With its focus on the needs and rights of the child, the United Nations Children's Fund (UNICEF) devotes as much as 80 percent of its funds to programs that can be classified under the broad umbrella of public health. Working in partnership with governments as well as health-related organizations, notably the World Health Organization (WHO), UNICEF is active in programs ranging from immunization and oral rehydration campaigns to water and sanitation projects, and from the fight against acute respiratory infections to the elimination of polio and micronutrient deficiencies. Its contribution to international public health, particularly for children and mothers, has been significant and extensive. Indeed, in the last two decades of the twentieth century, UNICEF, with its activist leadership, helped shape the agenda of international health.
THE EVOLUTION OF UNICEF
The United Nations General Assembly created the UN International Children's Emergency Fund as a temporary agency on December 11, 1946, to provide urgent relief aid to children in countries ravaged by World War II in Europe and Asia. Its assistance consisted of food, shelter, and medicine. In 1953, the General Assembly gave the fund
With infant mortality as high as 150 to 200 per 1,000 live births in many parts of Asia, Latin America, and Africa, UNICEF soon turned its attention to the urgent health issues of children and mothers. Guidance for such work came from a joint WHO/UNICEF committee on health policies that involved members of the governing boards of both institutions. In recent years, the UN Population Fund (UNFPA) has also joined the committee.
In the early 1950s, infectious diseases were rampant in many parts of the world, and UNICEF became heavily involved in campaigns against those diseases that could be prevented or for which there was a ready treatment. UNICEF furnished equipment and supplies to countries for mass-disease campaigns, with WHO providing the technical support. These campaigns included malaria, yaws, tuberculosis, typhus, trachoma, and leprosy. In its efforts to reduce infant mortality, UNICEF also promoted the training of traditional birth attendants and provided equipment, medicine, and transport for maternal and child health services.
The 1960s saw UNICEF working with the WHO and many governments in extending rural health services, and with the Food and Agriculture Organization of the United Nations (FAO) in fighting child malnutrition. Planning for the development of the "whole child," instead of a more piecemeal approach, became the basis of UNICEF's broader program thrust that opened the door for its focus on education as part of preparation for life.
NOBEL PEACE PRIZE
In 1965 UNICEF was awarded the Noble Peace Prize, thus linking its services for future generations with peace building. The Prize provided a solid base from which to build its effective role in advocacy for children.
UNICEF was the first UN body to take up the issue of family planning. Though the controversial subject was presented in the context of responsible parenthood to UNICEF's executive board in 1966, after an unprecedented and acrimonious debate the deeply divided board deferred its decision by one year, and it eventually took a relatively mild stance on the issue. As UNFPA was created in 1967, the pressure for UNICEF to take up the issue head-on was eased.
By the early 1970s, UNICEF shifted its emphasis to the provision of basic services for children (including education), while it maintained a predominance of its fund allocations to health programs. Though UNICEF changed its stance from its origin as a relief agency to that of a development organization, it continued to respond to emergencies. In 1974, in response to the global economic, food, and energy crises, UNICEF declared a child emergency and launched a special program to meet the urgent needs that existed.
Also in the 1970s, communication activities in support of programs made their appearance as a regular feature of UNICEF programs. These efforts were later broadened to include all relevant elements of society for a common objective, an approach now recognized as an effective development strategy by many development agencies and often referred to as "social mobilization."
ALMA-ATA AND IYC
After two decades of development, and frustrated by the slow progress for a vast majority of the rural population, public health professionals and development specialists began looking for alternative approaches to health care. Their efforts culminated in the 1978 Alma-Ata Conference, cosponsored by WHO and UNICEF, which produced the Declaration of Alma-Ata on Primary Health Care (PHC). The declaration codified earlier efforts by health pioneers in getting health care to the rural poor, and it defined a new philosophy of health that was for the people and by the people. This represented a revolutionary redefinition of health care and involved the training and employment of lay workers to tackle specific tasks at the community level, with appropriate referrals to secondary and tertiary facilities. The declaration called for a multisectoral approach to health, based on the principles of social justice, equity, self-reliance, and the use of appropriate technology.
The year 1979 was called by the UN General Assembly the International Year of the Child (IYC),
CHILD SURVIVAL AND DEVELOPMENT REVOLUTION AND GOBI
In 1982 UNICEF launched its Child Survival and Development Revolution (CSDR), which focused on four inexpensive interventions to reduce child deaths. The acronym "GOBI" represents the four program components of CSDR: growth monitoring to detect early signs of child malnutrition; oral rehydration to prevent death by dehydration as a consequence of diarrhea; breast-feeding to stop the unhealthy and often deadly effects of infant formula in poor communities; and immunization against six vaccine-preventable diseases (polio, measles, tuberculosis, whooping cough, tetanus, and diphtheria). Subsequently, UNICEF added food security, female education, and family planning to complement GOBI.
Initially, the WHO expressed caution because it viewed GOBI as vertical interventions, in contrast to the PHC approach, which called for a more horizontal approach that would strengthen health systems. UNICEF was able to reassure WHO officials that GOBI programs were meant to establish entry points for PHC, and the WHO became a partner in GOBI activities. It also joined UNICEF in sponsoring the Bamako Initiative, which aimed at making available essential drugs to African countries as part of PHC, but with cost-recovery and community management as key elements of the initiative.
