STRATEGIES FOR CHILDREN IN THE 1990s
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A UNICEF Policy Review
STRATEGIES FOR CHILDREN IN THE 1990s
UNICEF
unicef
United Nations Children’s Fund
A UNICEF POLICY REVIEW
STRATEGIES FOR CHILDREN IN THE 1990s
UNICEF
UNICEF
New York, N.Y., USA
Copyright (C) 1989
United Nations Children’s Fund
3 UN Plaza
New York, N.Y. 10017
USA
ISSN 1013-3194
May 1989
This Policy Review represents a slightly expanded version of the
document E/ICEF/1989/L.5, 7 February 1989, originally presented to the UNICEF
Executive Board in April 1989. The decision 1989/5 was adopted by the UNICEF
Executive Board on the recommendation of its Programme Committee.
All correspondence should be addressed to:
Dr. Pierre-Emeric Mandi
Chief, Research, Programme Publications and Library Section,
Programme Division
Telex: 175989TRT
Phone: 1-212-326-7062
Facsimile: 1-212-326-7096
CONTENTS
Page
SUMMARY
5
I.
BACKGROUND
7
II.
EVOLUTION OF THE SITUATION OF CHILDREN IN THE 1980s
13
III.
IV.
Children in industrialized countries
16
THE UNMET NEEDS OF CHILDREN
19
Critical poverty
19
Mortality
19
Maternal health
20
Nutrition
20
Water and sanitation
20
Education
20
Children in especially difficult circumstances
21
GOALS FOR THE YEAR 2000
23
The foundation of development: children first
24
Major goals for child survival, development and protection
25
Specific and sectoral goals
26
Maternal health
Child health
Nutrition
Safe water supply and environmental sanitation
Basic education
Children in especially difficult circumstances
26
27
28
29
29
30
Goals for children In industrialized countries
31
The Convention on the Rights of the Child
32
V.
STRATEGIES FOR MEETING THE GOALS FOR THE YEAR 2000
Country- and region-specific targets
33
Going to scale
34
Reaching the unreached and hard to reach
35
Advocacy and social mobilization
35
Empowering women for development
36
Building an economic base for meeting human goals
37
Alleviation of critical poverty
Debt relief
Trade and commodity agreements
Increased resource flows
Growth in the industrialized countries
VI.
VII.
33
37
37
38
38
39
Development with a human face
39
Sustainable development and the environment
40
Monitoring and evaluation
41
PROCESS OF STRATEGY FORMULATION
43
Participation in the preparatory process for the Fourth UN
Development Decade
43
Regional and subregional consultations
44
Country-specific consultations
44
UNICEF EXECUTIVE BOARD DECISION 1989/5
47
SUMMARY
This Policy Review presents the views and proposals of the United Nations
Children’s Fund (UNICEF) for development goals and strategies for the 1990s, the
proposed Fourth United Nations Development Decade (DDIV). The proposals have
been derived from an analysis of the experience of earlier development decades,
recommendations of several international commissions and conferences, and the
medium and longer term plans and perspectives of various United Nations agencies,
including UNICEF.
The proposed goals and strategies reflect the thinking of UNICEF as to how the
needs of children should be addressed in an international development strategy.
These do not necessarily constitute an agenda for UNICEF as such. As UNICEF is
one among many other actors involved in promoting the development and well-being
of children, the scope of its actions must necessarily be more limited than the wider
range of goals proposed for the international community in this paper. The proposed
goals and strategies, approved by the UNICEF Executive Board, will therefore con
stitute the broad framework for children and development which will be used for con
sultations with Governments and other partners in development as well as serving as
the UNICEF contribution to the work of the UN in constructing the international
development strategy for the 1990s.
5
A follow-up report to the Executive Board at its 1990 session will present the Ex
ecutive Director’s proposals for a UNICEF operational strategy to help implement
some of these goals and strategies in which UNICEF feels it can make a particular
contribution.
Following a brief review of the past development decades in section I, an over
view of the evolution of the situation of children in the 1980s is presented in section II.
Section III summarizes the unmet needs of children which sets the context for the
goals for the year 2000 in section IV. The report then goes on in section V to suggest
some strategies to achieve the goals and, in section VI, suggests how these goals and
strategies should be adapted to the different country and regional realities.
The report proposes that the development of human capabilities and meeting
basic human needs should be the underlying theme of the Fourth UN Development
Decade.
It is further suggested that the survival, development and protection of
children should be both a means and an end of a strategy of development with a
human face.
Several strategies are outlined to reach the ambitious goals proposed for the
year 2000. These include a commitment to environmentally sound and sustainable
development policies, building the necessary economic base for meeting human
needs, reaching the heretofore unreached, advocacy and social mobilization, and em
powerment of women in development.
6
I. BACKGROUND
In its resolution 1988/17 (E/ICEF/1988/13), the Executive Board requested the
Executive Director to present to the Board’s 1989 session "a report on the goals, tar
gets and elements of a global strategy for the well-being of children as an essential
part of overall development", and a subsequent report to the 1990 Board session that
would include both the global strategy for children and a UNICEF operational strategy
for the 1990s. The Board also recommended that UNICEF work with countries and
Governments directly, and at regional and sub-regional level, to prepare these
strategies which, together with the process of their preparation, would allow UNICEF
to provide input to the formulation of an international development strategy for the
proposed Fourth UN Development Decade: 1991-2000.
Pursuant to that resolution, the Executive Director held consultations with senior
staff, both at headquarters and in the field, to arrive at the present report. In the
process, UNICEF was guided by the Executive Board’s favourable review of the ideas
contained in the report of the Executive Director, "Children in a global context: Restor
ing momentum for human development in the 1990s" (E/ICEF/1988/2, Part I); the
Medium-term plan for the period 1987-1991 (E/ICEF/1988/3), which contained a sec
tion on goals towards the year 2000, and the 1988 State of the World's Children report.
In preparing this report, UNICEF also benefited from and drew on the goals
enunciated in the "Talloires Declaration" of the International Task Force on Child Sur
vival and Development; the views of WHO/UNICEF Joint Committee on Health Policy
(JCHP), the review of the International Drinking Water Supply and Sanitation Decade
(IDWSSD), the planned UNESCO/World Bank/UNICEF international conference on
Education for All by the Year 2000, and UN General Assembly resolutions 42/186 and
42/187 on the "Environmental Perspective to the Year 2000 and Beyond" and other
recommendations contained in the report, "Our Common Future", issued by the World
Commission on Environment and Development.
7
A REVIEW OF SELECTED GOALS AND ACHIEVEMENTS OF THE
FIRST, SECOND AND THIRD UNITED NATIONS DEVELOPMENT DECADES
GOALS
First
development
decade
Second
development
decade
ACHIEVEMENTS
Third
development
decade
Indicator
1960
1970
1980
580M
730M
1985/86
HEALTH AND NUTRITION ■
Accelerate
elimination
of hunger
Accelerate
elimination
of disease
Improve nutrition
Eliminate hunger
and malnutrition
Population with less than
90% of required calorie
intake: (Developing countries
minus China)
Mount a
world-wide effort
to eradicate one
or more diseases
Immunization by
1990
Establish a
health services
infrastructure for
prevention,
treatment and
health promotion
Primary health care:
Essential drugs
Education of
parents
Immunization
Environmental
health
Immunization of children
under-one (%):
BCG
DPT3
Polio3
Measles
Tetanus toxoid (for women)
(China not included in 1981)
Safe water
supply coverage
target to be
specified by
each country
Safe water and
sanitation for all by
1990
Access to water (%):
Urban
Rural
Life expectancy of
60 plus
Life expectancy (years):
LICs
LICs (excl. China and India)
Middle-income countries
IMR of poorest less
than 120 by 1990
and IMR in all
countries less than
50 by 2000
IMR:
LICs
LICs (excl. China and India)
Middle-income countries
Smallpox
eradicated
1977
Notes:
BCG: anti-tuberculosis vaccine
DPT3: three doses of combined
diphtheria/pertussis/tetanus vaccine
excl.: excluding
GDP: gross domestic product
GNP: gross national product
8
31
27
24
18
14
75*
67*
68*
61*
39*
65
13
73
32
74
42
41
41
50
48
44
55
57
48
60
61
52
63
165
163
126
127
150
104
94
130
80
69
106
65
IMR: infant mortality rate
LICs: low-income countries
ODA: overseas development assistance
OECD: Organisation for Economic Co-operation
and Development
*1988
ACHIEVEMENTS
GOALS
Second
development
decade
First
developmenlt
decade
Third
development
decade
Indicator
1960
1970
1985/86
1980
EDUCATION
■
Accelerate
elimination
of illiteracy
Substantial
reduction
illiteracy
Eradication or
considerable
reduction of
illiteracy
Literacy (%):
LICs
LICs (excl. China and India)
Middle-income countries
34
23
48
45
29
48
52
36
65
Universal
primary
enrolment
by 1990
Universal primary
enrolment by 2000
Primary enrolment (gross)(%):
LICs
LICs (excl. China and India)
Middle-income countries
80
38
75
86
59
87
93
70
100
99
67
104
0.51
0.34
0.37
0.35’
(1980/86)
Free education
at all levels
Non-formal
education
Equitable access
to education
ECONOMY ■
GDP
growth of
5%
Increase flow
ODA 1% of
GNPby 1972
ODA 0.7% by 1985
and 1% thereafter
ODA (%):
OECD GNP %
(1960/70)
(1970/80)
GDP growth of
6%
GDP growth of
7%
GDP growth (%):
LICs
LICs (excl. China and India)
Middle-income countries
4.4
4.4
5.9
4.6
3.5
5.6
7.5
2.9
2.3
Growth of
manufacturing
8%
Growth of
manufacturing
9%
Manufacturing growth (%):
LICs
LICs (excl. China and India)
Middle-income countries
5.5
6.3
7.3
3.7
3.6
6.4
11.2
4.8
2.5
Growth of
agriculture 4%
Growth of
agriculture 4%
Agriculture growth (%):
LICs
LICs (excl. China and India)
Middle-income countries
2.2
2.7
3.5
2.2
2.2
2.9
4.9
2.0
2.3
Based on GA Resolutions 1710 (XVI) United Nations Development Decade, 2626 (XXV) International
Development Strategy for the Second United Nations Development Decade and Resolution 35/56
International Development Strategy for the Third United Nations Development Decade. Figures are based
on World Bank and UNICEF sources.
