The Number of One Child Families Continues a Steady Increase Making Up About

Global Annual Results Report 2021: Every child survives and thrives

Goal Area 1: Progress, results achieved and lessons from 2021

As UNICEF marks its seventy-fifth year of service, it faces the sobering reality of multiple and overlapping threats to the health and well-being of children, their families and their communities. These threats - including the effects of climate changes and climate-related disasters, an increase in numbers of children living in conflict zones. and a dramatic increase in multidimensional poverty - compound already significant vulnerabilities and deprive children of access to health care and adequate nutrition, as well as many other rights essential to their growth and development. It is within this troubling and complicated global environment that UNICEF and its broad range of national and international partners continued to push forward, with a steady focus on reaching all children, everywhere, with high quality, equitable rights-based support.

This commitment is based on the Convention on the Rights of the Child, the Convention on the Elimination of All Forms of Discrimination against Women and the Convention on the Rights of Persons with Disabilities, through which UNICEF strives to address inequalities, abuses and discriminatory practices that prevent children from accessing their full human rights.

UNICEF's work in health is focussed on reaching the most vulnerable children, the so called 'zero-dose children' who often face multiple deprivations. With a focus on these children, informed by human rights approaches and principles, UNICEF uses primary health care as a foundation to deliver results at-scale, through integrated and multisectoral programming, so that children can survive and thrive.

Maternal and newborn health

UNICEF works with partners to help countries in saving the lives of newborns by supporting high-quality, low-cost care and services at health facilities and at home and by working towards the elimination of maternal and neonatal tetanus. UNICEF supports 52 high-burden countries in the provision of antenatal and postnatal care, skilled attendance at birth and deliveries in health-care facilities.

	38.9 million live births were delivered in health facilities through UNICEF-supported programmes
	39 countries strengthened the quality of maternal and newborn care with UNICEF support in 52 UNICEF high-burden countries
	80 per cent of live births were attended by skilled health personnel in 52 UNICEF high-burden countries
	3,618 health care facilities in UNICEF-supported programmes were supported with WASH facilities
	8 million women of reproductive age were reached through UNICEF supported supplementary immunization activities in four countries – CAR, Nigeria, Pakistan and South Sudan –  with more than 80 per cent vaccination coverage to prevent maternal and newborn tetanus

Quality of maternal and newborn care is critical, especially for sick newborns

The quality of care before, during and after childbirth is critical for healthy outcomes for mothers and newborns.

Sick Newborn Care Units are special newborn units in large hospitals, generally at district level that aim to reduce the case fatality among sick newborns.

Kangaroo mother care (KMC) is a practice that uses skin-to-skin contact  to warm and nurture a new-born baby in particular pre-term and low birth weight newborns: KMC can substantially increase a preterm or low-birthweight baby's chances of survival.

In Ethiopia: High risk mother giving birth to a high-risk newborn

In the Dominican Republic: Skin-to-skin contact has been a gift of life for little Nellys

Working towards maternal and neonatal tetanus elimination

UNICEF and partners remain committed to the elimination of maternal and neonatal tetanus, and are working to reduce the incidence of maternal and neonatal tetanus to 1 in every 1,000 births. UNICEF remains the flagbearer of the Maternal and Neonatal Tetanus Elimination (MNTE) Initiative and, together with WHO, augments technical assistance to countries for steering planning, implementation, and monitoring processes.

In Pakistan: Eliminating a silent killer — maternal and neonatal tetanus

Immunization

Immunization is a critical component of primary health care and has proven to be one of the most successful health interventions of all time. UNICEF advocates for the prioritization of 'zero-dose' children in remote rural, urban slums and conflict-affected communities, for the delivery of immunization and other basic health services. UNICEF is uniquely positioned to ensure that all children and women receive the vaccines they need. As a leader in advocacy for equity in immunization, UNICEF works with partners to supply vaccines, enough to reach 46 per cent of the world's children under five.

	More than 64 million children received DTP3 vaccinations supported by UNICEF and partners in 64 priority countries in 2020 – the last year for which global data is available
	53 countries had implemented a national health sector supply chain strategy/plan, with UNICEF support
	22.4 million children in 48 countries, were vaccinated against measles in humanitarian settings
	2.751 billion doses of vaccines were procured and delivered by UNICEF in 2021, including COVID-19 vaccine doses, for 123 countries
	958 million doses were delivered by COVAX (including donated doses) to 144 countries and territories.  In support of this, UNICEF delivered 800 ultra-cold freezers to nearly 70 countries

Ensuring equity in immunization coverage

Moving forward into the new Strategic Plan, UNICEF will renew its focus on zero-dose children, programming in conflict and fragile areas, urban poor communities and removing gender-related barriers as well as the integration of immunization services within primary health care.

