A Report Card for Haiti and the World: UNICEF 2007 Progress for Children Report

I would argue that the measurement of progress in a country is not the quantity of money a person has, not the ammount of technology possessed, but rather the ability of that country to meet the needs of its children.  The United Nations Children's Fund (UNICEF) has just released a report which suggests we have a long way to go, for Haiti and the world.

What is UNICEF?  UNICEF is the United Nations Agency mandated for meeting the needs, humanitarian and developmental, of children worldwide.  In Haiti they play a number of important roles. They advocate for social change, assist in carrying out immunization campaigns and help to reope defunct health care facilities.  They also build schools, equip them with water and sanitation facilities, and incorporate hygiene promotion messages into the curriculum.  In disasters, they are an important responder providing immediate needs to children such as food and drinkable water while helping them meet longer term needs such as counseling and identification.

UNICEF has a number of global functions and this is where the 2007 Report on Progress for Children comes in.  These comprehensive reports serve as a national and global "report card", and use the  Millenium Development Goals as a reference.

The MDGs have been committed to worldwide, but will and resources devoted to meeting them have varied wildly.  

Very quickly, the MDGs are:  

1) Eradicate Extreme Poverty and Hunger

2) Achieve Universal Primary Education

3) Promote Gender Equality and Empower Women

4) Reduce Child Mortality

5) Improve Maternal Health

6) Combat HIV/AIDS, malaria, and other diseases

7) Ensure environmental stability

8) Develop a Global Partnership for Development

Progress on each of these goals would benefit Haiti.  For more details on how Haiti and other countries are doing, you can check out the MDG monitor.

If we are talking about meeting the needs of children, we have to look at what is causing children to get sick and die.  The leading cause of mortality in children again goes to, not HIV and not malaria, but pneumonia. Pneumonia can have many underlying factors - being malnourished, poor hygiene, having another disease, etc.  It is important that a child with pneumonia be brought to a health center, diagnosed early, and treated with an appropriate antibiotic.

Why wouldnt a child with pneumonia receive treatment?  If a family doesnt have access to a facility that will treat the child for free, this may delay care-seeking. If the facility is free, but is extremely far away, this is another complication.  Disturbingly, it may not be enough to bring the child to a health facility -  the report states that 25% of health care providers cannot even correctly diagnose pneumonia...and if you dont know what it is, you can't treat it.

Three percent of children in Haiti with pneumonia have access to professional treatment.  By way of comparison, it is 32% in Somalia and 39% in the Central African Republic.  Ouch.  Clearly, we have to do a better job of making facilities physically accessible and making sure they have properly trained providers with the skills and resources to diagnosis and treat.

I'm going to be noting a lot of bleak data from this report, but it is not all bad.  Awareness in Haiti of the causes and prevention of HIV is growing steadily.  As a result, men and women are using condoms more frequently during higher risk sexual encounters.  For  women, condom use during higher risk encounters increased to 29% in 2006 versus 19% in 2002 and for men it was 43% up from 30%.  This seems to reflect the unequal balance of power between men and women in Haitian society.  But raising awareness is key - particularly as HIV "feminizies".  In other words, women are more vulnerable to, and are becoming infected with HIV on a greater scale than their male counterparts.  And as we've mentioned before, national HIV prevalence continues to decline. 

Concerning domestic vilence, the % of girls 15-49 who reported that it was acceptable for the husband to beat his wife in certain circumstances decreased from 40% in 2002 to 29% in 2006.  This is low compared to some countries in the high 80s (what's going on with Mali??) but anytime a woman feels that it is all right for someone to physically abuse her, this is unacceptable.  More progress clearly needed here.

We've written extensively on malnutrition, so won't go into too many details, except to say that 22% of children under five are underweight, severe malnutrition is still an issue, and no progress has been made toward the MDGs.  

Concerning education, only 50% of children are enrolled in primary school.  The percentage is about the same for both girls and boys.  No progress has been made against the MDGs here, but we wish there would be.  Education is at the core of solving many of Haiti's social problems.

We knew sanitation was going to be low.   Sanitation simply means the lowest cost technology for ensurign hygienic disposal of excreta.  It includes public sewer connection; septic system connection; pour-flush latrine; simple pit latrine; ventilated improved pit latrine. It doesnt have to be a toilet!  Regardless, in 1990, 24% of Haitians haad access to improved sanitation.  The figues rose to 30% in 2004.  The MDG Goal is 62% but, at the current rate, it will be about 75 years before we meet it.

If we are talking about sanitation, we must also touch on water which is central to maintaining good health.  Ever had a drink of water from an untreated water source in Haiti?  Then you probably know what I am talking about. The reports measures use of improved water sources - access (within one kilometer) to an adequate amount (20 liters/person/day) of water such as a household connection, public standpipe, borehole, protected well or spring, and rainwater collection.  Here is what doesn't count - vendors, tanker trucks, and unprotected wells and springs.  The MDG goal set for Haiti is 75% - we were at 47% in 1990 and have reached 54% in 2006.   Progress is being made but for something so fundamental to good health, it is being made much too slowly.

Only 5% of children receiving malarial drugs when having a fever.  In a perfect world, we could either use a rapid diagnostic test or a lab test (by a well trained microscopist) to determine if the child had malaria and then treat.  The reality is that the human and material resources to do that often aren't in place - so the golden rule is that if a child has a fever and lives in a malaria endemic area, you treat them because untreated malaria could kill them.  Unlike many parts of the world, Haiti is not resistant to chloroquine.....which is inexpensive.

The Maternal Mortality Ratio is comprable to many Sub Saharan African countries at 670.  Equatorial Guinea is 680 for example.  Against all odds, child mortality (kids under five) is declining, from 152 in 1990 to 80 in 2006.  By 2015, the goal is 50.  I hope we make it.  

This was a long blog for a long report.  What I take away from it though is that, when it comes to health and education, we are still working on fundamentals and there is much to be done.  For the most part, it is not that there is no progress - but that progress is not being made fast enough for a country sorely in need of improved health care and access to education.   Acceleration requires the political will of the government, the good will of the donor community, the engagement of civil society, and I would add, the skills and resources of the Diaspora.

We hope for more progress in the upcoming year, both for Haiti and the world. Welcome your thoughts.

Bryan