9
*1987
The goals and strategies recommended in this report will serve, among other
uses, as the UNICEF input to the Fourth UN Development Decade. Thus, it would be
appropriate to briefly review the experience of the previous UN Development Decades
to draw some conclusions and lessons for the future.
An overview of the goals and achievements of the First, Second and Third UN
Development Decades, especially in areas of direct relevance to children, is presented
in table 1.
Concern for social development (as can be inferred from the table) has become
more prominent in the successive development decades, with the later decades
specifying quantitative targets that had been mentioned only as general statements in
the preceding decade.
Although, in contrast to economic development, the targets for social develop
ment were fairly general during much of the First and the Second Development
Decades, the progress attained by most developing countries was actually far more
significant than their achievements in the economic field, when compared to the his
torical experience of the industrialized countries. For example, for developing
countries as a whole, between 1950 and 1987, infant mortality, a sensitive indicator of
health, nutrition and education, dropped from 188 to 80 per 1000 live births. It had
taken the industrialized countries more than 100 years to accomplish a similar reduc
tion when they were at the corresponding level of development a century ago. Similar
progress was achieved by developing countries in increasing life expectancy, literacy,
and school enrolment rates.
On the economic side, however, the picture is more sombre. Whereas each suc
cessive development decade projected increasing growth rates for gross domestic
product (GDP), agriculture, manufacturing and savings, the actual results for the
developing countries as a whole have been markedly below the targets in all of these
areas in each consecutive decade.
The Third Development Decade in particular has been a traumatic experience for
many developing countries, especially in Africa and Latin America. Only the newly in
dustrializing economies in East and South-East Asia had an annual output growth of
7.6%, just above the 7% target of the Third Decade, while growth in the least
developed countries was actually negative. Per capita income fell by some 20% be
tween 1980 and 1985 in Sub-Saharan Africa, the result of economic recession, a con
tinuous fall in commodity prices, a mounting debt burden, drought, pestilence, war
and famine. The heavily indebted developing countries of Latin America also suffered
a decline of over 10% in their GDP in the first half of the 1980s. A large drop in imports
10
on an attempt to generate substantial surpluses with exports to pay off foreign debt, at
a time of falling commodity prices and restricted markets, contributed considerably to
low or negative growth figures. The lower per capita income in most developing
countries at the end of the Third Development Decade was partly a cause but also a
consequence of slow growth in the industrialized countries. This took the form of
reduced markets and depressed prices for many primary export products, high real in
terest rates and a decline in net available external financial resources. In the absence
of international solutions of a long-term structural nature, the case-by-case treatment
made many of the economic goals of the International Development Strategy unreach
able, even for those countries which showed great ingenuity in their economic
management.
The economic decline led to reductions in tax revenues and in government
spending as part of adjustment packages. An analysis of government expenditure for
57 countries in the first half of the Third Development Decade shows that real health
expenditure per capita declined in nearly half of the African, two thirds of the Latin
American, and one third of the Asian countries. Also real per capita government ex
penditure on food subsidies declined in eight out of the ten countries for which com
parable data could be found.
The effects of declining expenditure on health and nutrition have become in
creasingly visible in the second half of the 1980s. In several countries, the historical
trend in decline in infant mortality rates has stopped or slowed down, and the in
cidence of malnutrition has increased.
Similar trends have been noted for education. In two thirds of the developing
countries for which adequate data are available, real public expenditure per primary
school pupil has dropped in the period 1980-1986, while in most countries private ex
penditure on education has also declined. The result has been a decline in primary
school enrolment in a number of African and Caribbean countries, a trend inconceiv
able some years ago. The quality and efficiency of education is another casualty of
this economic crisis.
The deteriorating economic situation, with its threat to reverse the unprece
dented progress made in the situation of children over the three post-war decades, led
to a search for innovative ways of doing more for less. The 1980s saw some remark
able innovations in providing low-cost, high-impact services for children which have
kept hopes alive for improving the situation of children even in these dark times of
painful adjustment to economic recession and austerity.
11
II. EVOLUTION OF THE SITUATION OF CHILDREN IN THE 1980s
As evident from the preceding analysis, in the 1980s, children were caught be
tween two opposing and powerful trends.
On the one hand, there was a sharp decline in the economies of much of Africa,
Latin America and the Caribbean, which led to cuts in social sector spending and
economic adjustments that often left poor urban and rural communities in a state of
extreme vulnerability. Even in some industrialized countries, a relatively large segment
of the population was deprived of the safety net of social security and, as usual, a dis
proportionate number of these were children and mothers.
On the other hand, several developing countries of East Asia made rapid
progress in the 1980s towards joining the ranks of the newly industrialized economies,
a process marked by impressive improvements in the social conditions for children.
China and India, which account for approximately 50% of the developing world’s
population, also experienced a marked acceleration in economic performance which
had a positive influence on the well-being of children on a global scale. Nonetheless,
the number of people in absolute poverty still remains staggering, especially in India
and its neighbouring countries in South Asia.
The decade of the 1980s started auspiciously for children following the great en
thusiasm generated during the International Year of the Child (IYC) in 1979. As a
result of IYC, an unprecedented level of interest was focused on issues concerning the
survival, development and protection of children throughout both the developing world
and the industrialized countries. Problems facing children were analyzed in all
countries, and plans of action at national, sub-national and sectoral level were formu
lated in most countries. New legislation to protect children was passed in many na
tions.
In the developing countries, two innovative policy thrusts, the Basic Services
strategy pioneered by UNICEF in the mid-1970s, and the Primary Health Care (PHC)
approach which was endorsed a WHO/UNICEF-sponsored international conference at
13
Alma Ata in 1978, gave a major boost to services for children. The Basic Services
strategy called for providing a set of convergent services to children using appropriate
technologies and community-based para-professional personnel. PHC refined the
Basic Services strategy in the health field by empowering communities to take care of
their basic health needs with the help of a trained community health worker, backed
up by a referral system. Moreover, PHC emphasized a multi-sectoral approach,
recognizing that health is not just the absence of disease, but a state of general human
well-being best attained through a combination of preventive, curative and promotive
health care. In 1981, WHO adopted the global strategy of "Health for All by the year
2000", with PHC as the key approach for its achievement. This was further
strengthened by the inclusion of specific goals for the Expanded Programme on Im
munization (EPI) and water supply and sanitation for all by 1990, which form important
parts of PHC.
