her young husband, Rooh Ullah and his family had lost all their household belongings when their rented house in Charsadda in Khyber Pakhtunkhwa province was washed away last year, in the worst monsoon floods to have ever hit the country. Her family had to move six times in the past six months, taking refuge in three different camps and two different rented accommodations. They are now living in a room provided by their relatives.
Sobia, then: Pregnant and suffering from severe anaemia and exhaustion, her eyes were completely devoid of any expression. UNICEF Pakistan/2010/Zaidi
Sobia, now: Sobia and her husband Rooh Ullah speak about their dreams for their new family. UNICEF Pakistan/2010/Zaidi
During this difficult time, child psychologist Nida Khan from Job Creation and Development Society (JCDS) an NGO and UNICEF partner has played a critical role in Sobias life. Her regular psychosocial support and her organisations strong child protection monitoring network ensured that Sobia could cope with the traumatic experiences and had access to life saving medical services. Her daughter was delivered safely in a public sector hospital in the nearby provincial capital Peshawar. The family was constantly on the move. It was very difficult to keep track and support them. But I am so happy that all the hard work is paying off. The young couple is coping well
and looking ahead to a prosperous future with their daughter, says Nida Khan. The young parents were provided intensive psychosocial counselling. Having a baby at such a young age and under very difficult circumstances has been very traumatic for Sobia as well as Rooh Ullah, who started taking drugs adds Ms. Khan. , Through the UNICEF-supported Child Protection monitoring and referral system, the young man is now in a drug rehabilitation programme. I feel much better. I go to work and provide for my wife and daughter says Rooh Ullah proud, ly. I hope one day I will build a home where we can live safely he adds. ,
Umairs story
them. Umair survived but his mother was hurt and later died because of complications as she was suffering from Hepatitis C, says Ms. Sultan.
Umair was identified in the camp by our Child Protection Monitor. He was withdrawn and mute and would turn very aggressive if approached. With intensive psychosocial support, including counselling sessions and play therapy at the UNICEF supported Child Friendly Space in Football Ground Camp Prang, his condition has improved.
Umair, then: Severely traumatised because of the loss of his home and mother, Umair was aggressive and anxious. UNICEF Pakistan/2010/Zaidi
January 2011
In a nearby UNICEF-supported Child Protection Centre, seven year old Umair plays happily. Umair, whose father died a few years back, now lives with his maternal grandmother and extended family.
October 2010
Seven year old Umair sits with Nighat Sultan, a child psychologist, in a child friendly space in a football ground camp in Charsadda district, Khyber-Pakhtunkhwa province, Pakistan. Umair is severely traumatised. He lost his mother in the recent floods, says Ms. Sultan. Umair and his mother, Uzlefat, a widow, lived with her mother and brothers in Kharbela village, Union Council Prang, an area badly damaged by the floods. Umair lost his father a few years back but his mother and maternal relatives took care of him. He was studying in Grade 2 before the devastating floods completely destroyed the family house and his life. While Umair and his mother were still inside the mud house, the roof collapsed on top of
Umair, now: After play therapy and counseling sessions his condition has improved. He now goes to school. UNICEF Pakistan/2010/Zaidi
Sobia, now: Sobia and her husband Rooh Ullah speak about their dreams for their new family. UNICEF Pakistan/2010/Zaidi
Umair was very disturbed when he returned to the village. His small mud house was completely razed to the ground. He was phobic, withdrawn and aggressive says Sania Gul, a child , psychologist at the centre. But look at him now. Its hard to believe it is the same Umair. He goes to school now and comes to the Center regularly, where through play therapy and group counselling his emotional conditional has improved remarkably adds , Ms. Gul.
I like drawing and playing on the swings says , Umair. I miss my mother but love my grandmother. I will become a doctor and look after her he adds. It has been very difficult looking , after him says the old Shamuna Fazle Maula, , Umairs grandmother, whose eyesight has been badly affected after floods. I love him dearly, as he is the only reminder of my daughter. I hope I live long enough to see him stand on his feet, she adds tearfully.