The term "child survival" proved an effective tool to garner considerable extra resources for child health programs. GOBI programs involving broad-scale social mobilization and the participation of many nongovernmental organizations became dominant public health activities in most developing countries in the 1980s. The oral rehydration and immunization programs have saved millions of children's lives annually. Along with GOBI, UNICEF also started a global effort in health education with its "Facts for Life" health messages, in which WHO and UNESCO were also associated.
WORLD SUMMIT ON CHILDREN
Following the initial success of GOBI, UNICEF engaged in promoting and organizing the World Summit for Children in 1990, which brought more than seventy heads of state and representatives of more than eighty member states to New York for a two-day meeting. The summit was precedent setting, as it was the largest such gathering and the first summit on social issues. It produced a declaration, a plan of action, and a set of goals to be achieved by the year 2000, most of which were in the public health domain. UNICEF followed up the summit with individual national plans of action to reach the goals, and has published an annual Progress of Nations to monitor and report on progress.
Concurrent with the summit preparation, the movement to turn the Declaration of the Rights of the Child into the convention made headway. In 1990 the General Assembly adopted the convention, and thus far all member states of the UN have signed the convention, and all but the United States and Somalia have ratified the treaty. UNICEF's current programs are now firmly set in the context of rights. In recent years, UNICEF has not only successfully promoted the convention, but has also undertaken programs in the fields of child labor and the removal of land mines.
There have been impressive gains as a result of UNICEF's contribution to various public health programs. About 7 million young lives are now saved each year as a result of immunization and oral rehydration. Polio has been eliminated from the Americas. Guinea worm cases in Africa have been reduced by 97 percent. An estimated 90 million infants worldwide are protected from a significant loss of intelligence quotient and learning ability because their families use iodized salt that stops iodine deficiency. In spite of the gains, the review of the year 2000 goals scheduled to take place in September 2001 is likely to show that the majority of the targets have not been met. HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) has become a major killer of children in Africa. The gap between countries and within countries has continued to widen. Few countries have paid heed to the Summit For Children call for 20 percent of national development investment in the social sector and
With its role in the summit, however, UNICEF played a major role in setting the international public health agenda for the last decade of the twentieth century, and the General Assembly Special Session for Children in September 2001 is likely to influence public health activities in first decade or two of the new millennium.
UNICEF faces the twenty-first century invigorated by prospects in tackling problems that impact harshly on children in developing countries. With deepening poverty and a widening gap between the rich and poor, plus escalating violence as a result of armed conflict and civil disturbances, child health and women's health will remain major foci of UNICEF.
Malaria, immunization, and micronutrient disorders are among old problems receiving substantial new infusions of funds. HIV/AIDS programs and safe motherhood activities will also be expanded in the years to come. Given the activism of many nongovernmental organizations, including secular, professional, and service-based organizations, and the potential collaboration of the commercial sector, UNICEF's cooperation with the civil society is likely to increase in the years to come.
Beginning in 1946 with a modest residue of funds from the defunct UN Relief and Rehabilitation Agency, UNICEF has grown to be a sizable development and humanitarian organization with an annual budget of around $1 billion. It operates entirely on voluntary contributions from both governmental and private sources. In addition to regular contributions, many governments also make special contributions for specific purposes, especially during emergencies. A network of thirty-seven national committees, registered as nonprofit entities in the industrialized countries, inform the public about the needs and rights of the child and raise funds to support UNICEF.
UNICEF has undertaken pioneering work with public personalities, including those in the performing arts or athletics, to generate public support for public health issues. A roster of goodwill ambassadors provides effective support in reaching specific audiences. Income from private sources includes the sale of greeting cards, the Halloween Trick for Treat for UNICEF campaign, television appeals, and special events such as concerts and sports activities. Substantial grants from private foundations, such as the ones created by Ted Turner and Bill Gates, are making private income an increasingly important resource for UNICEF.
As an operating agency of the United Nations, UNICEF is headed by an executive director, who is appointed by the Secretary General of the UN in consultation of its thirty-six-member executive board. Board members are in turn elected by the Economic and Social Council of the UN. There have only been four executive directors, all U.S. citizens, since its inception. Maurice Pate, a banker with experience in humanitarian relief, was the first. Pate steered the organization in its formative years and built its foundation. Henry R. Labouisse, a lawyer and the first foreign-aid chief for President John F. Kennedy, succeeded Pate. James P. Grant, another lawyer and president of the Overseas Development Council, followed Labouisse. Grant launched CSDR/GOBI and orchestrated the UN Summit for Children. Carol Bellamy, a lawyer and a former Director of the Peace Corps, succeeded Grant as executive director in 1995.
With a global staff of nearly 5,600, UNICEF operates from its headquarters at the United Nations in New York. There are eight regional offices—in Bangkok, Katmandu, Amman, Abidjan, Nairobi, Bogota, Tokyo, and Geneva—and 125 field offices serving 161 countries. UNICEF representatives at the country level have considerably more authority and resources than those of its sister UN agencies, but they generally serve under the leadership of the UN resident coordinator.
JACK CHIEH-SHENG LING
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