While basic services and PHC were major advances over the more traditional,
sectoral approaches to development of earlier decades, the global economic reces
sion of the early 1980s threatened their large-scale implementation. Conscious of the
need to accelerate action for the protection of children, the UNICEF Executive Board
in 1983 endorsed a child survival and development (CSD) strategy. Born out of the ex
perience gained in the application of basic services and PHC, the CSD strategy sought
to accelerate mass implementation of several low-cost, but highly effective interven
tions. These included growth monitoring, oral rehydration therapy (ORT), breastfeed
ing and immunization, along with a renewed emphasis on food supplementation,
family (child) spacing and female literacy. It was hoped that these highly "do-able" in
terventions would help save the lives of millions of children, prevent crippling dis
abilities and help attain the goals set for the Third Development Decade, including the
reduction of 1980 infant mortality rates (IMR) by half or to 50 per 1,000 live births,
whichever was less by the year 2000. These interventions were also intended to be
practical steps towards strengthening the infrastructure of PHC.
Progress achieved thus far through the CSD strategy has been encouraging.
Specific CSD actions in the 1980s have saved the lives of an estimated 7 million
children and have protected the health and growth of an even larger number. Im
munization coverage of children increased from less than 10% in 1980 to some 60% in
1988, saving an estimated 1.5 million lives annually by 1988. The incidence of polio
has been reduced considerably in the last decade, raising the hope that the disease it
self would soon be eradicated. Oral rehydration therapy against diarrhoea, the num
ber one killer of children in developing countries, was preventing nearly a million child
deaths a year by 1988. Breastfeeding has made a spectacular comeback in many in
dustrialized countries, though the trend towards its rapid decline has yet to be
reversed in most developing countries.
14
These and other successes on the child health front have demonstrated the
potential of combining technological breakthroughs, such as the more heat-stable
vaccines and the "invention" of ORT, with social mobilization involving the participation
of mass media, religious groups, community organizations and others, to generate
political will and strengthen action for children by putting issues concerning child
health and development high up on the political agenda.
Progress in the area of safe drinking water and sanitation, which have a direct
bearing on women’s workload and children’s health, has been considerably below the
ambitious targets set for the decade. Clean water has been made available to an addi
tional 700 million people and sanitation to another 480 million since 1980, but the
majority of the developing world’s population still lacks these basic necessities. Still,
remarkable progress has been achieved in such populous countries as China, India,
Pakistan and Nigeria, and the cost of water and sanitation has been drastically
lowered through improved hand-pumps, rainwater catchment devices and sanitary
latrines, which use simple technology and local materials and are, therefore, easy to
build and maintain locally.
Much has been learned about controlling such micronutrient deficiency diseases
as anaemia, xerophthalmia, goitre and cretinism, which kill or debilitate millions of
children, although actual achievement in overcoming them has lagged behind what is
medically, technically and economically feasible. Nevertheless, the experience and
achievements of the 1980s have been encouraging enough to estimate that some of
these diseases can be eradicated in the next decade.
In the area of basic education and literacy, the number of children enroled in
schools and adults made literate in the 1980s was impressive, but economic difficulties
and rapid population growth have largely offset these gains, especially in Africa, Latin
America and South Asia. Progress has been much slower for girls and women.
Increased attention was given to protecting children in especially difficult cir
cumstances in the 1980s and innovative activities were initiated to provide essential
services to "street children", especially in Latin America. Child immunizations were
carried out in Afghanistan, Lebanon, El Salvador, Sri Lanka and Uganda in the midst of
continuing conflicts. The international community has become increasingly sensitive
and responsive to the needs of children in man-made and natural disaster situations.
Despite some of these impressive achievements, the 1980s was also a decade of
lost opportunities for the children of most developing countries. Modest improve
ments in the social sector took place against a background of economic recession,
15
particularly in Africa and Latin America. The recession, combined with falling com
modity prices, rising external debt and worsening terms of trade, actually slowed the
rate of social progress in the 1980s compared to prior decades.
A major instrument of economic policy introduced in the 1980s to bring about a
greater balance in the economy was the concept of "structural adjustment". As
originally practised, most adjustment and stabilization policies often led to a short
term worsening of the situation of the poor as wages were frozen, food subsidies
abolished, and social services benefiting the poor drastically curtailed. The concept of
"adjustment with a human face" was elaborated in response to this crisis. This type of
adjustment calls for more expansionary macro-economic policies, the use of well-tar
geted meso-policies to secure the priority use of scarce resources to meet the needs
of vulnerable groups, sectoral policies aimed at raising the productivity of small-scale
rural and urban producers, restructuring public expenditure in favour of low-cost basic
services, special support programmes for vulnerable groups, and monitoring the
human situation during the adjustment process. The increasing acceptance of these
policies has broadened support for poor children and their families during the worst
phases of economic difficulty and decline.
Children in industrialized countries
In some developed market economy countries, the 1980s saw lower income
groups become worse off than in earlier decades as a result of economic restructur
ing. Given reduced social service funding, the children of single-parent families and
immigrants have been placed in a particularly disadvantaged position (single-parent
families now constitute 10-15% of all families in OECD member countries). However,
efforts were made to address the growing poverty, exemplified by the European
Community’s programmes to combat poverty and to tackle the particularly difficult cir
cumstances faced by minorities, immigrants and their children by offering bilingual in
struction in schools and courses in their cultures of origin.
In general, maternity leave and benefits improved over the 1980s, and a few
countries have introduced paternity leave. Legislation has been adopted to provide
special protection to handicapped and abused children. Efforts have also been made
to protect children through improved traffic safety. With regard to maternal and child
health, breastfeeding made a remarkable comeback in industrialized countries and on
the whole, industrialized countries continued to make progress in reducing IMR,
under-five mortality rates (U5MR) and other social indicators. Awareness of and sup
port for prenatal care and investment in early child development have grown consider
16
ably, although actions and achievements in that area are still inadequate in many
countries. An encouraging recent sign is that the situation of children has begun to
figure more prominently on the political agenda and media coverage.
The centrally planned economy countries of Europe have long given social
development —especially health and education—a high priority, and services for
children and mothers are generally well organized. However, after rapid progress in
earlier decades, these countries too experienced a slow-down in the rate of progress
in such areas as infant mortality and life expectancy. Sluggish economic growth and
reliance on highly institutionalized forms of service delivery may have inhibited these
countries from taking advantage of some of the more innovative, non-formal methods
of social services delivery in the 1980s. The evident political will for greater openness
and appreciation of the need for economic restructuring bodes well for the adoption
by these countries of innovative ways of addressing issues concerning the situation of
children in the 1990s. These countries have much to gain-and to contribute —in ex
changing experiences with other countries regarding the provision of essential ser
vices to children and mothers.
17
III. THE UNMET NEEDS OF CHILDREN
Children are faced with the interrelated problems of grinding poverty, environ
mental degradation and neglect of their right to survival, development and protection.
The Fourth Development Decade must target the fulfillment of these unmet needs as
its highest priority. While some of these needs are not easily quantifiable, and data for
others is not always reliable, the following statistical overview is presented to depict
the magnitude of problems that must be tackled.
Critical poverty
Approximately 155 million children (or 45% of children under-five in the develop
ing countries, excluding China) are living in absolute poverty. About 40 million of them
live in urban areas, and about 115 million in rural areas. Many of the problems
described below are symptoms as well as causes of this widespread poverty. The
solution to such problems will mitigate some of poverty’s consequences and con
tribute to the eradication of poverty itself by enhancing human capacities.
Mortality
Some 14 million children aged under-five die every year in developing countries.
The major causes of these deaths, many of which are attributable to multiple causes
and therefore cannot be fully overcome by interventions against just the principal
cause are diarrhoea and related causes (4 million deaths), EPI target diseases (3 mil
lion deaths), malaria (3 million deaths), acute respiratory infections (ARI), excluding
measles (2 million deaths), and typhoid, meningitis and other childhood diseases (2
million deaths). The overwhelming majority of these deaths are preventable by health
measures that are potentially within the reach of all communities while some 3 million
become seriously disabled from vaccine-preventable diseases. Yet, despite recent
progress, nearly half of the children under one year old are not fully immunized against
the six target EPI diseases, and while half of the children have access to oral rehydra
tion salts (ORS), only about 20% are actually treated with ORS.
19
Maternal health
Less than 60% of births in the developing countries are attended by trained
health personnel, and approximately 500,000 women die each year from causes re
lated to pregnancy and child birth, leaving over 1 million young children motherless.
Less than half the married women of child-bearing age have the family planning
knowledge to enable them prevent unwanted pregnancy.
Nutrition
About one third of all people in developing countries do not obtain sufficient
energy to allow an active working life. About 40% of children under-five suffer from
protein-energy malnutrition. About 20% of the infants in these countries are born with
low birth weight (weighing 2,500 grams or less). Some 40% of women of child-bearing
age and half of the children under-five suffer from nutritional anaemia. Approximately
500,000 children under-five lose their sight every year because of vitamin A deficiency.