If equitable access to and uptake of immunization services by caregivers and communities is to be attained, demand for immunization is critical.

In Cambodia: Ensuring access to routine vaccinations for children during COVID-19

In South Africa Using a truck to improve vaccine uptake

Making headway towards polio eradication

Within the Global Polio Eradication Initiative partnership, UNICEF continued to lead in vaccine procurement, logistics and management together with key strategic communication to build trust and motivate caregivers to vaccinate their children against polio.

	The number of wild poliovirus cases reduced to 6 (4 in Afghanistan; 1 in Malawi; and 1 in Pakistan).
	Almost 160 million children in 12 countries received the novel oral polio vaccine type 2 vaccination through Global Polio Eradication Initiative partners.
	The UNICEF polio programme supported the COVID-19 pandemic response in 21 countries across Asia and Africa

In Afghanistan: Polio survivor helps improve polio vaccination coverage

In the Syrian Arab Republic: Dr. Suliman Alnajem's work to reach the last mile: "Without our humanity and solidarity, we have very little hope to rise again"

Responding to the COVID-19 pandemic

On behalf of COVAX, UNICEF is using its unique and long-standing expertise in procurement and logistics, to lead the largest vaccine supply operation in history. UNICEF continued to play a central role in the Access to COVID-19 Tools Accelerator (ACT-A), a global collaboration to accelerate development, production and equitable access to COVID-19 tests, treatments and vaccines.

Child health

UNICEF works to expand access and quality of essential child health interventions. Focussing on a comprehensive, multi-sectoral life course approach, UNICEF continues to focus on the survive agenda while expanding its portfolio to support the thrive agenda, including nurturing care for early childhood development and disability interventions through health platforms, non-communicable disease (NCDs) and chronic care, injury prevention and interventions to address environmental pollution and climate change.

	8.75 million children with suspected pneumonia received antibiotics through UNICEF supported programmes
	25 high-burden countries institutionalized community health workers into their formal health systems
	32,059 community health workers enhanced their skills to improve equitable health care for children that need it the most
	9.5 million people received insecticide-treated nets
	71 countries had interventions to address  environmental pollution and climate change through UNICEF health programmes

Working to prevent child deaths from pneumonia, diarrhoea and malaria

Despite being entirely preventable and treatable, common infectious diseases are still killing young children in large numbers. UNICEF works around the world to protect and prevent children from dying of disease, by supporting countries to strengthen primary health care systems – especially at the community level – and combatting common infectious diseases such as malaria, pneumonia, diarrhoea, HIV and tuberculosis.

Pneumonia remains the main killer of children under five years of age with the highest number of deaths occurring in South Asia and sub-Saharan Africa. The provision of oxygen therapy is critical for the survival of newborns and children with severe pneumonia and other life-threatening conditions. COVID-19 exposed the large gaps in oxygen needs in many low- and middle-income countries during the pandemic

UNICEF exponentially increased its support to governments to scale oxygen systems, leveraging its capacity in procurement, supplies and programming.

Adolescent health

The healthy growth and development of today's 1.2 billion adolescents is fundamental to the health and wellbeing of future generations of adults. Unhealthy trends seen amongst adolescents include increased alcohol and tobacco use, unhealthy eating, overweight/obesity, inactivity, and mental health issues.

UNICEF's adolescent health portfolio has been elevated and increased country support has been provided to address the distinct needs of adolescents globally.

	81 countries had an inclusive, multisectoral and gender-responsive national plan to achieve targets for adolescent health and wellbeing
	2 additional countries were supported in the introduction of HPV vaccine to protect young girls against cervical cancer, making a total of 18 countries
	73 per cent of live births  to adolescent mothers were attended by skilled health personnel
	73 countries were actively supported by UNICEF with school health programmes

The onset of puberty for adolescent girls brings added risks.  UNICEF continues to work multisectorally to promote the sexual and reproductive health of adolescent girls, focussing on preventing child marriages and increasing school retention of young women to prevent adolescent pregnancy. Towards this goal, UNICEF supported governments in the development and implementation of national strategies as well as initiatives. To improve outcomes for adolescents, UNICEF has increased its focus on maternal and newborn programmes.