Opposite: Umair talks about his drawing to a UNICEF staff. He actively participates in various activities of the Child Friendly Space (CFS) in village Kharbela, Union Council Prang in Charsadda district, Khyber-Pakhtunkhwa province.
ReSoURCe MoBILISAtIon
FINANCIAL RESOURCES
For 2010, the UNICEF Executive Board approved resource mobilisation targets, not including emergency appeals, of US$ 29.5 million for health and nutrition, US$ 3 million for WASH, US$ 15.2 million for basic education, US$ 3.8. million for child protection, and US$ 6.2 million for cross-sectoral work. Almost all of this was to be mobilised under UN Joint Programmes. However, due to two large-scale emergencies in 2010, these targets were not reached. Instead, UNICEF under two humanitarian , appeals endorsed by the government, raised a large amount of emergency funds outside of the One UN Joint Programme framework. By the end of the year, the 2010-2011 budget for emergency and regular resources amounted to US$ 358..3 million, compared to US$ 102.8. million in December 2009. Of this, US$ 242 million was in humanitarian funds. The first emergency appeal was the Pakistan Humanitarian Response Plan, which focused on assisting internally displaced persons (IDP) in the north-west of the country. This was operational throughout 2010, and by the end of the year, UNICEF had raised US$ 26.2 million to support affected IDPs. The scale of the 2010 floods, combined with regular programme requirements, resulted in a need for immediate, large-scale resource mobilisation, which the government approved in the Pakistan Flood Emergency Response Plan on 11 August 2010. During August and September, senior UN and UNICEF officials, including UN Secretary-General Ban Ki-moon, UNICEF Executive Director Anthony Lake, UNICEF Regional Director Dan Toole and UNICEF Emergency Operations Director Louis-Georges Arsenault visited flood affected areas and reinforced the appeal for support. As the flooding continued for nearly six weeks, with millions more displaced or affected, it became clear that the original appeal would have to be revised. This resulted in the launch of the Pakistan Flood Emergency Relief and Early Recovery Response Plan in November, totalling US$ 1.93 billion the largest-ever humanitarian appeal in response to a natural disaster. UNICEFs own appeal was revised from US$ 47 million to US$ 252.3 million to support .3 activities through the end of July 2011. By the end of 2010, UNICEF had received US$ 168..4 million, with an additional US$ 22.9 million
Opposite: Ahsanullah, 3, sits on a donkey cart that carries containers of water collected for reconstruction from a nearby canal in flood affected Waruki Kili village of Tank district in Khyber-Pakhtunkhwa province in Pakistan. UNICEF Pakistan/2010/Noorani
in pledges, totalling US$ 191.3 million for flood relief activities. The remaining gap in funding amounted to US$ 61 million.
HUMAN RESOURCES
The scale of the flood emergency required a significant and immediate increase in national and international staff, including bringing in the Regional Director for South Asia as Special Representative for the flood response. In less than three months, the Pakistan Country Office staff expanded by 8.8. per cent through a combination of temporary posts, consultancies and surge staff from other offices and organisations. Also, dozens of existing staff were re-deployed to flood affected areas. The response benefited greatly from Surge capacity from standby partners, including CANADEM, Danish Refugee Council, Icelandic Crisis Response Unit, iMMAP , Oxfam GB, Norwegian Refugee Council and RedR Australia.
SUPPLIES
Supply operations in 2010 far exceeded anything previously processed by UNICEF Pakistan. In addition to vaccine procurement for the government by UNICEFs Copenhagen office, US$ 49.4 million in offshore procurement and US$ 40.9 million in local procurement also took place, and many donors contributed assistance in kind. There were major challenges to supply operations during the flood response; in particular, the Peshawar warehouse was flooded, which led to the loss of a large amount of contingency stock and new temporary warehouses and logistical arrangements had to be quickly established. Programme Mother and Child Health Care Water and Sanitation Primary Education Child Protection Monitoring and Evaluation Cross-Sectoral and Operational Costs Total
Table 1: Total Expenditure 2010 by Programme Area