Within a few weeks of becoming blind, two-thirds of these children die. Some 800 mil
lion people in the world are at risk of iodine deficiency disorders (IDD), and 200 million
have actually developed goitre. Some 3 million people-mostly children-suffer from
cretinism, a debilitating disease causing both mental and physical retardation.
Water and sanitation
Nearly half the children in the developing world have no access to clean drinking
water. Two thirds of the children do not have adequate sanitation. In rural areas, the
situation is much worse than these national averages.
Education
Approximately 100 million children in developing countries, 20% of children of
primary school age, do not attend school. Of those who attend, one third drop out
before completing four grades of schooling. There are some 900 million illiterate
adults in developing countries, two thirds of whom are women.
20
Children in especially difficult circumstances
Some 20% of children under age 15, fall into the category termed "especially dif
ficult circumstances", victims of armed conflicts, natural disasters and the breakdown
of traditional family support mechanisms. The number of such children, whether they
are abandoned street children, orphans, or living in with a single parent, has been in
creasing in recent years. The world now has some 25 million to 30 million refugees
and displaced persons, the majority of whom are children.
The above are some of the most pressing physical problems of children. Over
coming these problems is essential for their survival, development and protection, but
more is needed to enable them to lead lives with full human dignity and in ways that
are culturally fulfilling, socially rewarding and intellectually stimulating. For this,
children’s needs must also extend to other areas of human endeavours, if they are to
be enabled to enjoy a quality of life that not only meets the bare necessities for survival
but allows them to develop their full potential. Such needs are elaborated in the draft
UN Convention on the Rights of the Child. It is hoped that these "needs" will truly be
recognized as "rights" in the decade of the 1990s.
21
IV. GOALS FOR THE YEAR 2000
The fact that so many basic needs of children, not to mention their essential
human rights as reflected in the draft convention, remain unfulfilled is a testimony to
how the development of human capabilities has been neglected in the past three
decades of conscious development planning in most developing countries. An as
sessment of past experience and an analysis of future prospects suggest that the
development of human capabilities and meeting basic human needs should be a prin
cipal goal of the Fourth Development Decade, which should reaffirm that people are
both the means and end of development. Many societies with similar development
potential, based on their natural resources, have developed very differently because of
differences in their human capabilities. It is, in the final analysis, human capital, human
institutions, human values and skills that determine the level and pattern of develop
ment.
An emphasis on human development would bring about a greater balance in
development planning, both at national and international level, which in the past has
been largely preoccupied with macro-economic indicators such as GNP, savings, in
vestment, trade or sectoral production goals in agriculture, industry, transport, etc.
There are many examples of countries that have a high economic growth rate without
a corresponding decline in poverty, large stocks of food reserves and food exports
that coexist with high levels of malnutrition, staggering external debt and aid without
any visible progress in the standard of living. From this, it is clear that fulfilment of
basic human needs does not simply result from economic growth. Nor can it easily be
induced by economic growth. Realizing this, a growing number of development plan
ners and practitioners have concluded that the fulfilment of basic human needs —and
empowering people with the knowledge to do so-must become a central goal of
development, for which economic growth and the building of infrastructure can serve
as the means.
Empowering people with knowledge and resources to meet their basic needs
would imply that the success or failure of a development plan would be measured in
terms of its contribution to such factors as reducing hunger and malnutrition, extend
ing life expectancy and reducing death rates among children and adolescents, access
23
to health services, adequate shelter and sanitary living environment, access to basic
education, and provision for religious and cultural expression and political participa
tion.
Fortunately, fairly reliable and universally accepted indicators exist to measure
progress in most of these areas. The levels and rates of change of infant and child
mortality, life expectancy, literacy, family size, nutrition, shelter and access to water
and sanitation are among these indicators. What is needed is to ensure that these in
dicators are regularly collected, analyzed and made available to decision makers to
ensure effective monitoring and course correction to achieve planned targets.
The foundation of development: children first
Children should be the starting point of an international development strategy
that emphasizes human development, since, after all, it is the children whose individual
development and social contribution will shape the future of the world. A wise invest
ment in children’s health, nutrition and education will lay the foundation for future
growth and development and bring above-average returns on national investment. On
the other hand, neglecting children’s basic survival, development and protection
needs will condemn them and their society to high societal costs and the vicious cycle
of poverty, deprivation and underdevelopment. A young child’s growing mind and
body is susceptible to permanent damage from which there is no second chance to
recover.
Fortunately, technological breakthroughs, the communication revolution, the so
cial mobilization potential and the political commitment for the use of low-cost, highimpact interventions in MCH, nutrition, water supply and sanitation and basic
education make it both possible and desirable to formulate development strategies
which put children at the centre of human development and the latter at the centre of
all development.
For example, the capacity has existed since the beginning of the 1980s to
prevent over 100 million child deaths in the final two decades of the century and to
prevent an equal number of children from being physically or mentally disabled. In the
process, an even larger reduction in the number of child births might also be achieved,
as historically sustained declines in child mortality are followed by even greater
declines in fertility, with parents gaining confidence in their ability to ensure the survival
of their first children. At the same time, prospects for universal basic education and
literacy, water and sanitation and drastic reduction of malnutrition by the end of the
century are now also within reach.
24
The challenge for the International Development Strategy during the 1990s
should be to strengthen the emerging global ethic that large-scale premature death,
disability and lack of opportunity for development, when readily available preventive
actions can be taken, are as unconscionable as slavery, colonialism and racism. The
42-year history of UNICEF parallels and has contributed to the emergence of a world
ethic that no longer permits millions of children to perish in sudden emergencies of
drought, famine or earthquakes, but demands a quick and adequate response from
people and Governments. Incorporating survival, development and the protection of
children as a principal goal of the Fourth Development Decade would add a new moral
injunction to development that no longer accepts the silent emergency of avoidable
death, disablement and underdevelopment. This should be seen as both a moral im
perative and as part of a strategy of making a sound investment in the coming genera
tion in order to sustain long-term socio-economic development.
Major goals for child survival, development and protection
The principal objective of development should be to allow the survival, develop
ment and protection of today’s children through sustainable development that also
protects the environment for future generations. This objective can be reached using
a) a set of targeted development goals aimed specifically at overcoming the worst
manifestations of poverty through the enhancement of human capabilities, b) the care
ful design of development projects sensitive to environmental protection, and c) the
adoption of measures such as those proposed in the draft UN Convention on the
Rights of the Child which provides a legal as well as moral basis for the protection of
children.
While environmental considerations and legal and moral safeguards are pursued
in the very design of development programmes and social legislation, the following are
proposed as the major goals for child survival, development and protection in the
1990s in pursuit of the principal objective of development mentioned above—over
coming poverty through the enhancement of human capabilities:
i)
Reduction of I MR and U5MR in all countries by 50%, or to 50 and 70 per
1,000 live births respectively, whichever is less;
ii)
Reduction of the maternal mortality rate (MMR) by 50% and, after the
achievement of these goals, the continued reduction of infant, child and
maternal mortality rates by at least 3.5% annually;
iii)
Virtual elimination (less than 1%) of severe malnutrition and a 50% reduction
of moderate malnutrition;
25
iv)
Universal access to safe drinking water and eradications of guinea worm by
1995 in affected countries;
v)
Universal access to sanitary means of excreta disposal;
vi)
Universal basic (primary) education for children and accelerated adult literacy
programmes, especially for women;
vii)
Improved protection of children in especially difficult circumstances.
These goals will first need to be adapted to the specific realities of each country
with appropriate means to reach them also depending on each country’s circumstan
ces. To reach the IMR/U5MR goals, for example, the epidemiology of the major fatal
diseases must be identified. These could range from diarrhoeal diseases in one
country, malaria in another, to vaccine-preventable diseases in some and ARI or the
spreading scourge of AIDS in others. Similarly, to provide basic education for all, the
emphasis will be on formal primary education in most countries, whereas in others,
non-formal education may be emphasized or a special emphasis may be placed on
early child stimulation at the pre-primary level which is proven to enhance the quality
and efficiency of primary education.
A valuable tool in empowering parents with the knowledge to save their
children’s lives and protect their health and growth will be Facts for Life, the joint
WHO/UNESCO/UNICEF publication. Designed for adaptation by any health education
or literacy programmes, dissemination of the publication’s simple messages could
greatly help in reaching the above goals.
Specific and sectoral goals
While leaving room for country-specific adaptation, it is generally suggested that
the following specific targets be considered for all countries.