Read: Our Pathway to a Healthier Future - UNICEF has partnered with Astra Zeneca to create the Young Health Programme to promote healthy lifestyles.

Visit Voice of Youth website to read UNICEF's digital community for youth, by youth, including "Small steps for a healthier lifestyle"

Mental health

UNICEF has elevated the mental health of adolescents as a priority because of the impact of poor mental well-being on the survival, growth, and development of young people.

Read more:

The State of the World's Children 2021, On my mind

Helping Adolescents Thrive Toolkit

25 years of success: Achievements that are saving and improving lives

Children's survival and thriving was and will continue to be guiding principles behind UNICEF's work. Throughout the 2018–2021 Strategic Plan period, UNICEF continued to be the voice for children and adolescents and provided direct service provision to ensure access to rights-based, equity-focused HIV prevention and treatment services and intensified global advocacy.

UNICEF provided efficient and tireless technical support and policy advocacy to drive strong results in two main areas that focus on treatment and care of pregnant and breastfeeding women, children and adolescents living with HIV and adolescent HIV prevention in in 35 HIV priority countries experiencing the highest burden of disease. Despite these efforts however, the global 2020 target of reducing new HIV infections in children to fewer than 20,000 was not reached, with 160,000 new child infections reported that year. Results for children are, however, slightly better in UNICEF 35 Strategic Priority countries.

It is clear that the AIDS epidemic is not over. The pace of progress is too slow to meet the 2030 SDG targets. To promote faster and more consistent improvement, the new UNICEF Strategic Plan emphasizes differentiation, integration, partnership and innovation to address barriers to inequalities.

Reasons for stalled progress in 2021: Inequalities that are leaving too many behind

Innovative approaches to improve vertical transmission of HIV among adolescent girls and young women

In 2021, UNICEF-supported targeted effort to enhance care for adolescent girls and young women living with HIV resulted in thousands of women in 35 priority countries being identified and linked to eliminating vertical transmission of HIV services at health facilities. All those girls and women were also linked to health workers and peers at the community level who were able to follow them outside of facilities to provide ongoing support to ensure retention and adherence to care and treatment.

Generating demand for HIV prevention and broader well-being services among adolescents and young people

With UNICEF support, all 35 priority countries reached out to millions of adolescents through existing and enhanced health networks and interpersonal and virtual peer education programmes with information on the availability of services to prevent HIV and unintended pregnancy, and to receive care for gender-based violence and COVID-19.

Addressing structural barriers to enhance enabling policy environment

Throughout the Strategic Plan period, together with partners and community members, UNICEF promoted comprehensive adolescent health and well-being policy development. Collaborating closely with governments, partners and communities in the development, implementation and monitoring of policies and protocols focusing on adolescents that include HIV prevention components.  In 2021, 30 out of 35 countries were supported with high-impact, gender-responsive prevention interventions for adolescents

With these priority approaches in mind, UNICEF is doubling down on its support for better progress in West and Central Africa, where rates of access to HIV treatment and prevention services among remain far below global averages and targets. In that region and elsewhere, UNICEF aims to lead the way in comprehensively addressing adolescent prevention and meaningfully engaging adolescents in programme development.

Because it remains such a significant threat to children's survival and thriving, HIV has an important place within the UNICEF 2022–2025 Strategic Plan. UNICEF will work closely with governments and other partners to consistently reach children, adolescents and pregnant women living with or at risk of HIV. Strengthening primary health care systems to make them resilient is a major imperative, and even greater emphasis will be placed on the gathering and use of high-quality data and differentiated programming to better meet the needs of all who are vulnerable.

Read more: 2021 World AIDS Day Report: Stolen childhood, lost adolescence

	335.9 million children were reached with services to prevent stunting and other forms of malnutrition - a 38 per cent increase from 2020
	67.4 million adolescents benefited from services and support to prevent anaemia and other forms of malnutrition – a 90 per cent increase from 2020
	5.4 million children received treatment for life-threatening wasting – a 10 per cent increase from 2020

Children and their families need access to nutritious diets, essential services and positive practices that set them on the path to survive and thrive. UNICEF prioritizes interventions to prevent all forms of malnutrition – including stunting, wasting, micronutrient deficiencies and overweight. Where prevention falls short, the early detection and treatment of wasting and other forms of life-threatening malnutrition are critical to save lives and return children to healthy growth and development.