Amount (US$) 71,159,152 51,717 ,455 38.,100,745 14,323,993 2,711,612 12,269,995 190,282,952
Table 2: Total Funding Allocations 2010 by Donor

Donor Australia Austria Belgium CIDA/HAND CIDA/IHA Canada Denmark Finland Ireland Italy Japan Kuwait
Amount (US$) 20,094,626 1,360,540 2,8.06,011 278.,979 1,8.99,340 5,679,573 4,405,250 2,099,8.95 318.,015 1,063,041 12,559,000 250,000
Liechtenstein Luxembourg Netherlands New Zealand Norway Pakistan Republic of Korea Russian Federation SIDA - Sweden Saudi Arabia South Africa Spain Switzerland United Kingdom USA OFDA USA CDC USA USAID Total
97 ,466 705,273 20,08.1,541 727 ,8.00 12,244,8.90 1,023,233 400,000 1,000,000 2,140,900 4,665,330 137 ,419 4,667 ,98.4 8.50,000 14,035,950 19,396,977 441,362 11,717 ,692 147,148,087
Table 3: Total Funding Allocations 2010 by UNICEF National Committees

Donor Andorran National Committee for UNICEF Australian Committee for UNICEF Austrian Committee for UNICEF Belgian Committee for UNICEF Canadian UNICEF Committee Czech Committee for UNICEF Danish Committee for UNICEF Finnish Committee for UNICEF French Committee for UNICEF German Committee for UNICEF Hellenic National Committee Hong Kong Committee for UNICEF Iceland National Committee for UNICEF Italian National Committee Japan Committee for UNICEF Korean Committee for UNICEF Luxembourg Committee for UNICEF Amount (US$) 20,408. 5,768.,398. 405,58.0 2,38.5,760 2,459,255 11,111 2,040,949 8.55,650 5,563,327 10,573,907 204,8.19 128.,710 8.3,535 6,332,315 3,8.92,125 1,294,960 127 ,065
Netherlands Committee for UNICEF New Zealand Committee for UNICEF Norwegian Committee for UNICEF Portuguese Committee for UNICEF Spanish Committee for UNICEF Swedish Committee for UNICEF Swiss Committee for UNICEF Turkish National Committee for UNICEF UNICEF Ireland UNICEF Slovenia United Kingdom Committee for UNICEF United States Fund for UNICEF Total
7 ,123,592 290,411 1,326,8.92 317 ,662 1,594,8.91 1,919,649 1,572,743 16,8.92 430,910 153,106 10,305,538. 8.,645,604 75,845,764
Table 4: Total Funding Allocations 2010 from Other Donors

Donor Agfund Bill and Melinda Gates Foundation European Commission/EC European Commission/ECHO International online donations Micronutrient Initiative Red Crescent Society UAE Rotary International The GAVI Fund UNAIDS UNDP - JP UNDP - USA UNICEF Belgrade UNICEF Argentina UNICEF Bhutan UNICEF China UNICEF Guyana UNICEF India UNICEF Malaysia UNICEF Pakistan UNICEF Philippines UNICEF Russian Federation UNICEF Thailand Amount (US$) 50,000 3,38.6,707 105,28.6 9,667 ,08.6 245,8.58. 555,626 610,257 4,573,666 1,548.,973 105,601 1,351,121 2,628.,054 78.0 5,08.8. 642 1,68.1 147 ,762 2,932 31,911 8.00,000 2,498. 1,714 304,236
UNICEF Thailand EAPRO UNICEF United Arab Emirates UNMAS - New York UNOCHA WHO - Geneva Total
2,323 155,924 38.9,091 10,042,479 459,979 37,177,275
Table 5: Major Donors to UNICEF in PFRERP for Flood Emergency