Maternal health
Maternal health and nutrition are the key determinants of the health and well
being of the child in early infancy. Half a million maternal deaths each year and the
precarious nutritional situation of girls and women are just two of the many pointers
calling for specific actions in at least the following areas:
26
i)
Special attention must be given to the health and nutrition of the female child,
since poor health and nutrition in childhood will have dangerous consequen
ces for her as a mother and, then, for her offspring;
ii)
Access to information and services for child spacing for couples, but espe
cially for women, is also of crucial importance, as studies show that as many
as 25% of all infant and maternal deaths could be prevented by well-timed
births;
iii)
Tetanus toxoid (TT) vaccination is also necessary for all women at risk, yet at
present, TT coverage of women in developing countries as a whole is only
22%, less than half the coverage for the major childhood inoculations, and
needs to be increased dramatically by, among other means, starting vaccina
tion among school-age girls.
iv)
Finally, maternal health and the general socio-economic status of women will
be enhanced by universal primary education, with special emphasis on the
female child, a high female literacy rate and other educational and training
opportunities, underscoring how human development is both a means and
an end of all development.
Child health
The epidemiology of diseases responsible for the most prevalent causes of mor
tality and morbidity and the relative cost-effectiveness of the interventions will be the
basis for determining country-or region-specific child health interventions with a view
to attaining the IMR and U5MR reduction goals stated earlier and giving children a
healthy start in life. However, the common minimum goal for all countries should be:
°
Eradication of polio;
°
Elimination of neonatal tetanus;
°
Reduction of measles deaths by 95% and reduction of measles cases by
90%, compared to 1980 levels, thus paving the way for the eradication of
measles early in the next century;
°
Immunization coverage of at least 80% of children under one year of age
against DPT, tuberculosis, measles and polio (until its eradication is con
firmed);
27
°
Reduction of diarrhoeal deaths in children aged under-five by 70% and of the
diarrhoea incidence rate by 25%;
°
Reduction by 25% in deaths due to ARI in children under five, compared to
the 1980 level.
Nutrition
Much has been learned in the past decade about how to combat the three major
causes of malnutrition: ignorance, infections and inadequate food intake. The attain
ment of some of the health and education goals proposed for the 1990s will greatly
contribute to reducing malnutrition. The major nutritional goal of the Fourth Develop
ment Decade is the virtual elimination of severe malnutrition and the reduction by 50%
of moderate malnutrition. To that end, the following additional goals are proposed:
28
°
Reducing the rate of low birth weight infants (2.5 kg or under) to less than
10%;
°
Enabling all women to breastfeed their children exclusively for four to six
months from birth and to continue breastfeeding, with complementary foods,
well into the second year;
°
Virtually eliminating IDD;
°
Virtually eliminating blindness and other consequences of vitamin A defi
ciency;
°
Although not quantified yet, a principal goal in nutrition must be the widescale dissemination of knowledge of increasing food production, with em
phasis on high-yielding, nutritious crops, combined with policy reorientation
favouring agrarian reform, credit schemes and extension services for small
farmers, including women, to ensure adequate household food security;
°
Growth promotion through regular monitoring of children’s growth is another
goal of vital importance to child health and nutrition. Growth promotion is a
powerful tool which should be institutionalized to reach a majority of children
and families as the centre piece of PHC/Nutrition in all countries by the end
of the 1990s. It is an instrument for making the health and nutritional well
being of the child visible to parents and health workers and empowering
them to take timely preventive, curative and promotive actions.
The inter-agency food and nutrition surveillance (IFNS) programme supported by
the Food and Agriculture Organization of the United Nations (FAO), WHO and UNICEF
has proposed birth weight, weight-for-age of children under five, and height-for-age of
children entering primary school as the three core indicators for monitoring the growth
and development of children. As measured by these indicators, growth promotion is a
worthy goal of development in itself and a sensitive indicator of the efficacy of health
and nutrition interventions.
Safe water supply and environmental sanitation
Clean water and safe sanitation are not only basic to human health and well
being but also, in many societies, contribute significantly to freeing women from the
arduous chore of fetching water from long distances. The supply of clean drinking
water promises to help eliminate many water-borne diseases, including dracunculiasis,
the guinea worm disease, which debilitates millions of people in Africa and Asia.
Based on the many innovative, simple, low-cost techniques of providing water and
sanitation in rural areas and urban shanty towns, it seems feasible to propose the fol
lowing specific goals:
°
Universal access to safe drinking water;
°
Universal access to sanitary means of excreta disposal by the year 2000;
0
Elimination of guinea worm disease by 1995.
The first two goals were already part of the International Water Supply and
Sanitation Decade (1981-1990), but proved too ambitious. However, the experience
gained indicates that achievement of these goals by the year 2000 is feasible. The
third goal -elimination of guinea worm disease- is directly dependent on universal ac
cess to safe drinking water in the affected areas.
Basic education
"Basic education for all by the year 2000" is recognized as the counterpart to the
movement for "Health for All", which, with PHC as the leading edge, has gained con
siderable momentum in the 1980s. Having learned from earlier not so successful at
tempts at universal primary education and literacy, many Governments, NGOs and
several international agencies are now preparing for a major new initiative in this area.
It now appears feasible that universal coverage in basic education (90-95% of the
relevant age group of children) can be reached by the year 2000 through a combina
tion of formal schooling, non-formal education and other equivalency programmes.
29
The high rate of economic return on investment in primary education, its contribution
to better health, productivity and enlightened citizenship justifies making universal
basic education a major priority for the Fourth Development Decade. What requires
particular emphasis is the need to reorient priorities in both national plans and external
cooperation to give far higher priority to education relative to other sectors, and, within
education, a shift of emphasis in support of primary education as compared to the
secondary and tertiary levels. The quality and relevance of education must also be
strengthened to counteract the inadequacy in these areas that is often responsible for
low enrolment, high desertion and overall inefficiency of the educational system.
Functional literacy, particularly for women, has emerged as another crucial goal
for the 1990s. Attaining a high rate of female literacy by the year 2000 (around 80% of
adult women between the ages of 15 and 35-45 years, as determined in each country)
is considered both essential and feasible to meet and sustain all other socio-economic
goals of the decade.
Physical as well as psychosocial development and stimulation of the preschool
age child through appropriate health, nutrition, psychomotor and cognitive develop
ment interventions has a significant impact on the child’s educational attainment and
overall integral development. Low-cost, family-based approaches reaching under
privileged communities have been pioneered in many countries. Investment in such
schemes has yielded such high benefits in health, nutrition and education that early
child development is emerging as the precursor to all other development. A major ef
fort in this area deserves to be a priority goal for the 1990s.
Children in especially difficult circumstances
Having survived their infancy, many children in developing countries, and quite a
large number in the industrialized countries as well, find themselves in a situation of
neglect, abandonment and exploitation. Such is the case with "street children",
refugee children, children who are victims of war and natural disasters, orphans, dis
abled children, and youth trapped into the bondage of prostitution and drug abuse.
Many innovative ways of dealing with problems of such children have been pioneered
in recent years. Notable examples include programmes for the protection and
development of street children in Latin America, the concepts of "corridors of peace"
or "days of tranquility" which have allowed cessation of hostilities to permit immuniza
tion and provision of other health services to children in conflict areas, creation of om
budsmen to protect the rights of children, and many community-based actions to
promote the well-being of children facing especially difficult circumstances. There is
growing awareness of and sensitivity to children in such circumstances and strong
support for action to remedy their situation. The 1990s should see concerted efforts to
30
find more effective and innovative ways to help children already in such circumstances
and to tackle the root causes which created the situations in the first place. Religious
groups, NGOs and the media play a vital leadership role in this area.
Goals for children in industrialized countries
In the past, international development strategies, including those for children,
have generally not dealt with the situation of children in industrialized countries (both
in the Western market economies and the centrally planned economies of Eastern
Europe). During IYC, much analysis had been done and plans were formulated to
tackle the problems of children in these countries. It is opportune, therefore, in this
10th anniversary year of IYC, to review the situation of children in these countries and
to include them in formulating strategies for the 1990s.
Industrialized countries should also aim at meeting all of the development goals
listed for the 1990s. Contrary to popular perception, many industrialized countries
have not attained universal immunization. Furthermore, many of these countries have
a long way to go to meet some of the goals being proposed for developing countries
in terms of literacy rates, children born with low birth weight, prevalence of breastfeed
ing, perinatal care, early childhood development and prevention of child abuse.
In particular, industrialized countries should aim at reducing the differences be
tween certain groups within their countries so that all can lead socially and economi
cally fulfilling lives free of major diseases or disabilities.