In 2021, UNICEF supported countries to recover from pandemic-related service disruptions, helping them regain – and at times accelerate – progress towards targets. Despite the setbacks of the last two years, UNICEF achieved or exceeded nearly all nutrition targets in its Strategic Plan 2018–2021.

Prevention of stunting and other forms of malnutrition

The primary objective of UNICEF nutrition programmes is to prevent maternal and child malnutrition in all its forms. UNICEF works with governments to:

• improve access to nutritious, safe and affordable diets
• support good-quality nutrition, health, water and sanitation services
• promote optimal feeding, hygiene and care practices.

These foundations of good nutrition fuel children's growth, development and learning in childhood, with benefits that endure across generations.

UNICEF support from 2018 to 2021 allowed more countries to improve children's diets and strengthen policies and programmes to prevent malnutrition in early childhood:

	66 countries have a national strategy to prevent stunting
	63 countries have programmes to improve dietary diversity
	66 countries are integrating nutrition counselling into pregnancy care

Fed to fail? Tackling the crisis of children's diets
Most children are not being fed enough of the right foods at the right time in their development. This crisis of child diets has been compounded by the COVID-19 pandemic, which left many families facing significant barriers to accessing nutritious, safe and affordable diets in 2020 and 2021. UNICEF is working to change this. Read the Fed to fail? report.

Do you eat lunch in the restroom?of children's diets
In Mexico, UNICEF is supporting an innovative campaign to promote breastfeeding-friendly policies in the workplace. UNICEF worked with the Government and partners to: issue a series of recommendations to support breastfeeding; foster dialogue with national companies; produce a national guide to promote nursing rooms in businesses; and develop communication materials to raise awareness about breastfeeding support in the workplace.

Adolescent nutrition

During the school-age years, good nutrition can fuel growth and development, foster long-term healthy habits, improve learning and contribute to breaking the intergenerational cycle of malnutrition. In contrast, malnutrition during this time can trigger physical, mental and socioeconomic consequences that carry over generations.

UNICEF works with governments to introduce and scale up programmes to prevent all forms of malnutrition in adolescents, including anaemia, micronutrient deficiencies and overweight.

With UNICEF support in 2021:

	72 countries implemented programmes on the prevention of anaemia
	89 countries had a policy, strategy or plan of action for adolescent nutrition

Leading a 'Pacific Kids Food Revolution'
Across 14 Pacific Island nations, UNICEF partnered with the Pacific Islands Food Revolution – an innovative television programme that promotes local, healthy food across the region – to create a spin-off reality television series: the Pacific Kids Food Revolution. The series was broadcast across 26 networks, reaching approximately 5 million people each week in 2021, encouraging young people to cook healthy, local foods with their families. Read: Pacific Kids Food Revolution engages children across the region to promote healthy eating

Treatment and care of children with wasting

Wasting is the most visible and life-threatening form of hunger and malnutrition. When efforts to prevent malnutrition fall short, early detection, feeding, treatment and care can save children's lives and put them back on the path to healthy development.

While the COVID-19 pandemic exposed the weaknesses of current approaches to child wasting, it was also a pivotal opportunity to shift course. UNICEF supported countries to transition rapidly to a number of simplified approaches to early detection and treatment delivered at community level. These changes were adopted temporarily across at least 42 countries in 2021 to maintain life-saving care for children in need in the context of COVID-19.

	76 countries provided services for the early detection and treatment of child wasting
	5.4 million children with life-threatening wasting were admitted for treatment and 88 per cent of them recovered
	30 countries provided treatment for wasting as part of an essential package of services

In Somalia: Delivering life-saving treatment to the most vulnerable children and families
Humanitarian crises characterized by drought, conflict and displacement were reported in several states of Somalia in 2021. UNICEF partnered with 10 civil society organizations to increase the coverage of services to detect and treat children with wasting in affected areas.