Donor AgFund Andorran National Committee for UNICEF Australia Australian Committee for UNICEF Austria Austrian Committee for UNICEF Belgian Committee for UNICEF Belgium Canada Canadian Committee for UNICEF CERF Czech Committee for UNICEF Danish Committee for UNICEF European Commission Finland Finnish Committee for UNICEF French Committee for UNICEF German Committee for UNICEF Hellenic Committee for UNICEF Hong Kong Committee for UNICEF Iceland Committee for UNICEF International online donations Ireland Irish Committee for UNICEF Italian Committee for UNICEF Italy Japan Japan Committee for UNICEF Korean Committee for UNICEF Kuwait Amount (US$) 50,000 20,408. 15,111,570 5,768.,398. 1,360,540 405,58.0 2,38.5,760 2,628.,120 1,8.99,340 2,453,327 7 ,964,554 11,111 2,001,109 5,256,240 1,292,355 8.55,650 5,563,327 10,504,095 204,8.19 128.,710 8.3,535 245,8.58. 38.1,195 430,910 6,332,315 1,090,570 20,000,000 2,000,000 1,294,960 250,000
Liechtenstein Luxembourg Luxembourg Committee for UNICEF Netherlands Netherlands Committee for UNICEF New Zealand New Zealand Committee for UNICEF Norway Norwegian Committee for UNICEF Portuguese Committee for UNICEF Republic of Korea Russia Slovenia Committee for UNICEF South Africa Spain Spanish Committee for UNICEF Sweden Swedish Committee for UNICEF Swiss Committee for UNICEF Turkish Committee for UNICEF UAE Red Crescent UNICEF Argentina UNICEF Belgrade UNICEF Bhutan UNICEF China UNICEF EAPRO UNICEF Guyana UNICEF India UNICEF Malaysia UNICEF Pakistan UNICEF Philippines UNICEF Russia UNICEF Thailand UNICEF UAE United Kingdom United Kingdom Committee for UNICEF United States United States Fund for UNICEF Total
97 ,466 705,273 127 ,065 9,230,768. 6,8.76,8.58. 727 ,8.00 290,411 12,244,8.90 1,326,8.92 317 ,663 400,000 1,000,000 153,106 137 ,419 4,667 ,98.4 1,426,8.24 1,38.7 ,300 1,919,649 1,202,8.77 210,440 610,257 5,08.8. 78.0 642 1,68.1 2,323 152,421 2,932 31,911 8.00,000 2,498. 1,714 304,236 155,924 14,035,950 9,710,752 21,203,152 8.,8.43,968. 198,291,269
Table 6: Major Donors to UNICEF in PHRP to support IDPs

Donor Australia Belgium Canadian Committee for UNICEF Central Emergency Response Fund (CERF) Denmark European Union/ ECHO Finland German Committee for UNICEF Italy Japan Japan Committee for UNICEF Netherlands Saudi Arabia Sweden United Kingdom Committee for UNICEF United States Fund for UNICEF United States of America (USAID/OFDA) UNMAS WHO Total Amount (US$) 1,792,120 170,940 5,928. 2,295,8.18. 1,8.8.3,450 5,602,240 8.07 ,540 69,8.12 3,463,8.46 3,042,8.05 1,8.92,125 7 ,479,694 4,665,330 753,600 51,472 45,209 3,373,8.25 38.9,091 459,979 43,824,823
Table 7: Major Donors to UNICEF for UN Delivering as One Programme