Affordable child care should be universally available, especially to low-income
families, to promote the development of children and to increase employment, training
and recreation opportunities for parents. For the children of ethnic minorities and im
migrants, special efforts should be made to secure that they are as well-equipped to
lead an active and productive life in adolescence as the children of the national
majority, in terms of general school achievement, vocational training and access to
employment.
In order to improve the general well-being of people In developed countries, ef
forts should be made to promote positive health behaviour. In particular, serious ef
forts should be made to secure the health of the unborn child by encouraging
pregnant women to avoid illicit drugs and the harmful effects of smoking and alcohol
consumption.
Besides the functional literacy and numeracy skills required for life in a complex
urban industrial setting characterized by rapid technological changes, development
education should be emphasized in the curricula of schools in industrialized countries.
This teaches children to be aware of the problems of developing countries, the inter
dependence of nations in the modern world, how to protect the environment and how
to build a future that is humane, peaceful and just.
The Convention on the Rights of the Child
The tenth anniversary of IYC in 1989, is likely to be marked by the adoption of the
UN Convention on the Rights of the Child. All of the goals of child survival, develop
ment and protection that are part of the strategy for children in the 1990s are inherent
in the Convention. It is, therefore, fitting that the ratification of the Convention and the
implementation of the strategies for children in the 1990s should be seen by Govern
ments as mutually reinforcing acts. Increasing popular awareness of the contents of
the Convention and its assimilation into the national legislations of all countries by the
year 2000 constitute an important element of the strategy of development with a
human face.
32
V. STRATEGIES FOR MEETING THE GOALS FOR THE YEAR 2000
The goals for the year 2000 enumerated in the previous section are certainly am
bitious but feasible. In the 1980s, child immunization coverage increased from less
than 10% to over 60% within a period of eight years, ORT, once practically unknown is
now familiar to the majority of parents, and many countries, in the Middle East and
North Africa for example, are reaching their target of reducing IMR by 50% within this
decade. These achievements clearly demonstrate that dramatic improvements in the
situation of children are possible. Increased use of low-cost, high-impact technologies
of proven effectiveness, combined with massive social mobilization and an emphasis
on reaching the heretofore unreached will make it possible to reach the goals for
children in the 1990s and, it is hoped, surpass them.
Country- and region-specific targets
The goals, as stated in the previous section, are what might be termed interna
tional goals of minimum acceptable social indicators levels, applicable to all countries.
It is expected that many countries will exceed these goals, set higher standards and
earlier deadlines. For example, although the global goal is to eradicate polio by the
year 2000, it is hoped that the Americas region will have accomplished this by 1990.
The Middle East region, it is hoped, will have achieved IMR reduction goals by 1990,
10 years ahead of the global goal. The countries of the Caribbean have set 100%
coverage (not 80%) as their goal for universal child immunization (UCI) and have
pledged to eradicate measles from the subregion by 1995. The definition of universal
access to safe drinking water varies and often means one to two kilometres or 15 to 30
minutes walking distance from home. Depending on the country situation, such
regional or country-specific variations are not only legitimate, but highly desirable, if
the goals for the 1990s are to be taken seriously.
Adaptation of global goals to specific countries and regions is crucial to ensure
technical and logistical feasibility and to secure financial backing and political support
necessary to realizing these goals. If goals are formulated through a process of con
33
sultation with Governments, relevant NGOs, the media and other social organizations,
the chances of mobilizing these groups for the implementation of the goals will be
greatly enhanced.
In recent years, there have been some good examples of development goals for
mulated through regional consultations. In 1986, heads of Government of the South
Asian Association for Regional Cooperation (SAARC) approved a range of human
goals for the 1990s covering health, education, water supply and other basic services
for children. In 1988, heads of State of the Organization of African Unity (OAU) en
dorsed a proposal by their health ministers to launch the “Bamako Initiative", a major
programme to provide universal PHC for women and children, by providing essential
drugs while ensuring the self-financing and sustainability of MCH services. Similarly,
senior public health officials of Latin America, meeting in Mexico in 1988, issued “the
Cocoyoc Declaration", in support of the CSD goals proposed in the “Talloires Declara
tion". Goals and targets agreed at such regional meetings by leaders with authority to
assign priorities and allocate resources are likely to have a much greater chance for
implementation than compromise formulas negotiated at much more diffused interna
tional conferences. Hence the need for active regional, subregional and country
specific debate and action in determining the goals for the Fourth Development
Decade.
Going to scale
The 1980s demonstrated that many programmes related to the human goals for
the 1990s lend themselves to mass application at national levels. Therefore, there is
less need to concentrate on small-scale pilot projects in the 1990s as was the case in
earlier decades. The challenge of the 1990s is to disseminate what has already been
learned from pilot projects in earlier decades to a scale that can lead to universal
coverage of most of the basic services for human development.
There is, of course, always room for innovation and refinement of strategies al
ready known to work. Work on such innovation and refinement deserves support and
attention, but it should not detract from large-scale implementation of proven services.
In other words, the search for the best for tomorrow should not delay the implementa
tion of the "do-able" today. As UNICEF has often emphasized, the survival, develop
ment and protection of children is a task that often cannot wait for tomorrow, without
causing irreparable damage to the mind and body of today’s children.
34
Reaching the unreached and hard to reach
As coverage of services reaches the majority, it becomes increasingly difficult to
reach the last 15-20% of the population who live in remote, inaccessible areas or in
overcrowded urban shanty towns, often the poorest of the poor and the most vul
nerable. The difficulty of reaching them and the sometimes relatively high marginal
cost of providing services to them has often deterred and discouraged development
workers. In any development scheme that puts human well-being at the centre of the
development strategy, a high priority should be assigned to reach the unreached or
hard to reach.
Just as the least developed and landlocked countries should receive special at
tention from the international community, so should reaching the poorest communities
be a priority of national development. It is, after all, among the poorest 25% of families
that problems of malnutrition, ill health, child deaths, maternal mortality, illiteracy and
low productivity are concentrated. It is, therefore, not enough to state global goals in
terms only of national averages. As part of reaching national goals, some subregional
goals should be specified so that no sizeable administrative unit, ethnic, racial or
gender group is left out. The need of such underprivileged, sub-national target groups
should command a significant share of the investment available for development.
Advocacy and social mobilization
None of the major CSD achievements in the 1980s, the immense acceleration in
immunization coverage, ORT, family planning services or literacy programmes, could
have been accomplished by sectoral government departments alone. It has taken the
mobilization of many organizations, most of them previously uninvolved, to bring these
developments to the doorsteps of the masses. The active participation of NGOs, the
school system, churches and mosques, artists and intellectuals, labour unions and
peasant cooperatives, women’s movements and neighbourhood associations, using
the communications channels offered by newspapers, radios and television made it
possible to reach families that had never been reached by conventional government
services. Such massive mobilization is crucial, not only in offering alternative delivery
channels for essential services, but more importantly, in creating awareness of and the
demand for such services.
Creation of popular awareness of, demand for and the participation in human
development programmes will create its own momentum for the rapid fulfilment of the
human goals for the 1990s. In developing countries, politicians will have to respond to
an assertive constituency, scientists and technologists will be persuaded to orient their
research to meeting human needs, and public support for development cooperation
35
will be generated in the industrialized countries. In the absence of such social
mobilization and the creation of alliances and partnership for children and human
development, the goals of the Fourth Development Decade will remain a promise un
fulfilled.
In the 1980s, there has been an unprecedented level of involvement of the
highest levels of political leaders in CSD actions. Many heads of State or Government
and parliamentarians on all continents have personally participated in national vac
cination campaigns. SAARC and OAU heads of States have made collective declara
tions of their commitment to CSD. Similar efforts must be made in the 1990s to keep
children’s needs high on the political agenda.
Empowering women for development
In the past decade, the primacy of women in much of the development process
has been acknowledged and supported in various international meetings and declara
tions. It is well known that the women of the developing world are responsible for
producing and marketing most of its food crops and bear the main responsibility for
food preparation and home making, the supply of water and fuel, nutrition and health
care, hygiene and education of the young. Women are the de facto heads of
household in many families, particularly in situations characterized by migration from
rural to urban areas or when families are displaced by armed conflicts or natural
calamities. Women are also increasingly taking up employment in the modern sector
of the economy. Yet, in far too many development programmes, most of the educa
tion and training, the technology and inputs, credits and investment are targeted to
men, not women.
To bridge this gap between the recognized role of women in development and
their neglect in actual practice, it is essential that women receive equal access (some
times even preferential access) to education, training, credit and other extension ser
vices.