In Indonesia: Connecting caregivers with the information they need to care for children with wasting

Micke Mbotu thought her two children always had enough to eat. But during a visit to the health centre, her 17-month-old daughter Felicity was diagnosed with severe wasting and required urgent treatment. Micke and her husband had limited knowledge on how to care for their child and COVID-19 restrictions made it difficult to return to the health centre. But through a UNICEF-supported WhatsApp chatbot, they received online counselling, support and guidance from health workers during Felicity's treatment. Read Micke's story: When parents have questions about their children's nutrition, this chatbot has the answers they need

Early childhood development

	Only 71 per cent of children globally 36–59 months of age are developmentally on track
	99 countries have established an ECD national policy or action plan
	128 countries have government-owned multisectoral ECD programmes
	1.6 million children accessed stimulation, care, play and learning in humanitarian settings in 2021

Early childhood remains one of the most crucial periods for children's holistic development, given the profound, lifelong impact of early experiences on children's future learning, health and earning potential. Early childhood development (ECD) interventions that integrate across health, nutrition, education, child protection, social policy and other sectors are key accelerators towards programme impact. Throughout the 2018–2021 Strategic Plan period, UNICEF drove strong results in three output areas: enhancing ECD policy environments, institutionalizing multisectoral ECD programme packages and integrating ECD interventions into humanitarian action.

Generating demand for services and improving service delivery at scale

Countries have increasingly adopted, implemented and institutionalized multisectoral ECD packages integrating responsive caregiving, early stimulation, and other essential services across sectors.

 In 2021, a total of 128 countries had government-owned multisectoral ECD packages, including 61 countries with costed action plans, paving the way for a sustainable scale-up of packages. ECD intervention packages include the Nurturing Care Framework, Care for Child Development, Caring for the Caregiver and parenting support interventions, or a combination of these packages.

In Serbia: Caring for the Caregiver pilot
UNICEF is empowering mothers and fathers to nurture playful interactions with their children in Serbia. Preschool teachers, visiting nurses and social workers teach parents ways in which to engage their children in play and early learning and support them in coping with the stresses that are inherent to parenthood. Serbia is one of eight countries that piloted UNICEF's Caring for the Caregiver approach, with support from the LEGO Foundation.

Enhancing enabling policy environments for implementation at scale

Throughout the Strategic Plan period, UNICEF and partners continued to work in country to strengthen ECD policy environments. Ninety-nine countries had established ECD national policy or action plans in 2021, and the number of countries reporting having two or more family-friendly policies (FFPs) – on parental leave, support for breastfeeding, access to good-quality childcare and child benefits – has more than doubled. Yet, even as upward trends are expected to continue, policy gains must be protected amid potential loss of political will and investment in the ECD agenda.

In Rwanda: Supporting working mothers
A mother leaves her children at a day care centre during the hours she works on a tea estate in Rwanda. The children receive care and meals and have opportunities to play and learn with other children. The mother is more productive at work, and she has more time for herself and her family. FFPs help parents balance work and family life by increasing their access to time, resources and services

Renewed focus on ECD in emergencies – Action in humanitarian settings

Armed and violent conflict, natural disasters and chronic emergencies have acute impact on young children's development, and the effects of prolonged exposure to violence and insecurity in early childhood can last a lifetime. UNICEF's priorities for children under 5 in humanitarian action are to ensure they have safe and equitable access to ECD and early learning interventions and support their parents and caregivers in providing nurturing care. Over the Strategic Plan period, more countries began incorporating ECD into their humanitarian responses.

ECD in humanitarian action

UNICEF reached 1.6 million children under 5 years in 76 countries affected by humanitarian situations with early stimulation, care, play and learning interventions in 2021.

With thanks

This report highlights the achievements made possible by the generous contributions of softly earmarked thematic funding received from various partners. UNICEF would like to express it's sincere appreciation for these contributions.

Read more and support our work

Highlights

Throughout 2021 countries around the world continued to combat and recover from the COVID-19 pandemic. And while notable progress has been made in some of the results areas since the adoption of the Sustainable Development Goals in 2015, the world remains significantly off-track towards meeting many of them. Despite significant global challenges, UNICEF is deeply committed to reaching the SDGs through high quality and targeted programming, robust partnerships at the country, regional and international levels, and passionate advocacy on a global scale to keep the rights of children at the forefront of the development agenda.

This report covers progress made for children and their communities during 2021 through UNICEF's Goal Area 1, which feeds directly into SDGs 2, 3, 4 and 5 by bringing together four interconnected programmes – health, nutrition, HIV/AIDS and early childhood development (ECD) – with the aim of ensuring that all children survive and thrive.

Publication date

June 2022

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Source: https://www.unicef.org/reports/global-annual-results-2021-goal-area-1

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