Donor United Kingdom (DFID) Norway Programmable Amount (US$) 1,8.77 ,999 1,8.34,8.58.
ACRonYMS
ART CCC CERF CP CSO EC EMIS EPI ERRA FAO FATA GAVI IDP KP McRAM MDG MICS MRE NDMA NGO OCHA PAK PDMA PFRERP PHRP PME PPTCT UN UNDAC UNESCO UNFPA UNICEF UXO WASH WFP WHO Anti-retroviral Treatment Core Commitments for Children In Emergencies Central Emergency Response Fund (United Nations) Child Protection Civil Society Organisation European Commission Education Management Information System Expanded Programme on Immunisation Earthquake Reconstruction and Rehabilitation Authority Food and Agriculture Organization Federally Administered Tribal Areas Global Alliance on Vaccines and Immunisation Internally Displaced People Khyber Pakhtunkhwa Multi-Cluster Rapid Assessment Mechanism Millennium Development Goal Multiple Indicator Cluster Survey Mine Risk Education National Disaster Management Authority Non-Governmental Organisation Office for the Coordination of Humanitarian Affairs (United Nations) Pakistan Administered Kashmir Provincial Disaster Management Authority Pakistan Flood Relief and Early Recovery Plan Pakistan Humanitarian Response Plan Planning, Monitoring and Evaluation Prevention of Parent to Child Transmission United Nations United Nations Disaster Assessment and Coordination United Nations Educational, Scientific and Cultural Organization United Nations Population Fund United Nations Childrens Fund Unexploded Ordnance Water, Sanitation and Hygiene World Food Programme World Health Organization
United Nations Childrens Fund Pakistan Country Office P Box 1063, Islamabad .O. Tel: +92-51-209-7700 Fax: +92-51-209-7799 www.unicef.org/pakistan UNICEF 2011 Cover photo credit: UNICEF/PAK/2010/Noorani

UNICEF Pakistan 2010 Annual Report - Low Res

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UNICEF Pakistan 2010 Annual Report - Low Res

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ANNUAL REPORT 2010

ANNUAL REPORT 2010

Dan Rohrmann Representative UNICEF Pakistan

ANNUAL REPORT 2010 | 3

2010: YeAR In ReVIeW

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MAteRnAL AnD CHILD HeALtH CARe

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MOTHERS AND NEWBORNS

HIV AND AIDS

ANNUAL REPORT 2010 | 13

PLANS FOR 2011

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Mobile units and stabilisation centres

Demand exceeds capacity

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WAteR, enVIRonMent AnD SAnItAtIon

7 UNDAC. 2010. Multi-Cluster Rapid Assessment. Available at: http://www.pakresponse.info/LinkClick.aspx?fileticket= 7cXrpRTKX8.M%3d&tabid=8.6&mid=526.

ANNUAL REPORT 2010 | 21

the floods. UNICEF promoted improved

PLANS FOR 2011

ing them there, is thus doubly challenged by poverty and violence.

ANNUAL REPORT 2010 | 25

ANNUAL REPORT 2010 | 27

PLANS FOR 2011

ANNUAL REPORT 2010 | 33

Window of opportunity for education

Students eager to learn

ANNUAL REPORT 2010 | 35

ANNUAL REPORT 2010 | 37

ANNUAL REPORT 2010 | 39

PLANS FOR 2011

ANNUAL REPORT 2010 | 41

Case Study: Flash floods carry landmines from conflict zone

Volunteers save lives

ANNUAL REPORT 2010 | 43

THIRD PARTY MONITORING IN HUMANITARIAN SITUATIONS

ANNUAL REPORT 2010 | 45

GAVI SUPPORT FOR STRENGTHENING CIVIL SOCIETY ORGANISATIONS

ANNUAL REPORT 2010 | 47

CHILDREN OF THE FLOODS

ANNUAL REPORT 2010 | 49

ANNUAL REPORT 2010 | 51

ANNUAL REPORT 2010 | 55

Table 1: Total Expenditure 2010 by Programme Area

Table 2: Total Funding Allocations 2010 by Donor

Table 3: Total Funding Allocations 2010 by UNICEF National Committees

ANNUAL REPORT 2010 | 57

Table 4: Total Funding Allocations 2010 from Other Donors

2,323 155,924 38.9,091 10,042,479 459,979 37,177,275

Table 5: Major Donors to UNICEF in PFRERP for Flood Emergency

ANNUAL REPORT 2010 | 59

Table 6: Major Donors to UNICEF in PHRP to support IDPs

Table 7: Major Donors to UNICEF for UN Delivering as One Programme

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