In particular, investment in female education, safe motherhood,
income-generating activities and labour-saving devices of particular relevance to
women, such as more fuel-efficient methods of cooking and less labour-intensive ways
of preparing food and fetching water and fodder, should be regarded as among the
most productive investments in social and economic development. Empowering
women for development should, therefore, be both a means and an end.
36
Building an economic base for meeting human goals
It will be difficult to sustain progress in human development without restoring the
forward momentum of economic development. As the experience of the 1980s has
shown, social advances cannot move for any sustained period in a direction opposite
that of economic developments. The long-term viability of social development and, in
deed, the meeting of the human goals for the 1990s will be contingent upon significant
progress on at least several fronts.
Alleviation of critical poverty
The achievement of the social and human goals listed in section IV could go a
long way towards mitigating many of the worst manifestations of critical poverty. It is
equally important, however, that other more traditional indicators of economic
development-growth rates of GDP, agricultural and industrial output, trade and
transport, employment and housing-should be planned so that they contribute not
only to a certain average national growth, but, specifically, to reducing critical poverty.
All economic development programmes should be explicitly tested for their possible
impact on reducing critical poverty.
In the past, too many projects have been justified on the basis of often unsub
stantiated claims that in the long run they will contribute to reducing poverty. While
the long gestation period of many projects is recognized, development plans should
show how a given project will contribute to reducing critical poverty or mitigating its
consequences within the foreseeable future. For this purpose, the international
development strategy for the Fourth Development Decade should encourage all
countries to set specific poverty reduction goals within a specific time-frame.
Debt relief
With external debt exceeding $1.3 trillion dollars and annual repayments of inter
est and principal amounting to more than the total of all new aid and loans being
received each year, it is inconceivable for developing countries (especially those in
Africa and Latin America) to build the necessary economic foundation to meet the
human goals for the 1990s. Some form of significant debt relief is, therefore, a precon
dition for these countries to join the international consensus on meeting human goals.
Many proposals for debt restructuring and relief are currently under consideration, in
cluding a modest "debt relief for child survival" proposal from UNICEF. Agreement
and action on these proposals would facilitate realistic planning and implementation of
the Fourth Development Decade.
37
Trade and commodity agreements
The developing world as a whole still depends on raw materials for the majority
of its export earnings. But in the last 10 years, prices of their principal export com
modities (including fuels, minerals, jute, rubber, coffee, tea, oils, fats, sugar and tim
ber) have fallen by approximately 30%. Meanwhile, protectionist trade barriers,
development of synthetic substitutes, and weak economic growth in the industrialized
nations have further reduced their export earnings. A major restructuring of interna
tional trade patterns and preferences appears to be on the horizon for the 1990s, with
the emergence of a unified European market, the United States-Canadian trade pact,
the new trade and economic links between the developed market economies and the
centrally planned economies, and the efforts to resolve the massive trade and budget
deficits in some countries and surpluses in others. As this restructuring takes place,
favourable trade policies and commodity prices for the exports of developing
countries must be secured if they are to regain the economic vitality needed for sus
tainable human development.
Increased resource flows
The decade of the 1980s has witnessed a clear deterioration in both the quality
and quantity of official development assistance (ODA). In quantitative terms, the ODA
target of 0.7 % of GNP by 1985 and 1% thereafter has not been met. On average,
ODA has actually stagnated at around 0.35% of GNP since the 1970s. Even this has
been achieved thanks to the rising aid contribution of four European countries, which
have met or surpassed the ODA target of the Third Development Decade, while the
average ODA of several of the larger donor countries has declined. The overall record
of development cooperation in the last three decades stands in marked contrast with
the much higher percentage of resources mobilized for the reconstruction of Europe
and Japan as part of the Marshall Plan from 1948-1952.
There has also been a deterioration in the quality of ODA with over half of all
bilateral aid tied to procurement in the donor countries, less than 25% of all aid given
to the 40 least developed countries, less than 15% going to agriculture, less than 11%
to education, and less than 5% to health and family planning combined.
This overall deterioration in the quantity and quality of development cooperation
reflects not only the hard economic times facing the industrialized countries, but also
the disillusionment felt by the public and in the press in both industrialized and
developing countries with the ineffectiveness of aid. A new focus on measurably
eradicating the worst aspects of absolute poverty, as proposed with the human goals
for the 1990s, could well arouse greater public support for development cooperation in
both donor and recipient countries.
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Development cooperation in the 1990s should aim to increase not only ODA, but
to target it more precisely to the poorest countries and, within those countries, to the
poorest segments of the population in programmes that increase their income and en
hance their human capabilities.
Growth in the industrialized countries
The international development strategies of the past development decades have
not specifically dealt with goals and targets in the industrialized countries, with the ex
ception of ODA targets and some trade-related provisions. It is clear however that
poor or unbalanced economic performance by the industrialized countries directly im
pinges upon the aid, debt and trade issues affecting developing countries. The
economic future of the developing world, therefore, depends upon balanced and sub
stantial economic growth in the industrialized countries if it is to find markets for its
goods, aid for its development and relief for its debt. Reciprocally, economic growth
in developing countries would create markets for the exports of the industrialized na
tions, and enable developing countries to pay their debt, thus creating an upward
spiral, easing out the global economic problems of the industrialized countries.
Therefore, the development strategies for the 1990s must address the need for
growth-oriented structural adjustments in both the North and the South.
Development with a human face
The need for "structural adjustment" of economies that are out of balance is now
universally accepted. It is also increasingly recognized, that, too often, it is the
poorest segments of the population that carry the heaviest burden of economic adjust
ment. In the early 1980s, it was assumed that the negative repercussions of adjust
ment were unavoidable, but recent studies, including some by UNICEF, have
demonstrated that it is possible, and, of course, highly desirable, to design adjustment
packages that protect the poorest families and their children by improving their
productivity and incomes, by maintaining well-targeted food subsidies and expanding
PHC. Obviously, this imposes difficult choices on policy makers: between services
which are of concern to the richer and more powerful sections of society, such as
major city hospitals, universities and national airlines, and those that are for the poor,
such as immunization programmes, primary schools and subsidized public transport.
The choice is not between adjustment or no adjustment, it is between adjustment
aimed solely at balancing budget and trade deficits and adjustment that also seeks to
protect the poor and the vulnerable and enhance their productivity.
39
Even tougher choices will face the leaders of both industrial and developing
countries in pursuing not just adjustment but development policies with a human face
in the 1990s. The resolution of regional conflicts, progress in arms reduction by the
super-powers, the growing universal concern with the degradation of the environment
and support for human rights, including children’s rights, will undoubtedly prompt
policy debates on issues that were considered too sensitive for public debate in the
past. Thus, trade-offs involving military expenditures, capital flights and protection of
the environment could well become explicit issues, determining development policies
in the 1990s.
The widening gap between what is technically and financially feasible in terms of
low-cost, high-impact solutions to the most pressing problems of children and what is
actually being accomplished, points to enormous opportunities for action in the 1990s.
While material and financial resources continue to be limited, the ratio of resources to
results can be vastly improved. Several examples of impressive achievements in CSD
by countries that faced extraordinary odds in the 1980s, indicate that much can be
achieved with the right combination of technical skills, social mobilization and the
necessary political will and vision. Lessons of these experiences should be used in
formulating development strategies with a human or, perhaps, a child’s face, in the
same way that the painful experiences of structural adjustment in the early 1980s led
to the growing acceptance of adjustment policies with a human face.
Sustainable development and environment
The preponderence of man-made disasters, the drought of the Sahel, the floods
of Bangladesh which resulted from deforestation, soil erosion and the silting of rivers,
industrial disasters such as the Bhopal and Chernobyl tragedies, the depletion of the
ozone layer, the spectre of the "greenhouse effect" and acid rain have all shown how
mankind is ruining the environment irreparably in the pursuit of development. As the
Brundtland Report, "Our Common Future", argues, it is impossible to separate
economic development issues from environmental issues. Many forms of develop
ment erode the environmental resources upon which they must be based, and en
vironmental degradation undermines the sustainability of development.
Therefore, in pursuing the human development goals for the 1990s, the ap
proaches used must protect the environment and remedy the damage already done.
Since short-term national or local gains can have a long-term negative effect on the
environment, the international development strategy must ensure that environmental
considerations are an intrinsic part of development planning and not an afterthought.
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A human environment characterized by high rates of morbidity, mortality and fer
tility is not conducive to sustainable development. The CSD goals proposed for the
1990s seek to improve this environment by combating disease and malnutrition and
by promoting education. This contributes to lowering infant mortality as well as fer
tility, which are among the major causes of the vicious cycle of poverty and environ
mental degradation.
Given their relatively low use of capital resources and high reliance on social
mobilization, community participation, appropriate technology, the programmes
designed to reach the human goals of the 1990s appear to be compatible with, and
supportive of, environmental protection. However, each one of them needs to be
tested against an explicit set of criteria for sustainability and environmental soundness.
Children have the greatest stake in sustainable development. Their survival, develop
ment and protection depends on it and from their point of view, all development
strategies must meet the needs of the present generation without compromising the
ability of future generations to meet their own needs.
Monitoring and evaluation
If human goals are to be central in measuring the performance of the Fourth
Development Decade, we must be able to monitor changes in IMR, U5MR, maternal
mortality rates (MMR), literacy rates, nutritional status, access to water and sanitation,
and other social indicators based on estimates collected more frequently than every 5
or 10 years. The current system of data collection and feedback is clearly not respon
sive enough for a rapid appraisal of progress and constraints. New and innovative
ways of monitoring and evaluating the attainment of goals for the Fourth Development
Decade will need to be devised to ensure rapid course correction and remedial action.
For over a decade now, the international development community has been ex
pressing serious reservations about the primacy of the GDP as the principal measure
of a country’s level and pace of development. If human development is accorded the
first place in the 1990s, the international community under the leadership of the United
Nations should take bold measures to help develop more universally acceptable social
indicators of development. UNICEF would propose the use of the national U5MR as a
particularly sensitive indicator, with its average annual rate of reduction as the cor
responding "speedometer" of the rate of progress. In addition, other basic indicators
such as literacy rates, life expectancy, access to water and sanitation, nutrition surveil
lance data, should be strengthened, refined and used to monitor the achievements of
the Fourth Development Decade.
41
VI. PROCESS OF STRATEGY FORMULATION
As requested by the Executive Board, this report will be followed in 1990 by
another which will include a UNICEF operational strategy for contributing to the im
plementation of the goals and strategies for the 1990s as eventually approved by the
UNICEF Executive Board, by the General Assembly in its deliberation on the interna
tional development strategy for the Fourth Development Decade, and as a result of
consultations with Governments during the course of 1989.
The following actions will be undertaken as a follow-up to this report.
Participation in the preparatory process for the Fourth UN
Development Decade
At the end of 1988, the General Assembly began the formal process of delibera
tions for a possible international development strategy for the Fourth Development
Decade. Under the coordination of the Secretary-General and the Director-General,
UNICEF will be actively participating in the preparatory process, particularly for areas
related to the needs of children, as well as overall human development issues.
UNICEF is already actively involved in the various fora in the UN where
preparatory work is being done for the Fourth Development Decade and related is
sues. These include inter-agency discussions in the Administrative Committee on Co
ordination (ACC), the Senior Officials meetings, the ACC Task Force on Long-Term
Development and its Committee on Operational Activities (where UNICEF has
proposed a review of the role of operational activities in the Fourth Development
Decade). Consultations are also being held with the UN Department of International
Economic and Social Affairs (DIESA), WHO, UNESCO, the World Bank, the United Na
tions Development Programme (UNDP) and other multilateral organizations which are
themselves working on long-term development goals for the 1990s. The purpose of
UNICEF participation in these deliberations is to coordinate its plans with those of the
43
rest of the United Nations system and to bring up the needs of children in particular,
and social and human development in general, in the formative stages of the Fourth
Development Decade.
Regional and subregional consultations
The regional Economic and Social Commissions of the UN have been asked to
help formulate the goals and strategies for the Fourth Development Decade from the
perspective of their geographic regions. UNICEF is participating in these consult
ations, which have been organized by the regional Commissions for this purpose. It is
the strong conviction of UNICEF that the goals for the Fourth Development Decade
must grow out of regional and subregional consultations and an examination of
country-specific realities.
Besides the regional structures of the UN, other existing regional and sub
regional institutions, for example the SAARC, the Association of South-East Asian Na
tions (ASEAN), OAU, the League of Arab States, the Caribbean Community
(CARICOM) and others will be consulted in formulating the goals for children, which
will then be fed back to the UN.
As suggested at the 1988 session of the Executive Board, UNICEF will convene
several regional groups of experts in Asia, Africa, the Middle East, and Latin America
and the Caribbean to examine the present report and recommendations, as approved
by the UNICEF Executive Board. These independent groups will analyze the ap
plicability and feasibility of the global goals, targets and strategies in their respective
regions. They might also propose additional goals and strategies. The views of these
expert groups will be brought into the process of formulating regional and global goals
and strategies.
Country-specific consultations
The global goals suggested in this paper and in other proposals for the Fourth
Development Decade need to be considered on a country-by-country basis and trans
lated into national goals, with their own target dates, standards and the addition of
other country-specific objectives. Some of the global goals, at this stage, do not lend
themselves easily to measurable targets for example, goals related to early child
development and protection of children in especially difficult circumstances may be
more easily and appropriately quantified at the national level.
44
UNICEF will collaborate with the UN Resident Coordinator, with other agencies
of the UN system, and with national government counterparts to convene consult
ations for the national adaptation of these international goals and strategies. Where
appropriate, NGOs, academicians and leaders of the private sector will be invited to
participate in these consultations.
During the course of 1989, UNICEF representatives will be requested to analyze
the feasibility of implementing the proposed goals for children in the 1990s in each
country and to suggest country-specific targets and strategies. Feedback from this
exercise will be reflected in the Executive Director’s report and recommendations to
the Executive Board at its 1990 session.
45
VII. UNICEF EXECUTIVE BOARD DECISION 1989/5
On the recommendation of the Programme Committee,
The Executive Board,
Recognizing the important work being done to define the goals and key ele
ments of the strategy for children in the 1990s,
1. Encourages the Executive Director to use the ideas contained in document
E/ICEF/1989/L.5 as a basis for the global strategy for the well-being of children and for
consultation with Governments and other partners in development, as well as to serve
as UNICEF input into the formulation of the international development strategy for the
proposed Fourth United Nations Development Decade, 1991-2000;
2. Authorizes the Executive Director to prepare an operational strategy for
UNICEF to guide its activities and to help implement the national strategies in the con
text of the UNICEF country programme approach. The proposed operational strategy,
which should be more widely integrated and harmonized within the United Nations
system, will be submitted to the Executive Board at its 1990 session and, subject to
Board approval, will be reflected in the Medium-term plan and country programme
recommendations to be submitted to the Board in 1991 and thereafter;
3. Encourages further the Executive Director to continue to analyze those fac
tors that have an important bearing on the situation of children, to consider the long
term impact of the proposed actions and interventions and to include in the
elaboration of the strategy for children the strengthening of the countries’ capacities to
promote the well-being and development of children;
47
VII. UNICEF EXECUTIVE BOARD DECISION 1989/5
On the recommendation of the Programme Committee,
The Executive Board,
Recognizing the important work being done to define the goals and key ele
ments of the strategy for children in the 1990s,
1. Encourages the Executive Director to use the ideas contained in document
E/ICEF/1989/L5 as a basis for the global strategy for the well-being of children and for
consultation with Governments and other partners in development, as well as to serve
as UNICEF input into the formulation of the international development strategy for the
proposed Fourth United Nations Development Decade, 1991-2000;
2. Authorizes the Executive Director to prepare an operational strategy for
UNICEF to guide its activities and to help implement the national strategies in the con
text of the UNICEF country programme approach. The proposed operational strategy,
which should be more widely integrated and harmonized within the United Nations
system, will be submitted to the Executive Board at its 1990 session and, subject to
Board approval, will be reflected in the Medium-term plan and country programme
recommendations to be submitted to the Board in 1991 and thereafter;
3. Encourages further the Executive Director to continue to analyze those fac
tors that have an important bearing on the situation of children, to consider the long
term impact of the proposed actions and interventions and to include in the
elaboration of the strategy for children the strengthening of the countries’ capacities to
promote the well-being and development of children;
47
4. Requests the Executive Director to give increased attention to sustainability
and integration of complementary activities to secure not only survival, but develop
ment and protection of children, including disabled children, and, in this context, to
give particular attention to the further development of primary health care systems,
safe motherhood activities, birth spacing, water supply and sanitation, as well as to
basic education, with specific emphasis on female education, in accordance with the
UNICEF mandate;
5. Urges that global targets adopted by the Board be translated as appropriate
into national and regional development programmes that take into consideration the
specific needs and priorities and the constraints in human and financial resources, as
well as the policy initiatives and institutional changes needed at the country level.
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